Reverzibilni uzroci srčanog aresta

master's thesis

• Title (english): Reversible causes of cardiac arrest
• Author: Mateja Mirčić
• Mentor: Daniela Bandić Pavlović (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Srčani arest nastaje zbog nagloga prestanka mehaničke aktivnosti srca. Prestanak rada srčane crpke dovodi do sistemske hipoperfuzije koja u konačnici dovodi do smrtnog ishoda. Srčani arest očituje se naglim gubitkom svijesti, prestankom disanja ili prisutnošću agonalnoga disanja i prestankom cirkulacije. Prepoznavanje ovoga životno ugrožavajućeg stanja i brza reakcija od velike su važnosti jer vrijeme koje prolazi bez pravodobne reanimacije značajno umanjuje mogućnost preživljavanja bez neurološkoga deficita. Reanimacijski postupak ugroženih pacijenata podrazumijeva napredno održavanje života i ispravljanje reverzibilnih uzroka koji su doveli do aresta. Napredno održavanje života uključuje provjeru prohodnosti dišnoga puta, disanja i cirkulacije po ABC-mnemotehnici. Svaka ugroženost navedenih vitalnih funkcija zahtijeva hitno zbrinjavanje osiguravanjem dišnoga puta, ventilacijom i oksigenacijom te održavanjem cirkulacije vanjskom masažom srca. Napredno održavanje života podrazumijeva i dostupnost defibrilatora kojim možemo razlikovati osnovne ritmove srčanoga aresta. Dijelimo ih na ritmove koji reagiraju na defibrilaciju (ventrikularna fibrilacija i ventrikularna tahikardija bez pulsa) i ritmove koji ne reagiraju na defibrilaciju (električna aktivnost bez pulsa i asistolija). Tijekom zbrinjavanja pacijenata u arestu važno je pokušati odgonetnuti uzrok aresta jer kada se radi o reverzibilnim uzrocima, njihovo ispravljanje ujedno znači i rješavanje aresta i spašavanje života. Reverzibilni uzroci koje moramo znati i razmatrati tijekom reanimacije jesu 4H i 4T. To je mnemonička tehnika koja olakšava brže prisjećanje 4H uzroka (hipoksija, hipovolemija, hiperkalijemija i hipokalijemija i hipotermija). Četiri T uzroka koja moramo imati na umu su tromboza (plućna embolija i tromboza koronarne arterije), perikardijalna tamponada, tenzijski pneumotoraks i otrovanje toksinima.

Abstract (english)

Cardiac arrest is caused by a sudden stop of mechanical function of the heart. Cessation of cardiac function leads to decreased tissue perfusion that can cause fatal outcomes if not reversed. Cardiac arrest is clinically defined by unconsciousness, apnea or agonal breathing, and impalpable central pulse. Early recognition of an ongoing cardiac arrest is crucial since chances for neurologically intact survival decrease substantially as time passes without an appropriate intervention. Resuscitation efforts are directed toward advanced life support and correction of reversible causes of arrest. Advanced life support consists of several steps that are described by the ABC mnemonic. The letter A stands for checking the patency of the airway, B for checking appropriate breathing, and C for circulation. Vulnerability or immediate danger to any of these vital functions should be promptly dealt with, using available methods of airway management in order to provide appropriate ventilation and oxygenation. Tissue perfusion should be maintained by performing high quality chest compressions. Advanced life support also includes availability of a defibrillator, which can be used for rhythm assessment and early defibrillation if indicated. Depending on the recorded rhythm we differentiate between those rhythms that will respond to defibrillation attempts (ventricular fibrillation and pulseless ventricular tachycardia) and those that will not (pulseless electrical activity and asystole). During the cardiopulmonary resuscitation it is extremely important to mentally go through differential diagnoses of possibly reversible causes of arrest since their correction greatly increases reversal of cardiac arrest and survival. Those reversible causes are clinically referred to as 4H and 4T for easier recollection. The 4Hs include hypoxia, hypovolemia, hyperkalemia and hypokalemia, and hypothermia. The 4Ts include thrombosis (coronary thrombosis and pulmonary embolism), tamponade, tension pneumothorax, and toxins.

• Keywords: srčani arest; reverzibilni uzroci; kardiopulmonalna reanimacija
• Keywords (english): cardiac arrest; reversible causes; cardiopulmonary resuscitation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:815706
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-19 10:12:54