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Cardiac arrest and resuscitation

  • Heart rhythms associated with cardiac arrest can be divided into two groups
    • Ventricular fibrillation (VF) and ventricular tachycardia (VT)
    • Other rhythms including asystole and electromechanical dissociation (EMD)
  • Principal difference in management is attempted defibrillation in VF and VT
  • Subsequent action includes
    • Chest compression
    • Airway management
    • Ventilation
    • Venous access
    • Administration of adrenaline
    • Correction of contributing factors

Ventricular fibrillation

  • Commonest rhythm seen at cardiac arrest
  • Requires prompt defibrillation
  • Chance of success decreases by 10% for each minute of persisting VF
  • If arrest witnessed, single precordial thump may be useful
  • Three shocks should be given as follows:
    • 200 J
    • 200 J
    • 360 J
  • Can be repeated after one minute of CPR
  • Chest compression should be initiated
  • Airway and ventilation should be secured
  • Amiodarone can be considered in refractory VF or VT
  • Lignocaine is an alternative to amiodarone
  • Consider 50 mmol bicarbonate if pH fall below 7.1

ventricular fibrillation

ventricular tachycardia

Asystole

  • Its is essential that a correct diagnosis is made and VF is not missed
  • Asystole can be confirmed by:
    • Checking absence of a pulse
    • Checking leads are correctly attached
    • Checking the gain on the monitor
    • Viewing the rhythm in different leads
  • Chest compression should be initiated for 3 minutes
  • Airway should be secured
  • Venous access should be obtained
  • Adrenaline 1 mg iv or 2-3 mg via the endotracheal tube should be given
  • Atropine 3 mg iv or 6 mg via endotracheal tube should be administered
  • If rhythm changes to VF then treat as VF and shock

Resuscitation Council (UK) Guidelines and Algorithms (2005)

Guidelines

Algorithms

Causes of cardiac arrest

  • Hypoxia
  • Hypovolaemia
  • Hypothermia
  • Hyperkalaemia
  • Tension pneumothorax
  • Tamponade
  • Toxic therapeutic disorders
  • Thromboembolic events

Bibliography

Cleland M A,  Hynes-Gay P.  ACLS 2000;  overview of changes to the guidelines.  Dynamics 2002;  13;  11-16.

Cummins R O,  Hazinski M F.  The most important changes in the international ECC and CPR guidelines 2000.  Resuscitation 2000;   46:  431-437.

Eisenberg M S,  Mengert T J.  Cardiac resuscitation.  N Engl J Med 2001;  344:  1304-1313.

Vincent R.  Resuscitation.  Heart 2003;  89:  673-680.

 

 
 

Last updated: 05 January 2008

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