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SOURCE

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Source: Barletta JF. Cardiac arrest. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146055661. Accessed May 22, 2017.

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CONDITION/DISORDER SYNONYMS

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  • Cardiopulmonary arrest.

  • Circulatory arrest.

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DEFINITION

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  • Cessation of cardiac mechanical activity as confirmed by absence of signs of circulation (eg, undetectable pulse, unresponsiveness, apnea).

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ETIOLOGY

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  • Coronary artery disease.

  • Cardiomyopathies (eg, hypertrophic or dilated cardiomyopathy)

  • Structurally abnormal congenital cardiac conditions.

  • Structurally normal but electrically abnormal heart conditions.

  • In pediatric patients, cardiac arrest may follow respiratory failure or progressive shock.

  • Out-of-hospital arrests often associated with trauma, sudden infant death syndrome, drowning, poisoning, choking, severe asthma, and pneumonia.

  • In-hospital arrests associated with sepsis, respiratory failure, drug toxicity, metabolic disorders, and arrhythmias.

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PATHOPHYSIOLOGY

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  • Primary cardiac arrest: Arterial blood fully oxygenated at time of arrest.

  • Secondary cardiac arrest: Results from respiratory failure, leading to hypoxemia, hypotension, and cardiac arrest.

  • Usually results from arrhythmias in adults (eg, ventricular fibrillation [VF], pulseless ventricular tachycardia [PVT]).

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EPIDEMIOLOGY

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  • An estimated 320,000 or more people in the United States who experience emergency medical services (EMS)-assessed out-of-hospital cardiac arrest.

  • Survival to hospital discharge following out-of-hospital cardiac arrest is only 10.6% and survival with good neurologic function is only 8.3%.

  • In-hospital cardiac arrests occur in roughly 200,000 patients in the United States annually and this rate may be increasing.

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PREVENTION AND SCREENING

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  • Because primary cause is coronary artery disease, preventive measures include healthy diet, appropriate exercise, smoking cessation, blood pressure control, and management of dyslipidemia.

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RISK FACTORS

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  • Family history of coronary artery disease.

  • Personal history of myocardial infarction (MI) or previous cardiac arrest.

  • Smoking.

  • Hypertension.

  • Dyslipidemia.

  • Obesity.

  • Diabetes.

  • Sedentary lifestyle.

  • Increasing age.

  • Male sex.

  • Use of certain illegal drugs (cocaine, amphetamines)

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Preceeding an arrest:

    • Anxiety.

    • Crushing chest pain.

    • Diaphoresis.

    • Nausea or vomiting.

  • Following an arrest.

    • Hypotension.

    • Unresponsive.

    • Apnea.

    • Hypotension with no detectable pulse.

    • Cold and clammy extremities.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • Observation of clinical findings consistent with cardiac arrest.

  • Confirmation by evaluating vital signs, especially heart rate and respirations.

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DIAGNOSTIC PROCEDURES
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  • Electrocardiography (ECG) to determine cardiac rhythm.

    • VF: Electrical anarchy of ventricle resulting in no cardiac output and cardiovascular collapse.

    • Pulseless electrical activity (PEA): Absence of detectable pulse and presence of electrical activity other than VF or PVT.

    • Asystole: Flat line on ECG monitor.

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DIFFERENTIAL DIAGNOSIS
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  • Acute coronary syndrome.

  • Trauma.

  • Hypovolemia.

  • Hypoxia.

  • Metabolic acidosis

  • Tension pneumothorax.

  • Cardiac tamponade.

  • Electrolyte abnormality.

  • Drug overdose.

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