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Cardiac arrest cpr shock

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boudhayan bhattacharjee

1) Cardiac arrest is the abrupt cessation of cardiac function leading to loss of circulation unless reversed by emergency intervention. It can be caused by conditions like ventricular fibrillation, asystole or mechanical issues. 2) Most cardiac arrests occur outside hospitals and fewer than 10% of patients survive after attempted resuscitation. Survival rates are lower for black Americans and higher for Asian populations. 3) The chain of survival for out-of-hospital cardiac arrest includes early CPR, defibrillation if needed, advanced medical services and post-cardiac arrest care. Effective CPR provides some blood flow until further treatment.

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CARDIAC ARREST/ CARDIO PULMONARY RESUCITATION/ SHOCK Dr. Boudhayan Bhattacharjee
CARDIOVASCULAR COLLAPSE Sudden loss of effective circulation due to cardiac and/or peripheral vascular factors that may reverse spontaneously or require interventions Vasovagal syncope, vasodepressor syncope Same as cardiac arrest CARDIAC ARREST Abrupt cessation of cardiac function resulting in loss of effective circulation which may be reversible by prompt emergency medical intervention, but will lead to death in its absence Ventricular fibrillation, ventricular tachycardia, asystole, bradycardia, pulseless electrical activity, noncardiac mechanical factors (e.g., pulmonary embolism) SUDDEN CARDIAC DEATH (SCD) Sudden unexpected death attributed to cardiac arrest, which if witnessed occurs within one hour of symptom onset Same as cardiac arrest
DEMOGRAPHY Most Sudden cardiac arrests (SCA) occur outside hospital Fewer than 10% survive to be discharged from hospital despite after attempted resuscitation by emergency medical services (EMS) Women have a lower incidence of SCD and SCA than men Women are more likely to present with pulseless electrical activity (PEA) and to have their SCD occur at home as compared to men Black as opposed to white Americans have higher rates of SCD and are more likely to have unwitnessed arrests, to be found with PEA, and have worse rates of survival. Hispanic ethnicity appear to have lower rates of SCD, despite having a higher prevalence of cardiac risk factors Incidence of SCD may be relatively low among Asian populations as well, both within the United States and globally
PRECIPITATING FACTORS Time: Morning hours, late afternoon; winter in northern hemisphere, summer in southern hemisphere Location: Trains, airports, urban areas, living near roadways Certain activities and exposure: Earthquake, terrorist attacks; vigorous exercises
ETIOLOGY Cardiac causes: a) Coronary artery disease (40-70%)- Ischemic heart disease b) Non- ischemic heart disease- Cardiomyopathies. Arrythmias (VT, VF, PEA), Congenital heart disease, valvular heart diseases (MVPS, MR, AS), WPW, electrolyte abnormalities Non- cardiac causes: Stroke, Pulmonary embolism, aortic dissection, exsanguination, tension pneumothorax, sepsis, medication overdose, neurogenic
TREATABLE CAUSES OF CARDIAC ARREST Hypoxia Hypovolemia Hydrogen ion (acidosis) Hypo-/hyperkalaemia Hypothermia Toxins Tamponade (cardiac) Tension pneumothorax Thrombosis (pulmonary) Thrombosis (coronary)
SIGNS & SYMPTOMS Unconsciousness No breathing No blood pressure Pupils dilated (within 45 seconds) Seizures Death- like appearance Lips & nail beds- turns blue Diagnosis: Lack of carotid pulse
OUT-OF-HOSPITAL CHAIN OF SURVIVAL Initial evaluation and recognition of the SCA Rapid initiation of cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Defibrillation as quickly as possible usually with an automatic external defibrillation(AED) applied by the lay rescuer or EMT Basic and advanced EMS Advanced life support and postcardiac arrest care Initial goal of resuscitation is - achieve the return of spontaneous circulation Success is related to the time between collapse and initiation of resuscitation, decreasing markedly after 5 min, and the rhythm at the time of EMT arrival, being best for VT (2530%), worse for VF and poor for PEA and asystole (<5%).
Cardiac arrest cpr shock
Cardiac arrest cpr shock
EFFECTIVE CPR Provides 1/4th to 1/3rd of normal blood flow Rescue breath contain 16% of oxygen TIME LOSS BP measurement Checking peripheral artery pulse Listening to heart sounds 10 seconds for checking responsiveness 10 seconds to resume chest compression for rescue breaths 10 seconds to checking central pulses
CIRCULATION- AIRWAY- BREATHING (CAB) Circulation: chest compressions (100-120/min) Airway: Head tilt, chin lift (open airways) Breathing: Rescue breaths (30:2= compressions: breath; victims nose pinch; over one second; with visible chest rise) ADVANCED AIRWAY- 8-10 breaths/min (not synchronised with compressions) RESCUER- one/two; interchange every two minutes
WHEN TO STOP CPR Revives and starts breathing Advanced medical help arrives Exhaustion of rescuer Death Time of onset of CPR >6 minutes: continue for 15 minutes Time of onset of CPR <6 minutes: continue for 30 minutes
Cardiac arrest cpr shock
Cardiac arrest cpr shock
AFTER RETURN OF SPONTANEOUS CIRCULATION (ROSC) SpO2 94% Do not hyperventilate Advanced airway capnography Treat hypotension (SBP< 90 mm of Hg)- IV fluid bolus, vasopressors, consider treatable causes, do ECG Induce hypothermia Cardiac catheterisation

