Heart failure

The causes of cardiac arrest are various, but there are the most common ones:

Key Factors

• Ventricular fibrillation - about 90% of all cases of cardiac arrest;
• Ventricular asystole - about 5% of all cases of cardiac arrest;
• Ventricular paroxysmal tachycardia with lack of pulse on large vessels;
• Electromechanical dissociation - electrical activity in the form of rhythmic QRS complexes without corresponding contractions of the ventricles.

Additional factors

• ischemia ;
• acute obstruction of blood circulation;
• myocarditis ;
• cardiomyopathy ;
• hypovolemia ;
• hypoxia ;
• metabolic changes;
• hypothermia ;
• acute hypercalcemia .

Indirect factors

• Smoking;
• Alcohol abuse;
• Excessive load on the heart;
• Substance abuse;
• Age;
• Genetic.

From the side of the central nervous system

Loss of consciousness - usually does not occur immediately, but after 10-20 seconds from the onset of ventricular fibrillation or asystole , for this reason a person can still perform simple actions even after cardiac arrest.

From the respiratory system

Rare agonal breathing with a stop 2 minutes after unconsciousness.

Circulatory system

Gradual circulatory arrest.

From the muscular system

Perhaps the appearance of tonic clonic convulsions in 15-30 seconds after loss of consciousness.

From the side of the visual system

Dilation of the pupils after 2 minutes with loss of reaction to light.

On the part of the integumentary system

A rapidly growing discoloration of the skin in the form of cyanosis or pallor.

General

After loss of consciousness and respiratory arrest, clinical death occurs, hypoxia develops in organs and tissues.

First aid includes external heart massage and artificial respiration (two injections every 30 clicks) ^[3] . At most cardiac arrests, ventricular fibrillation occurs, which can be controlled by electrical defibrillation using an automatic external defibrillator . The likelihood of successful defibrillation decreases over time, by about 2-7% every minute, but first aid slows down this process, delaying the development of asystole .

• Indirect cardiac massage and emergency defibrillation. Its use without preliminary ECG monitoring is justified by the fact that in more than 90% of cases, the cause of cardiac arrest is ventricular fibrillation:
  • adults sequentially: 4.5-5.5-7.5 kV (200, 300 or 360 J);
  • children: subject to good contact with the surface of the chest, the largest electrodes are used (not only children's). First, defibrillation is carried out with a discharge of 2 J / kg, then it is increased to 4 J / kg.

• Mechanical ventilation (Ambu bag, hardware breathing);
• 100% oxygen with a mask or through an endotracheal tube;
• Central vein catheterization;
• Emergency drug therapy:

Drugs: lidocaine , atropine and epinephrine - can be administered through an endotracheal tube with 10 ml of 0.9% sodium chloride solution or sterile water, or iv, it is better to inject into the central venous catheter, epinephrine 1 ml = 1 mg (when diluted 1: 10,000) 0.1 ml = 0.1 mg (at a dilution of 1: 1000).

Procedure

In case of paroxysmal ventricular tachycardia with the absence of a pulse in the central arteries and ventricular fibrillation, measures should be taken in the following sequence:

• Defibrillation up to three times sequentially 4.5-5.5-7.5 kV (respectively 200, 300 or 360 J);
• Check for electrical activity on the cardioscope;
• After each drug administration, an indirect heart massage is performed for 30-60 s and defibrillation is repeated with a discharge of 7-7.5 kV (360 J);
• It is necessary to control the electrical activity of the myocardium and pulse after each subsequent event;
• Epinephrine - 1 mg iv in a jet; in the absence of effect, it should be reintroduced every 3-5 minutes. Repeatedly, epinephrine can be administered in medium (2-5 mg) or high (0.1 mg / kg) doses;
• Lidocaine - 1.5 mg / kg (bolus from 80 to 120 mg) iv, then iv drip for 5 min to a total dose of 3 mg / kg;
• Bretilia tosylate - 5 mg / kg iv in a stream, then iv in a drip for 5 minutes to a total dose of 10 mg / kg;
• Magnesium sulfate - 1–2 mg iv in case of suspected pirouette type tachycardia, refractory ventricular paroxysmal tachycardia or fibrillation;
• Procainamide - 30 mg / min iv with refractory ventricular fibrillation or tachycardia (maximum dose - 17 mg / kg);
• Sodium bicarbonate - 1 meq / kg only with previous metabolic acidosis, overdose of some drugs (for example, TAD);
• Atropine - 1 mg iv in a jet every 3-5 minutes to a total dose of 0.04 mg / kg. It can be administered every 1-2 minutes;
• In the absence of a pulse, but the presence of electrical activity (electromechanical dissociation, idioventricular rhythms, ventricular slipping rhythms, bradysystolic rhythms, idioventricular rhythms after fibrillation);
• The presence of myocardial kinesis with echocardiography ;
• Blood flow assessment by Doppler ultrasound (if possible);
• Each subsequent stage is carried out in case of inefficiency of the previous one;
• If the above measures are unsuccessful, a decision should be made within 45 minutes to terminate resuscitation measures.

Most people who have a heart failure rave or lie dead. Treatment takes place in intensive care units. Patients survive if the heart manages to start within 5-6 minutes after stopping. At the end of the resuscitation period, constant monitoring of the patient's condition is necessary. Cardiac activity and other functions may be impaired, often the patient needs prolonged cardiopulmonary resuscitation. Radiography is done to the patient, because when helping with cardiac arrest, the chest could be damaged. In addition, biochemical tests are prescribed, diuresis is monitored, and other tests are carried out that can reveal the development of dangerous complications. With prolonged heart failure, the nootropic support necessary for the full recovery of the brain is prescribed.

• Cardioplegia
• Tachycardia