Cardiac arrest, treatment

This electrolyte plays a vital role in the acid-base balance of the body. Bicarbonate may be given IV as sodium bicarbonate (NaHC03) in the treatment of metabolic acidosis, a state of imbalance that may be seen in diseases or situations such as severe shock, diabetic acidosis, severe diarrhea, extracorporeal circulation of blood, severe renal disease, and cardiac arrest. Oral sodium bicarbonate is used as a gastric and urinary alkalinizer. It may be used as a single drug or may be found as one of the ingredients in some antacid preparations. It is also useful in treating severe diarrhea accompanied by bicarbonate loss. 

Bicarbonate is no longer used as the first line treatment during cardiopulmonary resuscitation following cardiac arrest. Recent evidence suggests little benefit, and the drug may actually be detrimental to resuscitation. According to the American Heart Association, bicarbonate is used when all other treatment options have failed. 

Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced h)fpother-mia. N Engl J Med 2002 346 557-563. 

The desired outcomes for treatment are to (1) terminate VF, (2) achieve return of spontaneous circulation, and (3) achieve patient survival to hospital admission (in those with out-of-hospital cardiac arrest) and to hospital discharge. 

Cardiostimulation. By stimulating Pi-receptors, hence activation of ade-nylatcyclase (Ad-cyclase) and cAMP production, catecholamines augment all heart functions, including systolic force (positive inotropism), velocity of shortening (p. clinotropism), sinoatrial rate (p. chronotropism), conduction velocity (p. dromotropism), and excitability (p. bathmotropism). In pacemaker fibers, diastolic depolarization is hastened, so that the firing threshold for the action potential is reached sooner (positive chronotropic effect, B). The cardiostim-ulant effect of p-sympathomimetics such as epinephrine is exploited in the treatment of cardiac arrest Use of p-sympathomimetics in heart failure carries the risk of cardiac arrhythmias. 

At one time it was suggested to administer bicarbonate during cardiopulmonary resuscitation following cardiac arrest however, recent evidence suggests that little benefit is provided and its use may be detrimental. For treatment of acidosis in this clinical situation, concentrate efforts on restoring ventilation and blood flow. According to the American Heart Association guidelines, use as a last resort after other standard measures have been utilized. 

Mortality In the National Heart, Lung, and Blood Institute s Cardiac Arrhythmia Suppression Trial (CAST), a long-term, multicentered, randomized, double-blind study in patients with asymptomatic nonlife-threatening ventricular arrhythmias who had an Ml more than 6 days but less than 2 years previously, an excessive mortality or nonfatal cardiac arrest rate was seen in patients treated with encainide or flecainide (7.7%) compared with that seen in patients assigned to matched placebo-treated groups (3%). The averaged duration of treatment with encainide or flecainide in this study was 10 months. 

Parenfera/- The most important treatment-emergent adverse effects were hypotension, asystole/cardiac arrest/electromechanical dissociation (EMD), cardiogenic shock, CFIF, bradycardia, liver function test abnormalities, VT, and AV block. The most common adverse effects leading to discontinuation of IV therapy were hypotension, asystole/cardiac arrest/EMD, VT, and cardiogenic shock. Adverse reactions occurring in at least 3% of patients include nausea. 

Other adverse cardiovascular and respiratory effects Orthostatic hypotension, with or without syncope, can occur with clozapine treatment. Rarely, collapse can be profound and accompanied by respiratory and/or cardiac arrest. Orthostatic hypotension is more likely to occur during initial titration in association with rapid dose escalation. In patients who have had even a brief interval off clozapine, start treatment with 12.5 mg once or twice daily (see Warnings). Because collapse, respiratory arrest, and cardiac arrest during initial treatment have occurred in patients receiving benzodiazepines or other psychotropic drugs, caution is advised when clozapine is initiated in patients taking a benzodiazepine or any other psychotropic drug. 

Reinitiation of treatment - Nhen restarting patients who have had even a brief interval off clozapine (ie, 2 days or more since the last dose) treatment should be reinitiated with one half of a 25 mg tablet (12.5 mg) once or twice/day. If tolerated, patients may be titrated back to a therapeutic dose more quickly than is recommended for initial treatment. Any patient who has previously experienced respiratory or cardiac arrest with initial dosing but was then able to be successfully titrated to a therapeutic dose should be retitrated with extreme caution after even 24 hours of discontinuation. 

Alemtuzumab is a recombinant DNA-derived humanized monoclonal antibody used in the treatment of chronic lymphocytic leukemia and T-cell lymphoma. It targets CD52, a protein present on the surface of mature lymphocytes. Alemtuzumab has been associated with infusion-related events including hypotension, rigors, fever, shortness of breath, bron-chospasm, chills, and/or rash. Also reported were syncope, pulmonary infiltrates, cardiac arrhythmias, myocardial infarction and cardiac arrest. 

Cardiac uses Adrenaline may be used to stimulate the heart in cardiac arrest. Adrenaline can also be used in Stokes-Adam syndrome, which is a cardiac arrest occurring at the transition of partial to complete heart block. Isoprenaline or orciprenaline maybe used for the temporary treatment of partial or complete AV block. 

The primary cause of death in acute diazinon poisoning is a depression of the neurons in the brainstem (medulla), collectively known as the respiratory center, resulting in loss of respiratory drive or, in the case of managed treatment, cardiac failure due to electrical impulse or beat conduction abnormalities in cardiac muscles (fatal arrhythmias). Other effects, such as bronchoconstriction, excessive bronchial secretions, and paralysis of the respiratory muscles (intercostal muscles and diaphragm) may also contribute to respiratory insufficiency and death. Thus, death results from loss of respiratory drive and paralysis of the respiratory muscles, or cardiac failure, or both, with attendant asphyxia or cardiac arrest (Klaassen et al. 1986 Shankar 1967, 1978 Williams and Burson 1985). 

As that for a cardiac arrest, the clinical analysis of the ocular chemical bum is done only after the initiation of an emergency treatment the eye wash. 

Helfaer M. A., Ichord R. N., Martin L. J., Hurn P. D., Castro A., and Traystman R. J. (1998). Treatment with the competitive NMDA antagonist GPI 3000 does not improve outcome after cardiac arrest in dogs. Stroke 29 824-829. 

As can be seen from this review, most of the evidence suggesting a benefit to combination treatment has been performed in models of transient global ischemia. These models are generally considered to simulate hypoxic ischemic injury such as that seen following cardiac arrest rather than the prolonged focal ischemia usually associated with acute ischemic stroke. Only one thrombolytic study has been reported, and it... 

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