Cardiac Arrest In Special Circumstances

Cardiac Arrest In Special Circumstances

All cardiac arrests are managed as mention on the cardiac arrest page. However, there are some situations where extra management steps are needed. These are:

Asthma

  • Manage as per acute asthma: High flow oxygen, salbutamol 5mg nebulised back-to-back, ipatropium 0.5mg nebulised, magnesium 2g iv if not responding to the above
  • Intubate early
  • Consider tension pneumothorax early and manage accordingly

Hypocalcaemia

  • Calcium chloride 10 ml of 10% IV
  • Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected

Hyperkalaemia

  • Calcium chloride 10 ml of 10% IV
  • Sodium bicarbonate 50 ml of 8.4% IV
  • Insulin-dextrose IV infusion (10 units of actrapid in 50 ml of 50% dextrose)

Hypothermia

  • Palpate the carotid pulse and look for signs of life for up to one minute
  • Re-warm patient to 32-34 oC
  • Withhold drugs until temperature >30 degrees celcius
  • If VF/VT persists beyond 3 shocks, withhold further shocks until temperature >30 degrees celcius

Hyperthermia

  • Use active cooling methods
  • Dantrolene can be used in neuroleptic malignant syndrome or malignant hyperthermia

Hypokalaemia

    • Potassium 20 mmol IV over 10 minutes followed by 10 mmol IV over 5-10 minutes
    • Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected
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Opiate toxicity

  • Naloxone 0.4 mg IV; repeated doses up to 4 mg may be required
  • Tricyclic antidepressant toxicity
  • Sodium bicarbonate 50 ml of 8.4% IV

Local anaesthetic toxicity

  • 1.5 ml/kg of 20% lipid emulsion IV

Pregnancy

  • Manage by physically pushing the foetus to the left (left lateral no longer used) to relieve inferior vena cava (IVC compression)
  • If the foetus is >20 weeks gestation, emergency delivery via Caesarean section should occur within five minutes of cardiac arrest
  • If the foetus is <20 weeks it should not pose to much of a problem for resuscitation or place too many physiological demands on the mother and CPR can continue without Caesarian section

Trauma

  • Intubate early and manange hypovolaemia with fluids and haemorrhage control
  • Consider ED thoracotomy in specific circumstances

 

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