EmergenciesTomas Hitka

II.KAIM LFUK OUSA

Treatable causes of cardiac arrest

Definition

Air in the pleural space

Etiology

• Spontaneous• Primary- idiopathic- young male

• Secondary- underlying lung disease• Obstructive

• Destructive and cavitatory

• Traumatic• Chest wall

• Lung tissue

Classification

• Simple• Open

• Closed

• Tension

Patophysiology

Clinical picture

• Symptoms: • dyspnea, pleuritic chest pain

• Signs: • reduced chest wall movements,

reduced breath sounds, hyper-resonance to percussion

• Subcutaneous emphysema

• Shift of trachea to the contralateral side

• Hypoxia, cyanosis

• Tachycardia, hypotension, distended jugular veins

Investigations

• CXR- should not be requested if tension PNO suspected

USG

USG

Management

Definition

• Compression of the heart by fluid within the pericardium

Size does not matter

Etiology

• Trauma

• Iatrogenic- following heart catheterization and cardiothoracic surgery

• Infectious pericarditis

• Cancer

• Uremia

• Systemic autoimmune diseases (SLE, RA)

• Idiopathic

Patophysiology

Clinical picture

• Symptoms:• Anxiety, restlessness, dizziness, and loss of consciousness.

• Weakness

• Chest pain radiating to your neck, shoulders, or back.

• Dyspnoe, tachypnoe

• Discomfort relieved by sitting or leaning forward.

Clinical picture

• Signs:• Beck’s triad: hypotension, JVD, muffled heart sounds

• Tachycardia

• Pulsus paradoxus

• Oliguria, cold extremities, lactic acidosis

Pulsus paradoxus

• Drop in SBP during inspiration greater than 10mmHg

Investigations

• ECG- tachycardia

low voltage QRS

electrical alternans

Investigations

• CXR- water bottle sign

ECHO

ECHO

Management

Hypothermia

• a core temperature ≤ 35

• when body’s heat loss exceeds its heat generation

• Causes:• exposure to cold weather

• immersion in cold water

Management

• Mild: passive rewarming• Prevent heat loss- shelter, dry clothes• Energy supply- sweet drinks to provide energy for shivering and exercise• Active movement

• Moderate: active external rewarming• Prevent heat loss• Rewarming- direct heat to torso (heat packs, water bottles, warming blanket),

ambient T, warm i.v. fluids• Minimal movement

• Severe: active internal rewarming• GI lavage, body cavity lavage, cardio-pulmonary bypass• CPR until warm

Hyperkalaemia

K+ > 5 mmol/l

Etiology

• Increased intake: • blood transfusion

• Redistribution: (AIDST)• Acidosis• Insuline insufficiency (DM)• Drugs: digoxin, B-blockers, SCHJ• Trauma, rhabdomyolysis

• Decreased output:• Renal failure• Adrenocortical insufficiency (low aldosterone)• Drugs: potassium sparing diuretics, ACEi

• False positive:• Hemolysis, leukocytosis, trombocytosis

Clinical picture

• Symptoms: • tiredness or weakness

• nausea or vomiting

• trouble breathing

• chest pain

• palpitations

Clinical picture

• Signs:

Management

CASE