Management of a Patient with Cardiopulmonary Arrest. Flashcards
Cardiac arrest can be caused by…..
four rhythms, none of which generate significant forward movement of blood.
What are the 4 rhythms that cause cardiac arrest
(1) Pulseless Ventricular Tachycardia
(2) Ventricular Fibrillation
(3) Asystole: Absence of detectable ventricular activity (flat line).
(4) Pulseless Electrical Activity (PEA): Organized electrical rhythm, but absence of
mechanical ventricular activity sufficient to generate pulse.
Any of the 4 rhythms plus clinical correlation (pulseless) are indicative of what?
cardiopulmonary arrest.
If patient is awake and responsive, what do you do?
Check leads
After your rapid assessment your pt has no pulse what is your next step
start CPR immediately and call for AED or Defibrillator to assess rhythm.
determine Shockable or Non-Shockable
Should chest compressions be interrupted, the goal is to not exceed more than ____ in-between pauses
10 seconds
what are the shockable rhythms?
pulseless VT or pulseless VF
What is the algorithm for VT/VF
have fun…….
-Continue CPR until defibrillator available
-Deliver shock as soon as possible at the highest energy available
-Provide CPR for 2 minutes and obtain vascular access
-check pulse and rhythm for less than 10
seconds, switch chest compressors
-if rhythm is still shockable resume CPR and charge the defibrillator to deliver another shock
-Provide CPR for 2 minutes, administer Epinephrine 1mg IV push, consider advanced airway and capnography
-Shock!
-Provide CPR for 2 minutes, administer Amiodarone 300 mg IV push or Lidocaine 1-1.5 mg/kg IV push
-After 2 minutes of CPR then check pulse and rhythm for less than 10 seconds, switch chest compressors
-Shock!
-Repeat cycles of CPR, rhythm check, shock and medications as appropriate until the rhythm check reveals a nonshockable rhythm Return of Spontaneous Circulation (ROSC) is achieved or resuscitation is terminated.
resuscitation is terminated.
Following second round of medications then start to evaluate causes of cardiac arrest looking at H’s and T’s what are they?
1) Hypovolemia
2) Hypoxemia
3) Hydrogen ion excess (acidosis)
4) Hyper-/hypokalemia
5) Hypothermia
6) Hyper-/hypoglycemia
7) Tamponade
8) Tension Pneumothorax
9) Thrombosis (pulmonary embolism)
10) Thrombosis (myocardial infarction)
11) Toxins
For nonshockable rhythms what ias the algorithm
Repeat cycles of 2 minutes of CPR, epinephrine and rhythm check until
the rhythm check reveals a shockable rhythm, ROSC is achieved, or
resuscitation is terminated.
When ventilating during CPR you want to start at a rate of ___ breaths per min.
10
Post-Cardiac Arrest Care: Return of Spontaneous Circulation
-Establish (if not already done) cardiac monitoring, pulse oximetry, capnography, and noninvasive blood pressure monitoring or arterial pressure monitoring.
-Obtain 12 lead ECG and blood samples for laboratory testing expediently
-fluid bolus (1-2 liters of NS or LR solution).
-Initiate a vasopressor infusion.
Post-Cardiac Arrest Care: Return of Spontaneous Circulation
what vasopressors would you use?
(1 Norepinephrine infusion at 0.1-0.5 mcg/kg/min IV/IO OR
(2 Epinephrine infusion at 0.1-0.5 mcg/kg/min IV/IO OR
(3 Dopamine infusion at 5-10 mcg/kg/min IV/IO.
Suspicion of STEMI or suspected myocardial infarction
what temp would you maintain them at and for how long?
Maintain core body temperature 32-36 degrees Celsius for 24 hours
STEMI or suspected myocardial infarction
how can you cool your pt
Methods to cool the patient include: Ice-cold IV fluid bolus (30 ml/kg); Endovascular catheters; Surface-cooling strategies
