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32 Cards in this Set

  • Front
  • Back
CPR quality
-push hard (>=2 inches) and fast (>=100/min)
-Minimize interruptions to compressions
-Avoid excessive vent
-Rotate compressor q 2minutes
-If no advanced airway, 30:2 c-v ratio
-Quant. waveform capnography
-PETCO2<10, improve CPR quality
-Intra-arterial pressure
-If relaxation phase (diastolic) pressure <20mmHg, improve CPR quality
Return of Spontaneous Circulation (ROSC)
-Pulse and Pressure
-Abrupt sustained incr in PETCO@ (typically >=40mmHg)
-Spont arterial waves with intra-art. monitoring
Shock Energy
Biphasic: (initial 120-200J)
consider higher doses

Monophasic: 360J
Drug Therapy: Epinephrine
IV/IO Dose:
-1mg q 3-5 minutes
Drug Therapy: Vasopressin
IV/IO Dose:
-40 Units can replace first or second dose of epinephrine
Drug Therapy: Amiodarone
IV/IO Dose:
-First Dose: 300mg bolus
-Second Dose: 150mg
Advanced airway
-Supraglottic airway or endotracheal intubation
-Waveform capnography to confirm and monitor for ET tube placement
-8-10 breaths per minute with continuous chest compressions
Reversible Causes of Cardiac Arrest
-Hypovolemia
-Hypoxia
-Hydrogen Ion (acidosis)
-Hypothermia
-Hypo/hyperkalemia
-Trauma
-Toxin
-Thrombosis, pulmonary
-Thrombosis, coronary
-Tension pneumo
-Tamponade
Cardiac Arrest Algorithm
1) shout for help/ER
2) Rhythm shockable
-Yes-->VF/VT
-Shock
CPR 2 min
IV/IO access
Shockable Rhythm?
No -->If no signs of ROSC, continue CPR and give Epinephrine every (1mg) every 3-5 minutes and consider advanced airway
-Consider treating reversible causes

If Rhythm is not shockable, continue 2 minutes CPR and give 300mg dose of amiodarone
Immediate Post-Cardiac Arrest Algorithm
ROSC-->Optimize ventilation and ox (>94%)
- COnsider advaced airway and waveform capnography

-Treat hypotension
-IV/IO bolus 1-2L NS
-Vasopressor infusion
(epinephrine: 0.1- 0.5 mcg/kg/min)
(dopamine: 5-10 mcg/kg/min)
(norepinephrine: 0.1-0.5 mcg/kg/min)

Following commands?
-If no consider induced hypothermia

If STEMI or high suspicion AMI-->coronary reperfusion
Bradycardia with pulse algorithm
Assess appropriateness for clinical condition (HR<50 if bradyarrhythmia)

-Identify and tx underlying causes
-Maintain airway
-Oxygen (if hypoxemic)
-Monitor, BP, Pulse Ox
-IV access
-12-lead ECG

If persistent bradyarrhythmia-->hypotension, AMS, shock, chest pain, CHF
-->give Atropine
-->if atropine ineffective:
-transcut pacing, Dopamine infusion, or epi infusion-->
comnsider transvenous pacing
Doses of drugs for Bradyarrhythmia
Atropine IV Dose:
-First dose:
0.5mg bolus
-Repeat every 3-5minutes for maximum of 3mg

Dopamine infusion: 2-10
mcg/kg/min

Epi infusion: 2-10
mcg/kg/min
Tachycardia with Pulse algorithm

with hypotension, AMS, shock, CP, HF
Assess appropriateness for clinical condition.
(HR > = 150/min if tachyarrhythmia)

Identify and tx underlying cause (Maintain patent airway; assist breathing -->Oxygen if hypoxemic -->Monitor, BP, pulse ox)

Persistent tachyarrhythmia causing:
-hypotension
-AMS
-Shock
-Ischemic CP
-HF

-->Synchronized cardioversion
Recc Initial:
-narrow reg: 50-100J
-narrow irreg: 120 -220J biphasic, 200J monopha
-Wide reg: 100J
-Wide irreg: defribrillation dose (Not synchronized)

Consider Adenosine:
-first dose (6mg rapod IV push; follow with NS flush)
-Second dose: 12mg if required
Stable Wide-COmplex tach
IV access and 12-ECG
-Consider adenosine if regular and monomorphoic
-consider antiarrhythmic infusion

Procainamide IV: 20-50mg/min until arrhythmia suppressed (max dose 17mg/kg)
-avoid if prolonged QT or CHF

-Amiodarone IV Dose:
-First dose: 150mg over 10 minutes
-Rpt if VT recures
-maintainance infusion of 1mg/min for first 6 hrs

-Sotalol IV:
100mg over 5 minutes
Stable Narrow complex Tachychardia
IV
ECG
Vagal maneuvers
Adenosine (if regular)
Beta-blocker/Ca channel blocker
Tachycardia with Pulse algorithm

with hypotension, AMS, shock, CP, HF
Assess appropriateness for clinical condition.
(HR > = 150/min if tachyarrhythmia)

