Cardiac Arrest Flashcards
initial actions to take when patient brought in with cardiac arrest
assess responsiveness–shake and shout
call for help
position victim/rescuer
how do you do a primary survey
ABDC
Airway
–open airway with head tilt, chin lift, jaw thrust, remove foreign body, oropharyngeal airway if available
Breathing
- -look, listen, feel
- -give two quick breaths to rule out airway obstruction
Circulation
- -start chest compressions if remains pulseless
- -cardiac monitor
Defibrillation
–shock ventricular fibrillation or pulseless ventricular tachycardia
what rhythms do you defibrillate
ventricular fibrillation
pulseless ventricular tachycardia
what are the “Hs and Ts”
reversible causes of cardiac arrest
what are the “Hs” of H and Ts
hypovolemia hypoxia H ions (acidosis) hypo or hyperkalemia hypoglycemia hypothermia
what are the Ts of H and Ts
toxins tamponade tension pneumo thrombosis--coronary or pulmonary trauma
how do you do a secondary survey
ABCD
Airway
–advanced airway control as needed i.e intubation
Breathing
–continue PPV, assess adequacy of ventilation
Circulation
- -IV access
- -BP monitoring
- -rhythm appropriate cardiac drugs via IV followed by 20-30 cc NS bolus and arm elevation
Differential Diagnosis
in pulseless arrest, what is a shockable rhythm? not shockable?
shockable: VF, VT
not shockable: asystole, PEA
how do you manage pulseless arrest
do the BLS algorithm
call for help
give CPR
give O2 when available
attach monitor/defibrillator when available
how do you treat pulseless VF/VT
give 1 shock and the resume CPR
after 5 cycles of CPR check rhythm
if shockable, give another shock
resume CPR
if have IV, give EPINEPHRINE 1 mg IV/IO during CPR
–repeat every 3-5 minutes
OR may give 1 dose of vasopressin 40 U IV/IO to replace first or second dose of epinephrine
after another 5 cycles of CPR, check rhythm again
if shockable, give another shock, then resume CPR
at this point consider antiarrhythmics like amiodarone 300 mg IV/IO once then 150 mg once more thereafter
-or-
lidocaine
consider magnesium for torsades (1-2 g IV/IO)
what meds may be used in the algorithm for managing VF/VT in addition to shocks
epinephrine vasopressin amiodarone lidocaine magnesium
dose of epinephrine in cardiac arrest
epinephrine 1 mg IV/IO, repeat q3-5 min
dose of vasopressin in cardiac arrest
vasopressin 40 U IV/IO to replace first or second dose of epinephrine
dose of amiodarone in cardiac arrest
consider after third shock and after trying epinephrine
300 mg IV/IO x 1 then another dose of 150 mg IV/IO after if needed
dose of magnesium used to manage/prevent torsades in VF/VT arrest
1-2 g IV/IO for torsades