Cardiopulmonary arrest diagnosis

Rapid diagnosis of cardiopulmonary arrest is vital to the success of CPR. Patients must receive early intervention to prevent cardiac rhythms from degenerating into less treatable arrhythmias. 

Cardiopulmonary arrest is diagnosed initially by observation of clinical manifestations consistent with cardiac arrest. The diagnosis is confirmed by evaluating vital signs, especially heart rate and respirations. Electrocardiography (ECG) is useful for determining the cardiac rhythm, which in turn determines drug therapy. 

The majority of casualties were assessed at St. Luke s International Hospital, which is located within 3 km of five of the affected subway stations, although a further 568 patients were assessed at five other hospitals (Kato and Hamanaka, 1996 Masuda et al, 1995 Nozaki et al, 1995 Suzuki et al, 1995 Yokoyama et al, 1995,1996). Doctors at St Luke s were notified at 08 16 hours of an explosion and fire at a nearby subway system (Matsui et al, 1996 Okumura et al, 1996) and, twelve minutes later, the first victims arrived on foot at the emergency department. A casualty in cardiopulmonary arrest was brought in by private car at 08 43 hours. In all, 640 casualties were assessed at St Luke s Hospital on 20 March 1995, with the Chapel being used as the main treatment area (Okumura et al, 1996). Initially (at 09 12 hours), the Fire Department identified acetonitrile as the suspected agent. However, medical staff discounted this diagnosis as all casualties had marked miosis and atropine was therefore administered pralidoxime iodide was first given at 10 00 hours. Miosis appeared to be a more sensitive early indicator of exposure than erythrocyte acetylcholinesterase activity (Nozaki et al, 1997). 

---