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Cardiac arrest cpr shock

  • 1. CARDIAC ARREST/ CARDIO PULMONARY RESUCITATION/ SHOCK Dr. Boudhayan Bhattacharjee
  • 2. CARDIOVASCULAR COLLAPSE Sudden loss of effective circulation due to cardiac and/or peripheral vascular factors that may reverse spontaneously or require interventions Vasovagal syncope, vasodepressor syncope Same as cardiac arrest CARDIAC ARREST Abrupt cessation of cardiac function resulting in loss of effective circulation which may be reversible by prompt emergency medical intervention, but will lead to death in its absence Ventricular fibrillation, ventricular tachycardia, asystole, bradycardia, pulseless electrical activity, noncardiac mechanical factors (e.g., pulmonary embolism) SUDDEN CARDIAC DEATH (SCD) Sudden unexpected death attributed to cardiac arrest, which if witnessed occurs within one hour of symptom onset Same as cardiac arrest
  • 3. DEMOGRAPHY Most Sudden cardiac arrests (SCA) occur outside hospital Fewer than 10% survive to be discharged from hospital despite after attempted resuscitation by emergency medical services (EMS) Women have a lower incidence of SCD and SCA than men Women are more likely to present with pulseless electrical activity (PEA) and to have their SCD occur at home as compared to men Black as opposed to white Americans have higher rates of SCD and are more likely to have unwitnessed arrests, to be found with PEA, and have worse rates of survival. Hispanic ethnicity appear to have lower rates of SCD, despite having a higher prevalence of cardiac risk factors Incidence of SCD may be relatively low among Asian populations as well, both within the United States and globally
  • 4. PRECIPITATING FACTORS Time: Morning hours, late afternoon; winter in northern hemisphere, summer in southern hemisphere Location: Trains, airports, urban areas, living near roadways Certain activities and exposure: Earthquake, terrorist attacks; vigorous exercises
  • 5. ETIOLOGY Cardiac causes: a) Coronary artery disease (40-70%)- Ischemic heart disease b) Non- ischemic heart disease- Cardiomyopathies. Arrythmias (VT, VF, PEA), Congenital heart disease, valvular heart diseases (MVPS, MR, AS), WPW, electrolyte abnormalities Non- cardiac causes: Stroke, Pulmonary embolism, aortic dissection, exsanguination, tension pneumothorax, sepsis, medication overdose, neurogenic
  • 6. TREATABLE CAUSES OF CARDIAC ARREST Hypoxia Hypovolemia Hydrogen ion (acidosis) Hypo-/hyperkalaemia Hypothermia Toxins Tamponade (cardiac) Tension pneumothorax Thrombosis (pulmonary) Thrombosis (coronary)
  • 7. SIGNS & SYMPTOMS Unconsciousness No breathing No blood pressure Pupils dilated (within 45 seconds) Seizures Death- like appearance Lips & nail beds- turns blue Diagnosis: Lack of carotid pulse
  • 8. OUT-OF-HOSPITAL CHAIN OF SURVIVAL Initial evaluation and recognition of the SCA Rapid initiation of cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions Defibrillation as quickly as possible usually with an automatic external defibrillation(AED) applied by the lay rescuer or EMT Basic and advanced EMS Advanced life support and postcardiac arrest care Initial goal of resuscitation is - achieve the return of spontaneous circulation Success is related to the time between collapse and initiation of resuscitation, decreasing markedly after 5 min, and the rhythm at the time of EMT arrival, being best for VT (2530%), worse for VF and poor for PEA and asystole (<5%).
  • 11. EFFECTIVE CPR Provides 1/4th to 1/3rd of normal blood flow Rescue breath contain 16% of oxygen TIME LOSS BP measurement Checking peripheral artery pulse Listening to heart sounds 10 seconds for checking responsiveness 10 seconds to resume chest compression for rescue breaths 10 seconds to checking central pulses
  • 12. CIRCULATION- AIRWAY- BREATHING (CAB) Circulation: chest compressions (100-120/min) Airway: Head tilt, chin lift (open airways) Breathing: Rescue breaths (30:2= compressions: breath; victims nose pinch; over one second; with visible chest rise) ADVANCED AIRWAY- 8-10 breaths/min (not synchronised with compressions) RESCUER- one/two; interchange every two minutes
  • 13. WHEN TO STOP CPR Revives and starts breathing Advanced medical help arrives Exhaustion of rescuer Death Time of onset of CPR >6 minutes: continue for 15 minutes Time of onset of CPR <6 minutes: continue for 30 minutes
  • 16. AFTER RETURN OF SPONTANEOUS CIRCULATION (ROSC) SpO2 94% Do not hyperventilate Advanced airway capnography Treat hypotension (SBP< 90 mm of Hg)- IV fluid bolus, vasopressors, consider treatable causes, do ECG Induce hypothermia Cardiac catheterisation