Cardiorespiratory arrest . Known by the acronym PCR, it is a medical emergency that destroys the lives of a large number of patients. Although the incidence has been difficult to determine, since it is not always witnessed or constitutes a notifiable disease , it is considered that a high percentage of patients die, even in developed countries, due to this cause. In 1993, there were 400,000 cardiac arrests in the United States, of which only 305 were successfully resuscitated.
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- 1 Etiology
- 1 Cardiac causes
- 2 Extracardiac causes
- 2 Risk factors
- 3 Diagnosis
- 4 Treatment
- 5 premonitory signs
- 6 Recognition of respiratory arrest
- 7 Sources
- ) Hypoxemia.
- ) Coronary artery disease.
- ) Valvular heart disease.
- ) Hypertrophic cardiomyopathy.
- ) Dilated cardiomyopathy.
- ) Abnormalities of cardiac circulation.
- ) Metabolic (hyperkalemia, hypokalemia, hypomagnesemia, and acidosis).
- ) Pulmonary embolism.
- ) Occlusive or hemorrhagic brain vascular accidents.
- ) Others (electric shock, incomplete drowning and hypothermia).
- ) Cardiac conduction abnormalities (prolonged QT syndrome, preexcitation syndrome, and heart block).
- ) Drugs (intoxication, proarrhythmia).
There are numerous causes that can trigger a PCR and some authors classify them into 2 groups:
- Cardiac tamponade.
- Congenital heart defects.
- Torsion, pressure, or retraction of the heart.
- Myocardial infarction.
- Electrolytic disorders.
- Acid – basic disorders.
- Vagal or sympathetic reflex factors.
- Diaphragmatic hernia.
The major risk factors are of two types:
1.) Not modifiable:
- a) Inheritance.
- b) Sex: female.
- c) Age.
- a) Smoking.
- b) High blood pressure.
- c) Hypercholesterolemia.
- d) Physical inactivity.
The minor or contributing risk factors are as follows:
- . Diabetes mellitus (blood glucose can be controlled, but does not eliminate the risk).
- . Obesity
- . Stress.
The diagnosis of the PCR should not take more than 15 to 20 seconds at the most time to guarantee the possibilities of an effective resuscitation. Any patient with loss of consciousness, absence of pulsations of the femoral or carotid arteries and of respiratory movements should be considered in PCR.
Once the PCR has been confirmed, basic cardiopulmonary resuscitation should begin, the purpose of which is to achieve urgent oxygenation to the vital organs . These maneuvers are known as steps A, B, C, D, E, and F:
- A (Opening of the airway)
- B (Ventilation)
- C (Maintenance of circulation)
- D (Administration of drugs and liquids)
- E (Electrocardiographic diagnoses)
- F (defibrillation)
In some patients susceptible to cardiac arrest may be considered as warning signs:
- . Worsening of ventricular function.
- . Ventricular ectopia (dangerous extrasystoles and ventricular tachycardia).
- . Rapid drop in blood pressure or sustained low blood pressure.
- . Atrioventricular conduction disorders.
- . Extreme bradycardia.
Recognition of respiratory arrest
In the event of sudden loss of consciousness, it must be carried out in a few seconds using easily recognizable signs according to the following sequence:
- . Shake victim gently by the shoulders and ask, “Are you okay?”
- . Ask for help.
- . Recognize the absence of breathing by placing the ear close to the victim’s mouth and nose, while keeping the airways open.
- . Recognize the absence of a pulse. Locate the carotid pulse for 5-10 seconds (this is preferred in adults because it persists even when the others have disappeared). A reasonable variant may be to take the femoral pulse.
- . Give a stop alarm if help was not requested before.