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
CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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