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Cardiac Arrest: Difference between revisions
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* <b>Electrolyte disorder:</b> Electrolyte abnormalities are among the most common causes of cardiac arrhythmias. Potassium disorders are commonly seen, especially hyperkalaemia has a high risk of malignant arrhythmias. During cardiac arrest treatment of these abnormalities is no different than in the normal clinical setting, and aggressive treatment of the elektrolyte disorder should be initiated. | * <b>Electrolyte disorder:</b> Electrolyte abnormalities are among the most common causes of cardiac arrhythmias. Potassium disorders are commonly seen, especially hyperkalaemia has a high risk of malignant arrhythmias. During cardiac arrest treatment of these abnormalities is no different than in the normal clinical setting, and aggressive treatment of the elektrolyte disorder should be initiated. | ||
* <b>Hyperthermia:</b> Exogenous or endogenous hyperthermia can result in heat stress, progressing to heat exhaustion and results in heat stroke. Heat stroke can lead to varying levels of organ dysfunction accompanied by mental changes. Rapid cooling of the victim should occur as soon as possible. | * <b>Hyperthermia:</b> Exogenous or endogenous hyperthermia can result in heat stress, progressing to heat exhaustion and results in heat stroke. Heat stroke can lead to varying levels of organ dysfunction accompanied by mental changes. Rapid cooling of the victim should occur as soon as possible. | ||
* <b>Hypothermia:</b> In hypothermia (< | * <b>Hypothermia:</b> In hypothermia (<35<sup>o</sup>C) it is difficult to detect signs of life. Therefore resuscitation should proceed according to standard protocols until the patient has reached normothermia. Second to resuscitation, warming of the body temperature by passive or active external and internal methods should be started. Examples of passive rewarming are drying and insulation of the body, whilst examples of active rewarming are infusion of warmed intravenous fluids or forced air rewarming. As a result of rewarming vasodilatation occurs and fluid administration may be required.Resuscitation during hypothermia is difficult, the thorax is stiff and the heart is less responsive to medication and defibrillation. Furthermore drug metabolism is slowed, resulting in increased plasma levels of medication. Medication should be administered at double intervals in patients <35<sup>o</sup>C and withheld in patient <30<sup>o</sup>C. Rhythm disturbances usually seen at rewarming after hypothermia are bradycardia, atrial fibrillation followed by VF and asystole. Bradycardia and atrial fibrillation revert to normal sinus rhythm as the core body temperature increases. | ||
* <b>Poisoning:</b> Accidental poisoning in children or by therapeutic or recreational drugs in adults are the main causes of poisoning, however rarely causes cardiac arrest. It is important to identify the poison to start antidote treatment or decontamination. During the BLS and ALS care should be taken when performing mount-to-mouth ventilation in the presence of certain chemical types of poisoning. Respiratory arrest and airway depression is more common after poisoning. Early intubation can prevent cardiac arrest and pulmonary aspiration. When confronted with a poisoning in an ALS setting, temperature should be monitored as hypo- or hyperthermia my occur after drug overdose. Furthermore, due to the slow metabolization or excretion of certain poisons the resuscitation can continue for a long period. | * <b>Poisoning:</b> Accidental poisoning in children or by therapeutic or recreational drugs in adults are the main causes of poisoning, however rarely causes cardiac arrest. It is important to identify the poison to start antidote treatment or decontamination. During the BLS and ALS care should be taken when performing mount-to-mouth ventilation in the presence of certain chemical types of poisoning. Respiratory arrest and airway depression is more common after poisoning. Early intubation can prevent cardiac arrest and pulmonary aspiration. When confronted with a poisoning in an ALS setting, temperature should be monitored as hypo- or hyperthermia my occur after drug overdose. Furthermore, due to the slow metabolization or excretion of certain poisons the resuscitation can continue for a long period. | ||
* <b>Pregnancy:</b> If a cardiac arrest occurs during pregnancy the safety of the fetus should always be considered. Due to the growth of the uterus compression of the inferior vena cava can occur and as a result venous return and cardiac output is compromised. Furthermore the increased abdominal pressure can increase the risk of pulmonary aspiration and can hamper proper ventilation; therefore early intubation can lower risks and ease cardiopulmonary resuscitation. An emergency hysterotomy or caesarean section needs to be considered, if gestational age is after 20 weeks. After 20 weeks the size of the uterus is large enough to compromise cardiac output. | * <b>Pregnancy:</b> If a cardiac arrest occurs during pregnancy the safety of the fetus should always be considered. Due to the growth of the uterus compression of the inferior vena cava can occur and as a result venous return and cardiac output is compromised. Furthermore the increased abdominal pressure can increase the risk of pulmonary aspiration and can hamper proper ventilation; therefore early intubation can lower risks and ease cardiopulmonary resuscitation. An emergency hysterotomy or caesarean section needs to be considered, if gestational age is after 20 weeks. After 20 weeks the size of the uterus is large enough to compromise cardiac output. | ||