585
edits
Cardiac Arrest: Difference between revisions
Jump to navigation
Jump to search
→Special circumstances
| Line 53: | Line 53: | ||
* <b>Hyperthermia:</b> Exogenous or endogenous hyperthermia can result in heat stress, progressing to heat exhaustion and results in heat stroke. Heat stroke can lead to varying levels of organ dysfunction accompanied by mental changes. Rapid cooling of the victim should occur as soon as possible. | * <b>Hyperthermia:</b> Exogenous or endogenous hyperthermia can result in heat stress, progressing to heat exhaustion and results in heat stroke. Heat stroke can lead to varying levels of organ dysfunction accompanied by mental changes. Rapid cooling of the victim should occur as soon as possible. | ||
* <b>Hypothermia:</b> In hypothermia (<35oC) it is difficult to detect signs of life. Therefore resuscitation should proceed according to standard protocols. Resuscitation during hypothermia is difficult, the thorax is stiff and the heart is less responsive to medication. Furthermore drug metabolism is slowed, resulting in increased plasma levels of medication. Medication should be administered at double intervals. As a result of rewarming vasodilatation occurs and fluid administration may be required. Rhythm disturbances usually seen after hypothermia are bradycardia, atrial fibrillation followed by VF and asystole. Second to resuscitation warming of the body temperature by external and internal methods should be started. | * <b>Hypothermia:</b> In hypothermia (<35oC) it is difficult to detect signs of life. Therefore resuscitation should proceed according to standard protocols. Resuscitation during hypothermia is difficult, the thorax is stiff and the heart is less responsive to medication. Furthermore drug metabolism is slowed, resulting in increased plasma levels of medication. Medication should be administered at double intervals. As a result of rewarming vasodilatation occurs and fluid administration may be required. Rhythm disturbances usually seen after hypothermia are bradycardia, atrial fibrillation followed by VF and asystole. Second to resuscitation warming of the body temperature by external and internal methods should be started. | ||
* <b>Poisoning:</b> Accidental poisoning in children or by therapeutic or recreational drugs in adults are the main causes of poisoning. Respiratory arrest is more common after poisoning. Early intubation can prevent pulmonary aspiration. | * <b>Poisoning:</b> Accidental poisoning in children or by therapeutic or recreational drugs in adults are the main causes of poisoning, however rarely causes cardiac arrest. It is important to identify the poison to start antidote treatment or decontamination. During the BLS and ALS care should be taken when performing mount-to-mouth ventilation in the presence of certain chemical types of poisoning. Respiratory arrest and airway depression is more common after poisoning. Early intubation can prevent cardiac arrest and pulmonary aspiration. When confronted with a poisoning in an ALS setting, temperature should be monitored as hypo- or hyperthermia my occur after drug overdose. Furthermore, due to the slow metabolization or excretion of certain poisons the resuscitation can continue for a long period. | ||
* <b>Pregnancy:</b> If a cardiac arrest occurs during pregnancy the safety of the fetus should always be considered. Due to the growth of the uterus compression of the inferior vena cava can occur and as a result venous return and cardiac output is compromised. Furthermore the increased abdominal pressure can increase the risk of pulmonary aspiration and can hamper proper ventilation; therefore early intubation can lower risks and ease cardiopulmonary resuscitation. An emergency hysterotomy or caesarean section needs to be considered, if gestational age is after 20 weeks. After 20 weeks the size of the uterus is large enough to compromise cardiac output. | * <b>Pregnancy:</b> If a cardiac arrest occurs during pregnancy the safety of the fetus should always be considered. Due to the growth of the uterus compression of the inferior vena cava can occur and as a result venous return and cardiac output is compromised. Furthermore the increased abdominal pressure can increase the risk of pulmonary aspiration and can hamper proper ventilation; therefore early intubation can lower risks and ease cardiopulmonary resuscitation. An emergency hysterotomy or caesarean section needs to be considered, if gestational age is after 20 weeks. After 20 weeks the size of the uterus is large enough to compromise cardiac output. | ||
* <b>Traumatic Cardiorespiratory Arrest:</b> Blunt trauma can cause commotio cordis if there is an impact to the chest wall over the heart. This impact can cause arrhythmias and is sometimes seen during sports. Penetrating trauma can be cause for and emergency thoracotomy. It is important to treat the resuscitation according to protocol and treat reversible causes. | * <b>Traumatic Cardiorespiratory Arrest:</b> Blunt trauma can cause commotio cordis if there is an impact to the chest wall over the heart. This impact can cause arrhythmias and is sometimes seen during sports. Penetrating trauma can be cause for and emergency thoracotomy. It is important to treat the resuscitation according to protocol and treat reversible causes. | ||