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Anesthetic Outcome and Cardiopulmonary Resuscitation
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Cardiac arrest in the anesthetized horse is responsible for approximately 30% of mortalities. Factors that may predispose to arrest are an excessively deep anesthetic plane leading to cardiovascular collapse and hypotension. Signs of impending arrest include: Loss of palpebral and corneal reflexes, pupillary dilation.Loss of anal pinch reflex.Hypoventilation, < 4 breaths/min to apnea.Tachypnea > 20 breaths/min.Dyspnea or abnormal breathing pattern and agonal gasps.Cyanosis, injected or gray to white mucous membranes, prolonged CRT of > 2.5 seconds.Weak or irregular peripheral pulses, hypotension, MAP < 70 mmHg.Rapid > 60 beats/min or slow < 25 beats/min heart rate, muffled or absent heart sounds.Abnormal ECG, asystole.
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The most probable reasons are noted below. Classic reason is a high spinal block – sensory block higher than T4 due to the blocking of the sympathetic cardio accelerator fibres to the heart (T1–T4). This can cause severe bradycardia which if not treated can lead to asystole.Reflex bradycardia due to the use of vasopressors (phenylephrine) to maintain the feto-placental circulationReflex cardiovascular depression due to decrease in venous return, known as Bezold–Jarisch reflex or neurocardiogenic syncopeSevere reflex bradycardia has been supported in case studies during the time of placental expulsion and tractionManipulation of the abdominal viscera, peritoneum or traction of the visceral ligaments, uterine exteriorisation and inversionPatient with pre-existing cardiac disease such as sick-sinus syndrome can also have bradycardia
Syncope
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Douglas L. Wood, Bernard J. Gersh
In some patients, pharmacologic therapy will not prevent profound asystole. In these circumstances, artificial pacing may be required to limit the contribution of asystole to the symptoms of syncope or presyncope. The rationale is that elimination of the tachycardia will blunt the degree of hypotension, which is a function of both bradycardia and, to a larger extent, sympathetic withdrawal. Generally, the use of a single-chamber pacemaker is ineffective for a variety of reasons, and these patients are generally best served by having a dual-chamber pacing system implanted when permanent pacing is necessary.
Tests for the identification of reflex syncope mechanism
Published in Expert Review of Medical Devices, 2023
Michele Brignole, Giulia Rivasi, Artur Fedorowski, Marcus Ståhlberg, Antonella Groppelli, Andrea Ungar
It has been demonstrated that hypotensive phase during tilt-induced reflex syncope begins approximately 8–9 minutes before the loss of consciousness, while the CI phase begins 1-min prior to syncope [13]. In the real-life scenario, the introductory hypotensive phase may not be fully sensed by the patient who is thus not aware of the imminent syncope. As CI component acts very fast, for most of the affected individuals the sensing of cardioinhibition and imminent syncope may not be sufficient to take countermeasures. In an interesting study of Saal et al., approximately one-third of patients who demonstrated asystole during TT, lost their consciousness prior to the onset of asystole due to profound hypotension [14]. This finding might question the role of pacemaker therapy in such setting [15]. In the context of CI reflex, it is important to mention the role of age. As demonstrated by several independent studies, while vagal cardiac overactivity and sinus depression dominate in younger patients, vasodepression is more prevalent in older age, beginning with the age of 50 years [16,17].
When is a wearable defibrillator indicated?
Published in Expert Review of Medical Devices, 2021
Alexandre Bodin, Arnaud Bisson, Laurent Fauchier
Registries and retrospective studies with numerous patients in different countries showed the safety and effectiveness of the WCD, with a good tolerance to the device with high daily use duration (Table 1) [6,8,10–16]. Appropriate therapy for VT or VF events was between 1.3 and 4% across the different main studies described in Table 1 when inappropriate therapy was observed in 0.5 to 1.2% of patients. The survival rate within the 24 hours after an appropriate therapy was between 84 and 93%. Interestingly, asystole is reported in some studies in 0.03 to 0.6% of patients. Long-term follow-up in the PROLONG-II study showed that mean estimated survival after the WCD was similar between patients with and without WCD shocks. This emphasizes the transitory risk of SCD and the usefulness of WCD.
A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock
Published in Prehospital Emergency Care, 2021
Katherine Staats, Adriana H. Tremoulet, Helen Harvey, Jane C. Burns, J. Joelle Donofrio-Odmann
The patient received high quality chest compressions with minimal interruptions and had end tidal CO2 (ETCO2) readings greater than 15 mmHg during compressions with good chest rise with BVM. Unfortunately, the patient progressed from bradycardia, to pulseless electrical activity, to asystole within two minutes of CPR initiation. No shockable rhythm was appreciated. Vascular access was difficult throughout resuscitation with bilateral tibial and distal femoral IOs infiltrating, and a humeral IO successfully placed followed by a femoral central line. During the resuscitation the patient was intubated and received a total of six timed epinephrine doses followed by an epinephrine drip of 1-2 mcg/kg/min, a 20 ml/kg bolus of saline, two doses of sodium bicarbonate, and two doses of calcium. The patient received a total of 35 minutes of CPR without return of spontaneous circulation. Her family and social worker remained at the bedside for the resuscitation, and the KD team arrived to the bedside after the arrest. Both intensivists were present for the resuscitation and a discussion of ECMO (extracorporeal membrane oxygenation) cannulation took place but it was determined that the patient was not a viable candidate. Ultimately, revival attempts were unsuccessful. Myocarditis secondary to hand-foot-mouth-disease, coronary thrombus, or intracranial hemorrhage were the leading differentials considered by the physicians who cared for the patient in the Emergency Department.