Cardiac Arrest

HEARTSTART SKILLS Frasco
HEARTSTART SKILLS Frasco
6,450,853
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Published 2009-09-07
The most common cause of a lethal dysrhythmia is by a PVC hitting the peak of the T wave (known as R-on-T Phenomenon). This causes a pulseless shockable or non-shockable rhythm in at risk patients. 90% of cardiac arrests in adults are shockable (Pulseless VTach/Ventricular Fibrillation). This rhythm started with multifocal PVCs to a wide complex tachycardia (Pulseless VTach). This can only last from a few seconds to a few minutes before it becomes Coarse Ventricular Fibrillation (if no CPR and Defibrillatory shocks were administered). Coarse VFib can only last for about 4-5 minutes before it becomes Fine VFib. From then on, you have seconds for Fine VF to become Asystole.

INTERVENTIONS: Based on AHA 2016 Guidelines

For VF/pVT:
- High quality CPR
- Defibrillate 120-200 J biphasic or 360 J monophasic every two minutes
- Give Epinephrine 1 mg every 3-5 minutes, followed by a 10-20 mL flush of NS/LR
- May give Amiodarone 300 mg IV/IO bolus if refractory (if patient is not hypokalemic)
- May give Lidocaine 1-1.5 mg/kg IV/IO bolus if refractory (if patient is hypokalemic)

For Asystole/PEA:
- High quality CPR
- Give Epinephrine 1 mg every 3-5 minutes, followed by a flush of 10-20 mL NS/LR
- Correct possible causes (H/Ts)

Possible causes:
- Hypoxemia
- Hypo/Hyperkalemia
- Hydrogen Ions (Acidosis)
- Hypothermia
- Toxins
- Tamponade, Cardiac
- Tension Pneumothorax
- Thrombosis, Pulmonary Embolism
- Thrombosis, Acute Coronary Syndrome

If ROSC (Return of Spontaneous Circulation)
1. Optimize ventilation and Oxygenation
- Advance airway placement
- Ventilate 10-12/min
- Keep O2Sat greater than 94-99%, PETCO2 35-40 mm Hg

2. Treat Hypotension: Keep SBP above 90 mm Hg
- Give 1-2 L NS/LR
- May administer Dopamine 5-10 mcg/kg per minute IV/IO
- May administer Epinephrine 0.1-0.5 mcg/kg per minute IV/IO
- Treat H/Ts
- 12-Lead ECG

3. Consider TTM (Targeted Temperature Management) if ALOC
- Give cold NS/LR 4°C to reach a core temp of 32-36°C for at least 24 hours or greater
- Other cooling measures are used to induce hypothermia (jell beds/pads, thermo-coolers, cooling blankets, etc)

CONSIDERING CODE TERMINATION:
- Unsafe scene
- If (central) rigor mortis exists. Patient's intercostal muscles already filled with lactic acid from prolonged CPR disallowing compressions and decompressions
- If DNR (do not resuscitate). It's obvious you don't start ACLS when you have the DNR papers on chart. This happens sometimes when the patient arrives in the ER first via ambulance and the family coming from somewhere else arrives with the DNR papers.
- MD orders
- Code Team decision
- Lividity
- Decapitation
- Family request
All Comments (21)
  • @governmentlab6162
    I expected the end of this video to be finished with a long, long beep. But the end of this video was a sudden silence. It made me think a lot.
  • @kerosiima
    Its weird to watch how the flatline just brushes away the last evidence of the person being alive
  • @niccolopaganinifranzliszt3556
    I will never forget. That guy at grade 12, who's heart stopped becouse of seizures. Luckily, me and my sport teacher started doing cpr, plus there was a paramedic station near. Today this guy is 100% okay (for at least what I know). Thanks god.
  • @jerboarat
    therapist suggested this video as exposure therapy due to my mom having a almost fatal cardiac arrest. absolutely insane that she survived I can’t imagine this is what she felt.
  • @mariieett010
    I always found dying heart rate monitors way scarier than any scary scene in a movie
  • @hopelessguy5493
    And everyone starts loving you once the line gets straight .
  • @leahevehumphries
    My grandad had a cardiac arrest in 2009. If it wasn’t for my uncle giving him CPR he would have died right then and there, but he saved him and he survived another 17 days. Sadly he never spoke again but at least we were able to say goodbye to him thanks to my uncle. He also saved my grandma in February of this year, he was supposed to be going out but was delayed. My grandma started properly choking on some food and if he wasn’t there to help her and call the ambulance, she would have been gone. I’m next to her right now. My uncle sadly passed away last month in an accident. He saved both his parents, and in the end one of his parents outlived him. Life is strange AF sometimes…
  • @rosalina5328
    My grandfather died of cardiac arrest on my 15th birthday. I feel like I just watched it happen. This hurt me in ways I didn't expect.
  • @meercat1880
    the fact that we just witnessed the last signs of life leaving someone is incredible yet terrifyingly morbid
  • @captainfrost24
    Just to relieve some anxiety, I worked as a cardiac monitor tech at a hospital, and I have never seen anyone go through the fatal process shown here in this short amount of time. I believe this is a simulation. From what I saw this process typically took many minutes or hours, and with medical intervention the odds were very good to save the patient. Obviously there are fatal cardiac events that happens suddenly, but for a huge majority of patients I was always surprised at just how resilient the heart was. You realize it when you are monitoring a 90 year old lady in AFib with a heart rate of 200+bpm for 2 weeks, who is just acting normal and walking around her hospital room. We even saw people in ventricular tachycardia who were fully awake and reported having no symptoms.
  • @Teehee_vr
    The fact my dad had a cardiac arrest and lived to tell the tale is just crazy
  • @Dominion69420
    The scariest thing is people can be alert and aware of whats going on at the start, see the monitor, understand whats about to happen, and be dead in only 60 seconds later
  • @sircompliments8107
    I can't believe how scary this is. Way scarier than any movie portraying hospital bed death. I knew about how it goes silent and not a long note, but man.
  • @aurorapopplicious
    0:00 | Multifocal PVCs with an ST Elevation begin, 0:22 | R on T phenomenon happens when the PVC lands directly on a T wave. Heart rhythm transfers to Ventricular Tachycardia 0:35 | Rhythm transfers into a Ventricular Fibrillation, where ventricles quiver instead of beat, it will become fine VF in moments, which are electrical signals on the ECG are greater than 3mm in height 0:48 | VF waves become finer and smaller, indicating the heart is quivering less powerfully, this will lead to Asystole where the heart stops completely. 1:02 | Heart stops beating completely, no more electrical activity or contractions. No oxygen to the body will cause brain death if not treated immediately
  • @prahardarji6147
    For those that want to know the ecg, this patient was going through a myocardial ischemia ( heart attack) in which Premature ventricular contraction (PVC) are very common due to damaged heart tissue. Sometimes this PVC occur during vulnerable periods of cardiac cycle ( R ON T PHENOMENON) leading to Ventricular tachycardia which then leads to Ventricular fibrillation and finally cardiac arrest.
  • @xINTENSORx
    I've worked in an ER for 8 years now, I've seen this too many times. One of the most humbling things I've experienced is people's phones right after death. Their family's don't know their loved one has passed away yet and the calls and text messages keep coming as if everything is normal... You want to answer it but you can't...
  • @PatchworkRose567
    The silence is deafening. I can only imagine the horrible sense of dread and grief as you watch the person’s last signs of life quietly fade.
  • @RorzaEditz
    A football player yesterday night just witnessed a cardiac arrest. Prayers up for Damar Hamlin🙏🙏
  • @ian6729
    My friend asked "Who is Cardiac, why is he arrested"