Phenotypes Of Cardiac Arrest

1st Year CC Fellow Day 1

? “Code Blue” “North Hospital Basement Rm B153”

“Code Blue” “” “Code Blue” “” “Code Blue” “”

1.5% Refractory Arrest What Now?

1.5% ACLS Vasopressin SODIUM BICARBONATE High-performance CPR EPINEPHRINE THROMBOLYTICS 1.5% MAGNESIUM TOBACCO ENEMA LIDOCAINE AMIODARONE ACLS ATROPINE Mechanical Chest Compressions HIGH-DOSE EPINEPHRINE SODIUM BICARBONATE High-performance CPR INTRA-ARREST COOLING

Phenotypes Of Cardiac Arrest

Story

Warning : Animals were harmed in the making of this story With a shock to head, the animal was rendered lifeless and arose with a second shock to the chest; however, after the experiment was repeated rather often, the hen was completely stunned, and walked with some difficulty, and did not eat for a day and night; then later is very well and even laid an egg. Peter Christian Abdilgaard-1775

With a shock to head, the animal was rendered lifeless and arose with a second shock to the chest; however, after the experiment was repeated rather often, the hen was completely stunned, and walked with some difficulty, and did not eat for a day and night; then later is very well and even laid an egg.

William Kouwenhoven Thomas Edison

(3) Artificial circulation (2) Artificial ventilation (4) Drug therapy Steps in Cardiac Resuscitation (1) Rapid diagnosis (3) Artificial circulation (2) Artificial ventilation (4) Drug therapy (5) Electrocardiogram (6) Defibrillation if necessary

If there is ny evidence of damage to the central nervous system, further cerebral edema must be prevented. Some brain damage is evident if the patient does not immediately awaken. More severe damage is evident by dilated, fixed pupi s or persistent apnea. In such cases the body temperature i lowered to 32° to 34° C. (89.6° to 93.2° F.) and maintained for 72 hours or until there is no further evidence of cerebral deterioration. a c l s

Not all dying patients should have cardiopulmonary resuscitation attempted.

Bridge

Chance of Successful Resuscitation % ROSC Time (min)

Phenotypes Of Cardiac Arrest

PEA/ASYSTOLE

H ypothermia T oxins H ypo/yper K T amponade H ypovolemia T ension PTX H ypoxia T hrombosis H ypoglycemia T rauma H -ions

PEA =Prolonged downtime

Pseudo-PEA Hypothermia Toxins Tamponade Hypo/yper K Tension PTX Hypovolemia Thrombosis Hypoxia Hypoglycemia Trauma H-ions

Bedside Ultrasound

-Sensitivity 66.7% (35% to 90%) -Specificity 67.7% (64% to 71%) -LR+ 2.07 -LR- 0.49

-Initial Rhythm? -Witnessed? -Bystander CPR? -Age/CoMorbidities? -Correctable Causes V-fib/tach, pericardial effusion, Tension PTX, hyperdynamic underfilled LV