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- Cardiac arrest refers to a
condition in which the heart stops pumping blood to the
body. It occurs due to one of three main reasons, as will be
explained.
- The first is ventricular
fibrillation/pulseless ventricular tachycardia. In this
case, the heart shakes rapidly but does not pump blood
(ventricular fibrillation), or it tries to pump so rapidly
(pulseless ventricular tachycardia) it does not allow blood
to flow in, or effectively flow out.
- The second type is called pulseless
electrical activity (also known as electromechanical
dissociation). In this case there is normal electrical
conduction in the heart, but the heart does not contract.
- The third type is called asystole,
in which there is no electrical activity or muscle activity
of the heart.
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- Individual is unconscious
- Skin may be pale, clammy, or gray
- There is no
pulse
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- Ventricular fibrillation/pulseless ventricular
tachycardia
- Myocardial Infarction (heart attack)
- Myocardial ischemia
- Hypoxia (low oxygen blood level)
- Hypokalemia (low blood Potassium)
- Other electrolyte abnormalities
- Medications (e.g., Verapamil given to patients with
Wolff-Parkinson-White syndrome)
- Pulseless electrical activity
- Volume loss (e.g., bleeding from GI tract)
- Tension Pneumothorax
- Massive Myocardial Infarction (large heart attack)
- Cardiac Tamponade
(blood or fluid gets into the sac that holds the
heart)
- Hypoxia (low oxygen)
- Massive Pulmonary Embolism
(massive blood clot in the lungs)
- Hyperkalemia (high Potassium)
- Severe acidosis
- Drug overdose
- Hypothermia (low body temperature)
- Hypoxia (low oxygen)
- Acidosis
- Drug overdose
- Hypokalemia (low Potassium)
- Hyperkalemia (high Potassium)
- Hypothermia (low body temperature, e.g., cold
exposure)
- Prolonged cardiac arrest from another cause above
(ventricular fibrillation/tachycardia or pulseless
electrical
activity)
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- Airway is checked to make sure
patent
- Breathing is checked to see if
present
- Pulse, Heart and lungs are checked
- Rhythm strip will help determine
the cause -- in asystole, 2 separate leads should be checked
to make sure truly
asystole
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- Generally, the American Heart Association's Guidelines
for advanced cardiac life support are followed. These are
algorithms for management of these conditions (though the
physician may make adjustments for individual cases as
needed).
- Listed below are some typical treatment courses. This is
for informational purposes only. Advanced cardiac life
support should only be performed by highly trained
professions (e.g., physicians, nurses, etc.)
- Ventricular Fibrillation/Pulseless Ventricular
Tachycardia
- Defibrillation (three Shocks of 200J,
300J, 360J, as needed)
- Intubation
- Epinephrine (given at repeated intervals)
- Repeat defibrillation at 360J
- Lidocaine
- Repeat defibrillation at 360J
- Bretylium
- Repeated defibrillation at 360J as needed with
consideration for repeat doses of antiarrythmic
medications
- Pulseless Electrical Activity
- Intubation
- Epinephrine
- Quickly try to identify the cause
- Volume trial often given (since volume loss is the
most common cause)
- Carefully examine lungs for Pneumothorax
- Consider empirical pericardial tap
- Consider other causes
- Confirm in 2 separate monitor leads (we do not want to
mistakenly miss ventricular fibrillation)
- Intubate
- Epinepherine
- Atropine
- Consider transcutaneous
pacing
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- Ventricular fibrillation/pulseless ventricular
tachycardia is the most common cause of cardiac arrest and
is best treated by rapid defibrillation. Defibrillation is
the absolute priority in adult cardiac arrest. If cardiac
arrest occurs at home and there is only one other person
present -- call 911 first, then begin CPR (if more than
one person is present, one may call 911 while another
begins CPR).
- Some public arenas (such as sports stadiums) and
airplanes now have defibrillators available and are
specially designed to be used by lay people. The best
chance for someone to survive cardiac arrest is for
defibrillation to begin within the first four minutes of
arrest. For infants and children, see separate section
(please note children/infants are treated completely
differently).
- Defibrillation means giving an electrical Shock to the heart to change the rhythm back to normal (since the rhythm is called fibrillation, hence we are "defibrillating"). Also note, atrial fibrillation is a completely different type of rhythm from ventricular fibrillation, and is treated differently. Atrial fibrillation does not usually cause cardiac arrest (see section on atrial fibrillation for more details).
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