The pulseless arrest algorithm. You are in the hospital. MOST IMPORTANT TO KNOW.
What are the lst three things you do in this algothrithm?
1. BLS- call for help, give CPR 2. Give oxygen when available 3. attach a monitor/defibrillator
How do you know whether to give the shock or not?
Just get someone to attach the AED ASAP. Then the AED with check the rhytm and to see if it is shockable or not
Where does this algorithm frist split?
When the AED determines if it is a shockable or non-shockable rhythm
What is a non-shockable rhytm?
What is a shockable rhytm?
VF/VT- for example:
If it is shockable rhythm- what do you do right after the shock?
resume CPR immediately! same if it is not a shockable rhythm.- always do 5 more cycles before you try to shock again (or let it analyze the rhythm
After the lst shock, how many cycles of CPR do you give before you let it check the rhythm again?
Give 5 cycles of CPR
When do you give the first meds in VF/VT?
If nothing happens after the 2nd shock- then give meds
What is the first meds do you give after two shocks that dont work?
Give vasopressors- epi or vasopressin
How much epi do you give?
1mg IV/IO repeat every 3 to 5 min.
How much vasopressin would you give?
40 U IV/IO to replace the first or second dose of Epi
after the third shock what drugs should you give?
An antiarrhythmic- Amiodorone, Lidocaine or magnesium
How much Amiodarone should you give?
Give 300 mg IV/IO once then consider giving 150 mg once or give lidocaine
How much Lidocaine do you give?
1 to 1.5 first dose, then 0.5 to 0.75. Max dose is 3mg.
Why would you give Magnesium?
for torsades de pointes, magnesium 1 to 2g.
What does VF look like?
what if you do shocks and then it is aystole (not shockable)
Then start CPR again for 5 cycles.
How long is 5 cycles of CPR?
about 2 minutes
When doing continuous compressions, how often do you give breaths through the advanced airway?
give 8-10 breaths per minutes. Check rhythm every 2 minutes.
What if you get tired doing CPR?
Switch with someone every 2 minutes with the rhytm check
How long should you pause to allow for a rhytm check?
ideally not more than 10 sec
How is someone in hyporthermia treated differently? What is hypothermia defind?
Less than 86F or 30C. They just get one shock and then no drugs or shocks until the warm up.
How can you get the drugs to central circulation faster? b/c a peripheral line is put in/ not a central line (so chest compressions are not interupted)
Lift the arm up for about 10-20 secs
how should you admister in the peripheral venous route (IV) -3 things to do
1. give by bolus injection (unless otheriwise specified). 2.Follow with a 20 mL bolus of IV fluid. 3. Elevate extremity for 10-20 seconds
What do vasopressors do? Name the ones we use
They are vasoconstrictors that increases cerebral and coronary blood flow during CPR
What is the drug of choice for aystole or slow PEA rate?
after giving vasopressors, consider giving atropine 1 mg IV/IO
How much atropine do you give?
1 mg IV/IO every 3-5 min. --up to three doses
shockable drugs- first round? (after second shock)
Epi or Vasopressin
shockable drugs- 2nd round (after 3rd shock)
amiodarone or lidocaine. magnesium only if torsade de pointes
What are the only times you would interupt chest compressions?
ventilation (unless advanced airway is in place), rhythm checks, and shock delivery
How much of the drug would you give the ET route?
the optimal dose of most drugs is unknown but the typical is 2 to 2.5 times the IV route
How is epi thought to work?
stimulates adrenergic receptors, producing vasoconstriction, increasing BP and HR, and improving perfusion pressure to the brain and heart
when do you use vasopressin?
to replcae either the first or second dose of epi
When do you use amiodarone?
Tx VF/VT unresponsive to shock, CPR and a vasopressor
How much amuiodarone do you give?
during cardiac arrest, consider 300 mg IV/IO push for the first dose. If VF/VT persists consider 2nd dose of 150mg IV/IO in 3 to 5 minutes.
When do you use lidocaine? how much? how much would you give through ET route?
when amiodarone is not available. Give 1 to 1.5 mg/kg. Repeat if indicated at 0.5 to 0.75 mg/kg over 5-10 minute intervals to a max of 3 doses or 3mg/kg. Give 2-4 mg/kg ET route.
Why give magnesium?
may prevent or terminate recurrent torsades de pointes in pt who have a prolonged QT interval during normal sinus rhythm
What to remember about magnesium
pulseless VF is treated with a shock whereas mag is an adjunctive agent used to prevent or tx VT associated with torsade
What does tordade de pointes look like?
Notice it is VT
You know the arrest dose for amiodarone, but what is the postresuscitation dose? Max total?
2.2 g over 24 hours is the max cumlative dose. Start with an IV bolus of 150 mg IV over 10 min. Follow by a slow infusion of 360 mg IV over the next 6 hours (1mg/min). Then a maintenance infusion of 540 mg IV over the next 18 hours (0.5 mg/min)
Do you give lidocaine in ACS?
prophylactic administration of lidocaine in pt with ACS is not recommeded.