6. The Algorithm Flashcards
If you’ve identified cardiac arrest what do you do next ?
CPR 30:2
Attach defibrillator/ monitor
Call resuscitation team
What are the shockable rhythms?
VF
PULSELESS VT
What are the non-shockable rhythms ?
PEA
ASYSTOLE
For shockable rythm, what’s the plan?
Shock
Immediately restart CPR
2mins check rhythm
Shock again if still in VF/pVT
IMMEDIATELY restart CPR
2mins check rhythm
Shock again if still in VF/pVT
Immediately restart CPR AND Give adrenaline 1mg and Amiodarone 300mg IV
2 mins check rhythm
Shock
Give further 1mg adrenaline after every other shock
Give further 150mg amiodarone after 5 shock attempts
Continue until ROSC/ asystole/ clinical decision to stop
Define ROSC
Return of spontaneous circulation
What do you need to check for, even if you see organised electrical activity consistent with cardiac output?
Check for signs of ROSC!
Central pulse or end tidal CO2 if available.
No ROSC? Keep up CPR!
What do you do if electrical activity returns to compatible with cardiac output but no evidence of ROSC?
Continue CPR and switch to non-shockable pathway
For non-shockable rhythm, what’s the plan?
CRP30:20
Simultaneous adrenaline 1mg IV/IM
2min rhythm check
Immediately restart CPR
2min rhythm check
Can give 1mg adrenaline every other compression cycle.
If ROSC start post-circulation care. If pVT/VF follow shockable rhythm pathway.
What’s the alternative to amiodarone?
Lidocaine, but do not give it patient has had amiodarone
What can you do if it’s a witnessed VF/pVT cardiac arrest? E.g on a coronary care unit?
Three quick, successive ‘stacked’ shocks
Rapidly check Rhythm change and if appropriate ROSC after each shock.
CPR 30:2 if shocks unsuccessful
How much energy should be in each shock?
150 J minimum
What are the three main insertion sites for intraosseous access
Proximal humerus, proximal tibia and distal tibia
