Special Operations Forces Medical Handbook

4-7

Activity: Rest and limit heavy exertion when possible.
Diet: Low sodium
Medications: Can cause GI upset. Tinnitus (ringing in the ears) on ASA suggests the maximum dose has
been exceeded
No Improvement/Deterioration: Return for reevaluation if pain persists >7 days on ASA. Pericardiocentesis
may need to be repeated for recurrent tamponade.

Follow-up Actions
Return evaluation: Consider tamponade if increasing SOB and fatigue. Perform pericardiocentesis if falling
BP and rising neck veins associated with a pericardial rub.
Evacuation/Consultation Criteria: Recurrent tamponade, after pericardiocentesis or continued symptoms
despite time and treatment.

Cardiac: Cardiac Resuscitation

Lt Col Robert Allen, USAF, MC

Resuscitation of sudden cardiac death
Sudden cardiac death is a common presentation of coronary artery disease, and may be its first sign.
Approximately 75% of sudden cardiac death is due to cardiovascular disease. Sudden syncope may or may
not be preceded by chest pain, fluttering sensation in chest, diaphoresis or dizziness. Frequently, arrest is
due to malignant cardiac dysrhythmias, most commonly ventricular fibrillation (V-Fib) and pulseless ventricular
tachycardia (V-Tach). Early defibrillation of V-Fib or pulseless V-Tach is closely correlated with neurologically
intact survival. The most important goal in the treatment of sudden cardiac death is to provide diagnosis and
electrical defibrillation of V-Fib/pulseless V-Tach as soon as possible after onset.

When: A patient is unresponsive and in cardiac arrest.

What You Need: Monitor/Defibrillator, or Automatic External Defibrillator (AED), oxygen, airway adjuncts
as needed and ACLS drugs as needed.

What To Do:

1. Do a rapid scene survey/tactical assessment to determine any threats in the immediate area.


2. Establish that the patient is unresponsive.


3. Send for help; send for monitor/defibrillator or AED.


4. Open the patient’s airway, check for breathing.


5. If the patient is not breathing, give rescue breaths that cause the chest to rise.


6. Check carotid pulses.


7. If no pulse, begin CPR, continue until monitor/defibrillator or AED is available.


8. Intubate and give oxygen if possible.


9. If AED arrives first, attach leads to patient and turn on AED as per instructions.


10. Stop CPR while AED analyses rhythm.


11. Deliver shocks as advised, or if no shock advised, check pulses and continue CPR if pulses are absent.


12. When monitor/defibrillator arrives, attach leads to patient, and hold CPR while checking rhythm on the
    monitor.


13. Determine cardiac rhythm and initiate the appropriate resuscitation treatment algorithm.


14. Transport victim to highest-level of medical care available as soon as possible.


15. Establish IV access en route if not already done.

Remember the goal in cardiac resuscitation: preventing ischemic brain injury while restoring the normal
circulatory action of the heart. When evaluating a possible cardiac patient have your resuscitation medications
and equipment set up and ready to go. If the patient goes into arrest, the appropriate action can be taken
with a minimum of confusion.