8 pulseless arrest ok
TRANSCRIPT
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A Member of the
The Asian Representative of
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Cardiac Arrest Rhythms
Ventricular fibrillation - disorganized electric activity Pulseless ventricular tachycardia - represents organized
electric activity of the ventricular myocardium (Vtachwithout pulse)
Asystole - absence of detectable ventricular electricactivity with or without atrial electric activity Pulseless electrical activity - heterogeneous group of
organized electric rhythms that are associated witheither absence of mechanical ventricular activity or
mechanical ventricular activity that is insufficient togenerate a clinically detectable pulse.
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Cardiac Arrest Rhythms
VF
Pulseless VT
Asystole
PEA
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c
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c
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Manage asshockable rhythm
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VF / Pulseless VT
CPR CPR CPR CPR
Providers should give 1 shock rather than 3 successive shocks which were previously recommended in 2000
First shock success rate is high
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Asystole / PEA
CPR CPR
Epinephrine
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FOR ASYSTOLE & PEA
JUST DO P-E
P UMP (CPR)
EPINEPHRINE
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Does not benefit from defibrillation attempts Perform high-quality CPR with minimal
interruptions Continuous chest compressions 100/min Two rescuers should change compression roles
every 2 minutes Epinephrine can be administered every 3-5 min
Asystole & Pulseless Electrical Activity(PEA)
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Medications for Arrest Rhythms VF/Pulseless VT
Epinephrine Alpha-adrenergic effects can increase coronary &
cerebral perfusion pressure during CPR Beta-adrenergic effects may increase myocardial work &
reduce subendocardial perfusion
No evidence to show that it improves survival Dose: 1 mg every 3 -5 min (2-2.5 mg via endotracheal
route
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Vasopressin Nonadrenergic peripheral vasoconstrictor that
causes coronary & renal vasoconstriction No statistically significant differences between
vasopressin & epinephrine for return ofspontaneous circulation (ROSC), 24-hoursurvival or survival to hospital discharge
Dose: 40 U IV/IO
Medications for Arrest Rhythms VF/Pulseless VT
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Vasopressors May consider giving vasopressin for asystole but insufficient
evidence in PEA Epinephrine 1mg every 3-5 min
Atropine Reverses cholinergic-mediated decreases in heart rate, systemic
vascular resistance & BP No prospective studies to support its use in asystole/ PEA Dose: 1 mg IV every 3 -5 min ( maximum of 3mg)
Medications for Arrest Rhythms Asystole & PEA
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Amiodarone Affects Na, K and Ca channels as well as alpha
and beta adrenergic blocking properties May be administered for VF or pulseless VT
unresponsive to CPR, shock & vasopressor Dose: 300 mg IV/IO followed by 150 mg IV/IO
Medications for Arrest Rhythms Antiarrhythmics
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Lidocaine Alternative anti-arrhythmic to Amiodarone No proven short-term or long-term efficacy in
cardiac arrest Initial dose: 1-1.5 mg/kg IV, then 0.5 0.75 mg/kg
IV push every 5 -10 minutes ( maximum dose of 3mg/kg)
Medications for Arrest Rhythms Antiarrhythmics
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Magnesium Effectively terminates torsades de pointes Not effective in irregular/ polymorphic VT in
patients with normal QT Dose: 1-2 g in 10 ml D5W IV/IO push over 5-
20min When with pulse, 1-2 g in 50-100 ml D5W
Medications for Arrest Rhythms Antiarrhythmics
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40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?
A. Get a complete history and physicalexamination of the patient.
B. call for a Code ( MayDay; Code Blue)C. perform CPRD. hook to cardiac monitor
Case
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On hooking to a cardiac monitor:
What do you do next? A.Intubate the patient
B.Insert an IV lineC.Do chest compressionsD.Defibrillate 360 J
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Because of your management, he convertedto the following rhythm:
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40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?
A. Get a complete history and physicalexamination of the patient.
B. call for a Code ( MayDay; Code Blue)C. perform CPRD. hook to cardiac monitor
Case
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On hooking to a cardiac monitor:
What do you do next? A.Intubate the patient
B.Insert an IV lineC.Do chest compressionsD.Defibrillate 360 J
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Because of your management, he convertedto the following rhythm:
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40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?
A. Get a complete history and physicalexamination of the patient.
B. call for a Code ( MayDay; Code Blue)C. perform CPRD. hook to cardiac monitor
Case
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Vital Signs Zero
On hooking to a cardiac monitor:
What do you do next? A.Intubate the patient
B.Insert an IV lineC.Do chest compressionsD.Defibrillate 360 J
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Because of your management, he convertedto the following rhythm:
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The PHA Council on Cardiopulmonary Resuscitation
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