Identify and tx underlying cause (Maintain patent airway; assist breathing -->Oxygen if hypoxemic -->Monitor, BP, pulse ox)

Persistent tachyarrhythmia causing:
-hypotension
-AMS
-Shock
-Ischemic CP
-HF

-->Synchronized cardioversion
Recc Initial:
-narrow reg: 50-100J
-narrow irreg: 120 -220J biphasic, 200J monopha
-Wide reg: 100J
-Wide irreg: defribrillation dose (Not synchronized)

Consider Adenosine:
-first dose (6mg rapod IV push; follow with NS flush)
-Second dose: 12mg if required
Stable Wide-COmplex tach
IV access and 12-ECG
-Consider adenosine if regular and monomorphoic
-consider antiarrhythmic infusion

Procainamide IV: 20-50mg/min until arrhythmia suppressed (max dose 17mg/kg)
-avoid if prolonged QT or CHF

-Amiodarone IV Dose:
-First dose: 150mg over 10 minutes
-Rpt if VT recures
-maintainance infusion of 1mg/min for first 6 hrs

-Sotalol IV:
100mg over 5 minutes
Stable Narrow complex Tachychardia
IV
ECG
Vagal maneuvers
Adenosine (if regular)
Beta-blocker/Ca channel blocker
If in Torsades de pointes, what do you give
MgSO4 1-2g diluted in 10ml D5W given over 5 to 20 mintues
BLS Survey
1) Check Responsiveness
-Are you all right
-Absent abnormal breathing (scan chest for movement (5-10 seconds)

2) Activate ERS/ AED

3) Circulation
-Carotid Pulse fo 5-10 seconds
-No pulse-->CPR (30:2)

If pulse resumes-->start rescue breaths at 1 breath q 5-6seconds (10-12 breaths minute) check pulse q 2 minutes

4) Defibrillation
-No pulse-->check for shockable rhythmn with AED as sson as arrives
Rate of ventilation with patient in respiratory arrest
q 5-6seconds
Coronary perfusion pressure
Diastolic pressure - R atrial diastolic pressure
What do you do after shocking?
Immediatley resume CPR, beginning with chest comrpessions. GIve 2 minutes (5 cycles) of CPR

Establish IV/IO access

After 5 minutes, rhythm check
If the rhythm in organized (regular narrow) palpate pulse

ANy doubt about presence of pulse, resume CPR

IF there is a pulse-->post-cardiac arrest care

IF the rhythm is non-shockable-->asystole/PEA
Dose of epi and Vasopressin during VF/pulseless VT
Epi: 1mg IV/IO q 3- 5 minutes
improves coronary/cerebral perfusion presure

Vasopressin: 40 Units IV/IO - may substitute for 1st or second dose of epi

nonadren peripheral vasoconstrictor
What do you do after shock?
Give meds

continue CPR for 2 minutes
then analyze rhythm,

if nonshockable ryth present and it is organized (regular and narrow) check pulse -->any doubt about pulse-->resume CPR

Palpable pulse-->post-cardiac arrest care

nonshockable-->no pulse-->asystole/PEA

If shockable, resume CPR while defib charging
Do you give antiarrhythmics during cardiac arrest
No evidence that it increases survival to d/c

-can give amiodarone

1st dose: 300mg bolus
2nd dose: 150mg

If amiodarone is unavaiable
-Lidocaine 1 - 1.5mg/kg IV/IO 1st dose

2nd dose - 0.5 - 0.75mg/kg IV/IO at 5 - 10 minute intervals -->max, 3 mg/kg

Torsades de Pointes: 1 - 2 g IV/IO diluted in 10ml D5W given as bolus over 5 - 20 minutes
Goals of Post-Cardiac Arrest Care
-Optimize hemodynamic/vent status
-therapeutic hypotherm
-coronary reperfusion with PCI
-glycemic control
hypotension
IV bolus 1-2L NS, (may use 4 degree C if hypotherm)
-Epi: 0.1-0.5mcg/kg/min (7-35mcg/min in adult)
-Dopa: 5-10mcg/kg/min for SBP>90, MAP>65
-Norepi: 0.1-0.5 mcg/kg/min (7-35mcg/min in 70kg adult)
Post-cardiac care-->patient is not following commands
initiate therapeutic hypothermia
target temp: 32-34 deg C for 12 - 24 hrs

get 12 lead ECG-->if AMI or STEMI-->cath lab for PCI
How do you deliver synchronized cardioversion in Unstable tachycardia
Narrow Regular: 50-100J
Narrow Irregular: 120-200J biphas, or 200J monophas
Wide Regular: 100J
Wide Irreg: defib dose
Stable Wide-complex tachy drugs
Adenosine 6mg-->12mg if monomorphioc and regular

Procainamide 20-50mg/min (1-4mg/min maintenance dose)

Amiodarone (150mg/10min) Maintenance 1mg/min

Sotalol 100mg/5min
When to use synchronized shocks
-unstable SVT
-Unstable regular monomorphic tachy with pulses
-Unstable A fib
-Unstable A flutter