Pulseless arrest: Difference between revisions

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*3 & 3 Rule
*3 & 3 Rule


#Consider H's and T's
Consider H's and T's
##Hypovolemia
#Hypovolemia
##Hypoxia
#Hypoxia
##Hydrogen ion
#Hydrogen ion
##Hypo/hyperkalemia
#Hypo/hyperkalemia
##Hypothermia
#Hypothermia
**Tension pneumothorax
 
**Tamponade
#Tension pneumothorax
**Toxins
#Tamponade
**Thrombosis, pulmonary
#Toxins
**Thrombosis, coronary
#Thrombosis, pulmonary
#Thrombosis, coronary





Revision as of 19:23, 20 July 2013

Immediate

  1. Start CPR
  2. Give oxygen
  3. Attach monitor/defibrilator
  4. 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)

PEA.png
  • Epi 1mg q3-5min
  • 3 & 3 Rule

Consider H's and T's

  1. Hypovolemia
  2. Hypoxia
  3. Hydrogen ion
  4. Hypo/hyperkalemia
  5. Hypothermia
  1. Tension pneumothorax
  2. Tamponade
  3. Toxins
  4. Thrombosis, pulmonary
  5. 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
  • C (advanced circulation)
    • Place IO instead of central line
  • D (differential)

See Also

Source

  • AHA 2010 ACLS Guidelines
  • EMCrit Podcast #31