causes and prevention of cardiac arrest. the importance of early recognition of the deteriorating...
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Causes and Prevention of Cardiac Arrest
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• The importance of early recognition of the deteriorating patient
• The causes of cardiac arrest in adults
• The ABCDE approach
Learning outcomes
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Early recognition prevents:
• Cardiac arrests and deaths• Admissions to ICU• Inappropriate resuscitation attempts
Chain of survival
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Early recognition ofthe deteriorating patient
• Most arrests are predictable
• Hypoxia and hypotension are common antecedents
• Delays in referral to higher levels of care
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Recognition of the deteriorating patient
• Several alternative systems to cardiac arrest team• e.g. Medical emergency team (MET)
• Track changes in physiology• e.g. Early warning scores
• Trigger a response if abnormal values:• Call senior nurse• Call doctor • Call resuscitation team
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Recognition of the deteriorating patient -Early Warning Scoring Systems
Example of early warning scoring (EWS) systemFrom Prytherch et al. ViEWS—Towards a national early warning score for detecting adult in-patient deterioration. Resuscitation. 2010;81(8):932-7
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Recognition of the deteriorating patient -Early Warning Scoring Systems
Example escalation protocol based on early warning score (EWS)
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The ABCDE approach to the deteriorating patient
Airway
Breathing
Circulation
Disability
Exposure
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ABCDE approach
Underlying principles:
• Complete initial assessment
• Treat life-threatening problems
• Reassessment
• Assess effects of treatment/interventions
• Call for help early
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ABCDE approach
• Personal safety
• Patient responsiveness
• First impression
• Vital signs• Respiratory rate, SpO2, pulse, BP, GCS, temperature
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ABCDE approachAirway
Causes of airway obstruction:
• CNS depression• Blood • Vomit • Foreign body • Trauma
• Infection • Inflammation • Laryngospasm • Bronchospasm
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ABCDE approachAirway
Recognition of airway obstruction:
• Talking
• Difficulty breathing, distressed, choking
• Shortness of breath
• Noisy breathing• Stridor, wheeze, gurgling
• See-saw respiratory pattern, accessory muscles
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ABCDE approachAirway
Treatment of airway obstruction:
• Airway opening• Head tilt, chin lift, jaw thrust
• Simple adjuncts
• Advanced techniques• e.g. LMA, tracheal tube
• Oxygen
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ABCDE approachBreathing
• Decreased respiratory drive
• CNS depression
• Decreased respiratory effort
• Muscle weakness • Nerve damage• Restrictive chest defect• Pain from fractured ribs
• Lung disorders • Pneumothorax• Haemothorax • Infection• Acute exacerbation COPD• Asthma• Pulmonary embolus• ARDS
Causes of breathing problems:
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ABCDE approachBreathing
Recognition of breathingproblems:• Look
• Respiratory distress, accessory muscles, cyanosis, respiratory rate, chest deformity, conscious level
• Listen • Noisy breathing, breath
sounds
• Feel • Expansion, percussion
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ABCDE approachBreathing
Treatment of breathingproblems:• Airway
• Oxygen
• Treat underlying cause• e.g. antibiotics for pneumonia
• Support breathing if inadequate • e.g. ventilate with bag-mask
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ABCDE approachCirculation
• Primary (pump)• Acute coronary syndromes• Arrhythmias• Hypertensive heart disease• Valve disease• Drugs• Inherited cardiac diseases• Electrolyte/acid base
abnormalities
Causes of circulation problems:
• Secondary (Flow)• Asphyxia• Hypoxaemia• Blood loss• Hypothermia• Septic shock
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Hypovolaemia
One of most common causes of crisis
Fluid loss not always obvious:•Haemorrhagic – blood loss within body•Distributive Shock - vasodilation•Cardiogenic Shock – myocardial insufficiency•Restrictive Shock – pericardial effusion•Obstructive Shock – Emboli•Relative Shock – anaemia
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ABCDE approachCirculation
Recognition of circulation problems:
• Look at the patient• Pulse - tachycardia, bradycardia• Peripheral perfusion - capillary refill time• Blood pressure• Organ perfusion
• Chest pain, mental state, urine output
• Bleeding, fluid losses
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ABCDE approachCirculation
Treatment of circulation problems:
• Airway, Breathing• Oxygen if needed• IV/IO access, take bloods• Call for help• Treat cause• Fluid challenge
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ABCDE approachCirculation
Acute Coronary Syndromes
• Unstable angina or myocardial infarction
• Treatment• Aspirin 300 mg orally (crushed/chewed)• Nitroglycerine (GTN spray or tablet if first dose ever)• Oxygen (guided by pulse oximetry if uncomplicated)
- Give if in shock/heart failure/Saturations indicate• Morphine (or fentanyl)
• Consider reperfusion therapy (PCI, thrombolysis)
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ABCDE approachDisability
(Drugs/Diabetes/Documentation)
Recognition
• AVPU or GCS• Pupils• Blood sugar • Check drug chart• Check for any history
(documentation, alert jewellery)
Treatment
• ABC• Treat underlying cause• Blood glucose
• If < 4 mmol l-1 give glucose
• Consider lateral position
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ABCDE approachExposure
• Remove clothes to enable examination• e.g. injuries, bleeding, rashes
• Check all • Look at and examine surface, orifice, extremity and
cavity
• Avoid excessive heat loss
• Maintain dignity
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Any questions?
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• Early recognition of the deteriorating patient may prevent cardiac arrest
• Most patients have warning symptoms and signs before cardiac arrest
• Airway, breathing or circulation problems can cause cardiac arrest
• ABCDE approach to recognise and treat patients at risk of cardiac arrest
Summary
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Immediate Life Support Course Slide set
All rights reserved© Australian Resuscitation Council & Resuscitation Council (UK) 2010