CARDIAC ARREST EMERGENCY MANAGEMENT, UNCONSCIOUS PULSELESS PATIENT TREATMENT ACLS RHYTHM REVIEW 2021

okay so in this video we'll be talking about cardiac arrest we'll discuss that what is the presentation and what are the causes of cardiac arrest how to approach a patient who presents to you with cardiac arrest how to perform cpr and what is shockable and non-shockable rhythm and how to use defibrillator today we are going to discuss all of this first of all what is cardiac arrest cardiac arrest is basically sudden loss of consciousness with absent major pulses there is no breathing and death is inevitable if the patient is not treated so the presentation of the patient will be that the patient will be unconscious there will be absent major pulses and patient will have no breathing you can imagine that a person is in a market and all of a sudden he falls down and patient gets unconscious you check that he's breathing and he's not breathing at that time you check his pulses and pulses are absent that is a cardiac arrest now what are the causes of cardiac arrest cardiac arrest can be due to a ventricular fibrillation it can be due to an ace history and it can be due to an electromechanical dissociation what happens in ventricular fibrillation is that there is abnormal electrical activity in the ventricles that does not let the ventricles to contract properly and push the blood out to the body so that the pulses are absent and if there is no blood supply to the brain the person will get unconscious and breathing will stop it is the most common cause ventricular fibrillation is the most common cause and it is also the most easily treatable cause as well it also occurs due to mi ischemia or electrocution can cause ventricular fibrillation and cardiac arrest and the second one is acestilly in a sisterly there is no systolic contraction of the heart whenever there is no systolic contraction the blood is not pushed out to the body there are no pulses and it is basically due to failure of the conducting system and it has a poor prognosis what happens in electromechanical dissociation is that either you will see a normal electrical activity when you do the ecg of the person either you see a normal activity but the pulses are absent or even you see an abnormal activity and pulses are absent a pulseless electrical activity is recorded on ecg you will see an electrical activity but the pulses will be absent so that is called as electromechanical dissociation it can occur in cardiac rupture it can also occur in massive pulmonary embolism whenever a patient presents to you with cardiac arrest you must remember that irreversible damage to the brain will take place if circulation is not restored within two to three minutes so you must attempt to restore the circulation within two to three minutes first you should confirm the diagnosis that whether the patient is having an arrest or not you should see that if the patient is conscious or not patient should be unconscious there should be no breathing and pulses should be absent you do not check these pulses for diagnosing cardiac arrest you check the major pulses you check the carotids why do you check carotids because sometimes when the patient is hypotensive these pulses get absent but in hypotension these pulses will be present so you check the major pulse if the major pulse is absent then you make the diagnosis of cardiac arrest if the breathing is normal this cannot be a cardiac arrest there will be no breathing patient will be unconscious and patient will have no pulse you ask for help immediately and you position the patient on a firm flat surface with the patient's face upward look listen and feel for breathing basically what you do is that when you are checking for the corroded pulses you check the corroded pulses for at least 10 seconds not more than 10 seconds and at the same time you are also looking for breathing so you check the pulses and you are looking for the breathing if no pulse is found start chest compression and perform 30 compression and then 2 ventilation 30 compression and 2 ventilation in cardiac arrest abc approach is now cab approach circulation is the most important thing that you have to protect since we said that irreversible damage to the brain occurs if you do not reinitiate circulation so what you are helping while doing the chest compressions is that you are trying to push the blood to the brain so that ischemia does not take place so abc in cardiac arrest is cab where circulation is the priority after that you go for ventilation so 30 compressions after that you give two ventilations and you repeat the cycle that's a cycle of cpr with 30 compression and two ventilations now how do you give a chest compression basically what you do is that you put this part of your hand slightly above the zifi sternum and you place your second hand like this and you push the heart and you push that part of sternum and remember that you have to keep your hands straight you do not bend your elbows so that the weight of the body will also help the chest compressions so depth of the compression should be at least two inch or in centimeters it should be five centimeters allow the chest to recoil between the compression so between the compression allow the chest to require but do not take your hands off the chest and shoulders should be directly over the sternum your elbows should not be bent in adults you have to provide 30 compressions and after 30 compressions you have to provide two ventilations two breaths and you perform compressions at the rate of 100 per minute you have to push hard and you have to push fast you have