Cardiac Arrest: Types, Prevention, and Post-Resuscitation

Posted on Feb 14, 2025 in Medicine & Health

Cardiac Arrest Management

Types of Cardiac Arrest

Shockable Rhythms:
  1. VF/PVT (Ventricular Fibrillation)
  2. VT (Ventricular Tachycardia)
  3. Torsades de Pointes

These rhythms can potentially be restored with a shock!

Non-Shockable Rhythms:
  1. Asystole
  2. Pulseless Electrical Activity (PEA)

These rhythms cannot be restored by a shock. Use CPR + Medications (Myocytes aren’t working).

Myocardial Infarction (MI) can cause Ventricular FibrillationUse CPR + Medications

Prevention of Cardiac Arrest

(Prevention of an Incoming Cardiac Arrest)

Monitor Patients

Good Doctor Team to Recognize Deteriorating Patients:

  • HR (<50 or >150)
  • RR (<8 or >30)
  • SpO2 (<90%)
  • SBP (<90)
  • Mean Arterial BP (<65)
  • Degenerating Consciousness (<12 points on Glasgow Coma Scale)
  • Electrolyte Imbalance (<3.5 or >6.5)
  • pH (Acidosis)
  • Oliguria

All Deteriorating Patients should have:

  1. Monitor
  2. IV access
  3. Fluids
  4. O2

Managing Bradycardia

Determine Stable / Unstable Bradycardia:

STABLE: Physiological, the person can function normally!

UNSTABLE:

  • Shock
  • Ischemic Pain
  • Hypoxemia
  • Loss of Consciousness
  • Low BP
  1. Give Atropine 0.5 mg – repeat every 5 minutes.
  2. Check the pulse of the person and see if Vital Signs have returned.
  3. If Vital Signs not restored, give Epinephrine (as Vasopressor) + Dopamine! + Salbutamol!
  4. If Nothing improves: Pacing stimulation:
    1. Temporary pacing with defibrillator (but gives sedation)
    2. IV Pacing

Managing Tachycardia (A-Fib)

How will you Treat:

Stable Tachycardia: Normal BP, normal Body function… Patients Feel fine more Most part still needs to be Treated But More Time is available!

Unstable Tachycardia:

  • Shock
  • Loses Consciousness
  • Can Use Medications (Also Cardioversion but with Medications)

Only 1 Method: Electrical Cardioversion >> Medications (Medications take too much Time)

Post-Resuscitation: Advanced Life Support (ALS)

Components:

  1. High-quality CPR
  2. Give oxygen
  3. Plan actions before interrupting
  4. Consider advanced airway and capnography
  5. Vascular access (IV, intraosseous)
  6. Adrenaline every 3-5 min
  7. Reversible causes

Reversing the Causes:

  1. Hypoxia ——–> O2 intubation
  2. Hypovolemia ——–> Control Bleeding (Trauma/ GI / Aortic aneurysm) + Fluids
  3. Metabolic disorder (Hypo/hyperkalemia) ——–> Arterial blood Gases because lab tests are too long, ——–> Hyperkalemia = Give Calcium, Protect the Heart! as K antagonist!… Ca 10%-10ml 5-10Min IV 25 g Glucose 10 U insulin in 15 min NaHCO3 50 mmol – If acidosis or Renal Failure Hemodialysis Mechanical Chest Compression
  4. Hypothermia ——–> Intubate ASAP/Compressions/No Defibrillation! -Intubation -Check Vital Signs in 1 min -possible stiffness in Chest wall making Ventilation & chest compression difficult but Keep going! -Do Not Defibrillate or Give NE until patient is >30 C because it could damage his Heart! -Once >30c interval between Shock doses should be doubled Adrenaline every 6-10 min!
  5. Tension pneumothorax ——–> Needle Decompression (For small cases) + Central Venous Access (Larger Ones)
  6. Cardiac tamponade ——–> Resuscitation
  7. Intoxication ——–> Find out By History (bottles, Thrombosis)

In Ventricular fibrillation Think of MI as initial Cause!! History of Chest Pain

Intubation in Good condition should not be more then 5 S !!(Not sure what that means)!