Cardiac Arrest Resuscitation

Terminal ArrhythmiaTerminal Arrhythmia

157 patients with SCD

VT degenerated to VF 62%

Primary VF 8%

Torsade de pointes 13%

Bradyarrhythmias 17%

Chain of SurvivalChain of Survival

Early Access

Early CPR

Early Defibrillation

Early Advanced

Care

Team Leader

- one voice

- interpret inputs (ECG, case-notes, investigations, processes and makes decisions

Does not physically participate in Resus

Decides when to terminate Resus

Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader

Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions

Nurse 3

- performs Chest Compressions

30:2

or 100/min

Doctor 1 - BVM followed by Intubation

Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,

portable ventilator

Call Anesthesia if

difficult airway

Call CVM/Medical ICU Registrar for further management

Team Leader

- one voice

- interpret inputs (ECG, case-notes, investigations, processes and makes decisions

Does not physically participate in Resus

Decides when to terminate Resus

Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader

Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions

Nurse 3

- performs Chest Compressions

30:2

or 100/min

Doctor 1 - BVM followed by Intubation

Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,

portable ventilator

Call Anesthesia if

difficult airway

Call CVM/Medical ICU Registrar for further management

Team Leader

- one voice

- interpret inputs (ECG, case-notes, investigations, processes and makes decisions

Does not physically participate in Resus

Decides when to terminate Resus

Doctor 2 - establish IV Drip and administration of IV drugs on orders of Team Leader

Nurse 2 - assist Doctor 2 and preparation of drugs, putting up infusions

Nurse 3

- performs Chest Compressions

30:2

or 100/min

Doctor 1 - BVM followed by Intubation

Nurse 1 - assist doctor 1, cricoid pressure during BVM and intubation, check & prepare laryngoscope, ETT,

portable ventilator

Call Anesthesia if

difficult airway

Call CVM/Medical ICU Registrar for further management

Adult Cardiac ArrestAdult Cardiac Arrest

Primary ABCD Phase•Check responsiveness•Focus on ABCD - basic CPR(30:2) and defibrillation•Activate code blue - 1414

Secondary ABCD PhaseA Airway : perform endotracheal intubation (video)B Breathing : Ventilate with BVM, portable ventilator C Circulation : check pulse, give chest compressionsD Differential Diagnosis & Defibrillate

Primary ABCD Phase•Check responsiveness•Focus on ABCD - basic CPR(30:2) and defibrillation•Activate code blue - 1414

Secondary ABCD PhaseA Airway : perform endotracheal intubation (video)B Breathing : Ventilate with BVM, portable ventilator C Circulation : check pulse, give chest compressionsD Differential Diagnosis & Defibrillate

Assess rhythmAssess rhythm

Code BlueCode Blue

Resuscitation

1. Focus on the primary and secondary ABCDs

2. Decisive, professional, unflappable attitude

3. One voice

4. Ensure that the leader knows all drugs & procedures done

5. Leader gives clear information on next steps to be taken

Secondary Survey (some points)

C. Circulation

• Ante-cubital vein / external jugular vein• Infusion fluid : Normal saline• Drugs administered via ETT : adrenaline, atropine

• Circulation time in cardiac arrest

Atropine

Secondary Survey (more points)

Differential Diagnosis

•What caused the arrest?

•Are there any reversible causes - those that had a specific therapy?

•Are there any complications of resuscitation that have an immediately remediable

cause?

Post-ResuscitationTransfer

1. Relinquish care to a team of equal or greater expertise

2. Provide complete, concise, and well-organised information

3. Ensure that patient airway is secured and patient stabilised prior to transfer

Phase 4Phase 4

Critique

1. Dealing with Grief

2. Debrief

3. Education

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

VF/Pulseless VT

Drug

Shock

CPR

Thomas Schneider et al, Multicenter, Randomized, Controlled Trial of 150-J Biphasic Shocks Compared With 200- to 360-J Monophasic Shocks in the Resuscitation of Out-of-Hospital Cardiac Arrest VictimsCirculation, Oct 2000; 102: 1780 - 1787

Automated Defibrillation

•Recommended mode for those not ACLS trained

Step 1

• Switch to AED mode

Step 2

• Connect electrodes to patient and to defibrillator

Step 3

• Analyse rhythm Do not touch patient

Step 4

• Shock the patient

Step 5

• Check ECG & patient,• Start CPR (30:2) if no pulse

• Hypovolemia - Volume Infusion• Hypoxia - Ventilation• Hypothermia - Rewarming, warmed fluids• Hyperkalemia - CACL2, Insulin, Glucose, NAHCO3, Dialysis• Hydrogen ion (Acidosis) - NAHCO3

• Tamponade - Pericardiocentesis• Tension Pneumothorax - Needle Decompression• Thrombosis (AMI) - Rx Cardiogenic Shock• Thromboembolism - Thrombolysis• Tablets -Overdose - Lavage, Activated Charcoal, Specific Rx

Non VF/VT Cardiac Arrest

Reversible Causes - 5Hs & 5Ts

“primum nil nocere - First Do No Harm” (Galen 129 AD)

Thank you

2. Play video on endotracheal intubation

1. Play video on Bag Valve mask Ventilation