1. Phenotypes Of
Cardiac Arrest

2. 1st Year CC Fellow
Day 1

3. ?
“Code Blue”
“North Hospital Basement Rm B153”

4. “Code Blue” “”
“Code Blue” “”
“Code Blue” “”

6. 1.5%
Refractory Arrest
What Now?

7. 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

8. Phenotypes Of
Cardiac Arrest

9. Story

10. 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

11. 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.

12. William Kouwenhoven
Thomas Edison

15. (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

16. 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

17. Not all dying patients should have cardiopulmonary
resuscitation attempted.

21. Bridge

22. Chance of Successful Resuscitation
% ROSC
Time (min)

23. Phenotypes Of
Cardiac Arrest

26. PEA/ASYSTOLE

27. 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

29. PEA
=Prolonged downtime

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

32. Bedside Ultrasound

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

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