Arrest Flashcards
Defib used when?
Pulseless Vtach or Vfib
Defib mode?
Starting joules?
Immedate (not synchronized)
200 j (max amount unit can deliver)
Airway mgmt: 1st intervention?
Air vol delivered?
BLS delivered how?
BVM (bag-valve-mask)
500 to 800 mls
GENTLE inflation w/ Synch’d 30:2 delivery
Airway mgmt: Advanced?
Max vent interruption?
Tube size?
Delivered how?
Trach intubation preceded by pre-oxygenation
30 sec
8mm
8-10 bpm w/ asynch’d compressions (don’t interrupt compressions)
Trach intubation placement confirmed how? (2)
Monitored how*?
Auscultation
Capnography
Continuous waveform
Capnography (PETCO2) End Tidal goal during compressions*?
If less than goal, CPR is what*?
≥ 10 mmHg
Ineffective
Pulseless VT/Vf 1° mgmt steps ? (3)
Goal of mgmt*?
1) Establish pulselessness
2) Start CPR:BVM of 30:2
3) Defib in single shocks (biphasic 200j)
Defib (shock and return imm to CPR w/o waiting to see result of shock)
Pulseless VT/Vf 2° mgmt steps? (3)
Sequencing? (5)
1) Establish anticubital peripheral IV (or IO)
2) Pre-O2 then intubate
3) Check placement
1) 2 min CPR
2) Assess rhythm/pulse
3) Shock if nec
4) Return to CPR
5) Meds
Maximum CPR interruption?
10 sec
Perfusion meds in arrest delivered how often?
Q 4min
Epi class?
Action?
Catecholamine (sympathomimetic)
α1 = Vasoconstriction (primary reason we use this, ↓SA of vascular bed will move blood faster)
β = ↑HR, conduction and contractility
Epi indications?
DOC for all types of arrest
Epi dosage: Initial?
Repeat?
Special inst?
Initial: 1 mg
Repeat: 1 mg Q 4 min
Give IV push, IO or ETT
Add’l meds for Pulseless Vtach/Vfib?
Amiodarone
Mg
Amiodarone dosing for Arrest: Initial?
Repeat?
Special inst?
Max?
Continuous infusion?
Initial: 300 mg
Repeat: 150 mg Q 4 min
Dilute to 20 mls, IV push
Max: 2.2 gm/24 hrs
Infuse: 1 mg/min x 6 hrs, 0.5 mg/min x 18 hrs
Magnesium indications?
DOC for Torasde
2nd line for dysrhy not responding to Amiodarone
Magnesium dosing for Arrest: Initial?
Repeat?
Special inst?
Max?
Initial: 1 to 2 gm
Repeat: 1 gm if 1st dose was 1 gm Q 4 min
Dilute in 10 mls over 2 min (NO IV PUSH)
Max: 2 gm
Rule for drug use in Arrest?
One drug at a time, push thru max dose
Then move to next drug if needed
Summary: Pulseless VT/Vfib tx?
Defib 200 j
Epi 1 mg
Amiodarone 300 mg/ 150 mg
Mg 2 gm
Primary Electrical Activity (PEA) is?
tx? (3)
Rhythm that should produce a pulse but isn’t
1) CPR, BMV
2) Establish IV and intubate
3) Epi
NO ELECTRICAL
Causes of PEA (stroke volume problems): 5 Hs?
Hypovolemia (start here -> fill the tank) Hypoxia Hydrogen ion (acidosis) Hyper/HypoK+ Hypothermia
Causes of PEA: 5 Ts?
Toxins Tamponade Tension pneumo Thrombosis, coronary Thrombosis, pulmonary
Asystole mgmt steps? (3)
1) CPR, BVM
2) IV, intubate
3) Epi
NO ELECTRICAL
CPR steps*? (6)
1) ≥ 100 bpm w/ ≥ 2 in
2) Allow for complete recoil
3) Rotate compressors every 2 min
4) < 10 sec interruption
5) Non-advanced 30:2
6) Advanced asynch compression/slow gentle vents 8-10/min
ROSC mgmt steps*? (3)
1) Support O2/vent
2) Support BP w/ fluids
3) Support BP w/ pressors
ROSC O2/Vent support*? (3)
Waveform capnography
Goal PETCO2 35-40 mmHg
Goal O2 94%
ROSC BP fluid support*? (2)
Goal SBP 90 mmHg
Bolus 1-2 L NS if < 90
ROSC BP pressor support*? (2)
1° Norepi
2° DA
Noreip action?
α - vasoconstriction
Norepi indications*?
SBP < 70 mmHg
DA action*?
Rate-related:
1-5 ug/kg/min = dilation of gut
5-10 ug/kg/min = β contractility
> 10 = α vasocontriction
DA indication*?
ROSC support if
SBP 70 - 100
Use of hypothermia?
For ROSC comatose pt
Not for conscious pts
