CARDIAC ARREST AND CARDIOPULMONARY RESUSCITATION

condition of sudden arrest rt By cardiac arrest we meanhanical activity of heart This should be consid hyperacute medical em
is expected to he versatile in the management aly and every medical personnel essution of cerebral naw, irreversible brain damage is expected to occur within 4-6 minutes Therefore, very prompt manager importance to have a fruitful outcome. It is to be remembered that within 15 seconds of circulatory arest unconsciousnena and apnoea invariably follow. Thus prerequisite for diagnosisof cardiac arrest will be absence of pulse and respiration in an is f immense unconscious patient
Management The basie management should be remembered by the threeletters of English alphabet ABC where A’ stands for airway ‘B, for breathing and C” for circulation However, cardiopulmonary resuscitation (CPR) can bedivided into two phases
2. Advanced cardiac life support (ACLS)
BASIC CARDIOPULMONARY RESUSCITATION
Shake the patient and try to rouse him by calling. Call out for help and next urn the patient, then keep him in supine position
and now proceed with ABC of cardio-pulmonary resuscitation. First open the airway. The head-tilt-chin-lift manocuvre is
superior to jaw-thrust and neck-lift manoeuvre. Tilt the head backwards by applying firm pressure on forehead while the
fingers of other hand are placed under the mandible near the chin. In presence of neck injury modified jaw thrust technique
may be used. During this manoeuvre soft tissue under the chin should not be compressed. Now look for chest movement and
by placing the ear over the mouth and nose of the patient and looking towards his chest and abdomen simultaneously assess
whether the patient had started breathing or not. If no breathing has commenced, remove any obstruction in oropharynx
(artificial denture, foreign body, mucus) by the finger and reassess again. If the patient is conscious ask him to cough. If
these are not successful, apply firm blows to the back alternating with finger sweeps, Heimlich manoeuvre, instead
of back-blow is recommended by AHA and ARCS If the patient is still not breathing gently pinch the nostrils to
close them by the index finger and thumb kept over the forehead Now after taking a deep breath place your mouth over patient’s
mouth with an air tight seal. Two slow full breaths in succession are to be given within five seconds allowing a pause after each
compression and ventilation, to improve the oxygen perfusion or to give another shock Airway control, Ventilation and Oxygenation As soon as available 100% oxygen should be used The objective is to maintain an arterial PO, greater than 60 mm of Hg. Endotracheal intubation may be done by qualified personnel but CPR should not be discontinued for more than
30 seconds for this plea. If endotracheal intubation is unsuccessful for cervical spinal injury or due to upper airway
obstruction, cricothroidotomy should be done instead. Drugs In such situations drug therapy means intravenous delivery
IV channels should be kept ready in upper arms. Feroral veins are inappropriate and intracardiac routes may be hazardous
Most of the drugs are given as bolus. Isotonic injections, e.g Epinephrine, Atropine, Lidocaine may be diluted with 10 cc
saline and be injected IV or through endotracheal tube into the tracheobronchial vein. Injections should not be delivered
in endotracheal tubeEpinephrine This is used mainly for its o adrenergic rather than nergic agonist properties. Vasoconstriction is extremely useful for coronary perfusion. The dose is 0.5-l mg: e.g I cc in 1 1000 dilution or 5-10 cc 1 10000 dilution shoul
be given every 5 minutes. The drug may start cardiac contraction and may produce ventricular fibrillation which can
be treated by DC counter shock.adre 0.5 Bicarbonate Hypoxia in cardiac arrest results in lactic acidosis. Paripasu  ion and respiratory acidosis hold for production failure leals to C duetion of anhythmia In presence of escellent basi tion and afler establishment of fibrillation Acidosis also inhilbils arlequute vetilation Ii may also be used if specific indica
Sodium bicarbonate 3.75 gm (446 meu should be given IV und repeatee is restored A slow infusion of te is more suitable. PlI and PaCo, should be uently It should not be given in the same IV line with calcium and calecholamine as the former may be
meusured freq I and the latter is inactivated This drug is vagolytie und thus increases the rute of SA node
Due to its vagolytic effect it also improves AV conduction Atropine is indicated
(i) When there is relative or absolute bradycardia in presence of narrow QRS complex
(ili) In presence of ventricular ectopics due to bradycardia or having symptoms pertaining to bradycardia,
(i) In presence of hypotension with inappropriate heart rate and in absence of use of negative chronotrop
drugs.
The usual dose is 0.5 mg IV repeated at 5 minutes interval In presence of ventricular usystole 1-2 mg IV should be given
Total dose should not exceed 2 mg. It should be remembered that smaller dose will have a vagotonic effect. Calcinm
Very high level of serum calcium has been observed after cardiac arrest. Thus unless definite hypo-calcaemia or calcium
channel blocker toxicity is present, it should not be given Calcium ion enhances ventricular automaticity apart from
increasing myocardial contractile force. It may have a profound effect on cardiovascular collapse and may be useful for
establishing electrical rhythm when asystole is present. Calcium chloride is injected i.V as 10% solution and repeated
at 10 minutes interval if necessary Isoproterenol It is an adrenergic stimulator increasing heart rate, cardiac contractility and AV conduction. In presence of bradycardia refractory to atropine while preparation for pacemaker
lodgement is being made, this may be used in a dose of I mg in 500 cc of 5% Dextrose water at a rate of 3 cc per minute
Antiarrhythmic drugs Of all antiarrhythmic drugs Lidocaine and Bretylium are best used for ventricular fibrillation but as Bretylium has a hypotensive property Lidocaine is maximally used. Thus when arrhythmia is refractory to Lidocaine one may use Bretylium
and Procainamide

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