What are the two shockable rhythms?
VF and pulseless VT
First step in adult cardiac arrest
Shout for help/activate emergency response
After activating emergency response… (3)
After starting CPR has started, check if they are in a shockable rhythm. If yes…
What are the two types of shock energy and what dose is given with each?
Biphasic - Manufacturer recommendation (120-200 J)
Monophasic - 360 J
What if the manufacturer recommendation is not known for defibrillator dose?
Use maximum available.
After initial shock… (2 things)
Immediately start CPR (2 minutes)
After 5 cycles of CPR, next step is to…
Conduct a rhythm check
The pause in chest compressions to check the rhythm should not exceed _______
If a nonshockable rhythm is present and the rhythm is organized (regular and narrow complexes), a team member should…
try to palpate a pulse
If there is any doubt about the presence of a pulse…
immediately resume CPR
If the rhythm is organized and there is a palpable pulse…
proceed to post-cardiac arrest care
When IV/IO access is available…
give a vasopressor during CPR
The two vasopressors that can be administered are…
Dose and timing of two vasopressors
Epinephrine - 1 mg IV/IO - repeat every 3 to 5 minutes
Vasopressin - 40 units IV/IO - may substitute for the first or second dose of epinephrine
What are the three antiarrhythmics to consider?
What is the dose given of Amiodarone?
300 mg IV/IO bolus, then consider an additional 150 mg IV/IO once
What is the dose given of Lidocaine? What is the maximum dose? When should Lidocaine be used?
1 to 1.5 mg/kg IV/IO first dose, then 0.5 to 0.75 mg/kg IV/IO at 5- to 10-minute intervals to a maximum dose of 3 mg/kg
Lidocaine should be used if Amiodarone is unavailable
When should Magnesium sulfate be used?
Only for torsades de pointes
What is the dose of Magnesium sulfate?
Loading dose 1 to 2 g IV/IO diluted in 10 mL of D5W given as IV/IO bolus, typically over 5 to 20 minutes
What are the two main things monitored by quantitative waveform capnography?
Optimize chest compressions
Detect ROSC during chest compressions
What is the main determinant of PETCO2 during CPR?
Blood delivery to the lungs
Persistently low PETCO2 values below _____ during CPR suggest ROSC is unlikely
10 mm Hg
If PETCO2 abruptly increases to a normal value of ____ to ____, it is likely to consider this an indicator of ROSC
35 to 40 mm Hg
Coronary Perfusion Pressure or Arterial Relaxation Pressure correlate with _____ and ______
Myocardial blood flow and ROSC
If the arterial relaxation pressure is below _______ it is reasonable to try to improve __________ or _________
20 mm Hg
Normal range for central venous oxygen saturation is ____ to ____.
If SCVO2 is less than _____ it is reasonable to try to improve chest compressions and vasopressor therapy
60% to 80%