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Cardiac Arrest: Difference between revisions
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====Shock protocol==== | ====Shock protocol==== | ||
When a shockable rhythm is detected, it is important to minimize the time between chest compressions and defibrillation. When the shock is delivered immediately resume with chest compressions to minimize delay. Even after successful shock the heart can be stunned and effective circulation can only be maintained through chest compressions. After the first round of shock and compressions reassess rhythm and act according to the protocol. After the third shock has been given, adrenaline 1mg and | When a shockable rhythm is detected, it is important to minimize the time between chest compressions and defibrillation. When the shock is delivered immediately resume with chest compressions to minimize delay. Even after successful shock the heart can be stunned and effective circulation can only be maintained through chest compressions. After the first round of shock and compressions reassess rhythm and act according to the protocol. After the third shock has been given, adrenaline 1mg and amiodarone 300mg can be administered intravenously. Further adrenaline 1mg can be administered every 3-5 minutes, there is no further indication for anti-arrhythmic drugs during resuscitation. | ||
====No-shock protocol==== | ====No-shock protocol==== | ||
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====Post-cardiac arrest treatment==== | ====Post-cardiac arrest treatment==== | ||
After cardiac arrest and return of spontaneous circulation the whole body ischemia/reperfusion affects all organ systems. Multiple organ failure, increased risk of infection, neurocognitive dysfunction, myocardial dysfunction are common problems encounter after a cardiac arrest and resembles the problems encountered with sepsis. After resuscitation strict control of oxygenation, cardiac output and glucose metabolism can improve outcome after cardiac arrest. Studies have indicated that a period of 12-24 h after cardiac arrest therapeutic hypothermia (32-34oC) can increase neurological outcome. This can be achieved by internal infusion or external cooling. Cooling should be initiated quickly after return of circulation. When cooled the temperature should be maintained without to much fluctuations. Warming of the patient should occur very slowly (0.25oC to 0.5oC per hour) to prevent rapid plasma electrolyte concentration, intravascular volume and metabolic rate change. | |||
====Prognosis after cardiac arrest==== | |||
Prognosis after cardiac arrest is difficult and not fully predictable. Survival after cardiac arrest is poor, mainly due to neurological damage. Clinical examination of the patient can give information on the prognosis of the patient after cardiac arrest. The absence of both papillary light and corneal reflex at >72h predicts poor outcome. In patients that are not treated with therapeutic hypothermia absence of vestibulo-ocular reflexes at >24h and a Glasgow coma scale motor score of 2 or less >72 are possible prognostic markers of a worse outcome. Furthermore myoclonus status is associated with poor outcome, but recovery can occur, and is therefore not useful in prognostication. Electrophysiological studies measuring somatosensory evoked potentials after 24 hours, absence of N20 cortical response to median nerve stimulation predict poor outcome. | |||
==Special circumstances== | ==Special circumstances== | ||