POST CARDIAC CARE SUPPORT

CARDIAC ARREST
Introduction
It is the term when the patient heartbeat, circulation of blood and respiration suddenly
and unexpectedly stop due to disturb activity with in the heart. Cardiac arrest is an abrupt
cessation of pump function in the heart (as evidence by palpable pulse) due to failure of heart
to contract effectively during systole.
Cardiac arrest is characterized by unresponsiveness and lack of breathing (with an occasional
gasp) and is often the end result of apnea or respiratory failure to bradycardia and then
pulseless electrical activity or asystole. It is medical emergency because arrested blood
circulation prevents delivery of oxygen to all vital system and all parts of the body.

Causes
The most common causes of cardiac arrest in children are:

 Structural cardiac abnormalities (congenital heart diseases and postoperative

repairs, coronary artery anomalies, or Marfan syndrome)
 Abnormalities of the electrical system of the heart (also known as primary
electrical diseases), such as long QT syndrome and Wolff-Parkinson-White syndrome
 Abnormalities of the heart muscle structure or function, such as hypertrophic
cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), or
dilated cardiomyopathies
 Acquired heart disease (inflammation or infection in the heart/myocarditis)
 Arrhythmias, including atrial flutter/atrial fibrillation, ventricular tachycardia
(VT), ventricular fibrillation (VF), sinus node dysfunction, and complete heart block
 Atherosclerotic coronary disease
 Commotiocordis (caused by a blow to the chest)
 Drug-induced cardiac arrest

Conditions causing SCD are typically not diagnosed prior to the arrest. In many cases,
these conditions are inherited, but family members are unaware of their family history.

Signs
Warning signs and symptoms do exist in 30-50 percent of cases of SCA/SCD, but are
often ignored or misunderstood.
If your child has any of the warning signs or symptoms of SCA, make an immediate
appointment with your pediatrician or take your child to the ER if they appear
distressed in any way.

Warning signs and symptoms may include:

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 Apnea or gasping for breath Unexplained fainting (syncope) or near fainting,

especially with or just after activity
 Apnea or gasping for breath
 Absent of heart beat (pulselessness),no pulse in femoral ,radial and carotid)
 Pupillary dilation
 Absent of blood pressure

Diagnostic test

 Physical assessment: especially absent carotid pulse, gasping, colour, twisting

and movement.
 Blood test for acute coronary syndrome
 Serum analysis for digoxin level ,electrolytes(sodium ,potassium, magnesium)
 PT/INR
 ABGs
 Blood glucose and urea
 Cardiac enzymes

Treatment

The best chance of Sudden cardiac Arrest survival is prompt recognition, and a planned
emergency response with CPR and AED use.
If sudden cardiac arrest is not treated within minutes to establish a normal heart
rhythm, a person will die. The heart is either quivering or has stopped completely, and
cannot pump blood effectively. Blood flow to the brain and body stops and death results
if life-sustaining care is not provided
Cardiac Arrest requires immediate attention. If child suddenly collapses and does not
immediately awaken, call for help and start CPR. If an AED is available, it should be
applied. The best chance of cardiac arrest survival is prompt recognition, and a planned
emergency response with CPR and AED use. If cardiac arrest is not treated within
minutes to establish a normal heart rhythm, a child will die. The heart is either
quivering or has stopped completely, and cannot pump blood effectively. Blood flow to
the brain and body stops and death results if life-sustaining care is not provided.

The chain of survival concept represents the sequence of five events that must occur
quickly to optimize a person's chance of surviving a cardiac arrest. The five links of the
chain:

1. Immediate recognition of cardiac arrest and activation of the emergency response

system.
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2. Early cardiopulmonary resuscitation (CPR) with emphasis on chest

compressions.
3. Rapid defibrillation using an AED can establish a normal heart rhythm to a
person suffering a cardiac arrest. It is most effective when it is performed in the first few
minutes of a cardiac arrest.
4. Effective advanced life support.
5. Integrated post-cardiac arrest care.

How CPR works

CPR manually pumps blood around the body and maintains the circulation, allowing
blood with oxygen to reach the body organs and brain, until a normal heart beat can be
restored. Hands-only CPR is most effective when performed right after the collapse and
when an AED is also applied quickly. 

CPR should continue until emergency medical services (EMS) arrives and takes over,
unless the affected person has a return of normal circulation (either spontaneously or
after AED shock) and is awake (moving and breathing), and alert and talking.  Rescue
breathing as part of CPR is recommended to be used by trained health professionals.

How AEDs work

.When the heart is in sudden cardiac arrest, an AED can deliver an electrical shock
through the chest (which travels to the heart) to halt the abnormal, ineffective rhythm.
This enables a normal heart rhythm to resume.AEDs are safe for use by anyone who has
been trained to use them, as well as bystanders who follow instructions given by the
devices. Studies have shown that sixth-graders briefly trained in AED use are able to
correctly operate the device almost as quickly as emergency medical personnel.

Steps for cardiopulmonary resusctication

1. Check to see if the child is conscious

 Make sure you and the child are in safe surroundings.

 Tap the child gently.
 Shout, “Are you OK?"
 Look quickly to see if the child has any injuries, bleeding, or medical problems.

2. Check breathing

 Place your ear near the child’s mouth and nose. Is there breath on your cheek? Is the
child’s chest moving?
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3. Begin chest compressions

 If the child doesn’t respond and isn’t breathing : Carefully place the child on
his/her back. For a baby, be careful not to tilt the head back too far. If you suspect a neck
or head injury, roll the baby over, moving his/her entire body at once.
 For a baby, place two fingers on breastbone. For a child, place heel of one hand on center
of chest at nipple line. You also can push with one hand on top of the other.
 For a child, press down about 2 inches. Make sure not to press on ribs, as they are fragile
and prone to fracture.
 For a baby, press down about 1 1/2 inches, about 1/3 to 1/2 the depth of chest. Make sure
not to press on the end of the breastbone.
 Do 30 chest compressions, at the rate of 100 per minute. Let the chest rise completely
between pushes.
 Check to see if the child has started breathing.
 Continue CPR until emergency help arrives.

