Post on 29-Jan-2016
transcript
Management ofManagement ofcardiac arrestcardiac arrest
Ali Asgari, MD, PGY2Ali Asgari, MD, PGY2
2005 American Heart Association2005 American Heart Association
www.circulationaha.orgwww.circulationaha.org
ARRESTARREST
Unresponse patientUnresponse patient
A B C
LookLookListenListenFeelFeel
Check pulseCheck pulseCheck leadsCheck leads
22 rescuerescuebreathingbreathing
BreathingBreathing
Adults >>> gasping = No breathingAdults >>> gasping = No breathing
Ped >>> grunting & tachypnea = breathingPed >>> grunting & tachypnea = breathing
Recommended maneuver for advanced healthcare provider : Jaw thrust
TV = 6-7 cc/kgIns. Time = 1 sec
circulationcirculation
Check pulse:
radial, brachial, femoral, carotid
Which finger?
2 nd , 3rd
Max. time?
check breathing & pulse , max 10 s.
In hypothermia ->->-> 35 s.
why?
startstartThe patientThe patient
Not monitored MonitoredNot monitored Monitored
Start CPR Start CPR ((with with
BLSBLS)) A B CA B C
Airway BreAirway Breathing Circulationathing Circulation
Jaw thrust 2 rescue B. Chest compJaw thrust 2 rescue B. Chest comp..
Attach defibrillator as soon as Attach defibrillator as soon aspossiblepossible
A B CA B C
Airway BreAirway Breathing Circulationathing Circulation
Jaw thrust 2 rescue B. Chest compJaw thrust 2 rescue B. Chest comp..
Attach defibrillator as soon as Attach defibrillator as soon as possiblepossible
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Breathing (BLS)Breathing (BLS)
Bag- mask ventilationBag- mask ventilation
C.T.V. ratioC.T.V. ratio
11 rescuer 2 rescuerrescuer 2 rescuer
Adult < 8 yrAdult < 8 yr..
3030 : : 22 30:230:2 15:215:2
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Breathing (ACLS)Breathing (ACLS)
Advanced airwayAdvanced airway
ET intubationET intubation LMALMA
Combi tubeCombi tube
RR = 8-10 asyncRR = 8-10 asyncVolume = 6-7 cc/kg max. 500-600ccVolume = 6-7 cc/kg max. 500-600ccIns. Time = 1 secIns. Time = 1 secCompress 1lit bag: half wayCompress 1lit bag: half way
22 lit bag: 1/3 waylit bag: 1/3 way
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DON’T DON’T INTERRUPTINTERRUPT
CHEST CHESTCOMPRESSIOCOMPRESSIO
NN
DON’T DON’T INTERRUPTINTERRUPT
CHEST CHEST COMPRESSIOCOMPRESSIO
NN
Chest compChest comp..
Rate = 100Rate = 100Without interruptionWithout interruption
Change hand Q 2 min / max. 5sec Change hand Q 2 min / max. 5sec delaydelay
Push hard, Push fastPush hard, Push fastAllow to enough chest recoilAllow to enough chest recoil
Compress 3-5 cm in adultCompress 3-5 cm in adult 1/31/3 to ½ depth of chest in childrento ½ depth of chest in children
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Advanced life supportAdvanced life supportAdvanced life supportAdvanced life support
A B CA B CA B CA B C
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Defibrillator attachedDefibrillator attachedCCHHEESSTTCCOOMMpp
Check rhythmCheck rhythm
VT , VFVT , VF PEA, Asystole
..
RhythmRhythm
Shockable Shockable NonshockableNonshockable
VF AsystoleVF Asystole
Pulseless VT PEAPulseless VT PEA
Shockable rhythmShockable rhythm
VF, Pulseless VTVF, Pulseless VT
Witnessed, early mins LateWitnessed, early mins Late
22 rescue breath 2 rescue rescue breath 2 rescue breathbreath
First shock 2min chest First shock 2min chest copmcopm..
then shockthen shock
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ShockShock? ?