to provide 30 chest compression and after chest compressions you have to provide two breaths to ventilations and if you are in a hospital facility you will have the facility of ambu bag and if you are outside the hospital then you have to provide the breath to mouth a cycle of cpr should be of almost 2 minutes not more than that 30 compressions 2 ventilation should almost take 2 minutes most of the patients get cardiac arrest outside the hospital facility and you provide this management outside the hospital but when you are inside the hospital or when the patient has reached the hospital then ecg machine defibrillator and cardiac medications must be there you apply the ecg machine and you detect the abnormal rhythm and you bombard that abnormal rhythm with defibrillator and you stop that abnormal rhythm with a defibrillator and you also give cardiac medications to help the heart push blood out of it and generate a pulse remember that these chest compressions only help the circulation of blood in the body they do not stop any abnormal electrical activity of the heart if there is serious arrhythmia like ventricular fibrillation asystole there is no survival if the electrical activity is not restored within 10 minutes chest compression only perfuse the blood to the vital organs they do not stop the arrhythmia so remember that chest compression only help perfusion of the body and they give you some time to perform defibrillation and stop this arrhythmia now if the patient has cardiac arrest and you perform ecg you can see a rhythm like this this is ventricular fibrillation you can also see ventricular tachycardia and if a patient is having acesty then you see a flat line like this because there is no systolic contraction no electrical activity will be seen and a flat line shows a system electromechanical dissociation can present to you with either as a normal ecg or an abnormal ecg but the most important thing is that even with this normal ecg or abnormal ecg the pulse will be absent patient will be having absent pulse and electrical activity will be present that can present in different ways this is a graph showing the cardiac arrest management in emergency department do not get overwhelmed by the look of this chart this chart is not as complex as it looks i'll try to make it as easy for you and by the end of this video you will have mastered this chart on your fingertips it's very easy so just follow me so if a patient presents to you with pulseless arrest what you do is that you call for help and you give cpr as i described and you give oxygen when available and you attach the monitor you attach the ecg leads and you have the defibrillator available with you and then you perform ecg ecg will show two types of rhythm either the rhythm will be shockable or the rhythm will be non-shockable there are few types of rhythms in which when you shock the patient when you defibrillate the patient the patients get better and there are few types of rhythm that cannot be treated with shocks that cannot be treated with uh defibrillator and that are called as non-shockable rhythm so remember when you check the rhythm and if the patient is having ventricular fibrillation or ventricular tachycardia we fib we take shock we feed we attack will need shock will need defibrillation and if the patient is having ancestrally that is a known shockable rhythm and you do not need to perform defibrillation in that patient so the conclusion is that not every patient is eligible for defibrillation if only a shockable rhythm is on president on ecg only then you give the shocks so now when you are giving the shock it depends upon the type of defibrillator that you are having if you are having a manual biophysic device then you have to give 120 to 200 joules of electrical shock if you have automated external defibrillator then that automated external defibrillator will detect by itself that how much shock is needed and will give the shock automatically you do not need to enter any value in that and if you are having a monophasic then you have you give 360 joel monophysic is not commonly used manual biophasic and aed are commonly used then when you are performing the shock always remember that you take your hands off the patient because the patient can conduct that electrical activity towards you so hands off and shock the patient then you resume the cpr after you have given shocks you give 5 cycles of cpr each cycle consisting of 30 compression 2 ventilation five cycles and each cycle should be of two minutes then again you check the rhythm and you see whether that rhythm is shockable or not and if the patient is having a shockable rhythm then what you do is that you again give a shock hands off and you shock the patient and you can even use a higher dose this time a d will divide decide by itself that how much patient needs and then you resume the cpr after the shock iv line must be there and you give a vasocompressor through the iv line what you do is that you give epinephrine 1mg iv and that 1mg iv epinephrine will help the heart contract more and generate a pulse and supply the blood to the body and you repeat the dose to the every three to five minutes then you again repeat five cycles of cpr with 30 chest compression and two breaths to ventilation and then again you check that whether that rhythm is shockable or not if the rhythm is shockable then you give the shock again depending upon the shock you either increase the dose or you give the same dose and then you resume cpr and now you consider giving anti-arrhythmic drugs since we have tried so much we have given shocks we have given epinephrine and