Snapshot A 72-year-old man is brought into the emergencydepartment in cardiac arrest. He lost consciousness and stopped breathing suddenly. His EKG shows electrical activity but the EMT was unable to feel a pulse. Introduction Cardiac arrest with electrical activity that should be producing a pulse but does not heart either does not contract or cannot sustain adequate cardiac output Causes include cardiac massive MI cardiac tamponade hypovolemia (trauma) thrombosis respiratory tension pneumothorax massive PE hypoxia hypothermia thrombosis metabolic hyperkalemia or hypokalemia acidosis hypoglycemia other drug overdose memory aid H's and T's H's hypovolemia heart attack hypokalemia hyperkalemia hypo/hyperthermia hypoxia H+ (acidosis) T's tamponade tension pneumothorax toxic (TCA, CCB, beta-blocker) thromboembolism (PE) Presentation Symptoms sudden LOC and respiratory arrest Physical exam absent pulses Evaluation EKG required for diagnosis shows electrical activity different than VT or VF activity should produce pulse, but does not Differential Must distinguish between ventricular tachycardia, ventricular fibrillation Treatment Initiate ACLS CAB of cardiac arrest (Circulation, Airway, Breathing) immediate initiation of chest compressions epinephrine 1mg every 3-5 minutes do not cardiovert Treat the underlying condition Prognosis, Prevention, and Complications If systemic perfusion is not restored, will inevitably lead to death