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Cardiac arrest - Coggle Diagram

- - - - Weil, 1992, Chest
      - Chandra, 1994, Circ
      - Berg, 1993, Circ
  - - - Cingolani, 1975, Surgery
      - Downing, 1965, AJP
      - Poole-Wilson, 1975, Lancet
      - Tang, 1991, Crit Care Med
      - Weisfeldt, 1975,
    - - Tang, 1992, Cri Care Med
      - Kerber, 1979, Circ
    - - Kerber, 1979, Circ
      - Tang, 1992, Cri Care Med
    - - hypoxemia, hypokalemia
        
        causes VF by shortening APD
        
        Burn, 1960, Pharmacol
      - Hypercarbia
        
        lowers VF threshold
        
        Dong, 1967, Surgery
  - - - Langhelle, 2000, Resus
  - - - Weisfeldt, 1975, Metabolism of Contraction
      - Gremels, 1926, J Physiol London
      - Jacobus, 1982, J Mol Cell Cardiol
      - Monroe, 1960, AJP
  - - - Duration of increased intrathoracic pressure is proportional to the ventilation rate
      - Pepe, 2003, J Trauma
      - Babbs, 2002, Resus
      - Dorph, 2003 Resus
      - Dorph, 2004 Resus
      - Kern, 2002, Circ
      - Sanders, 2002, Ann Emerg Med
      - Turner, 2002, Resus
      - Turner, 2002, Resus
    - - Yannopoulos, 2006, Crit Care Med
    - - 8-10 ventilations/min recommended when advanced airway is placed
      - 10-12 breaths/min recommended when ROSC occurs
    - - Decreased intrapulmonary shunting, pulmonary vascular collapse, and atelectasis without adverse hemodynamic effects
        
        Markstaller, 2002, Resus
    - - interferes with venous return and decreases blood flow
        
        Hodgkin, 1980, Crit Care Med
  - - - AHA 2005 guidelines
- - - - Chapman, 2006, Resus
    - - Stiell, Circ, 2007
    - - Kerber, 1984, Circ
  - - - Larsen, 1993, Ann Emerg Med
      - Valenzuala, 1997, Circ
  - - - Babbs, AHJ, 1980
      - Yabe, Circ Res, 1990
      - Jones, AJP, 1978
    - - Steill, Circ, 2007
    - - Xie, 1997, Circ
  - - - biphasic waveforms safer compared to monophasic waveforms
      - impedance compensation
        
        adjusts energy to account for higher patient impedances
        
        Kerber, 1985, Circ
        
        improved defibrillation efficacy with impedance compensation
        
        Kerber, 1985, Circ
      - Impedance compensated BTE waveforms superior to monophasic truncated exponential and monophasic damped sine waveforms in defib efficacy and speed and ROSC
        
        Martens, 2001, Resus
    - - the resistance of the thorax to the flow of current; can be used to check if defib electrodes are corrected attached to patient's thorax
        
        Heyer, 2022
      - Lower transthoracic current flow can help prevent myocardial damage, necorsis, and skin burns
        
        Sado, 2005, J R Soc Med
    - - Lerman, 1990, Circ Res
  - - - At high energies, no difference in defib efficacy after 15 sec compared with 5 sec
        
        Winkle, 1990, Circ
      - Time before defibrillating shock is not a determining factor in successful defib
        
        Gascho, 1979, Cric
        
        Greg Walcott's unpublished abstract on defib threshold
      - Timing is an important factor in defib
        
        Success of defib inversely proportional to duration of VF
        
        canine model
        
        Yakaitis, Crit Care Med, 1980
        
        Duration of VF before shock, acidosis, hypoxia were significant factors in determining defib success
        
        Clinical
        
        Kerber and Sarnat, Circ, 1979
      - Monophasic
        
        A delay in defib therapy up to 90 sec has no significant effect on defibrillation efficacy
        
        Fujimura, 1989, Pacing Clin Electrophysiol
        
        a delay >40 sec is associated with a higher incidence of complete heart block and ventricular arrhythmias
        
        Fujimura, 1989, PACE
        
        DFT increases with increasing fibrillation time. DFT was 50% greater after 5 min compared to 15 seconds after fibrillation
        
        Walcott, 1998, Circ
    - - Improved survival in in-hospital witnessed VT/VF patients
        
        Spearpoint, Resus, 2000
      - Rapid defibrillation (<10 min) improves long-term survival rates
        
        Bunch, 2003, NEJM
    - - At all durations of VF, the biphasic threshold was lower than the monophasic defib threshold. The difference increased with fibrillation duration
        
        Walcott, 1998, Circ
- - - - Halperin, Circ, 1986
      - Babbs, Ann Emerg Med, 1983
    - - Babbs, Ann Emerg Med, 1983
    - - Michael, Circ, 1984
  - - - Chandra, Circ, 1994
    - - Berg, 2001
    - - Berg, 2011
- - - - ECG morphology reflects the degree of pathophysiologic derangement or time from onset of cardiac arrest
        
        Aufderheide, 1989, Resuscitation
        
        Stueven et al., 1989, Resuscitation
        
        Paradis et al, 1992, Chest
    - - mechanical (tension pneumothorax, cardiac tamponade, auto-PEEP)
      - Preload reduction (hypovolemia, sepsis, pulmonary embolism)
      - primary myocardial dysfunction (acute MI, congestive HF, drug ingestions, hyperkalemia, hypothermia)
      - Postdefibrillation PEA (following countershock from VF)
    - - Woda, 1999, Crit Care Med
    - - Patients tend to be younger, have shorter time from onset of cardiac arrest, and a higher frequency of witnessed arrests
        
        Bedell, NEJM, 1983
        
        Arcasoy, Chest, 1999
      - higher measured coronary perfusion-pressure than true PEA patients
      - Pseudo-PEA patients have a less deranged pathophysiologic state and are likely to have better results from resuscitation
        
        return of ROSC with standard doses of epinephrine more likely
        
        Herlitz, Heart, 2003
      - Psuedo PEA patients have significantly shorter QR intervals/QRS complexes
      - Results from a primary condition that profoundly decreases preload or afterload or causes severe inflow or outflow obstruction
        
        Hypovolemia
        
        pulmonary embolsim
        
        acute MI
        
        decreased LV contraction due to CHF