Cardiac Arrest Survivor Hot Case

GENERAL APPROACH

Prognositication

• Rhythm
• CPR (time to and quality)
• Time to ROSC
• Cause of arrest – ability to treat cause
• Therapeutic hypothermia
• Coma -> need to wait until 72 hrs
• Assessment @ 72 hours – pupils, corneal reflexes, motor response, SSEPs (N20 peak absence), iso-electric EEG, burst suppression, status myoclonus

Other issues

• Cause of cardiac arrest – IHD, arrhythmias, drowning, drug
• Complications (organ failures)

INTRODUCTION

CUBICLE

• number and amount of organ support
• cooling device

INFUSIONS

• sedation: type and when ceased
• vasoactives
• fluid boluses
• paralysis
• nimodipine: SAH as a cause for cardiac arrest

VENTILATOR

• mode
• level of support
• level of oxygenation: FiO2, PEEP: APO, atelectasis, ARDS, aspiration, nosocomial pneumonia
• disease specific questions

MONITOR

• ECG: rate, rhythm, pacing spikes, conduction defects -> ask for 12 lead ECG
• temperature: therapeutic hypothermia
• CVP: number, waveform
• arterial trace: MAP, swing, pulsus paradoxus, pulse pressure

EQUIPMENT

• IABP: position, efficiency, complications
• PAC or PiCCO: ask for a recent set of output data
• pacing: box, wires, settings
• EVD: primary intra-cranial event
• surgical scars

QUESTION SPECIFIC EXAMINATION

• hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general: habitus
-> cardiovascular: sternal stability, cardiac failure, graft sites, shock, endocarditis stigmata, femoral.
-> respiratory: effusions, aspiration, APO
-> abdominal: distension, GI failure, liver laceration

• neurological (if hypothermic, comment that will effect neurological assessment)

-> paralysed
-> unconscious: pupils, corneals, cough, breathing, hemiparesis -> CVA, motor response
-> conscious

• burns from defibrillation
• rib #’s
• aspiration pneumonia
• secondary trauma that may occur at the time of collapse
• groins: femoral artery puncture or vascular sheath from PCI.
• clarify: rhythm, by-stander CPR, time to ROSC, shocks and adrenaline administered.

RELEVANT INVESTIGATIONS

• CXR
• TNT:
• other organ failures
• ABG: gas exchange
• EEG: N20 peak

OPENING STATEMENT

=

• Cause
• Treatment
• Prognosis