Cardiac arrest - for nursing students

Easy explanation

1. Presented by:
Ms. Elizabeth M.Sc (N)
Asst. Professor,
Dept of MSN
NNC, GNSU.

2. Introduction
Cardiac arrest describes the sudden and
complete loss of cardiac output due to
asystole, ventricular tachycardia or
fibrillation, or loss of mechanical cardiac
contraction (pulseless electrical activity).
Death is virtually inevitable, unless
effective treatment is given promptly.

3. Epidemiology
•Sudden cardiac death is usually caused by a catastrophic
arrhythmia and accounts for 25–30% of deaths from
cardiovascular disease, claiming an estimated 70 000 to 90 000
lives each year in the UK.
•Many of these deaths are potentially preventable.

4. Causes
Coronary artery disease is the most common cause of cardiac
arrest.
Ventricular fibrillation or ventricular tachycardia is common in
the first few hours of MI and many victims die before medical
help is sought.

6. Symptoms of cardiac arrest
Cardiac arrest symptoms are immediate and drastic.
•Sudden collapse
•No pulse
•No breathing (respiration arrest – may be in 30 seconds after cardiac arrest)
•Loss of consciousness
•Enlargement of pupils – may be in 90 seconds after cardiac arrest

7. Diagnosis
•The clinical diagnosis is based on the victim being
unconscious and pulseless
•Breathing may take some time to stop completely after cardiac
arrest.

8. Delay Can Be Deadly
Patient delay is the biggest cause of not
getting care fast.
Do not wait more than a few minutes—
5 at the most

9. Basic life support
ABCDE approach to management
•Prompt assessment and restoration of the Airway
•Maintenance of ventilation using rescue Breathing
•Maintenance of the Circulation using chest compressions
•Disability
•Exposure entails removal of clothes to enable defibrillation, auscultation
of the chest, and assessment for a rash caused by anaphylaxis, for injuries
and so on.

10. BLS
The term basic life support (BLS) encompasses manœuvres that
aim to maintain a low level of circulation until more definitive
treatment with advanced life support can be given.

12. Starting and stopping
•Resuscitation attempts requiring longer than 20 minutes of
CPR have a very high mortality rate
•We recommend stopping at around 20 minutes unless there
is a clinical reason to continue for longer
•Transport to hospital with CPR enroute usually has no role

13. “Chain of Survival”

14. Advanced life support (ALS)
•It aims to restore normal cardiac rhythm by defibrillation when
the cause of cardiac arrest is a tachyarrhythmia
•The initial priority is to assess the patient’s cardiac rhythm by
attaching a defibrillator or monitor.
•Once that this has been done, treatment should be instituted
based on the clinical findings.
•Ventricular fibrillation or pulseless ventricular tachycardia
should be treated with immediate defibrillation.

15. Defibrillation

16. Manual Defibrillator

17. Defibrillation
•It is more likely to be effective if a biphasic shock defibrillator
is used
•Defibrillation is usually administered using a 150-joule
biphasic shock
•CPR resumed immediately for 2 minutes without attempting to
confirm restoration of a pulse because restoration of
mechanical cardiac output rarely occurs immediately after
successful defibrillation.
•If, after 2 minutes, a pulse is not restored, a further biphasic
shock of 150–200 joules should be given.
•Thereafter, additional biphasic shocks of 150–200 joules are
given every 2 minutes after each cycle of CPR.

18. •During resuscitation, adrenaline (epinephrine, 1 mg IV) should
be given every 3–5 minutes and consideration given to the use
of intravenous amiodarone, especially if ventricular fibrillation
or ventricular tachycardia re-initiates after successful
defibrillation.
•Pulseless electrical activity should be treated by continuing
CPR and adrenaline (epinephrine) administration while
seeking such causes.
•Asystole should be treated similarly, with the additional
support of atropine and sometimes external or transvenous
pacing in an attempt to generate an electrical rhythm.

19. An ICD monitors the heartbeat and delivers
shock when it detects lethal dysrhythmia.
Implantable Cardioverter

20. üEpinephrine
üAtropine
üAmiodarone
üMagnesium Sulphate
üLidocaine
üSodium Bicarbonate
üCalcium

21. Epinephrine
üFirst line cardiac arrest drug, given after every 3 minutes of CPR
üDose 1mg (10ml of 1 in 10,000) IV
üCauses vasoconstriction
Atropine
üGiven for asystole or pulseless electrical activity with a rate less than 60
beats per minute
ü3mg is given as a single intravenous dose
üincreasing sinus automaticity and facilitating AV node conduction
Amiodarone
üVF/VT
üIf VF or pulseless VT persists after the first 3 shocks then Amiodarone
300mg is considered.

22. Magnesium Sulphate
üFor refractory VF when hypomagnesaemia is possible
üventricular tachyarrhythmias when hypomagnesaemia is possible
üIn refractory VF – 1 to 2g (2-4ml of 50% magnesium sulphate)
peripherally over 1 to 2 minutes.
Lidocaine
üFor Refractory VF/ pulseless VT (when Amiodarone is unavailable)
ü100mg for VF/ pulseless VT that persists after three shocks.
üAnother 50mg can be given if necessary
Sodium Bicarbonate - severe metabolic acidosis and Hyperkalaemia
Calcium -Hyperkalaemia, Hypocalcaemia

23. Lifestyle changes
•Reduce intake of fatty foods and eat more fruits and vegetables
•Walk 30 minutes a day
•Exercise prevents stroke, heart disease and other conditions