Pulseless arrest: Difference between revisions
No edit summary |
|||
| Line 28: | Line 28: | ||
#Pump Failure | #Pump Failure | ||
===[[ACLS (Treatable Conditions)|Treatable ACLS Conditions]] (H's and T's)=== | |||
#Hypovolemia | #Hypovolemia | ||
#[[Hypoxia]] | #[[Hypoxia]] | ||
| Line 41: | Line 40: | ||
#[[PE|Thrombosis, pulmonary]] | #[[PE|Thrombosis, pulmonary]] | ||
#[[ACS|Thrombosis, coronary]] | #[[ACS|Thrombosis, coronary]] | ||
==General== | ==General== | ||
Revision as of 22:03, 3 December 2015
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
Treatable ACLS Conditions (H's and T's)
- Hypovolemia
- Hypoxia
- Hydrogen ion (i.e. acidemia)
- Hypo/hyperkalemia
- Hypothermia
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)
Refractory Ventricular Fibrillation
A patient is considered refractory after ≥3 defib, ≥3mg epi, and 300mg amio
Esmolol for Failure of Standard ACLS[1]
- Place a second set of defib pads in an alternative location on the chest
- Continue CPR
- Deliver 360J simultaneously from both defibrillators
- Continue CPR
- Give Esmolol bolus at 0.5mg/kg and start drip at 0.1mg/kg
- Deliver 360J simultaneously from both defibrillators
- Continue CPR
See Also
References
- ↑ Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with ventricular fibrillation. Resuscitation. 2014; 85(10):1337-1341.
- 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