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Cardiac Arrest: Difference between revisions
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* <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.<cite>Kornberger, Reuler, Zell</cite> 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.<cite>Paal</cite> 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, VF and asystole. Bradycardia and atrial fibrillation revert to normal sinus rhythm as the core body temperature increases.<cite>Mattu</cite> | * <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.<cite>Kornberger, Reuler, Zell</cite> 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.<cite>Paal</cite> 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, VF and asystole. Bradycardia and atrial fibrillation revert to normal sinus rhythm as the core body temperature increases.<cite>Mattu</cite> | ||
* <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.<cite>Bronstein</cite> It is important to identify the poison to start antidote treatment or decontamination.<cite>Zimmerman</cite> 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.<cite>Yanagawa</cite> 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.<cite>Bronstein</cite> It is important to identify the poison to start antidote treatment or decontamination.<cite>Zimmerman</cite> 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.<cite>Yanagawa</cite> 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. During CPR displace the uterus to the left or apply a left lateral tilt of the surface the patient is lying upon to minimize compression from the uterus. 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. During ALS normal defibrillator shock energies can be used. An emergency hysterotomy or cesarean 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, however fetal viability begins at approximately 24-25 weeks. | * <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. During CPR displace the uterus to the left or apply a left lateral tilt of the surface the patient is lying upon to minimize compression from the uterus.<cite>Bamber</cite> 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. During ALS normal defibrillator shock energies can be used.<cite>Nanson</cite> An emergency hysterotomy or cesarean section needs to be considered, if gestational age is after 20 weeks.<cite>Katz</cite> After 20 weeks the size of the uterus is large enough to compromise cardiac output, however fetal viability begins at approximately 24-25 weeks.<cite>Allen</cite> | ||
* <b>Traumatic Cardiorespiratory Arrest:</b> Cardiac arrest caused by trauma has low chance of survival.<Cite>Rosemurgy</cite> Blunt trauma can cause commotio cordis if there is an impact to the chest wall over the heart.<cite>Maron</cite> This impact can cause arrhythmias (usually ventricular fibrillation) and occurs often during sports.<cite>Maron2</cite> Penetrating trauma can be cause for an emergency thoracotomy. Emergency thoracotomy has to be performed early after onset of CPR.<cite>JACS</cite> It is important to manage the resuscitation according to protocol and treat reversible causes. | * <b>Traumatic Cardiorespiratory Arrest:</b> Cardiac arrest caused by trauma has low chance of survival.<Cite>Rosemurgy</cite> Blunt trauma can cause commotio cordis if there is an impact to the chest wall over the heart.<cite>Maron</cite> This impact can cause arrhythmias (usually ventricular fibrillation) and occurs often during sports.<cite>Maron2</cite> Penetrating trauma can be cause for an emergency thoracotomy. Emergency thoracotomy has to be performed early after onset of CPR.<cite>JACS</cite> It is important to manage the resuscitation according to protocol and treat reversible causes. | ||