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Incidence
1 in 100,000 per year in young adults
Myocardial hypertrophy
Electrocution
Tension pneumothorax
Electrophysiologic
Abnormalities (e.g. WPW)
Trauma
Electrolyte disturbances
Pulmonary embolism
Drowning
Myocardial hypertrophy
Electrocution
Tension pneumothorax
Electrophysiologic
Abnormalities (e.g. WPW)
Trauma
Electrolyte disturbances
Pulmonary embolism
Drowning
Myocardial hypertrophy
Electrocution
Tension pneumothorax
Electrophysiologic
Abnormalities (e.g. WPW)
Trauma
Electrolyte disturbances
Pulmonary embolism
Drowning
An arrest is called
(Do YOU know the emergency number?)
Supraventricular Tachycardia
Pulseless Electrical Activity (EMD) (~10%)
Cardiac Standstill (Asystole) (20%-40%)
More difficult to treat with worse prognosis
Ventricular Fibrillation
Unconscious
Treat as for VF
AF with WPW
Tension PTx
Cardiac Tamponade
Hypoxaemia
Asystole
Impaired automaticity of SA node
Problems with conduction pathways
usually due to ischaemia/hypoxea
Point To Note
VF or asystole without CPR within the first
4 to 6 min has a poor outcome, and there
are few survivors among patients who had
no life support activities for the first 8 min
after onset
General Management
In A WITNESSED Arrest
A praecordial thump delivered to the
junction of the middle and lower third of the
sternum may occasionally revert VT or VF
It may convert VT to VF
Works by delivering a 4J shock
BLS vs ALS
BLS = EAR + ECC = CPR
(A,B,C)
ALS = BLS +
Advanced Airway Management
IV meds
Defibrillation
Fluids
Defibrillation
When?
VF/pulseless VT
Torsades
? Asystole / fine VF (often post adrenalin)
How much?
200/200/360 (mono)
120-150 (biphasic) can max to 200
Biphasic may have less post-resus myocardial dysfunction (less
energy/thermal effects)
When to sync?
Defibrillation
Paddle position
Where should they be?
IV Access
Central line best
direct access to heart
Adrenaline
Atropine
Amiodarone
Adenosine
Lignocaine
Sotalol
NaHCO3
CaCl2
Hypocalcaemia
Hyperkalaemia
Ca++ channel blocker
OD
MgSO4
Torsades
Refractory VF
Adrenalin
Adrenalin
Increasing doses (cumulatively) may
produce poor neurological outcomes post
VF arrest
May be as low as 6mg
If given 3-5 minutely, may be a time factor
Atropine
Anticholingeric
Increases heart rate
Useful in bradycardia
May be of use in asystole (after adrenalin)
Give enough
at LEAST 300 mcg (usually 500mcg to 1mg)
Otherwise may get paradoxical effects
Amiodarone
Anti Arrhythmic
Useful in refractory VF or Pulseless VT
Give 300mg as bolus
Then an infusion
Adenosine
Useful in SVT
May be helpful in obtaining the diagnosis
Ultra short acting
Must be followed by large bolus flush
Lignocaine
Local anaesthetic
Membrane stabilizing properties
Dose 1mg/kg
for refractory VF/VT
Vasopressin