Office and operating room management of cardiac arrest

Management of cardiac arrest depends on a four-minute period of potential reversibility. Success depends on immediate diagnosis, documentation of the onset of cardiac arrest, and establishment of treatment priorities. Pupillary dilation, complete in two minutes, serves to verify the onset and duration of cardiac arrest. Treatment involves two phases--the emergency phase of oxygenation and perfusion and the definitive phase of restoring the spontaneous effective heartbeat. The two mechanisms of cardiac arrest, ventricular fibrillation and asystole, are characterized, and the conditions necessary for each to occur are listed. The treatment of ventricular fibrillation is defibrillation, whereas ventricular asystole responds to cardiac stimuli--a precordial blow, epinephrine, or calcium. The mnemonic "SALT CAN ADD GOOD TIME" is suggested as a guide for drug dosage, and a treatment flowchart is outlined.