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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