Cardiac Arrest and Codes

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Cardiac Arrest and Codes

• Jamie Shandro MD
• April 1, 2009
• Class 2 Med 550

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Goals

• Approach to the pulseless patient
• ACLS overview
• How codes are managed

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Cardiac Arrest Reality Check

• TV/Movie cardiac arrest survival
• gt90
• Survival of cardiac arrest
• Out of hospital
• At best, 30-45 survival
• In-hospital
• 20-50 survival x 24 hours
• 15-20 survival to discharge
• Varies by initial rhythm, time of day and day of
  week
• Expectations

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Where to start?
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Cardiac Arrest Surveys
Primary (BLS)
Secondary (ACLS)

• Airway advanced intervention
• Breathing confirm secure tube ventilatory
  rate 8-10 per min
• Circulation IV access Meds SHOCKS as
  appropriate
• Differential Diagnosis

• Airway assess open
• Breathing provide
• Circulation Good, uninterrupted CPR
• Defibrillate when AED or Life-Pak arrives (if
  Vfib or pulseless Vtach)

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Rhythms
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Rhythms
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Rhythms
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Rhythms
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What can we shock?

• Ventricular fibrillation (VF) or pulseless
  ventricular tachycardia (VT)
• SHOCKABLE
• Asystole and Pulseless Electrical Activity (PEA)
• NOT SHOCKABLE

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VF/VT
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VF/VT

• ABCD
• Key to survival is rapid defibrillation
• 360J on monophasic defibrillators
• 200J (or as indicated) on biphasic defibrillators
• Drugs
• Epinephrine, Vasopressin
• Amiodarone, Lidocaine

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Survival curve for VF arrest

• 7-10 decrease in survival rate for every 1
  minute delay in defibrillation

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CLINICAL CASE

• 50 yo male presents via the paramedics with an
  acute anterior MI. Now loses consciousness.
• Care for him NOW.

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Asystole/PEA
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CLINICAL CASE

• 45 yo male, recent hip replacement. Collapses
  and is unresponsive.
• CPR is ongoing.
• Care for him NOW.

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CLINICAL CASE

• 58 yo female, on dialysis. Collapses and is
  unresponsive. CPR is ongoing.
• Care for her NOW.

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Managing Codes

• Good Codes vs. Bad Codes
• Team effort
• Importance of a team LEADER
• One voice, smooth functioning
• Debrief/Wrap-up afterwards
• What went well
• What didnt go as well
• What we can do better next time

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CARDIAC ARREST THE STUDENTS ROLE

• Perfect CPR
• Assist IV, blood draw, call LAB (ABG machine to
  room)
• Get chart
• Inform family of progress
• Crowd control
• Debrief with resident/team
• HELP in whatever ways you can!

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YOUR turn to run a code!