Cardiopulmonary arrest treatment

Opiates are used clinically because of their analgesic properties. Opiates also cause sedation, euphoria, respiratory depression, orthostatic hypotension, diminished intestinal motility, nausea, and vomiting. The major manifestations of morphine overdose are coma, miosis (pinpoint pupils), and respiratory depression. Pulmonary edema often is a complication of morphine overdose, and death may result from cardiopulmonary arrest. Treatment for morphine overdose includes administration of the opiate antagonist naloxone (Narcan), which dramatically reverses the effects of morphine. 

FIGURE 7-1. Advanced cardiac life support (ACLS) treatment algorithm for adult cardiopulmonary arrest. (CPR, cardiopulmonary resuscitation PEA, pulseless electrical activity PVT, pulseless ventricular tachycardia VF, ventricular fibrillation.)... 

FIGURE 12-1. Treatment algorithm for adult cardiopulmonary arrest. 

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). 

A 15-year-old female patient ingested 6000mg of propafenone resulting in cardiopulmonary arrest.. CPR was performed. There was no reaction to sodium bicarbonate administration. Subsequently, treatment with intravenous insulin lU/kg and 500cc of 10% dextrose was initiated which resulted in detection of arhythm, pulse and blood pressxue. Upon observing a pulse, a dopamine infusion was administered and transvenous transient pacemaker was applied [32]. 

A 92-year-old African-American woman suffered from smoke inhalation during a house fire. The patient was transferred from a cross-town hospital to receive hyperbaric oxygen (HBO) therapy for carbon monoxide intoxication. Before arrival she was sedated, intubated, and administered with 5g hydroxocobalamin intravenously for suspected cyanide poisoning. In the emergency department (ED) a Foley s catheter was placed and, upon inspection, her urine was tinted a deep red colour. She received prompt HBO treatment and was transferred to the intensive care unit (ICU). Despite mechanical ventilation, HBO therapy and treatment for cyanide toxicity, the patient suffered cardiopulmonary arrest while in the ICU and died days later. 

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. 

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. 

Consumption of small amounts of antifreeze can be deadly. Poisonous constituents are typically ethylene glycol and methanol. There is no home treatment aside from standard first-aid and cardiopulmonary resuscitation (CPR) for signs of shock or cardiac arrest. Gastric treatment and dialysis may be immediately necessary for survival depending on the dose, and long-term kidney and brain damage are possible. 

During cardiopulmonary resuscitation, Epi and other a agonists increase diastolic pressure and improve coronary blood flow, a agonists also help to preserve cerebral blood flow. Thus, during external cardiac massage, Epi facilitates distribution of the limited cardiac output to the cerebral and coronary circulations. The optimal dose of epinephrine in patients with cardiac arrest is unclear. Once a cardiac rhythm has been restored, it may be necessary to treat arrhythmias, hypotension, or shock. Treatment of cardiac arrhythmias is detailed in Chapter 34. 

Open cardiac massage, with direct warm irrigation of the ventricle, or a partial cardiopulmonary bypass may be necessary in hypothennic patients In cardiac arrest who are unresponsive to the above treatment. 

Because respiratory arrest and fibrillation are common effects, knowledge of cardiopulmonary resuscitation (CPR) is essential for those who work with electrical circuits and equipment. Without immediate treatment for these injuries, chances of survival are minimal. 

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