ACLS: Adult Cardiac Arrest
Vasopressors (____________ and ________________) may improve the patient's chances for ROSC. A vasopressor should be given every 3-5 minutes during cardiac arrest.
(Epinephrine and Vasopressin)
The arrest rhythms include:
Asystole Pulseless Electrical Activity (PEA) Ventricular Fibrillation Pulseless Ventricular Tachycardia
2. Immediate intervention
Call code/Activate EMS Immediately begin CPR Establish an airway and administer Oxygen Attach monitor/defibrillator, establish rhythm
High-Quality CPR is
Compression rate greater or equal to 100/min Compress chest to depth of at least 2 inches Allow complete chest recoil Minimize interruptions Avoid hyperventilation Rotate compressor every 2 minutes to prevent fatigue
Continue to Evaluate, Identify and Intervene on underlying reversible causes. Use the H's and T's to identify the possible cause of arrest.
Hypovolemia -Treatment includes infusion of saline or lactated Ringer's solution. Hypoxia -Treatment should include airway management and effective ventilation and oxygenation. Hydrogen Ion excess (Acidosis) -Treatment should include hyperventilation and bolus of sodium bicarbonate. Hypoglycemia -Treatment includes bolus of dextrose. Hypokalemia - Treatment may include infusion of potassium. Hyperkalemia - Treatment may include calcium chloride, sodium bicarbonate, and glucose with insulin. Hypothermia - Treatment should include rewarming. Tension Pneumothorax - Treatment will include needle decompression or thoracostomy. Tamponade (Cardiac) - Treatment will be pericardiocentesis by experienced team member. Toxins - Treatment will be based on the specific overdose. Thrombosis (pulmonary embolus) - Treatment may include fibrinolytics or surgical embolectomy. Thrombosis (acute MI) - Consult cardiology.
4. PEA/Asystole
If it is determined at any time that the patient is in asystole or PEA, continue CPR, establish vascular access, administer Epinephrine 1 mg every 3-5 minutes. Consider Advanced Airway with ETCO2 monitoring Reevaluate the rhythm every 2 minutes and shock if the patient develops VT or VF. Continue to Evaluate, Identify and Intervene on underlying reversible causes. Use the H's and T's to identify the possible cause of arrest.
1. Establish unresponsiveness
In Cardiac arrest, the pulse cannot be felt, the patient is unresponsive, and respirations are absent or agonal.
3. Shockable Rhythm?
PEA/Asystole - NO Vfib or Vtach - YES
The goal of intervention in cardiac arrest is
Return of spontaneous circulation (ROSC).
Antiarrhythmics, particularly _______________________, may increase short term survival. If not available, __________________ may be used.
amiodarone; Lidocaine is the antiarrhythmic that can be administered through an ET tube.
5. Vfib or Vtach
immediately apply the pads and shock the patient with 120-200 Joules on a biphasic defibrillator or 360 Joules on a monophasic defibrillator. Continue CPR for 2 minutes while establishing IV or IO access. If the patient is still in VT or VF, shock again. Continue CPR for 2 minutes while giving Epinephrine 1 mg every 3-5 minutes. Consider Advanced Airway with ETCO2 monitoring If the patient is still in VT or VF, shock again. Continue CPR for 2 minutes while giving Amiodarone 300 mg bolus; may repeat with a 2nd dose of 150 mg bolus as needed. If amiodarone is not available, Lidocaine 1-1.5 mg/kg may be given followed by half doses ever 5-10 minutes to a maximum of 3 mg. Continue shocking any shockable rhythms.
For pulseless persistent torsades de pointes, _____________ ____________ may be given with a loading does of 1-2 gram over 5-20 minutes.
magnesium sulfate may be given with a loading does of 1-2 gram over 5-20 minutes. Magnesium should also be given in a case of known or suspected hypomagnesemia.