Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cardiac Arrest 277

Cardiac Arrest.......................................

MICHEL ACCAD, MD

history & physical

History

■Determine time of arrest (if witnessed)

■Antecedent complaints: chest pain, breathlessness, palpitations,

choking, abdominal pain. severe headache. Underlying condition:

sepsis, renal failure, known heart/lung disease, toxic exposure.

■Was death anticipated (known terminal illness)?

Signs & Symptoms

■Unresponsiveness (“are you alright?”)

■Absent breathing (look, listen, feel), or agonal breathing (not effective

breathing)

■Absent circulation: absent carotid pulse, no breathing, coughing or

movement.

■Signs of irreversible death: rigor mortis, dependent lividity

tests

n/a

differential diagnosis

n/a

management

What to Do First

■Call CODE, check for valid DNR order

■Primary ABCD survey:

■Airway: position patient supine on firm surface. Head tilt-chin lift or

jaw-thrust maneuver. If foreign body aspiration suspected, tongue-

jaw lift and finger sweep, followed by Heimlich maneuver.

■Breathing: bag-mask device, produce visible chest rise. Additional

rescuer to provide bag-mask seal, cricoid pressure as needed. If can-

not ventilate, consider foreign body aspiration.

■Circulation: chest compressions. Elbows locked, 1^1 / 2 ′′to 2′′excur-

sions,∼100 compression/min

■Defibrillation: attach monitor/defibrillator. If rhythm VT/VF, deliver

shock (200J, 200–300J, 360J)