Heart failure

Heart failureCLINICAL SIGNS:

* the patient is in a state of apparent death :

– loss of consciousness, brutal and complete.

– the patient does not breathe or gasp.

– absence of carotid or femoral pulse, absence of heart sound at the auscultation.


* syncope.

* profound hypothermia.


* heart causes:

– hypertrophic heart disease.

– ventricular fibrillation (70%) or inefficient ventricular tachycardia primitive.

– Primitive BAV.

– arrhythmogenic dysplasia of the right ventricle.

– long QT syndrome.

– tamponade, IDM or coronary insufficiency, pulmonary embolism, heart failure.

* respiratory causes:

– foreign body, obstructive laryngeal edema.

– respiratory depression due to drug poisoning or neurological involvement.

– suffocating pneumothorax, OAP, severe acute asthma.

* accidental causes:

– CO intoxication, intoxication by fire fumes, electrocution, drowning, hypothermia.

– hypovolemia.

Hypo or hyperkalemia.


* scope, ECG:

– asystole, idioventricular rhythms.

– FV, TV.

– apparently sinus rhythm in the case of electromechanical dissociation.

– extreme bradycardia.


* alert and record the time of start of resuscitation.

* make an electric shock immediately if possible because the first cause is ventricular fibrillation.

* setting in common condition:

– place the patient in a supine position on a hard plane.

– give a vigorous punch on the middle of the sternum.

– remove the dentures and possibly unclog the oropharynx, unclip tie, shirt and belt, and put the head hyperextension.

– place a cannula of Guedel.

 mouth-to-mouth ventilation , or mask with pure oxygen at 12-20 breaths / min (if the air does not pass a Heimlich maneuver).

– cardiac massage at 80 or 100 compressions per minute. (One can use the Ambu Cardiopompe).

 alternate ventilation and massage:

 if you are alone: ​​2 breaths for 15 compressions.

 if there are two rescuers: 1 insufflation for 5 compressions.

    – put a venous route:

 the best is the subclavian which ensures the highest serum peaks.

 the fastest: the peripheral way (external jugular vein).

 infuse saline isotonic saline.

    – if the venous route is impossible, use the endotracheal route but using higher dosages for the drugs (Adrenaline, Xylocaine, Atropine):

 5 mg of Adrenaline diluted in 10 ml of water.

 inject this preparation using a tracheal suction probe as deeply as possible then insufflation of 2 to 3 large volumes.

* specific treatments, while continuing the basic gestures of survival:

– if ventricular fibrillation (VF) or ventricular tachycardia (VT) poorly supported:

 external electric shock immediately :

 with a manual defibrillator: start with 200 joules (J) (3 J / kg in the child), then if failure, make a new shock at: 200 J, then if failure at 360 J.

 with a semi-automatic defibrillator.

 then intubation and poses venous route.

 if failure, Adrenaline: 1 to 3 mg IV / 3 min.

 if failure, new defibrillations up to 3 shocks of 360 J.

 then, if failure: Xylocaine, 1 mg / kg IV.

 if failure, new series of 3 electric shocks of 360 J.

 if failure, bicarbonates: 1 mmol / kg IV every 10 minutes.

 if failure, return to adrenaline IV.

 if successful, take preventive measures: Xylocard 1-3 mg / min or Cordarone 600 mg / day with an electric syringe.

– if asystole:

 Adrenaline : 1-3 mg IV to be renewed every 3 minutes.

 Bicarbonates molar after 15 minutes on a route other than adrenaline at the initial dosage of 1 mEq / kg or 1 ml / kg IV and ½ mEq / kg / 15 min.

– if significant bradycardia:

 Adrenaline: 1 to 3 mg IV to be renewed every 3 minutes.

 if failure, Atropine: 1 mg IV / 3 min (maximum total dose: 0.05 mg / kg).

 if failure: electrosystolic drive.

– if torsade de pointe:

 Magnesium sulphate: 1.5-3 g IV slow in 2 minutes then 6-12 g / 24 h in the electric syringe.

– if electromechanical dissociation or idioventricular ryhtms:

 Adrenaline: 1-3 mg IV to renew eventually.

 Bicarbonates-molar 8.4%: 100-200 ml in 10 minutes, after 15 minutes, every 10 minutes.

 etiological treatment.

* monitor the disappearance of the mydriasis, the recoloration, the return of the pulse every 2 minutes.

* avoid the injection of Calcium, barbiturates, Glucose more harmful than beneficial.

* Official duration of resuscitation without effectiveness: 20 minutes unless drowned, hypothermic, child where resuscitation is continued longer.

* hospitalization as soon as possible if recovery.