Thromboembolism and Amniotic Fluid Embolism
Afshan B. Hameed, Diana S. Wolfe in Cardio-Obstetrics, 2020
The harbinger of treatment of cardiovascular collapse relies on urgent, immediate delivery in the setting of current pregnancy and high-quality cardiopulmonary resuscitation per ACLS guidelines [35]. When return of spontaneous circulation (ROSC) is achieved, the cardiovascular system must be maintained. Resuscitative efforts are multidisciplinary and employ maternal-fetal medicine, intensive care, cardiac surgery, and pulmonary medicine. In the setting of acute right-sided failure, inotropic support with milrinone and dobutamine may be of great use. Both agents aid in right-sided cardiac contractility, and also milrinone has pulmonary artery vasodilatory effects which allows further optimization of preload in biventricular failure resulting in an increased cardiac output [37,38]. However, care must be taken with these medications because they can be arrhythmogenic and cause systemic hypotension, which is undesirable with the combined distributive shock of an AFE.
Recognition and management of cardiopulmonary arrest
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
Following a successful resuscitation as determined by a return of spontaneous circulation (ROSC) the patient will need to be transferred to an intensive care unit or high-dependency facility for close monitoring and further management. This process usually takes some time and while awaiting transfer the patient should be monitored and managed using the ABCDE approach. The aim of this is to optimise oxygenation and tissue perfusion whilst observing for, identifying and treating any complications such as hypoglycaemia or convulsions. During this time a member of the medical team will usually remain with the patient.
Recognition and management of cardiopulmonary arrest
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Following a successful resuscitation, as determined by a return of spontaneous circulation (ROSC), the patient will need to be transferred to an intensive care unit or high-dependency facility for close monitoring and further management. This process usually takes some time and, while awaiting transfer, the patient should be monitored and managed, using the ABCDE approach. The aim of this is to optimise oxygenation and tissue perfusion while looking for, identifying and treating any complications, such as hypoglycaemia or convulsions. During this time, a member of the medical team will usually remain with the patient.
Death associated with intravenous turmeric (Curcumin) preparation
Published in Clinical Toxicology, 2018
Daniel R. Lasoff, Frank Lee Cantrell, Binh T. Ly
A 31-year-old female with a history of food allergies to soy protein, gluten, and lactose presented to a naturopathic practitioner for treatment of eczema with intravenous turmeric infusion. Minutes after the onset of the infusion, the patient became unresponsive and was found to be in cardiac arrest. Cardiopulmonary resuscitation was initiated, an intramuscular dose of epinephrine was administered on scene, and the patient was transferred to a local emergency department by ambulance. Return of spontaneous circulation (ROSC) was achieved in the emergency department, and the patient was admitted to the intensive care unit. Initial vital signs after ROSC were as follows: temperature of 35.8 °C, pulse 130 beats per minute, blood pressure of 110/70 mmHg, respiratory rate 12 breaths per minute, on a ventilator, and pulse oximetry 100% on 60% oxygen. On initial examination, the patient was noted to have dilated pupils, myoclonus, and decerebrate posturing. The patient was therapeutically cooled for 36 h.
Comparison of Out-of-Hospital Cardiac Arrests Occurring in Schools and Other Public Locations: A 12-Year Retrospective Study
Published in Prehospital Emergency Care, 2022
Brian Haskins, Ziad Nehme, Jocasta Ball, Emily Mahony, Laura Parker-Stebbing, Peter Cameron, Steve Bernard, Karen Smith
This study uses the recommended definitions as per the Utstein guidelines (34). Public locations are locations to which the general public has access, including workplaces, airports, public buildings, shopping areas etc. they do not include medical clinics or nursing homes. Cardiac arrest etiology is determined from information in the patient care record and is presumed to be of cardiac origin when no other etiology or obvious cause is recorded. EMS treated patients are classified as those receiving any attempt at cardiopulmonary resuscitation (CPR) and/or defibrillation by EMS personnel and those that receive a shock from a PAD not achieving a return of spontaneous circulation (ROSC). Bystander CPR is any attempt at chest compression by non-dispatched responders, with or without ventilations. Bystander application of an AED is the placement of AED pads without defibrillation. PAD is the delivery of a shock using a public accessible AED. ROSC is the return of a palpable pulse during the resuscitation attempt, event survival is the presence of a pulse on arrival at the hospital and survival to hospital discharge is the patients discharge from acute hospital care.
Paramedic-Performed Carotid Artery Ultrasound Heralds Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Case Report
Published in Prehospital Emergency Care, 2023
Amanda L. Humphries, Jenna M. B. White, R. Elliott Guinn, Darren A. Braude
Current literature supports aggressive treatment for pseudo-PEA, with the presence of cardiac activity on ultrasound demonstrating a 91.5% specificity for ROSC and increased odds for overall survival in a recent meta-analysis (14). Continuing external chest compressions however may result in additional cardiac structural damage or work counter to native function, and may potentially overload a fragile heart. If it were known that a patient in cardiac arrest in fact had blood flow to the brain, this could help stratify patients with pseudo-PEA along a spectrum of survivability. One common approach to this in the in-hospital setting is placement of an arterial line to assess mean arterial pressure (MAP). Another less common approach is assessing for carotid artery flow with POCUS. While POCUS-detected flow through the carotid artery has not been definitely correlated to brain perfusion, several studies have demonstrated a relationship between qualitative detection of two-dimensional flow through this vessel with measurable MAP (15–19). It is possible that the identification of blood flow through the carotid arteries may precede detection of palpable pulses or suggest that true return of spontaneous circulation (ROSC) may be imminent.
Related Knowledge Centers
- Asystole
- Cardiac Arrest
- Cardiopulmonary Resuscitation
- Coronary Perfusion Pressure
- Defibrillation
- Ventricular Fibrillation
- Ventricular Tachycardia
- Pulseless Electrical Activity
- Cardiac Conduction System
- Post-Cardiac Arrest Syndrome