| ID | 384 |
|---|---|
| Name | CARDIORESPIRATORY ARREST |
| Cause | Coronary artery disease. ... Heart attack. ... Enlarged heart called cardiomyopathy. ... Heart valve disease. ... Heart problem present at birth, called a congenital heart defect. ... Long QT syndrome (LQTS) and other heart signaling problems. |
| Signs Symptoms | Shortness of breath (more common in women than men) Extreme tiredness (unusual fatigue) Back pain. Flu-like symptoms. Belly pain, nausea, and vomiting. Chest pain, mainly angina (more common in men than women) |
| Diagnosis | A heart imaging test called an electrocardiogram (ECG or EKG) will show a severe ventricular arrythmia or no heartbeat at all |
| Investigations | Blood tests. Heart tests such as cardiac event monitoring, stress testing, and imaging tests. Genetic testing: Some genes changes increase the risk of cardiac arrest. ... Cardiac catheterization. Electrophysiology (EP) study: An EP study is like an ECG that is done inside your heart. |
| Management | Management: 1. Quickly confirm that cardiac arrest has occurred by auscultation. 2. Clear the airway by brief suction of mouth and pharynx. 3. Bag-&-mask the patient with oxygen at 5-81/min. Do not waste time trying to intubate the patient initially. 4. Commence external cardiac massage. A second doctor should do this. The patient should be placed on a firm board. The lower third of the sternum is compressed in the midline for 2-5 cm depending on age, using 2 fingers for an intant or the heel of the hand for an older child, at the rate of 80-100 times per minute or faster in a neonate. Compre-ssion should be a firm rapid downward movement and done 4 and 5 times between each ventilation. Adequate ECM should produce palpable pulses. 5. If abdominal distension is marked, a nasogastric tube is passed. 6. If there is response to initial management, set up an i.v drip of 5% dextrose and give 8.4% sodium bicarbonate i.v, give up to 3mmol /kg (Immol = 1ml of 8.4% solution) initially and then Immol/kg every 5 minutes of cardiac arrest. I.V adrenaline 1 : 10,000 as a cardiac stimulant in asystole. Dosage up to 3 ml in neonate, and 3-10 ml in an older child (0.25 ml/kg). It may be given intracardiac as a last resort. Note : Dilute ordinary adrenaline 1:100 to 1:10,000 i.v 10% calcium gluconate 0.2 ml/kg, may also be given slowly. For ventricular fibrillation confirmed by ECG, DC defibrilation is done. Dose: 2 Joules/kg for the first attempt, 4 Joules/kg for subsequent attempts. 7. Endotracheal intubation should be done by an experienced doctor. Only uncuffed tubes are used in children. Under the age of 6 months, use a straight bladed laryngoscope. Diameter of tube used varies with age, viz. 2.5 mm for prematures; 3 mm for neonate, after infancy use following formula-Size = A8e/4 + 4 8. Do necessary investigations including Hb, blood gases, CXR, blood glucose, serum electrolytes. 9. Closely monitor vital functions and progress of child. 10. Record details of events and treatment given, otherwise they will be* forgotten. Where there is no response to resuscitation, the senior doctor will decide how long efforts should be continued. Refractory cardiac asystole and fixed dilated pupils are hopeless signs. |
| Introduction | Cardiorespiratory emergencies in children differ from those in adults. The majority are due to hypoxia (e.g. from aspiration) rather than a heart condition and the heart is almost always in asystole. Many will respond to prompt resuscitation, for which adequate circulation and ventilation must be reestablished before irreperable brain damage has occurred. |
| History | |
| Etiology | The main cause of cardiac arrest is ventricular fibrillation or ventricular tachycardia, which are types of arrhythmias. Important risk factors include prior cardiac arrest, coronary heart disease, heart valve disease, congenital heart defects, and arrhythmias caused by faulty genes |
| Clinical Features | Shortness of breath (more common in women than men) Extreme tiredness (unusual fatigue) Back pain. Flu-like symptoms. Belly pain, nausea, and vomiting. Chest pain, mainly angina (more common in men than women) |
| Preventions | The interventions that have proven to reverse cardiac arrest include early CPR and early defibrillation. The initial step involves identification and basic life-support measures. If public access defibrillation is available, it should be activated and utilized if needed |
| Treatment | Adrenaline. This is the first drug given in all causes of cardiac arrest and should be readily available in all clinical areas. ... Amiodarone. ... Lidocaine. ... Atropine. ... Additional drugs. ... Calcium chloride. ... Magnesium sulphate. ... Miscellaneous drugs. |
| Complications | Neurologic dysfunction, brain injury, disorders of consciousness, neurocognitive deficits, changes in quality of life, as well as physical and psychological wellbeing |
| Prognosis | Most people who experience cardiac arrest do not survive. Among those who do, there is risk of neurologic dysfunction, brain injury, disorders of consciousness, neurocognitive deficits, changes in quality of life, as well as physical and psychological wellbeing |
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