that arrhythmia is not stopping now you have to give a mitron a mitorone is given with a dose of 300 mg iv once and then you give additional 150 mg again so you give a miter on an anti-arrhythmic drug amedron is usually given more oftenly than lidocaine you can also consider magnesium and lidocaine and then you again repeat the cpr now so this was all about the shockable rhythm in which you gave cpr and you shocked the patient then you gave epinephrine then you started cpr and you shocked the patient and then you give amidarone what if the patient is having a non-shockable rhythm what if the patient is having an asystole or a pulseless electrical activity that is not consistent with b fiber v tag in that patient you can not give uh shocks to the patient you cannot defibrillate the patient it is a non-shockable rhythm it cannot be treated with the shocks what you do is that you resume cpr immediately after five cycles and you maintain an iv excess and you give epinephrine one mg iv and you the same way you repeat every three to five minutes or you can also consider oesopractin and then again you start the cpr you give cpr you give epinephrine and then you start the cpr again minimize interruptions between the cpr there should be minimal interruptions in the cpr the only interruption should be that when you are shocking the patient the hand should be off only then it should be interrupted otherwise continue cpr because cpr is going to save the patient's life you in non-shockable rhythm you do not give any shocks you or you only give cpr and you give epinephrine and you want a new cpr and you check the rhythm again and again sometime it happens that a non-shockable rhythm converts into a shockable rhythm and you give shocks and that patient gets treated and sometimes it also happens that the patient was having shockable rhythm initially and when you give the shocks that patient rhythm converted to a non-shockable rhythm so you do not stay on the one side all the time the patient can shift from one side to another side from shockable to non-shockable and from non-shockable to shockable rhythm you check the rhythm and if it is shockable then you follow the same protocol as we followed in the shockable rhythm and if it is not shockable then you have to continue the cpr as we did in the box number 10 so cpr and epinephrine is the main treatment in non-shockable rhythms in shockable rhythms we also give shocks with it we also give amidarone we also give epinephrine so if the patient's pulse comes up after all this effort the outcome can be that the patient pulse is back or the patient is deceased so these are the two outcomes that you can face and if the patient pulse comes back then you have to begin your post resuscitation care during cpr there are few important points that i will uh talk about you have to push hard you have to push fast and push it at the rate of 100 per minute ensure full chest recoil between the compression minimize interruptions one cycle should be of two minutes and you secure the airway and confirm replacement remember that circulation is important circulation is the foremost thing it is the cab approach not abc approach and during all this you can search for the treatable causes like hypovolemia hypoxia hydrogen ion hypo are hyperkalemia hypoglycemia hypothermia toxins temporary tension pneumothorax thrombosis trauma these are all the causes that can cause cardiac arrest so you while you're doing cpr you must also look for these causes as well if you want to download this chart i have put the link of this chart in the description below you can download it from that so now we will summarize this chart that whenever a patient presents to you with a pulseless rhythm you check the rhythm if it's shockable you give shocks you give you continue the cpr then you give shocks again and you give epinephrine then you continue cpr you check the rhythm and if it is still shockable you give the shocks and you continue cpr you give a miter on and you can also give lidocaine and if the patient is having unknown shockable rhythm you do not need to give shocks you have to continue cpr and you give magnesium and you keep repeating ecg you keep checking the rhythm if whether the rhythm is normal whether the pulse has come up or not so this was all about cpr in summary we talked about the causes of cardiac arrest we fib being the most common and most easily treatable then we talked about this cab approach where just compression is the most important depth of the compression and shoulders should be straight elbows should not be bent 30 compression two ventilations and almost for two minutes ecg machine defibrillator these things must be available while you are doing cpr especially when you are in the hospital this is all the chart of the management of cardiac arrest if you liked my video please click on the subscribe button and check out my other videos on emergency medicine and cardiology boot camp the link of those videos is given in the description below thank you very much

Channel: MedNerd - Dr. Waqas Fazal

Views: 221,893

Keywords: cardiac arrest emergency management, emergency drugs in cardiac arrest, cardiac arrest emergency treatment, cardiac arrest symptoms, cardiac arrest treatment acls, cardiac arrest treatment algorithm, acls algorithms 2021, acls algorithms 2020, acls training video, unconscious patient, first aid unconscious patient, unconscious patient assessment, pulseless electrical activity, pulseless rhythm treatment, pulseless rhythm acls, acls rhythms, no breathing no pulse

Id: 0d85qKobfP8

Length: 17min 50sec (1070 seconds)

Published: Thu Sep 23 2021