Principles of Cardiac Arrest Management

1. Principles of Cardiac Arrest Management Richard Lake 10/2003

2. Background Information • 40% of deaths under the age of 75yrs in Europe are due to cardiovascular disease • One third of people who suffer a myocardial infarction die before reaching hospital • Most die within an hour of the onset of acute symptoms • The majority of these deaths the presenting rhythm is Ventricular Fibrillation or pulseless Ventricular Tachycardia, (VF/ pulseless VT)

3. The only treatment for VF/ pulseless VT is attempted defibrillation • With each minute’s delay the chance of a successful outcome fall by 7-10% • Once in hospital the incidence of VF after Myocardial Infraction is approximately 5% • Most likely presentation of in hospital cardiac arrest is asystole or pulseless electrical activity (PEA).

4. The Chain of Survival

5. Early Access to emergency services or cardiac arrest team • Out of hospital summon EMS by dialling 999/112 • In hospital call cardiac arrest team ring 2222 (check number when on placement)

6. External chest compressions and ventilation will slow down the rate of deterioration of the brain and heart • Basic Life Support should be performed immediately

7. Basic Life Support • Danger • Response • Shout for Help • Airway • Breathing • If no help arrived leave victim, go for help • Circulation

8. Danger • Check for danger to: • Yourself • Bystanders • Victim • Even clinical areas can have dangers, so ALWAYS CHECK

9. Response • Check the victim for response • Ask a question, ‘hello are you alright?’ • Give a command, ‘open your eyes!’ • Give a painful stimulus; pinch the shoulder • If no response shout for help

10. Checking for response

11. Airway • Check the airway • Open the airway, place one hand on the victims forehead and gently tilt head back • Remove any visible obstruction from the victims mouth, including dislodged dentures. Leave well fitting dentures in place • DO NOT ATTEMPT ANY FINGER SWEEPS

12. Opening the airway

13. Jaw thrust technique may be needed if C-spine injury

15. If available use airway adjuncts

16. Nasopharyngeal airway insertion

19. Oropharyngeal airway insertion

20. Breathing • Keeping the airway open: • Look – for chest movements • Listen – at the victims mouth for breath sounds • Feel – for air on your cheek • Look, listen and feel for no more than 10 seconds to determine if the victim is not breathing.

21. If not breathing and no help has arrived • Leave the victim and go to summon help

22. Turn the victim onto his back if he is not already in that position • Give 2 effective rescue breaths, each of which should make the chest rise and fall • If you have difficulty achieving an effective breath: • Recheck the victims mouth and remove any obstruction • Recheck there is head tilt and chin lift • Make up to 5 attempts to achieve 2 effective breaths • Even if unsuccessful move onto check circulation

24. If available use a pocket mask

26. Bag valve mask device may be used

28. Circulation • Look, listen and feel for normal breathing, coughing, swallowing, eye flickering, or any movement by the victim • If you feel confident check for a carotid pulse • You should take no more than 10 seconds to do this

29. Always check pulse same side as you

30. If no breathing but signs of circulation • Continue rescue breaths at a rate of 10 breaths per minute • After every 10 breaths (every 1 minute) recheck for signs of circulation • This should take no longer than 10 seconds to check

31. If no breathing and no signs of circulation • Commence CPR at a ratio of 15 Compressions to 2 ventilations

32. Ensure correct hand position

34. The Chain of Survival

35. Out of hospital the aim is to deliver a shock within 5 minutes of the EMS receiving a call • In hospital the first healthcare responder should be trained and authorised to use a defibrillator immediately

36. Automated External Defibrillator

37. AED hands off pads

38. Automated External Defibrillators may be used

40. Manual Defibrillator

41. Manual Defibrillator Paddles

42. Defibrillation

43. Defibrillation should be performed promptly

44. Often defibrillation restores a perfusing heart rhythm, this is often inadequate to sustain circulation and further advanced life support is required to improve the chances of long term survival

45. Remember the chain of survival

46. The Universal Treatment Algorithm An important part of Advanced Cardiac Life Support

47. Objectives • Recognise the four cardiac arrest rhythms • Identify correctly the appropriate algorithm for each of the rhythms • Discuss the potential reversible causes of cardiac arrest

48. BLS Algorithm if appropriate Precordial Thump Attach Monitor/Defib Assess rhythm +/- Pulse Check VF / VT NON VF/VT DEFIB X 3 as necessary During CPR Correct reversible causes CPR 3 min Re-assess one minute after defibrillation CPR 1 MIN Check electrode / paddle positions Attempt/verify airway/02/IV access Give adrenaline every 3 mins ? buffers/atropine/ pacing/antiarrhythmics

49. BLS Algorithm if appropriate Precordial Thump if appropriate Attach Monitor/Defib Assess rhythm +/- Pulse Check ? VF / VT Non VF / VT

50. BLS Algorithm if appropriate Precordial Thump Attach Monitor/Defib Assess rhythm +/- Pulse Check VF / VT During CPR Correct reversible causes DEFIB X 3 as necessary Check electrode / paddle positions Attempt/verify airway/02/IV access Give adrenaline every 3 mins ? buffers/atropine/ pacing/antiarrhythmics CPR 1 MIN