Pulseless arrest: Difference between revisions
| Line 23: | Line 23: | ||
#Severe Hypovolemia | #Severe Hypovolemia | ||
#Obstruction | #Obstruction | ||
##Tension Pneumothorax | ##[[Tension Pneumothorax]] | ||
##Cardiac Tamponade | ##[[Cardiac Tamponade]] | ||
##Massive Pulmonary Embolus | ##Massive [[Pulmonary Embolus]] | ||
#Pump Failure | #Pump Failure | ||
| Line 31: | Line 31: | ||
Consider H's and T's | Consider H's and T's | ||
#Hypovolemia | #Hypovolemia | ||
#Hypoxia | #[[Hypoxia]] | ||
#Hydrogen ion | #Hydrogen ion (i.e. acidemia) | ||
#Hypo/hyperkalemia | #[[Hypokalemia|Hypo]]/[[hyperkalemia]] | ||
#Hypothermia | #[[Hypothermia]] | ||
#Tension | #[[Tension Pneumothorax]] | ||
#Tamponade | #[[Cardiac Tamponade|Tamponade]] | ||
#Toxins | #[[Toxicology (Main)|Toxins]] | ||
#Thrombosis, pulmonary | #[[PE|Thrombosis, pulmonary]] | ||
#Thrombosis, coronary | #[[ACS|Thrombosis, coronary]] | ||
Revision as of 03:38, 13 January 2014
Immediate
- Start CPR
- Give oxygen
- Attach monitor/defibrilator
- Rhythm shockable?
V-Fib and Pulseless V-Tach (Shockable)
- Shock as quickly as possible and resume CPR immediately after shocking
- Biphasic - 200J
- Monophasic - 360 J
- Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
- Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
- 1st line: Amiodarone 300mg IVP w/ repeat dose of 150mg as indicated
- 2nd line: Lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
- Polymorphic V-tach: Magnesium 2g IV, followed by maintenance infusion
Asystole and PEA (Non-Shockable)
- Epi 1mg q3-5min
- 3 & 3 Rule:
Three major mechanisms of PEA
- Severe Hypovolemia
- Obstruction
- Pump Failure
Consider H's and T's
- Hypovolemia
- Hypoxia
- Hydrogen ion (i.e. acidemia)
- Hypo/hyperkalemia
- Hypothermia
See Also: ACLS (Treatable Conditions)
General
- A (adjunct) - Place oropharyngeal airway
- B (breathing) - place on Ventilator to assure slow ventilation rate (attach to BVM mask)
- 10-12 bpm, 500cc tidal volume, Fio2 100%
- C (compressions) - Switch out providers q pulse check; use metronome
- D - defibrillation
- Ok to shock during compressions if wearing gloves and using biphasic device
- A (advanced airway)
- Use LMA (NOT ET tube - no break in compressions required)
- B (advanced breathing)
- Connect LMA to Ventilator
- Pressure control 20, RR 10, insp rate 1.5-2s
- Connect LMA to Ventilator
- C (advanced circulation)
- Place IO instead of central line
- D (differential)
See Also
Source
- Desbiens NA. Simplifying the diagnosis and management of pulseless electrical activity in adults: a qualitative review. Critical Care Medicine. 2008;36(2):391–396.
- AHA 2010 ACLS Guidelines
- EMCrit Podcast #31