Cardiac arrest(rev 4 2011)
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Transcript of Cardiac arrest(rev 4 2011)
Cardiac Arrest Resuscitation
Terminal ArrhythmiaTerminal Arrhythmia
157 patients with SCD
VT degenerated to VF 62%
Primary VF 8%
Torsade de pointes 13%
Bradyarrhythmias 17%
Chain of SurvivalChain of Survival
Early Access
Early CPR
Early Defibrillation
Early Advanced
Care
Team Leader
- one voice
- interpret inputs (ECG, case-notes, investigations, processes and makes decisions
Does not physically participate in Resus
Decides when to terminate Resus
Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader
Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions
Nurse 3
- performs Chest Compressions
30:2
or 100/min
Doctor 1 - BVM followed by Intubation
Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,
portable ventilator
Call Anesthesia if
difficult airway
Call CVM/Medical ICU Registrar for further management
Team Leader
- one voice
- interpret inputs (ECG, case-notes, investigations, processes and makes decisions
Does not physically participate in Resus
Decides when to terminate Resus
Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader
Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions
Nurse 3
- performs Chest Compressions
30:2
or 100/min
Doctor 1 - BVM followed by Intubation
Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,
portable ventilator
Call Anesthesia if
difficult airway
Call CVM/Medical ICU Registrar for further management
Team Leader
- one voice
- interpret inputs (ECG, case-notes, investigations, processes and makes decisions
Does not physically participate in Resus
Decides when to terminate Resus
Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader
Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions
Nurse 3
- performs Chest Compressions
30:2
or 100/min
Doctor 1 - BVM followed by Intubation
Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,
portable ventilator
Call Anesthesia if
difficult airway
Call CVM/Medical ICU Registrar for further management
Adult Cardiac ArrestAdult Cardiac Arrest
Primary ABCD Phase•Check responsiveness•Focus on ABCD - basic CPR(30:2) and defibrillation•Activate code blue - 1414
Secondary ABCD PhaseA Airway : perform endotracheal intubation (video)B Breathing : Ventilate with BVM, portable ventilator C Circulation : check pulse, give chest compressionsD Differential Diagnosis & Defibrillate
Primary ABCD Phase•Check responsiveness•Focus on ABCD - basic CPR(30:2) and defibrillation•Activate code blue - 1414
Secondary ABCD PhaseA Airway : perform endotracheal intubation (video)B Breathing : Ventilate with BVM, portable ventilator C Circulation : check pulse, give chest compressionsD Differential Diagnosis & Defibrillate
Assess rhythmAssess rhythm
Code BlueCode Blue
Resuscitation
1. Focus on the primary and secondary ABCDs
2. Decisive, professional, unflappable attitude
3. One voice
4. Ensure that the leader knows all drugs & procedures done
5. Leader gives clear information on next steps to be taken
Secondary Survey (some points)
C. Circulation
• Ante-cubital vein / external jugular vein• Infusion fluid : Normal saline• Drugs administered via ETT : adrenaline, atropine
• Circulation time in cardiac arrest
Atropine
Secondary Survey (more points)
Differential Diagnosis
•What caused the arrest?
•Are there any reversible causes - those that had a specific therapy?
•Are there any complications of resuscitation that have an immediately remediable
cause?
Post-ResuscitationTransfer
1. Relinquish care to a team of equal or greater expertise
2. Provide complete, concise, and well-organised information
3. Ensure that patient airway is secured and patient stabilised prior to transfer
Phase 4Phase 4
Critique
1. Dealing with Grief
2. Debrief
3. Education
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
VF/Pulseless VT
Drug
Shock
CPR
Thomas Schneider et al, Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest VictimsCirculation, Oct 2000; 102: 1780 - 1787
Automated Defibrillation
•Recommended mode for those not ACLS trained
Step 1
• Switch to AED mode
Step 2
• Connect electrodes to patient and to defibrillator
Step 3
• Analyse rhythm Do not touch patient
Step 4
• Shock the patient
Step 5
• Check ECG & patient,• Start CPR (30:2) if no pulse
• Hypovolemia - Volume Infusion• Hypoxia - Ventilation• Hypothermia - Rewarming, warmed fluids• Hyperkalemia - CACL2, Insulin, Glucose, NAHCO3, Dialysis• Hydrogen ion (Acidosis) - NAHCO3
• Tamponade - Pericardiocentesis• Tension Pneumothorax - Needle Decompression• Thrombosis (AMI) - Rx Cardiogenic Shock• Thromboembolism - Thrombolysis• Tablets -Overdose - Lavage, Activated Charcoal, Specific Rx
Non VF/VT Cardiac Arrest
Reversible Causes - 5Hs & 5Ts
“primum nil nocere - First Do No Harm” (Galen 129 AD)
Thank you
2. Play video on endotracheal intubation
1. Play video on Bag Valve mask Ventilation