√ Cardiac Arrest In Special Circumstances

All cardiac arrests are managed as mention on the cardiac arrest page. However, there are some situations where extra management steps are needed. These are:

Asthma

• Manage as per acute asthma: High flow oxygen, salbutamol 5mg nebulised back-to-back, ipatropium 0.5mg nebulised, magnesium 2g iv if not responding to the above


• Intubate early


• Consider tension pneumothorax early and manage accordingly

Hypocalcaemia

• Calcium chloride 10 ml of 10% IV


• Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected

Hyperkalaemia

• Calcium chloride 10 ml of 10% IV


• Sodium bicarbonate 50 ml of 8.4% IV


• Insulin-dextrose IV infusion (10 units of actrapid in 50 ml of 50% dextrose)

Hypothermia

• Palpate the carotid pulse and look for signs of life for up to one minute


• Re-warm patient to 32-34 oC


• Withhold drugs until temperature >30 degrees celcius


• If VF/VT persists beyond 3 shocks, withhold further shocks until temperature >30 degrees celcius

Hyperthermia

• Use active cooling methods


• Dantrolene can be used in neuroleptic malignant syndrome or malignant hyperthermia

Hypokalaemia

• 
  
  
  
  • Potassium 20 mmol IV over 10 minutes followed by 10 mmol IV over 5-10 minutes
  
  
  • Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected
  
  
  
  

Opiate toxicity

• Naloxone 0.4 mg IV; repeated doses up to 4 mg may be required


• Tricyclic antidepressant toxicity


• Sodium bicarbonate 50 ml of 8.4% IV

Local anaesthetic toxicity

• 1.5 ml/kg of 20% lipid emulsion IV

Pregnancy

• Manage by physically pushing the foetus to the left (left lateral no longer used) to relieve inferior vena cava (IVC compression)


• If the foetus is >20 weeks gestation, emergency delivery via Caesarean section should occur within five minutes of cardiac arrest


• If the foetus is <20 weeks it should not pose to much of a kasus for resuscitation or place too many physiological demands on the mother and CPR can continue without Caesarian section

Trauma

• Intubate early and manange hypovolaemia with fluids and haemorrhage control


• Consider ED thoracotomy in specific circumstances

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