Causes and Prevention of Cardiac Arrest 2010v1

8/13/2019 Causes and Prevention of Cardiac Arrest 2010v1

1/22

Lecture

Causes and Preventionof Cardiac Arrest


2/22

Learning outcomes

The importance of early recognition of the

deteriorating patient

The causes of cardiac arrest in adults

Identify and treat patients at risk of cardiacarrest using the ABCDE approach


3/22

Chain of survival

Early recognition prevents:

Cardiac arrests and deaths

Admissions to ICU

Inappropriate resuscitation attempts


4/22

Early recognition of the deteriorating patientMost arrests arepredictable

Deterioration prior to50 - 80% of cardiacarrests

Hypoxia andhypotension arecommonantecedents

Delays in referral tohigher levels of care


5/22

Recognition of the deteriorating patient -

Early Warning Scoring Systems

Example of early warning scoring (EWS) system*

* From Prytherch et al. ViEWSTowards a national early warning score for

detecting adult in-patient deterioration. Resuscitation. 2010;81(8):932-7


6/22


7/22

The ABCDE approach

to the deteriorating patient

Airway

BreathingCirculation

Disability

Exposure


8/22

ABCDE approach

Underlying principles:

Complete initial assessment

Treat life-threatening problems

Reassessment

Assess effects of treatment/interventions

Call for help early


9/22

Initial assessment

Personal safety

Patient responsiveness

First impression Movement

Pulse

Respiratory effort

Temperature


10/22

ABCDE approach: Airway

CNS depressionBlood

Vomit

Foreign bodyTrauma

InfectionInflammation

Laryngospasm

Bronchospasm

Causes of airway obstruction:


11/22


Recognition of airway obstruction:

TalkingDifficulty breathing, distressed, choking

Shortness of breath

Noisy breathing Stridor, wheeze, gurgling

See-saw respiratory pattern, accessory muscles


12/22


Treatment of airway obstruction:

Airway opening Head tilt, chin lift, jaw thrust

Simple adjuncts

Advanced techniques e.g. LMA, tracheal tube

Oxygen

Early Caponography


13/22

ABCDE approach: Breathing

Decreased respiratory

drive CNS depression

Decreased respiratory

effort

Muscle weakness

Nerve damage

Restrictive chest defect

Pain from fractured ribs

Lung disorders Pneumothorax

Haemothorax

Infection

Acute exacerbation COPD

Asthma

Pulmonary embolus ARDS

Causes of breathing problems:


14/22


Recognition of breathing problems:

Look Respiratory distress, accessory muscles, cyanosis,

respiratory rate, chest deformity, conscious level

Listen Noisy breathing, breath sounds

Feel Expansion, percussion, tracheal position


15/22


Treatment of breathing problems:

AirwayOxygen

Treat underlying cause e.g. drain pneumothorax

Support breathing if inadequate e.g. ventilate with bag-mask

Establish continuous monitoring (SpO2, respiratory rate)


16/22

ABCDE approach: Circulation

Primary

Acute coronary syndromes

Arrhythmias

Hypertensive heart disease

Valve disease

Hereditary cardiac diseases

(Drugs)

(Electrolyte/acid base

abnormalities)

Secondary

Asphyxia

Hypoxaemia

Blood loss

Hypothermia

Septic shock

(Drugs)

(Electrolyte/acid base

abnormalities)

Causes of circulation problems:


17/22


Recognition of circulation problems:

Look at the patientPulse - tachycardia, bradycardia

Peripheral perfusion - capillary refill time

Blood pressure

Organ perfusion Chest pain, mental state, urine outputBleeding, fluid losses

Record and document an ECG


18/22


Treatment of circulation problems:

Airway, Breathing

Oxygen

IV/IO access, take bloods

Establish ECG monitoring

Treat cause

Fluid challenge

Haemodynamic monitoring

Inotropes/vasopressors

Aspirin/nitrates/oxygen (if appropriate) and

morphine for acute coronary syndrome


19/22

ABCDE approach: Disability

Recognition

AVPU or GCS

Pupils

Lateralising signs

Treatment

ABC

Treat underlying causeBlood glucose If < 4 mmol l-1give glucose

Consider lateral position

Check drug chart


20/22

ABCDE approach: Exposure

Remove clothes to enable examination e.g. injuries, bleeding, rashes

Avoid heat loss

Maintain dignity


21/22

Any questions?


22/22

Summary

Early recognition of the deteriorating patientmay prevent cardiac arrest

Most patients have warning symptoms andsigns before cardiac arrest

Airway, breathing or circulation problems can

cause cardiac arrest

ABCDE approach to recognise and treatpatients at risk of cardiac arrest

Causes and Prevention of Cardiac Arrest 2010v1

Documents

Transcript of Causes and Prevention of Cardiac Arrest 2010v1