Cardiac Arrest Management Techniques

Cardiac Arrest Management

• Initial Actions: Defibrillation (asynchronous mode, 4 J/kg shocks) should be performed immediately. CPR (compressions and ventilation) must continue throughout the process (except during the shock itself) until adequate circulation is established.

• Shock Cycles: If ventricular fibrillation or pulseless ventricular tachycardia persists, administer shock cycles every 4 minutes for a total of 3 cycles (2-minute shock intervals).

• Adrenaline (Epinephrine) Administration: After the third shock cycle, administer adrenaline 1:10 000 (diluted) IV at 0.1 mL/kg. Administer subsequent doses every 4 minutes (after every second shock). Each administration should be followed by a small bolus of 0.9% sodium chloride.

• Dilution: Dilute 1 mL of 1:1000 adrenaline (epinephrine) with 9 mL of 0.9% sodium chloride or sterile water to create a 1:10 000 solution.

• Dose Equivalents: 0.1 mL of a 1:10 000 solution equalling 10 mcg of adrenaline.

• CPR and Rhythm Check: Allow one minute of CPR between any medication administration and the next shock cycle.

• IO Adrenaline: Intrathoracic adrenaline is no longer preferred; intraosseous (IO) access and injection are recommended for faster and more consistent absorption.

• Asystole/PEA Treatment: If the rhythm is asystole or pulseless electrical activity, administer adrenaline 1:10 000 at 0.1 mL/kg, IV/IO, repeated every 4 minutes during CPR.

• Circulatory Shock Preceding Arrest: If the arrest was preceded by circulatory shock, administer 0.9% sodium chloride or Modified Ringer’s Lactate at 20 mL/kg as an IV bolus.

Post-Resuscitation Care

• Admission/Referral: Admit to a monitoring facility (high-care or intensive care unit) as soon as possible.

• Underlying Pathology: Identify and manage any underlying medical conditions.

• Normoxia Maintenance: Maintain appropriate oxygen levels (avoid both hyperoxia and hypoxia).

• Acid-Base Balance: Control blood pH by avoiding hypo- and hypercapnia.

• Blood Pressure: Maintain systolic blood pressure above the 5th percentile for the patient's age; monitor and manage by fluids and inotropes.

• Fever Management: Control and reduce fever.

• Nutrition: Provide adequate nutrition.

• Glucose and Electrolytes: Monitor and correct glucose and electrolyte imbalances.

• Pain Management: Provide appropriate analgesia.

• Rehabilitation: Consider and plan for rehabilitation requirements.

Termination of Resuscitation

• Clinical Judgment: The decision to stop CPR relies on the specific patient’s condition and should be based on clinical judgment.

• Stopping Criteria: Consider stopping resuscitation attempts in the presence of incurable conditions, or in cases of asystole lasting more than 20 minutes.

• Exception to Termination criteria: Cases should be considered for continued resuscitation under certain circumstances: severe hypothermia, drowning, poisoning, medicine overdose, and neurotoxic envenomation.

Foreign Body Inhalation

• Diagnostic Criteria: Active choking, persistent unilateral or bilateral wheezing, chronic cough, stridor, segmental or lobar pneumonia unresponsive to typical treatment, mediastinal shift, or radiographic (chest X-ray) evidence of hyperinflation, collapse, or an opaque foreign body.

• Airway Management: If chest movement is inadequate with bag-valve-mask ventilation, reassess airway patency and adjust position with a tube as necessary (naso or oropharyngeal tube/airway, endotracheal tubes).

• Respiratory Rate: Post-stabilization, initiate chest compressions of 100-120/minute (excluding neonates). Ventilation ratio is 30:2 for single rescuers, and 15:2 for two rescuers.

• Monitoring and Access: Attach a cardiac monitor and secure vascular access (or IO access if IV is inaccessible).

Epilepsy

• Definition: Epilepsy is a chronic neurological disorder characterized by recurrent seizures.

• Seizures: Seizures are sudden, uncontrolled electrical disturbances in the brain. These disrupt normal brain function, leading to various symptoms depending on the affected brain region.

• Types: Epilepsy is not a single disease but a group of different disorders, each with unique causes and characteristics.

• Causes: Causes of epilepsy can include genetic predisposition, brain injuries (traumatic brain injury, stroke, infections), developmental disorders, tumors, and metabolic conditions.

• Mechanisms: The exact mechanisms underlying seizure generation are still under investigation.

Seizures

• Neurological Activity: Seizures are defined by abnormal, excessive, and hypersynchronous neuronal activity in the brain.

• Neural Firing: During a seizure, neurons fire rapidly and in an uncontrolled manner, leading to temporary disruptions in brain function.

• Categorization: Different types of seizures are categorized based on their characteristics, location of origin in the brain, and duration.

• Focal Seizures: Focal seizures originate in a specific area of the brain and can manifest with localized symptoms.

• Generalized Seizures: Generalized seizures involve both hemispheres of the brain and often lead to immediate loss of consciousness.

• Absence Seizures: Absence seizures are a type of generalized seizure characterized by brief, sudden lapses in consciousness without major motor activity.

• Tonic-Clonic Seizures: Tonic-clonic seizures (grand mal) involve a loss of consciousness, muscle stiffening (tonic phase) followed by rhythmic jerking movements (clonic phase).

• Symptoms: The symptoms of a seizure can vary greatly depending on the specific type of seizure and the location of the seizure focus in the brain. Possible symptoms include muscle stiffening or jerking, loss of consciousness or awareness, sensory disturbances, emotional or behavioral changes, unusual or involuntary movements, and auras (sensations indicating an impending seizure).

Relationship between Epilepsy and Seizures

• Recurrent Seizures: Epilepsy is the tendency to have recurrent seizures.

• Single Seizure: A single seizure is not sufficient to diagnose epilepsy.

• Diagnosis: Recurrent seizures (two or more unprovoked seizures over a set period) are crucial for epilepsy diagnosis.

• Provoked Seizures: Some seizures are considered "provoked", meaning they are caused by known factors not related to epilepsy (fever, lack of sleep, medications).

• Evaluation: Epilepsy diagnosis requires careful evaluation of the patient's medical history, neurological examination, and often relevant diagnostic tests like EEG and neuroimaging (CT or MRI scans).

• Variability: The frequency and severity of seizures vary among individuals with epilepsy.

Treatment for Epilepsy

• Aims: Epilepsy treatment aims to reduce or eliminate seizure frequency and improve quality of life.

• Medications: Medications (antiepileptic drugs) are the primary treatment for epilepsy, aiming to control abnormal electrical brain activity.

• Surgery: Surgical intervention may be considered for drug-resistant epilepsy, particularly when the cause is localized to a specific brain area.

• Interventions: Lifestyle modifications and other therapies can also play an important supportive role in epilepsy management.

This quiz focuses on the essential techniques for managing cardiac arrest, including the proper use of defibrillation and adrenaline administration. It covers step-by-step actions to take during an emergency situation and the critical importance of continuous CPR. Test your knowledge on shock cycles and medication dosages.