Life-threatening arrhythmias in ICU (Maggiorini)
Narrow vs wide classification is a good framework to build on
Revisit the pathophysiology!
Always start with the patient – have a system for evaluating and assessing the patient AND ECG
Most anti-arrhythmic drugs have pro-arrhythmic effect
ICDs saves more lives than amiodarone in stable patients with heart failure
Cardiac arrest: Management and post-resuscitation care (Sunde)
Death is a protracted pathophysiological process, not a moment – P Safer
Post cardiac arrest syndrome – underlying cause AMI/CHD; ischaemic/reperfusion syndrome – primary (arrest and during CPR) and secondary ischaemic damage; SIRS
Post resuscitation care – optimising physiology;
- BP (brain) – vasopressor, fluids, inotropes
- myocardial dysfunction
- blood glucose – < 10mM
- anticonvulsants – detect and treat early
Active optimal and standardised treatment
- Coronory angiography/PCI – even PEA/asystole , a significant proportion will have lesions amenable to PCI
- Temperature – avoid fever but probably not a one size fits all
- Haemodynamics – the optimal MAP and vasopressor requirements are affected by temperature management; bradycardia associated with better outcomes
- Prognostication – multimodal approach required
Ethical dilemmas: Communication and decision making during CPR (Csomos)
Perimortem caesarean delivery – consider within 5 minutes!
If family are present during arrest resuscitation, have a dedicated member of staff look after them.
Have a structured communication plan – SBAR or RSVP
Skill and experience should take over seniority