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Cardiac arrest: Difference between revisions
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<section begin="A&IC" />'''Cardiac arrest''' refers to when the heart stops beating, providing no or very little [[cardiac output]]. It is diagnosed when a patient is unresponsive and not breathing or breathing abnormally. As there is no cardiac output there is no pulse either, but an unconscious patient who is not breathing likely has cardiac arrest so time is not wasted feeling for a pulse. | <section begin="A&IC" />'''Cardiac arrest''' refers to when the heart stops beating, providing no or very little [[cardiac output]]. It is diagnosed when a patient is unresponsive and not breathing or breathing abnormally. As there is no cardiac output there is no pulse either, but an unconscious patient who is not breathing likely has cardiac arrest so time is not wasted feeling for a pulse. | ||
Cardiac arrest inevitebly leads to death unless successfully and rapidly managed. Management of cardiac arrest is called '''cardiopulmonary resuscitation''' (CPR). | Cardiac arrest inevitebly leads to death unless successfully and rapidly managed. Management of cardiac arrest is called '''cardiopulmonary resuscitation''' (CPR). For every minute CPR is not initiated after cardiac arrest, survival decreases by 7-10%. | ||
We distinguish two types of CPR, basic life support (BLS) and advanced life support (ALS). CPR always involves chest compressions and ventilation. Basic life support can be learned by anyone and provided by any bystander and layman under guidance by emergency services over the phone. Some public places have automatic external defibrillators (AEDs) which any layman can use as well. | We distinguish two types of CPR, basic life support (BLS) and advanced life support (ALS). CPR always involves chest compressions and ventilation. Basic life support can be learned by anyone and provided by any bystander and layman under guidance by emergency services over the phone. Some public places have automatic external defibrillators (AEDs) which any layman can use as well. | ||
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It is ethically and medically inappropriate to give futile medical therapy, including CPR. The worst case scenario following CPR is that ROSC is achieved but the patient has no neurological function or needs mechanical ventilation or similar for the rest of their life. | It is ethically and medically inappropriate to give futile medical therapy, including CPR. The worst case scenario following CPR is that ROSC is achieved but the patient has no neurological function or needs mechanical ventilation or similar for the rest of their life. | ||
In cases where the physician percieves a patient's odds of surviving cardiopulmonary resuscitation with good neurological outcomes as very low the physician can discuss a ''do-not-resuscitate'' order with the patient, also called a DNR or a "no code". In some countries, the physician can decide this for the patient (even if the patient disagrees); this is the case in Norway, for example. In other countries, like the USA, the patient (or guardian) must agree and sign a written form. I do not know the routine in Hungary. In most cases, when patients are informed of the poor prognosis of CPR, they understand and accept their DNR order, as most would much rather allow a natural death than surviving but risking significantly reduced functioning.<section end="A&IC" /> | In cases where the physician percieves a patient's odds of surviving cardiopulmonary resuscitation with good neurological outcomes as very low the physician can discuss a ''do-not-resuscitate'' order with the patient, also called a DNR or a "no code". In some countries, the physician can decide this for the patient (even if the patient disagrees); this is the case in Norway, for example. In other countries, like the USA, the patient (or guardian) must agree and sign a written form. I do not know the routine in Hungary. In most cases, when patients are informed of the poor prognosis of CPR, they understand and accept their DNR order, as most would much rather allow a natural death than surviving but risking significantly reduced functioning.<section end="A&IC" /><section begin="Peri-arrest" /> | ||
== Peri-arrest and warning signs == | |||
The peri-arrest state is the state just before cardiac arrest, indicating the need for immediate intervention and/or preparation for CPR. It’s important to recognize so that CPR can be initiated early. A peri-arrest state occurs in 80% of cases before cardiac arrest. | |||
The so-called “OMG” signs of peri-arrest: | |||
* Respiratory rate > 30/min or < 8/min | |||
* Heart rate > 140/min or < 40/min | |||
* Systolic BP > 220 mmHg or < 90 mmHg | |||
* GCS decrease by > 2 | |||
* Imminent airway obstruction (decrease in SpO2) | |||
Other important signs of peri-arrest: | |||
* Seizure | |||
* Asystolic periods (> 2 – 3 seconds) | |||
* Acute significant bleeding | |||
* Any unexplained deterioriation | |||
Immediately perform ABCDE management. Secure airways and breathing, monitor and support circulation, check for disabilities and exposure/environment. | |||
<section end="Peri-arrest" /> | |||
[[Category:Intensive care]] | [[Category:Intensive care]] | ||