Adult cardiac arrest circular algorithm Flashcards
1
Q
Rythm is shockable
A
- ventricular fibrillation (VF)
- pulseless ventricular tachycardia (pVT)
2
Q
Rhythm is not shockable
A
- asystole
- pulseless electrical activity (PEA)
3
Q
VF/pVT
A
- shockable
- first step is to shock!
- CPR for 2 mins (while obtaining IV access)
- shock again and do CPR for 2 mins if rhythm is still shockable (VF, pVT) -> EPINEPHRINE after the second shock -> then give again every 3-5 minutes
- if rhythm is still shockable CPR for 2 minutes -> amiodarone or lidocaine
- if rhythm ever becomes unshockable (asystole/PEA) with no return of spontaneous circulation -> CPR and epinephrine or treat underlying cause
- if rhythm ever becomes unshockable (asystole/PEA) with return of spontaneous circulation -> post-cardiac arrest treatment
4
Q
reversible causes
A
- Hypovolemia
- Hypoxia
- hydrogen ion (acidosis)
- Hypo-/hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
- treat these for unshockable rhythms
5
Q
PEA/asystole
A
- Non-shockable
- start with epinephrine ASAP
- CPR 2 mins with epinephrine every 3-5 mins
- if rhythm is still not shockable CPR for 2 mins and treat reversible causes
- if rhythm becomes shockable give shock and continue CPR and epinephrine for another 2 mins -> CPR 2 mins with amiodarone or lidocaine and treat reversible causes
6
Q
return of spontaneous circulation obtained
A
- start post-cardiac arrest care
- STABILIZE:
- manage airway
- manage respiratory vitals
- manage hemodynamic parameters (BP) -> systolic over 90 and MAP over 65
- 12 lead EKG
- CONTINUED MANAGEMENT:
- consider intervention if STEMI present, unstable cardiogenic shock, mechanical circulatory support required
- if unconscious -> targeted temperature management, brain CT, electroencephalogram (EEG)
- if awake -> temp, EEG, lung protective ventilation, maintain vitals
- evaluate and treat rapidly reversible etiologies
- involve expert consultation for continued management
7
Q
epinephrine
A
- 1 mg every 3-5 mins after the first time you give it
- give asap for nonshockable
- give after 2nd shock for shockable and every 3-5 mins after
8
Q
amiodarone
A
- first dose- 300 mg bolus
- second dose- 150mg
- lidocaine can be used instead of this
9
Q
lidocaine
A
- first dose- 1-1.5 mg/kg
- second dose- .5-.75 mg/kg
10
Q
bradyarrhythmia
A
- <50/min
- maintain airway, oxygenate, monitor BP and oximetry
- cardiac monitor to identify rhythm
- 12 lead EKG is available -> therapy is more important though
- consider hypoxic and toxicologic causes
- CONSIDER:
- hypotension
- AMS
- shock
- ischemic chest discomfort
- acute heart failure
- > IF YES -> atropine
- if atropine is ineffective -> transcutaneous pacing and/or dopamine or epinephrine infusion
- consider- expert consultation and transvenous pacing
- > IF NO -> monitor and observe
11
Q
atropine dose
A
- first dose- 1 mg bolus
- repeat every 3-5 mins
- maximum 3 mg
12
Q
dopamine
A
- 5-20 mcg/kg min
- titrate to patient response
13
Q
epinephrine
A
- 2-10 mcg min
- titrate to response
14
Q
causes of bradycardia
A
- myocardial ischemia/infarction
- drugs/toxicologic (calcium channel blockers, beta blockers, digoxin
- hypoxia
- electrolyte abnormality (hyperkalemia)
15
Q
tachyarrhythmia
A
- greater than or equal to 150
- maintain patent airway, assist breathing, oxygen, monitor to identify rhythm, monitor BP, oximetry, IV, 12 lead EKG
- CAUSES:
- hypotension
- acute AMS
- shock
- ischemic chest discomfort
- acute HF
- > IF YES -> synchronized cardioversion (consider sedation bc painful) -> if regular narrow complex, consider adenosine
- > IF NO -> consider if there is a wide QRS > .12 second
- IF YES -> consider adenosine only if regular and monomorphic, antiarrhythmic infusion, expert consultation
- IF NO -> vagal maneuvers, adenosine, beta-blocker or calcium channel blocker, consider expert consultation
