CARDIAC ARREST
DIAGNOSIS OF CARDIAC ARREST
• Lack of movement or response to vigorous
stimulation, without signs of effective breathing (e.g.,
no breathing other than an occasional gasp) should
be treated as cardiac arrest until proven otherwise.
• more advanced monitoring is in place at the time of
arrest (e.g., pulse oximetry, exhaled CO2, arterial
catheter), this can be used to support the diagnosis.
DIAGNOSIS OF CARDIAC ARREST
• The cause of the arrest should be determined in the
early minutes of resuscitation. A focused physical
exam should be conducted and a brief medical
history obtained. A cardiopulmonary monitor should
be placed and the ECG should be examined. A blood
gas analysis with electrolytes (Na+, K+, Ca2+) should
be performed with point-of-care testing if available
B. Breathing
• First steps to evaluation of a collapsed patient no longer
involve physically opening the airway and spending up to 10
seconds assessing breathing. Instead, the patient’s general
appearance, with attention to a lack of effective breathing,
must be assessed immediately to determine whether chest
compressions are indicated. Irregular or agonal respirations
(e.g., gasping) should not be interpreted
• as a stable respiratory pattern; an unresponsive patient with
agonal respirations requires immediate
• chest compressions.
IV. MECHANISM OF BLOOD
FLOW
A. Physiology of Coronary Blood Flow
• The coronary arteries provide blood flow from
the aortic root to the myocardium. The
normally beating heart is mainly perfused by
coronary blood flow during diastole
B. Physiology of Ventilation
• During the decompression phase (chest
compression release), negative intrathoracic
pressure allows venous
return to the heart and improved coronary
artery blood flow.
• Increased negative pressure promotes venous
return, cardiac output, and mean aortic
pressure.
• The algorithmic sequence of rescue interventions
for the arrested patient has changed from
A-B-C to C-A-B (compressions–airway–breathing).