Monophasic 360 J / at beginningMonophasic 360 J / at beginning
Biphasic 120 J / then 200 JBiphasic 120 J / then 200 J
Children first 2 J/kg then 4 J/kgChildren first 2 J/kg then 4 J/kg
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00 - -shockshock
chest compchest comp
check rhythmcheck rhythm
22 - -shockshock
chest comp. chest comp. 1 mg1 mg EpinephrineEpinephrine
check rhythmcheck rhythm
44 - -shockshock
chest comp, chest comp, AmiodaroneAmiodarone 300 mg300 mg
check rhythmcheck rhythm
66 - -shockshock
chest comp, Epichest comp, Epi
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Do not check Do not check pulse untilpulse until
The rhythm The rhythm changedchanged
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88 - -shockshock chest compchest comp..
check rhythmcheck rhythm1010 - -shockshock
chest comp, Epichest comp, Epi check rhythmcheck rhythm
1212 - -shockshock chest compchest comp..
check rhythmcheck rhythm1414 - -shockshock
chest comp. Epichest comp. Epi check rhythmcheck rhythm
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1616 - -shockshock
chest comp, chest comp, Amiodarone 150 mgAmiodarone 150 mg
check rhythmcheck rhythm
1818 - -shockshock
chest comp, Epichest comp, Epi
check rhythmcheck rhythm
2020 - -shockshock
chest compchest comp. .
: :
: :
: :
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DrugsDrugsAntiarrhythmicsAntiarrhythmics::
Amiodarone Amiodarone : 300 mg first dose: 300 mg first dose
if needed after 15-20 min, 150 mgif needed after 15-20 min, 150 mg
max, 450 mgmax, 450 mg
LidocaineLidocaine : 1.5 mg/kg first dose : 1.5 mg/kg first dose
if needed Q 10 min--- 0.75 mg/kgif needed Q 10 min--- 0.75 mg/kg
for 2 doses max. 3 mg/kgfor 2 doses max. 3 mg/kg
Nonshockable rhythmNonshockable rhythm
after initial assessmentafter initial assessment 00 - -chest compchest comp check rhythmcheck rhythm
22 - -chest comp, chest comp, Atropine 1mg, Epi 1mgAtropine 1mg, Epi 1mg check rhythmcheck rhythm
44 - -chest compchest comp check rhythmcheck rhythm
ShockShock
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66 - -chest comp, Atropine 1mg, Epi 1mgchest comp, Atropine 1mg, Epi 1mg
check rhythmcheck rhythm
88 - -chest compchest comp
check rhythmcheck rhythm
1010 - -chest comp, Atropine 1mg, Epi 1mgchest comp, Atropine 1mg, Epi 1mg
check rhythmcheck rhythm
1212 - -chest compchest comp
check rhythmcheck rhythm
1414 - -chest comp, Atropine 1mg, Epi 1mgchest comp, Atropine 1mg, Epi 1mg
check rhythmcheck rhythm
1616.………………………………………….…………………………………………
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VasopressorsVasopressors
Epinephrine hydrochlorideEpinephrine hydrochloride: : S & NS rhythmsS & NS rhythms
11 mg- IV, IO, ETmg- IV, IO, ET
Q 3-5 min/ cont to ENDQ 3-5 min/ cont to END
AtropineAtropine: Only : Only asystole & PEA with HR<60asystole & PEA with HR<60
11 mg- IV, IO, ETmg- IV, IO, ET
Q 3-5 min Q 3-5 min max. 3 mgmax. 3 mg
Drug routDrug rout
As a lawAs a law::
Drugs injections in CPR must beDrugs injections in CPR must be::
PUSHPUSHETT administrationETT administration::
22 - - 2.52.5 times as IV dosestimes as IV doses
plusplus
5-105-10 ml distilled waterml distilled water
As a lawAs a law::
Drugs injections in CPR must beDrugs injections in CPR must be::
PUSHPUSHETT administrationETT administration::
22 - - 2.52.5 times as IV dosestimes as IV doses
plusplus
5-105-10 ml distilled waterml distilled water
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Chest Chest compcomp
Prolonged CPRProlonged CPRProlonged CPRProlonged CPR
HypothermiaHypothermia
ToxicityToxicity
DrowningDrowning
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