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.

🧑‍⚕️ Case Examples — Cardiorespiratory Arrest

• Case 1: 👩‍⚕️ A 72-year-old woman with a history of ischaemic heart disease collapses at home. On arrival she is pulseless, with initial rhythm showing ventricular fibrillation. Diagnosis: Cardiac arrest due to ventricular fibrillation (VF). Immediate CPR is commenced, and she is defibrillated twice before return of spontaneous circulation (ROSC). She is transferred to CCU for post-arrest care and consideration of PCI.
• Case 2: 👨 A 55-year-old man with poorly controlled asthma suddenly becomes unresponsive in the emergency department. Monitoring shows pulseless electrical activity (PEA). Diagnosis: Cardiorespiratory arrest secondary to severe asthma with dynamic hyperinflation. Advanced life support is commenced, reversible causes identified, and adrenaline administered. After prolonged resuscitation with airway support and IV magnesium, he regains circulation and is admitted to ICU.
• Case 3: 🧓 An 80-year-old nursing home resident with advanced COPD and heart failure is found unresponsive and not breathing. On arrival, she is asystolic despite immediate CPR. Diagnosis: Cardiorespiratory arrest presenting with asystole in end-stage respiratory disease. After 30 minutes of unsuccessful ALS, resuscitation is stopped. The decision is communicated sensitively to the family, with a debrief for the care team.
• Case 4: 🏃 A 35-year-old marathon runner collapses suddenly at the finish line. Bystanders initiate CPR, and the ambulance crew records ventricular tachycardia without a pulse. Diagnosis: Sudden cardiac arrest from ventricular tachycardia, likely due to hypertrophic cardiomyopathy. Early defibrillation restores a perfusing rhythm, and he is stabilised before undergoing cardiology work-up and ICD insertion.
• Case 5: 🧑‍🔧 A 42-year-old construction worker collapses after an electric shock. On arrival he is pulseless with ventricular fibrillation. Diagnosis: Cardiac arrest triggered by electrocution-induced VF. Immediate CPR and defibrillation are performed, followed by IV amiodarone. He regains ROSC and is admitted for burns management and cardiac monitoring.
• Case 6: 👩‍🍼 A 29-year-old woman, two weeks postpartum, suddenly develops chest pain and collapses. Rhythm strip shows pulseless electrical activity. Diagnosis: Cardiorespiratory arrest due to massive pulmonary embolism. She receives CPR, IV adrenaline, and emergency thrombolysis. ROSC is achieved, and she is transferred to ICU for ongoing care.
• Case 7: 🚑 A 68-year-old man undergoing dialysis suddenly becomes unresponsive. ECG shows asystole, and blood tests reveal severe hyperkalaemia (K+ 7.8 mmol/L). Diagnosis: Cardiac arrest due to hyperkalaemia-induced asystole. Resuscitation includes CPR, IV calcium chloride, insulin with glucose, and dialysis. After treatment he regains circulation and is stabilised.
• Case 8: 🏊 A 16-year-old boy is pulled from a swimming pool after being submerged for several minutes. He is pulseless and apnoeic on arrival. Diagnosis: Cardiorespiratory arrest secondary to drowning and hypoxia. Immediate CPR with rescue breaths is performed, oxygen therapy given, and ROSC achieved after 10 minutes. He is admitted to PICU for neuroprotective post-arrest care.