Makindo Medical Notes

⚡ Cardiorespiratory arrest is the sudden cessation of both ventilation and circulation. It is a medical emergency where immediate recognition and resuscitation can be life-saving.

📖 Definition

• 🫁 Respiratory arrest = absence of breathing.
• ❤️ Cardiac arrest = absence of effective circulation (no central pulse).
• When both occur together → cardiorespiratory arrest.

🔎 Recognition

• Patient is unresponsive 😴.
• Absent or abnormal breathing (agonal gasps) 🫁.
• No central pulse (carotid, femoral) ❤️.
• Monitors may show asystole, pulseless VT/VF, or PEA on ECG 📟.

⚠️ Common Causes (The “Hs and Ts”)

• 💧 Hypovolaemia
• 🫁 Hypoxia
• 🌡️ Hypo-/hyperkalaemia, metabolic disorders
• ❄️ Hypothermia
• 💉 Thrombosis (coronary or pulmonary embolism)
• 💔 Tamponade (cardiac)
• ⚡ Tension pneumothorax
• 🧪 Toxins (overdose, poisoning)

🛠️ Immediate Management (Per UK Resus Council)

• 📢 Shout for help, call 2222 (hospital) or 999 (community).
• 🔄 Start CPR — 30 compressions : 2 breaths, rate 100–120/min, depth 5–6 cm.
• ⚡ Defibrillate if shockable rhythm (VF/pulseless VT).
• 💉 IV/IO access, give adrenaline 1 mg every 3–5 min (non-shockable and after 2nd shock for shockable rhythms).
• 💊 Amiodarone for refractory VF/VT (300 mg IV after 3rd shock).
• 🧪 Treat reversible causes (Hs & Ts).

🌬️ Airway & Breathing

• Provide high-flow oxygen.
• Basic airway manoeuvres: head tilt, chin lift, airway adjuncts.
• Advanced airway (e.g. supraglottic device, intubation) if trained.

❤️ Circulation

• Quality chest compressions are critical: minimise interruptions, allow full recoil.
• Monitor ETCO₂ if available — useful to assess CPR quality and ROSC (return of spontaneous circulation).

📊 Rhythms in Cardiac Arrest

Rhythm	Shockable?	Management
Ventricular fibrillation (VF)	✅ Yes	CPR + defibrillation, adrenaline after 2nd shock, amiodarone after 3rd shock
Pulseless VT	✅ Yes	Same as VF pathway
Asystole	❌ No	CPR + adrenaline ASAP, treat reversible causes
PEA (Pulseless electrical activity)	❌ No	CPR + adrenaline, search for reversible causes (Hs & Ts)

🏥 Post-Resuscitation Care

• Stabilise airway, breathing, and circulation.
• Maintain oxygenation and normocapnia.
• Monitor for arrhythmias and treat underlying cause.
• Targeted temperature management (TTM) in selected patients ❄️.
• Urgent coronary reperfusion if cardiac cause suspected.

🧠 Key Teaching Points

• Rapid recognition and high-quality CPR are the most important factors in survival.
• Shockable vs non-shockable rhythm distinction is crucial for management.
• Always consider reversible causes (Hs & Ts).
• Post-arrest care is part of the chain of survival — it affects long-term outcome.