Pulseless Arrest

Question 1

What is the first steps in assessment and action?

Answer 1

Pulse Check quickly <10s

Then – CPR, 100

Question 2

What do you do if you are solo?

Answer 2

First do 30 compressions, then perform the Head Tilt - Chin Lift and 2x breaths.
-Check for FB before breaths

Question 3

Why is it bad to do more than 10 breaths per minute on a CPR patient?

Answer 3

Increased intrathoracic pressure, decreases venous return to the heart, impairs cardiac output

Question 4

How do you know if a rhythm is shockable or not?

Answer 4

Shockable – Ventricular Fibrillation, Pulseless VT

Not Shockable – Pulseless Electrical Activity, Asystole

Question 5

If the monitor shows Asystole, what do you do next?

Answer 5

Do not shock, double check connections.
- Continue CPR 30:2
- Give Epi 1mg q3-5min (No Atropine)
After 5 cycles of CPR 30:2, check for rhythm/pulses

Question 6

What to do if there is no IV Access?

Answer 6

I/O Access

ET Tube administration of NAVEL (Narcan, Atropine, Vasopressin, Epi, Lidocaine)

Question 7

Whats the algorithim if pulseless electrician activity?

Answer 7

CPR (30:2), Epi q3-5min, After 5 Cycles Check rhythm and pulse. – Keep going with Epi until a reversal cause is found.

Question 8

What are causes and cures of PEA? (H-version)

Answer 8

The Six H’s

• Hypovolemia – IV Fluids
• Hypoxia – airway restoration
• H+ (Acidosis) - Bicarb and Hyperventilation
• Hyperkalemia - Insulin/Dextrose
• Hypoglycemia - Dextrose
• Hypothermia - Warming Core Body

Question 9

What are the causes and cures of PEA? (T-version)

Answer 9

• Toxins – Digoxin (Digibind), TCA (Bicarb), Betablocker (Glucagon)
• Tamponade - pericardiocentesis
• Tension Pneumothorax.. Thoracostomy
• Thrombosis – tPA
• Trauma

Question 10

What are the two shockable rhythms?

Answer 10

• Ventricular Fibrillation

- Pulseless Ventricular Tachycardia

Question 11

If you find a patient that has pulseless VTachy, what do you do first?

Answer 11

Start CPR until AED is charged and ready.

Question 12

What strength of shock is recommended if VFib rhythm?

Answer 12

360 J Monophasic

200 J Biphasic

Question 13

What is the key order of events in the algorhythm treatment for pulseless VTach?

Answer 13

CPR until AED charged to shock (360/200J)

– After Shock give 5x rounds of CPR before checking for the rhythm

Question 14

If there is a shockable rhythm and the patient has been shocked and CPR is continuing after no change in rhythm, what do you do next?

Answer 14

Continue CPR, Give 1mg Epi, CPR until AED is charged and ready. Shock Again.

Question 15

What do you give after the 1st Epi and 2nd Shock to a shockable rhythm?

Answer 15

300mg of IVB Amiodarone – Then do 5 rounds of CPR before checking for a rhythm

Question 16

What is the general rule for shockable rhythm algorithm?

Answer 16

CPR in 5x Cycle amounts before pulse checking – Alternate giving Epi and Antiarrhythmic (Amiodarone)

• Always 1mg Epi
• Amiodarone –300mg –>150mg

Question 17

If you shock a patient who is in cardiac arrest and their rhythm develops into Torsades de Pointes, what do you do?

Answer 17

IV Magneisum 2g over 5 minutes

– If pulseless or unstable patient shock

Question 18

Once the patient is back into NSR, what do you do?

Answer 18

Support BP with NS, give vasopressors to support pressure while myocardium recovers

• Check K+ and Mg+
• EKG
• Hypothermic protocol –> ICU

Question 19

How many breaths should the patient receive during the code?

Answer 19

Approximately 10x breaths. Too much = reduces venous return