Cardiac Arrest and CPR

Cardiopulmonary resuscitation is an emergency lifesaving procedure is performed when there is

sudden cessation of heartbeats. It involves the combination of chest compressions and artificial

ventilation to preserve blood flow to the organs including the brain function. Early initiation of CPR

can double or triple the chances of survival after cardiac arrest.

Note: HIGH QUALITY CPR

Compressions:

• Infant: 2 finger compression (if alone) or thumb encircling technique (if you have

assistance)

• Child: 1 or 2 hand

• Adult: Two hands

• Compression rate: 100-120/min

• Compression depth: approximately 1/3 anteroposterior diameter of the chest

• Compression/ventilation ratio: 30:2 (adults and children), 30:2 (If alone) and 15:2 (If

you have assistance)

·        Allow chest recoil

·        Minimize interruptions

·        Adequate ventilation

 

Clinical presentation

·         Unresponsiveness (sudden loss of consciousness)

·         Absence of central pulse (carotid pulse/femoral pulse or brachial pulse in infants)

·        Loss of spontaneous respiration

Investigations

While continuing with CPR, point of care (POC) tests are conducted while looking for the reversible

causes of the cardiac arrest (Hypovolemia, hypoxia, hypo/hyperkalemia, acidosis, hypothermia,

hypoglycemia, tension pneumothorax, toxins, thrombi, cardiac tamponade). These includes:

·         POC Blood gases

·         POC Bicarbonates

·         POC Electrolytes- Potassium, sodium, Calcium, Chloride,

·         POC Creatinine, POC urea

·         POC RBG

·         Bedside ultrasound- looking for pneumothorax, cardiac tamponade or thrombi

·         POC Toxicology screens (If available)

·         POC ECG (if there is a return of spontaneous circulation)

·         POC lactate

·         POC Troponin

 

Management

·         HAZARDS- ensure safety and use of PPEs

·         HELLO- Check for responsiveness, Carotid pulse (not more than 10 seconds) and

breathing

·        •CPR starts with early recognition (unresponsiveness, loss of spontaneous breathing and

absence of a carotid pulse. In infant’s CPR is initiated when the heart rate is below 60

beats/min

·        •Call for HELP and immediately start chest compression. As more members arrives to help

assign different roles including airway and breathing management, time recording,

documentation, AED/monitor, medications

·         Open the airway by performing chin lift or jaw thrust (if suspecting C spine injury). Use

airway adjuncts to open the airway.

·         Give 2 breaths using a bag valve mask connected to oxygen source and observe for chest

rise

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·        Establish IV access for administration of fluids and medications, if failed perform

Intraosseous access

·        After FIVE cycles of compressions/ventilation (2 minutes) check for pulse and use

AED/Defibrillator to analyze rhythm if there is a need to deliver a shock

·         If no need for shocking continue with CPR for another 2 minutes (FIVE cycles)

 

Pharmacological Treatment

 

A: adrenaline (IV) Adult: 1mg, Pediatrics0.01mg/kg (repeat every 3-5 minutes)

AND

A: 0.9% sodium chloride (IV):Adult 2000mls, pediatrics 20mls/kg; if suspecting

hypovolemia as a cause of the arrest

AND

A: dextrose 5% (IV) if needed to correct hypoglycemia

OR

C: dextrose 10%, 25% or 50% (IV) if needed to correct hypoglycemia

AND

C: sodium bicarbonate 1mmol/kg (IV) push (if needed to correct acidosis)

*Additional medications may be required depending on the cause of the cardiac arrest (the

reversible cause)

Disposition

Upon achieving the return of spontaneous circulation (ROSC), the definitive airway is achieved by

performing endotracheal intubation for mechanical ventilation and patient must be admitted to the

ICU or transferred to a facility with an ICU capacity.

REFERENCES;

•      Braunwald & Fauci (2001). Harrison’s principles of internal medicine 15th Ed.  Oxford: McGraw Hill

•      Davidson, S (2006). Principles and practice of medicine 20th Ed.  Churchill: Livingstone.

Kumar & Clark (2003) Textbook of clinical medicine. Churchill: Livingstone.

•      Douglas Model (2006): Making sense of Clinical Examination of the Adult patient. 1^st Ed. Hodder Arnold

•      Longmore, M., Wilkinson, I., Baldwin, A., & Wallin, E. (2014). Oxford handbook of clinical medicine. Oxford

•      Macleod, J. (2009). Macleod's clinical examination. G. Douglas, E. F. Nicol, & C. E. Robertson (Eds.). Elsevier Health Sciences.

•      Nicholson N., (1999), Medicine of Non-communicable diseases in adults. AMREF

•      Stuart and Saunders (2004): Mental health Nursing principles and practice. 1^st Ed. Mosby

•      Swash, M., & Glynn, M. (2011). Hutchison's clinical methods: An integrated approach to clinical practice.