Pulseless arrest: Difference between revisions
| Line 34: | Line 34: | ||
==General== | ==General== | ||
*A (adjunct) - Place oropharyngeal airway | *A (adjunct) - Place oropharyngeal airway | ||
*B (breathing) - place on | *B (breathing) - place on [[Ventilator]] to assure slow ventilation rate (attach to BVM mask) | ||
**10-12 bpm, 500cc tidal volume, Fio2 100% | **10-12 bpm, 500cc tidal volume, Fio2 100% | ||
*C (compressions) - Switch out providers q pulse check; use metronome | *C (compressions) - Switch out providers q pulse check; use metronome | ||
| Line 43: | Line 43: | ||
**Use LMA (NOT ET tube - no break in compressions required) | **Use LMA (NOT ET tube - no break in compressions required) | ||
*B (advanced breathing) | *B (advanced breathing) | ||
**Connect LMA to | **Connect LMA to [[Ventilator]] | ||
***Pressure control 20, RR 10, insp rate 1.5-2s | ***Pressure control 20, RR 10, insp rate 1.5-2s | ||
*C (advanced circulation) | *C (advanced circulation) | ||
**Place IO instead of central line | **Place IO instead of central line | ||
*D (differential) | *D (differential) | ||
**[[Ultrasound: In Shock and Hypotension]] | **[[Ultrasound: In Shock and Hypotension]] | ||
Revision as of 19:39, 10 March 2012
Immediate
- Start CPR
- Give oxygen
- Attache 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
- Magnesium 2g IV, followed by maintenance infusion
- Only for polymorphic V-tach
Asystole and PEA (Non-Shockable)
- Give Epi 1mg q3-5min
- Consider H's and T's
- Hypovolemia
- Hypoxia
- Hydrogen ion
- Hypo/hyperkalemia
- Hypothermia
- Tension pneumo
- Tamponade
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
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
- AHA 2010 ACLS Guidelines
- EMCrit Podcast #31