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• A CRASH BLEEP WENT OFF DURING THE NIGHT SHIFT, YOU WENT TO SEE A 78 YEAR-OLD MALE WHO BECAME UNRESPONSIVE. • HE HAS BACKGROUD OF METASTATIC PROSTATE CANCER AND ANAEMIA. • NURSE INFORMED THAT HE WAS ADMITTED WTH CONFUSION AND UNWELL AND WAS TREATED FOR UTI WITH IV ANTIBIOTICS. SCENARIO • BECOME UNRESPONSIVE THIS MORNING.HE NIGHT AND • YOU WERE THE THIRD PERSONS WHO ARRIVE. THE OTHERS ARE FY2 AND FY1 DOCTORS. HELP IS ON THE WAY. WHAT WOULD YOU DO?Check for a response CONFIRM signs of life < 10 seconds CARDIAN ARREST Confirm cardiac arrest Call for help Confirmrespectform / Start CPR without DNACPR delay 2222 or resusteamCPR • 30:2 • DEPTH 5-6 CM • RATE 100 -120 COMPRESSIONS PER MIN • MINIMISE ANY INTERRUPTIONS TO CHEST COMPRESSIONWHA T ARE THESIGNSOFAIRWA Y OBSTRUCTION? Inspiratorystridor Expiratory wheeze Gurgling SnoringSUCTION – TO REMOVE LIQUID (BLOOD, SALIVA, GASTRIC CONTENT) BLOCKING THE UPPER AIRWAYAIRWAYMANAGMENT OPEN THE AIRWAY USING HEAD TILT AND CHIN LIFT JAW THRUST IF THERE IS A RISK OF CERVICAL SPINE INJURY Whatelsecanyoudotoprotecttheairway? AIRWAY ADJUNCTS OROPHARYNGEAL AIRWAY / GUEDELNASOPHARYGEAL AIRWAY / NPABAGVALVEMASKVENTILATIONSUPRAGLOTTICAIRWAY USE OF SUPRAGLOTTIC AIRWAYS MAY ENABLEN, MORE EFECTIVE VENTILATIONNOWYOUHAVESTARTEDCPRANDPROTECTEDTHEAIRWAY,WHATWOULDYOUDONEXT?CARDIACRHYTHM NON-SHOCKABLE RHYTHM SHOCKABLE RHYTHM - VENTRICULAR FIBRILLATION (VF) - PULSELESS ELECTRICAL ACTIVITY (PEA) - PULSELESS VENTRICULAR - ASYSTOLE TACHYCARDIA (PVT)• VENTRICULAR MYOCARDIUM DEPOLARIZES RANDOMLY • RAPID, BIZARRE, IRREGULAR WAVES OF WIDELY VARYING FREQUENCY AND AMPLITUDE• VENTRICLE DEPOLARIZES AT THE RAPID SPEED, CAUSING PROFOUND LOSS OF CARDIAC OUTPUT • A BROAD-COMPLEX TACHYCARDIA• THERE IS NEITHER ATRIAL NOR VENTRICULAR ACTIVITY • STRAIGHT LINEPULSELESS ELECTRICAL ACTIVITY (PEA) • DOES NOT REFER TO A SPECIFIC CARDIAC RHYTHM • IT DEFINES THE CLINICAL ABSENCE OF CARDIAC OUTPUT DESPITE ELECTRICAL ACTIVITYIn shockablerhythm, deliver shock as indicated by AED. Continue2 minutes CPR cycles and assess cardiac rhythm after each cycles. If remains in shockablerhythm, give IV adrenaline 1 mg after the third round of the cycle, then in the alternative cycle (every 3-4 mins) In non-shockable,do not deliver shock. Continue2 minutes CPR cycles and assess cardaic rhythm after each cycles. Give IV adrenaline1 mg as soon as having IV access, then in the alternative cycles (every 3-5 minutes). If the rhythm changes from shockable to non-skockable rhythm or vice cersa, proceed accordinglyCPR Airway management Assessrhythm Identify andtreatreversiblecauses What are the reversible causes of cardiac arrest?REVERSIBLE CAUSE OF CARDIAC ARREST 4HAND4T4H Hypoxia – ensure effective Hypovolaemia - usually due airway management and to severe bleeding such as ventilation during CPR trauma, GI bleeding and rupture of aortic aneurysm Hyperkalaemia, hypokalaemia, Hypothermia – check hypocalcaemia – suggested temperature by PMHx such as renal failure4T Thrombosis – if feasible, perform PCI during ongoing CPR for coronary thrombosis. For pulmonary thrombosis / PE, consider giving thrombolyticagent immediately Tension pneumothorax – Decompress quickly by thoracostomyor thoracocentesis Cardiac temponade- common after trauma or cardiac surgery. Need needle pericardiocentesis Toxins – review drug chart for allergy and history of overdoseBACKTOTHESCENARIO • Started CPR • I-gel inserted to maintain airway • Cardiac rhythm shows asystole • 4H & 4T but could not find the reversible cause • After 5 cycles of CPR. Medical team decided to stop resuscitationREFERENCE • RESUSCITATION COUNCIL UK THANKYOU Please complete the feedback form for the certificate of attendance