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Cardiac Arrest: Difference between revisions
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==Special circumstances== | ==Special circumstances== | ||
In all circumstances the normal protocol for BLS and ALS is the cornerstone in the treatment of cardiac arrest. However some conditions encountered during resuscitation or as a cause of cardiac arrest, can affect the procedure.<cite>Soar8</cite> | In all circumstances the normal protocol for BLS and ALS is the cornerstone in the treatment of cardiac arrest. However some conditions encountered during resuscitation or as a cause of cardiac arrest, can affect the procedure.<cite>Soar8</cite> | ||
* <b>Anaphylaxis:</b> Anaphylaxis is a life-threatening hypersensitivity reaction and can be accompanied by airway/breathing/circulation problems due to swelling of the mucosa. The cause of the anaphylaxis should be identified and can be a broad range of triggers (food, insects, drugs etc.). Anaphylaxis rapidly develops after exposure to the trigger, usually within minutes. Patients should receive intramuscular adrenaline before an intravenous route is established and anti-inflammatory drugs (steroids, anti-histamines) should be initiated. Oxygen en fluids should be administered as swelling of the airway can result impair breathing and due to fluid loss is out of the circulation hypovolaemia can develop. | * <b>Anaphylaxis:</b> Anaphylaxis is a life-threatening hypersensitivity reaction and can be accompanied by airway/breathing/circulation problems due to swelling of the mucosa.<cite>Soar3</cite> The cause of the anaphylaxis should be identified and can be a broad range of triggers (food, insects, drugs etc.).<cite>Lieberman</cite> Anaphylaxis rapidly develops after exposure to the trigger, usually within minutes. Patients should receive intramuscular adrenaline before an intravenous route is established and anti-inflammatory drugs (steroids, anti-histamines) should be initiated.<cite>Lieberman, Kemp, Sheikh, Choo</cite> Oxygen en fluids should be administered as swelling of the airway can result impair breathing and due to fluid loss is out of the circulation hypovolaemia can develop. | ||
* <b>Asthma:</b> Patients with asthma who experience a cardiac arrest usually have a long period of hypoxaemia, however cardiac arrest is not necessarily related to asthma severity.<cite>Romagnoli</cite> Patients with acute severe asthma require oxygen, aggressive medical therapy and should be admitted to the critical care area. The main troubles encountered in the resuscitation of patients with asthma relates to the underlying lung disease. In general increased lung resistance makes ventilation of these patients difficult and can increase the risk of gastric inflation.<cite>Bowman</cite> Early intubation is indicated in these patients during the ALS setting. Due to the hyperinflation of the lungs more energy might be required in defibrillating these patients, as the heart is isolated by air.<cite>Deakin5</cite> | * <b>Asthma:</b> Patients with asthma who experience a cardiac arrest usually have a long period of hypoxaemia, however cardiac arrest is not necessarily related to asthma severity.<cite>Romagnoli</cite> Patients with acute severe asthma require oxygen, aggressive medical therapy and should be admitted to the critical care area. The main troubles encountered in the resuscitation of patients with asthma relates to the underlying lung disease. In general increased lung resistance makes ventilation of these patients difficult and can increase the risk of gastric inflation.<cite>Bowman</cite> Early intubation is indicated in these patients during the ALS setting. Due to the hyperinflation of the lungs more energy might be required in defibrillating these patients, as the heart is isolated by air.<cite>Deakin5</cite> | ||
* <b>Cardiac arrest after cardiac surgery: </b>Cardiac arrest after cardiac surgery is usually caused by specific causes related as a consequence of the cardiac surgery, such as tamponade, hypovolaemia, myocardial ischaemia, tension pneumothorax, or pacing failure. Early resternotomy can be the key to survival, especially after repeated defibrillation has failed or if asystole is observed. When the sternum is opened internal cardioversion (output of 5-20J) and cardiac compression can be applied across the ventricles. | * <b>Cardiac arrest after cardiac surgery: </b>Cardiac arrest after cardiac surgery is usually caused by specific causes related as a consequence of the cardiac surgery, such as tamponade, hypovolaemia, myocardial ischaemia, tension pneumothorax, or pacing failure. Early resternotomy can be the key to survival, especially after repeated defibrillation has failed or if asystole is observed. When the sternum is opened internal cardioversion (output of 5-20J) and cardiac compression can be applied across the ventricles. | ||