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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