Cardiac Arrest Algorithm

Question 1

First actions to perform when a patient is found down

Answer 1

1. BLS Scene Safe, NOI/MOI, C-Spine, # patients, resources needed
2. Check for responsiveness
3. Open airway and check for breathing and FBO
4. Feel for carotid pulse
5. If no pulse begin CPR

Question 2

What is the next priority after you initially begin CPR?

Answer 2

Put the pt on the monitor (paddles and 4 lead), stop CPR to check the rhythm, if VF or pulseless VT shock it, immediately resume CPR

Question 3

After the initial rhythm check, when do you check a rhythm?

Answer 3

After each 2 min (5 cycles) of CPR

Question 4

What do you do if at your rhythm check you see VF?

Answer 4

Shock followed by 2 min of CPR and either a pressor or an antidysrhythmic

Question 5

What do you do if at your rhythm check you see VT?

Answer 5

Check pulses.
Pulseless - deliver shock, begin 2 min CPR, give either pressor or antidysrrhythmic
Pulsed - go to ROSC algorithm

Question 6

What is the drug administration order for VF/pulseless VT?

Answer 6

Alternate pressor every 3-5 min with antiarrhythmic

1. Pressor
   a. Epi - 1mg 1:10,000
   b. Vasso - 40 units
2. Antidysrrithmic
   a. Amio - 1st dose 300mg, 2nd dose 150mg
   b. Lido - 1st dose 1-1.5mg/kg, repeat doses .5-.75mg/kg every 5-10 min, max total dosage <= 3mg/kg
   c. Mag - 2g diluted in 10ml of NS or D5W pushed over 5-20 min

Question 7

During CPR what are you additional considerations to get ROSC other than shocks and drugs?

Answer 7

H’s and T’s
Hypovolemia, Hypoxia, Hydrogen Ion, Hypoglycemia, Hypo/Hyperkalemia, Hypothermia
Tension pneumothorax, Tamponade cardiac, Toxins, Thrombosis (cardiac, pulmonary)

Question 8

What do you do if you get an organized rhythm immediately following a shock delivery?

Answer 8

2 min of CPR followed by rhythm check and if rhythm is still organized then follow ROSC algorithm

Question 9

What is the bpm rate and compression rate for CPR without advanced airway?
With advanced airway?

Answer 9

1. 30:2, >100/min

2. 8-10 bpm, >100/min with no pause in compressions

Question 10

What are your first signs of ROSC?

Answer 10

1. Return of a pulse and organized rhythm
2. BP
3. Abrupt rise in ETCO2 (typically >40)

Question 11

During CPR if you have ETCO2 < 10 what should you attempt?

Answer 11

Improve quality of CPR, consider slowing RR slightly

Question 12

What are your priority considerations after ROSC?

Answer 12

Optimize ventilation and oxygenation

1. O2 sat > 94%
2. Consider advanced airway and capnometry
3. Do not hyperventilate
4. Maintain SBP >90

Question 13

In ROSC, after ventilation and oxygenation has been optimized, what is you next consideration?

Answer 13

Treat hypotension < 90 SBP

1. IV Fluid bolus (even if wet lung sounds)
2. Vasopressor infusion
   a. Epi - .1-.5 mcg/kg/min (70kg adult = 7-35mcg/min)
   b. Dopamine - 5-10 mcg/kg/min
   c. Norepi - .1-.5 mcg/kg/min (70kg adult = 7-35mcg/min) same as epi

Question 14

In ROSC, after ventilations and oxygenation and hypotension have been addressed, what are you next considerations?

Answer 14

Treat H’s and T’s
Hypovolemia, Hypoxia, Hydrogen Ions, Hypoglycemia, Hyper/Hypokalemia, Hypothermia, Tension pneumo, Tamponade, Toxins, Thrombosis (pulmonary, cardiac)

Question 15

If pt is unable to follow commands after ROSC what is the next course of action?

Answer 15

Consider hypothermia protocol

Question 16

After ROSC, obtain a 12 lead to look for …

Answer 16

STEMI and initiate MONA protocol if indicated (coronary perfusion)

Question 17

4 criteria for terminating CPR in the field

Answer 17

Non-witnessed arrest
No bystander CPR
No ROSC after complete ALS care
No shocks administered up