Anda di halaman 1dari 18

Jurnal Reading

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).

• The change was made because blood flow during


cardiac arrest depends on chest compressions,
and efforts to address airway and breathing delay
the reestablishment of blood flow
A. Circulation
• Keys to High-Quality Cardiopulmonary
Resuscitation
• Push hard
• Push fast
• Minimize interruptions
• Allow full chest recoil
• Avoid overventilation
B. Airway
• Effective blood flow is critical to achieving ROSC,
compressions or defibrillation must be initiated
immediately, along with bag-mask ventilation.
Tracheal intubation for ventricular fibrillation (VF)
may not be necessary, and defibrillation should
be prioritized to ensure the best chance of
successful conversion to a perfusing rhythm.
1. Why Delayed Intubation With
Ventricular Fibrillation Makes Sense?
• During sudden witnessed collapse (VF cardiac arrest),
an oxygen reserve remains in the lungs. Acceptable
PaO2 and PaCO2 levels persist 4-8 minutes during
chest compressions without rescue breathing. Aortic
oxygen and carbon dioxide concentrations do not
change from pre-arrest levels
• even without chest compressions because no blood
flows and aortic oxygen consumption is minimal.
• Adequate oxygenation and ventilation can continue
without rescue breathing because the lungs serve
• as a reservoir for oxygen during the low-flow state of
CPR
C. breathing
• 1. Ventilation and Compression-Ventilation
Ratios
Physiologic estimates suggest the amount of
ventilation needed during CPR is much less
than that needed during a normal perfusing
rhythm because the cardiac output during CPR
is only 10% to 25% of that during normal sinus
rhythm.
C. breathing
• 2. Rate of Ventilation
• The recommended respiratory rate during
pediatric CPR is 8-10 breaths per minute in
sync with compressions when the patient is
not intubated, and 8-10 breaths per minute
asynchronously (not coordinated with
compressions) in the intubated patient
C. breathing
VI. CPR QUALITY
A. Monitoring
• The goal of CPR is to provide near continuous
blood flow and perfusion to vital organs.
Clinical evidence of good quality CPR during
cardiac arrest can include return of
movement, persistence of gasping, and eye
opening.
B. Quality of CPR Monitoring
• The depth, rate, full chest recoil, and
continuation of chest compressions, as well as
the ventilation rate, should be constantly
monitored, with or without adjuncts. Because
poor-quality CPR is associated with worse
outcome and reduces the likelihood of
defibrillation success, rescuers should focus
on the quality of their efforts.
• Automated feedback devices to improve CPR
quality and
• compliance with guidelines are available.
• 1. Vascular Access
• Place an intraosseous needle if intravenous
access is not immediately achievable.

Anda mungkin juga menyukai