| ID | 77 |
|---|---|
| Name | CARDIAC ARREST |
| Cause | Causes: 1. Ventricular fibrillation or pulseless ventricular tachycardia (most common)- 80% 2. Ventricular asystole-15% 3. Electromechanical dissociation (due to hypovolaemia, tension pneumothorax, massive pulmonary embolism, pericardial temponade). 4. Others- a. snake bite, b. poisoning, c. cardiac surgery, d. accident- such as electrocaution, drowning etc. |
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| Diagnosis | Diagnosis: By absence of carotid or femoral pulses. |
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| Management | Management: Management of cardiac arrest is divided in two phages: A. Basic life support (BLS) B. Advanced life support (ALS) A. Basic life support (BLS)- Aim of ‘basic life support’ is prompt assessment of the victim and restoration of the ‘airway’, ‘breathing’ and ‘circulation’ (ABC) until more definitive treatment with advanced life support can be applied. 1. Assessment of the patient- i. Whether the patient is unconcious- shake & shout at the patient, ii. Whether any obstruction in the airway- check, clean or remove any cause of obstruction, iii. Whether the patient breaths or not- by looking, listening and feeling the movement of chest & abdomen, iv. Whether circulation is present or not- feeling the carotid or femoral pulse. 2. Cardiopulmonary resuscitation (CPR)- when the patient is unconcious, breathing and circulation is not present, CPR should be started immediately, i. A smart blow should be given to the left of the sternum with hand or fist, ii. Closed chest cardiac message (external cardiac compression). Procedure- The patient laid on the back of the floor or some other firm surface. The operator should place the hands one on the top & the other on the lower end of the patient’s sternum. Forceful rhythmic compressions at the rate of 60-100/min. (sternum should be depresed upto 3 cm, pulse should be observed in femoral & carotid artery), iii. Mouth to mouth breathing- for every 5 cardiac compressions one breathing. B Advanced life support (ALS)- Aim of ‘advanced life support’ is to restore normal cardiac rhythm by defibrillation, administering i.v drugs & positive pressure ventilation by endotra-chial intubation. Patient should be hospitalized urgently for application of the following measures. If it is due to ventricular fibrillation- 1. Defibrillate the patient using 200 joules. If no response, repeat with 200 joules further; if no response, repeat third tune with 360 joules. 2. If ventricular fibrillation persists after three attempts of DC conversion, then give-Inj. adrenaline Img i.v, followed by further Img, after 1 minute of CPR before trying a further application of 3 D.C shocks (as below). 3. Now try and defibrillate again with 3 D.C shocks each at 360 joules. Then, it should be maintained, a lignocaine infusion 2.4mg/min. for 24 hours. If Asystole: Try to restart a normal rhythm or atleast produce a ventricular fibrillation. 1. Give- a. Inj. atropine 1.2mg i.v- this relieves the cholinergic depression of the sinus and AV node, b. Inj. adrenaline (1:1000) 1ml by i.v route. c. Inj. calcium gluconate (10%) 10ml by i.v route. 2. Wait for the heart to fibrillate and then defibrillate. 3. If defibrillation does not occur within 5 minutes repeat the dose of adrenaline. Other points to be kept in mind : The other causes of cardiac arrest may be- acute hypoxia, fits, upper air way obstruction, electrolyte disturbance, hypo- or hyperkalaemia. In any of these conditions appropriate measure should be undertaken. |
| Introduction | Cardiac arrest may be defined as the sudden and complete loss of cardiac function. The patient loses conciousness, there is no heart beat, no peripheral pulse; respiration ceases almost immediately. If emergency cardiac resuscitation is not undertaken immediately, death is virtually inevitable. |
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