Sudden Cardiac DeathRisk factors & Managements

Department of Emergency TherapyTranslated by Academic Bureau of SMSA 2012

Risk Factors for SCD• Old aged

• Male

• Has PMHx of Coronory Artery Diseases

• High total cholesterol level

• Arterial hypertonia (Hypertrophy of Left Ventricle)

• Diet factors

• Has active physical lifestyle

• Smoking

• Tachycardia / Variable heart rhythm

• Prolonged Q-T segment

Stages of SCDProdromal PeriodProdromal PeriodProdromal PeriodProdromal Period

Acute Cardiac SymptomsAcute Cardiac SymptomsAcute Cardiac SymptomsAcute Cardiac Symptoms

Disturbances in blood Disturbances in blood circulationcirculation

Disturbances in blood Disturbances in blood circulationcirculation

Biological DeathBiological DeathBiological DeathBiological Death

Evidence of clinical deathMain Features• Asystolic • Absent of pulsation at major vessels (Carotid artery)

Additional Features• Dilated pupils • Areflexia ( Absent Corneal Reflex and Pupil reflex towards light )• Skin paleness (pallor)

SCD Management1. Primary evaluation of patient’s condition

2. Basic Life Support (CPR)

3. Advanced measures to maintain life support &

full resuscitation of patient

4. Treatment during post- resuscitation period

5. Long- term treatment

Protocol Basic Life Support(CPR)

Evaluate patient’s conditionEvaluate patient’s condition(Hit patient’s shoulder, wake him)(Hit patient’s shoulder, wake him)

Evaluate patient’s conditionEvaluate patient’s condition(Hit patient’s shoulder, wake him)(Hit patient’s shoulder, wake him)

Restore patient’s upper respiratory tractRestore patient’s upper respiratory tract(Lay back head and lower his mandible) (Lay back head and lower his mandible) Restore patient’s upper respiratory tractRestore patient’s upper respiratory tract(Lay back head and lower his mandible) (Lay back head and lower his mandible)

Evaluate patient’s breathingEvaluate patient’s breathing(movement of chest)(movement of chest)

Evaluate patient’s breathingEvaluate patient’s breathing(movement of chest)(movement of chest)

Absent of Absent of breathingbreathingAbsent of Absent of breathingbreathing

Present of Present of breathingbreathingPresent of Present of breathingbreathing

Do 2 effective breathing into patient’s mouthDo 2 effective breathing into patient’s mouthDo 2 effective breathing into patient’s mouthDo 2 effective breathing into patient’s mouth

Check for pulse (not more than 10 seconds)Check for pulse (not more than 10 seconds)Check for pulse (not more than 10 seconds)Check for pulse (not more than 10 seconds)

Pulse present Pulse present (Continue breathing (Continue breathing

assistant)assistant)

Pulse present Pulse present (Continue breathing (Continue breathing

assistant)assistant)

Pulse absent. (Start pressing the base of Pulse absent. (Start pressing the base of sternum with ratio of 15:2)sternum with ratio of 15:2)

Pulse absent. (Start pressing the base of Pulse absent. (Start pressing the base of sternum with ratio of 15:2)sternum with ratio of 15:2)

Criteria of adequateCPR

1. Returning of pulse on major vessels, synchronous with

compression

on chest.

2. Present of pupil reflex

3. Pink condition of patient

Algorithm of Advanced measures to maintain life support

Disturbances on blood supplyDisturbances on blood supplyDisturbances on blood supplyDisturbances on blood supply

Cardiac Strike (Biological Cardiac Strike (Biological Death)Death)

Cardiac Strike (Biological Cardiac Strike (Biological Death)Death)

CPRCPRCPRCPR

Apply Defibrillator and Apply Defibrillator and cardiomonitorcardiomonitor

Apply Defibrillator and Apply Defibrillator and cardiomonitorcardiomonitor

Evaluate Evaluate Heart Heart

RhythmRhythm

Evaluate Evaluate Heart Heart

RhythmRhythm

VTachycardVTachycardia/Vfibia/Vfib

VTachycardVTachycardia/Vfibia/Vfib

No VT / No VT / VFibVFib

No VT / No VT / VFibVFib

3-multiple 3-multiple defibrillatordefibrillator3-multiple 3-multiple

defibrillatordefibrillatorCardio-Cardio-pulmonologpulmonolog

y y resuscitatioresuscitatio

nn

Cardio-Cardio-pulmonologpulmonolog

y y resuscitatioresuscitatio

nn

Cardio-Cardio-pulmonologpulmonolog

y y resuscitatioresuscitation 3 mins n 3 mins

Cardio-Cardio-pulmonologpulmonolog

y y resuscitatioresuscitation 3 mins n 3 mins

During resuscitation, During resuscitation, 1. Control its position, electrods and 1. Control its position, electrods and contact of defibrillatorcontact of defibrillator2. Ensure oxygen supply thru UPRT2. Ensure oxygen supply thru UPRT3. Do intravenous line for preparations3. Do intravenous line for preparations4. Adrenaline for every 3 minutes4. Adrenaline for every 3 minutes

Prepare for :Prepare for :1. Amiodarone , Atropine1. Amiodarone , Atropine2. Heart electrical stimulator2. Heart electrical stimulator

During resuscitation, During resuscitation, 1. Control its position, electrods and 1. Control its position, electrods and contact of defibrillatorcontact of defibrillator2. Ensure oxygen supply thru UPRT2. Ensure oxygen supply thru UPRT3. Do intravenous line for preparations3. Do intravenous line for preparations4. Adrenaline for every 3 minutes4. Adrenaline for every 3 minutes

Prepare for :Prepare for :1. Amiodarone , Atropine1. Amiodarone , Atropine2. Heart electrical stimulator2. Heart electrical stimulator

Algorithm of management of ventricular tachycardia / Vfib

1. 3 - multiple defibrillator (200 J, 300 J, 360 J) (if not effective)

2. Continue resuscitation method, tracheal intubation, prepare lines for IV

(If not effective)

3. Introduce Adrenaline IV 1 mg bolus(if not effective)

4. Second defibrillator (360 J)(if not effective)

5. Antiarrhythmic Drugs Amiodarone ( 300mg IV)Lidocaine (2.0 -1.5 mg/kg IV)Magnesium Sulfate (1.0-2.0 g IV)

6. Third Defib (360 J)

Antiarrhythmic Drugs1. It is to stabilize patient’s condition2. If patient’s condition is still unstable, continue with defibrillator3. All Anti-arrhythmic drugs have pro-arrhythmic effects.4. Do not use more than 1 anti-arrhythmic drug

Atropine in Sudden Cardiac Death

Indications1. Asystolic2. Heart arrest or bradyarrythmia

1st bolus dose 0.6 - 1.0 mgIf atropine is not effective, change to adrenaline or euphiline.