4. Do rescue breathing

 To open the airway, lift the child’s chin up with one hand. At the same time, tilt the head
back by pushing down on the forehead with the other hand. Do not tilt the head back if
the child is suspected of having a neck or head injury.
 For a child, cover his mouth tightly with yours. Pinch the nose closed and give breaths.
 For a baby, cover the mouth and nose with your mouth and give breaths.
 Give the child two breaths, watching for the chest to rise each time. Each breath should
take one second.

5. Repeat compressions and rescue breathing if the child is still not breathing

 Two breaths can be given after every 30 chest compressions. If someone else is helping
you, you should give 15 compressions, then 2 breaths.
 Continue this cycle of 30 compressions and 2 breaths until the child starts breathing or
emergency help arrives.
 If you are alone with the child and have done 2 minutes of CPR (about 5 cycles of
compressions and breathing), call for help and find an AED.

6. Use an AED as soon as one is available

For children age 9 and under, use a pediatric automated external defibrillator (AED), if available.
If a pediatric AED is not available, or for children age 1 and older, use a standard AED.

 Turn on the AED.

 Wipe the chest dry and attach the pads.
 The AED will give you step-by-step instructions.
 POST CARDIAC CARE SUPPORT

 Continue compressions and follow AED prompts until emergency help arrives or the
child starts breathing.

POST CARDIAC ARREST CARE

PEDIATRIC BASIC LIFE SUPPORT

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POST CARDIAC CARE SUPPORT
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Medication

medication is important to adjunct CPR ,and may be used before and after
CPR.medication are given mainly to correct hypoxemia,increase perfusion pressure
during chest compression ,accelerate cardiac rate ,stimulate spontaneous and forceful
myocardial contraction,correct metabolic acidosis .

DRUG AND DOSE INDICATION

Epinephrine HCL IV/IO -0.01 mg/kg Systematic bradycardia

Endotracheal tube 0.1 mg/kg Pulseless arrest

Reapeat dose :0.1 ml/kg

Sodium bicarbonate Severe metabolic acidosis,hyperkalaemia

IV or IO meq/kg/dose

Newborn-0.5 meq/kg (4.2 %)

Atropine sulfate Brady arrhythmias

o.o2mg/kg (minimum doseo.1 mg

Calcium gluconate Hypocalcaemia,hypermagnesemia,hyperkalaemia

(10%=9 mg/ml)

1ml/kg IV slow push)

Magnesium sulfate Acute severe hypomagnesemia, acute severe asthma

25 to 50mg/kg rapid push for first two

indication and an infusion over 30
minute for asthma
Glucose Suspected or documented hypoglycemia

0.5 to 1 g/kg

Naloxone Opioid intoxication

0.1 mg_kg IV or ET
Amiodarone Pulseless ventricular fibrillation or trachycardia

5 mg/kg IV/ET
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POST CARDIAC CARE SUPPORT
 POST CARDIAC CARE SUPPORT

1. Check to see if the child is conscious

 Make sure you and the child are in safe surroundings.

 Tap the child gently.
 Shout, “Are you OK?"
 Look quickly to see if the child has any injuries, bleeding, or medical problems.

2. Check breathing

 Place your ear near the child’s mouth and nose. Is there breath on your cheek? Is the
child’s chest moving?
 POST CARDIAC CARE SUPPORT

3. Begin chest compressions

 If the child doesn’t respond and isn’t breathing : Carefully place the child on
his/her back. For a baby, be careful not to tilt the head back too far. If you suspect a neck
or head injury, roll the baby over, moving his/her entire body at once.
 For a baby, place two fingers on breastbone. For a child, place heel of one hand on center
of chest at nipple line. You also can push with one hand on top of the other.
 For a child, press down about 2 inches. Make sure not to press on ribs, as they are fragile
and prone to fracture.
 For a baby, press down about 1 1/2 inches, about 1/3 to 1/2 the depth of chest. Make sure
not to press on the end of the breastbone.
 Do 30 chest compressions, at the rate of 100 per minute. Let the chest rise completely
between pushes.
 Check to see if the child has started breathing.
 Continue CPR until emergency help arrives.

4. Do rescue breathing
 To open the airway, lift the child’s chin up with one hand. At the same time, tilt the head
back by pushing down on the forehead with the other hand. Do not tilt the head back if
the child is suspected of having a neck or head injury.
 For a child, cover his mouth tightly with yours. Pinch the nose closed and give breaths.
 For a baby, cover the mouth and nose with your mouth and give breaths.
 Give the child two breaths, watching for the chest to rise each time. Each breath should
take one second.

5. Repeat compressions and rescue breathing if the child is still not breathing

 Two breaths can be given after every 30 chest compressions. If someone else is helping
you, you should give 15 compressions, then 2 breaths.
 Continue this cycle of 30 compressions and 2 breaths until the child starts breathing or
emergency help arrives.
 If you are alone with the child and have done 2 minutes of CPR (about 5 cycles of
compressions and breathing), call 911 and find an AED.

6. Use an AED as soon as one is available

For children age 9 and under, use a pediatric automated external defibrillator (AED), if available.
If a pediatric AED is not available, or for children age 1 and older, use a standard AED.

 Turn on the AED.

 Wipe the chest dry and attach the pads.
 The AED will give you step-by-step instructions.
 POST CARDIAC CARE SUPPORT

 Continue compressions and follow AED prompts until emergency help arrives or the
child starts breathing.

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