Zanjan University of medical science Four rhythms produce pulseless cardiac arrest Ventricular fibrillation VF rapid ventricular tachycardia VT Pulseless electrical activity PEA Asystole ID: 918986
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Slide1
A.
Jafari . MDAssistant Professor of emergency medicineZanjan University of medical science
Slide2Slide3Slide4Slide5Slide6Slide7Slide8Slide9Slide10Slide11Slide12Slide13Slide14Slide15Slide16Slide17Slide18Slide19Slide20Slide21Slide22Slide23Slide24Slide25Slide26Slide27Slide28Slide29Four rhythms produce pulseless cardiac arrest:
Ventricular fibrillation (VF).rapid ventricular tachycardia (VT).Pulseless electrical activity (PEA).
Asystole.
Slide30VF
Slide31V.tach
Slide32PEA
Slide33Asystole
Slide34Slide35Do not Forget ABCD
A: Insert an advanced airway.B: PPV, Pulseoximetry.C: Continuing chest compression, Obtaining certain IV root, Fluid & drug administration.
D:
Differential diagnosis.
Slide36Endotracheal
route:What drugs? Lidocaine, Epinephrine, Atropine, Naloxone
, and Vasopressin.
Results in lower blood concentrations than the same dose given
intravascularly
.
The optimal
endotracheal
dose of most drugs is unknown, but typically
2
to
2.5
times recommended IV dose.
should dilute recommended dose in 5 to 10
mL
of water or normal saline.
Slide37VF / Pulseless VT:
immediate bystander CPR with minimal interruption in chest compressions and defibrillation as soon as possible.witnessed arrest + defibrillator on-site:
Deliver 2 rescue breath.
Check pulse. If no pulse;
Turn on the defibrillator, place paddles, and check the rhythm.
If VF/pulseless VT is present ,deliver 1 shock & immediately resume CPR.
Slide38Unwitness arrest in out-of-hospital setting:
Give 5 cycles of CPR before attempting defibrillation.(??)
Slide39Management of VF / pulseless VT:
Deliver 1 shock. Monophasic: 360 j biphasic: 120-200 jThen resume CPR immediately and continue for 2 min then check rhythm.
When a rhythm check reveals VF/VT, rescuers should provide CPR while the defibrillator charges.
Recall H’s & T’s.
Slide40H
ypovolemia.Hypoxia.Hydrogen ion.Hypo/
H
yperkalemia.
H
ypothermia.
T
oxin.
T
amponade.
T
.P
T
hrombosis (coronary or pulmonary).
Slide41If VF/VT persists after
1 or 2 shocks plus CPR, give Epinephrine 1mg q3-5
min.
When VF/
pulseless
VT persists after
2-3
shocks plus CPR and
vasopressor
, consider
antiarrhythmic
.
Rhythm checks should be brief, and pulse checks should generally be performed only if an organized rhythm is observed.
Slide42Continue shock-CPR(2 min) sequence + antiarrhythmic.
Amiodarone 300 mg IV/IO bolus. Repeat amiodarone 150 mg after
10-15
min.
Lidocaine
1-1.5
mg/kg first dose then
0.5- 0.75
mg/kg. maximum
3
doses or
3
mg/kg with 5-10 min interval.
Consider
MgSO
4
for torsades de pointes. Loading dose
1-2
gr in 10cc DW5% IV/IO.
Slide43Fibrinolysis
Ongoing CPR is not an absolute contraindication to fibrinolysis.Fibrinolytic therapy should not be routinely used in cardiac arrest.
It may be considered on a case-by-case basis when PTE (MI) is suspected.
Slide44Pacing in Arrest
Several randomized controlled trials failed to show benefit from attempted pacing for asystole. At this time use of pacing for Pts with asystolic cardiac arrest is not recommended.
Slide45Precordial Thump
It can deteriorate in cardiac rhythmIt may be considered for termination of Witnessedmonitored
unstable ventricular tachyarrhythmias
when a defibrillator is not immediately ready for use.
Slide46Sodium Bicarbonate
It’s routine use is not recommendedCan be beneficial:Preexisting metabolic acidosisHyperkalemiaTCA overdose
Slide47