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  • Cuases of Cardiac Arrest

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    Jixon George
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    Cardiac arrest is most commonly caused by ischemic heart disease and ventricular fibrillation in adults. The main causes of cardiac arrest include hypovolemia, hypoxia, hypothermia, electrolyte imbalances, tension pneumothorax, tamponade, thrombosis, toxins, and respiratory arrest. Hemorrhage from trauma, esophageal varices, peptic ulcers, or obstetric complications can also lead to hypovolemia and shock, resulting in organ dysfunction and cardiac arrest. The main rhythms seen in cardiac arrest are ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole.

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    Cardiac arrest is most commonly caused by ischemic heart disease and ventricular fibrillation in adults. The main causes of cardiac arrest include hypovolemia, hypoxia, hypothermia, electrolyte imbalances, tension pneumothorax, tamponade, thrombosis, toxins, and respiratory arrest. Hemorrhage from trauma, esophageal varices, peptic ulcers, or obstetric complications can also lead to hypovolemia and shock, resulting in organ dysfunction and cardiac arrest. The main rhythms seen in cardiac arrest are ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole.

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    3 views20 pages

    Cuases of Cardiac Arrest

    Uploaded by

    Jixon George
    Cardiac arrest is most commonly caused by ischemic heart disease and ventricular fibrillation in adults. The main causes of cardiac arrest include hypovolemia, hypoxia, hypothermia, electrolyte imbalances, tension pneumothorax, tamponade, thrombosis, toxins, and respiratory arrest. Hemorrhage from trauma, esophageal varices, peptic ulcers, or obstetric complications can also lead to hypovolemia and shock, resulting in organ dysfunction and cardiac arrest. The main rhythms seen in cardiac arrest are ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, and asystole.

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    of 20

    Cardiac Arrest-Causes & Rhythm

    Gp Capt RM Sharma
    Senior Advisor (Anaesthesiology &
    Critical Care)
    Sudden Death

    Most dreaded emergency


    Aetiology of Cardiac Arrest
    • Adults : IHD ( commonest)
    along with ventricular fibrillation
    • 5H
    Hypovolemia
    Hypoxia
    Hypothermia
    Hyper / Hypokalaemia
    Hydrogen ion (acidosis)
    • 5T
    Tension Pneumothorax
    Tamponade (cardiac)
    Thrombosis (coronory)
    Thrombosis (pulmonary)
    Toxin
    • Respiratory Arrest – less common
    Haemorrhage: Causes
    • Traumatic haemorrhage
    – Polytrauma
    – Surgical mishap
    • Non-traumatic hemorrhage
    – Esophageal varices
    – Peptic ulcer
    – Obstetric haemorhage
    Shock

    Poor tissue perfusion (lack of oxygen)

    Organ dysfunction

    Multi Organ Failure

    Death
    Clinical classification of hemorrhage
    Class I Class II Class III Class IV
    Bld loss <750 ml 750-1500 1500-2000 ml >2000 ml
    !5% ml 15-20% 30-40% >40%
    Pulse <100/min >100/min >120/min >140/min

    BP Normal Normal Decreased Decreased


    Resp 14-20/min 20-30/min 30-40/min >35/min
    Rate
    Urine >30 ml/hr 15-30 5-15 ml/hr <5 ml ml/hr
    ml/hr
    Fluids Crystalloid Crystalloid Cryst +Bld Cryst+Bld

    Adapted from ATLS manual, American College of Surgeons ,1989


    Clinical Features of Hypovolemia
    • Tachycardia, tachypnea
    • Hypotension, narrow PP, MAP<60 mm Hg
    Cold extremities
    • Altered sensorium, anxious, confused,
    lethargic
    • Oliguria
    Hypoxia
    • Failure of the tissues to receive adequate
    quantities of O2 is called hypoxia
    • Severe hazard
    • Haldane says -- “ not only stops the
    machine but also wrecks it”
    Energy Cycle
    • Photosynthesis
    6CO2+6H2O C6H12O6+6O2
    • Within cells
    C6H12O6+6O2 6H2O+6CO2+energy
    Metabolism

    Aerobic Anaerobic

    Glucose Glucose

    38 ATP 2ATP
    H2O+CO2 Lactic acid
    Classification of Hypoxia
    • Hypoxic hypoxia
    • Circulatory hypoxia
    • Hemic hypoxia
    • Demand hypoxia
    • Histotoxic hypoxia
    Hypoxic Hypoxia
    • High Altitude ----  Barometric pressure
    mmHg PO2 PAO2
    • Sea level 760 159 100
    • 10,000’ 523 110 67
    • 20,000’ 349 73 40
    • 30,000’ 226 47 18
    • 40,000’ 141 18
    Hypoxic hypoxia

    • Hanging, asphyxia, drowning


    • Airway obstruction-unconsciousness, head
    injury, poisoning, CVA, food bolus
    • Alveolar hypoventilation- Drug overdose,
    COPD exacerbation
    • Pulmonary diffusion defect-
    Emphysema, pulm fibrosis
    • Ventilation/ perfusion mismatch-
    Asthma, pulm emboli
    • R  L shunt- Atelectasis, cyanotic
    Hypoxia (contd)

    • Circulatory hypoxia:
    –  cardiac output -
    – congestive heart failure,
    – myocardial infarction,
    – dehydration
    Effects of Hypoxia

    • Cardiovascular System: SVR , CO ,


    Sympathetic activity 
    • Resp System: Ventilation 
    • Metabolism: Metabolic acidosis due to
    anaerobic metab.
    • Organ failure: Brain- very sensitive
    • Haemoglobin: Cyanosis
    Hypoxia (contd)

    • Hemic hypoxia-
    • reduced hemoglobin :Anemias
    • reduced hemoglobin function :
    carboxyhaemoglobin, methhemoglobin.
    • Histotoxic hypoxia- Cyanide toxicity
    Effects of Hypoxia

    • Cardiovascular System: SVR , CO ,


    Sympathetic activity 
    • Resp System: Ventilation 
    • Metabolism: Metabolic acidosis due to
    anaerobic metab.
    • Organ failure: Brain- very sensitive
    • Haemoglobin: Cyanosis
    Hyerpkalemic ECG
    Rhythms in Cardiac Arrest

    • Ventricular Fibrillation

    • Pulse less VT

    • Pulse less electrical activity (PEA)

    • Asystole
    Hypovolemia

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