8 pulseless arrest ok

7/30/2019 8 Pulseless Arrest Ok

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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)



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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



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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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Case


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Case


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Vital Signs Zero





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The PHA Council on Cardiopulmonary Resuscitation


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8 pulseless arrest ok

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