Cardiac Arrest VF/Pulseless VT Learning Station Checklist

Transcription

1 Cardiac Arrest VF/Pulseless VT Learning Station Checklist VF/VT 00 American Heart Association Adult Cardiac Arrest Shout for Help/Activate Emergency Response Epinephrine every - min Amiodarone Start CPR Give oxygen Attach monitor/defibrillator 0 9 If no signs of return of spontaneous circulation (ROSC), go to 0 or If ROSC, go to Post Cardiac Arrest Care Asystole/PEA Epinephrine every - min Go to or CPR Quality Push hard ( inches [ cm]) and fast ( 00/min) and allow complete chest recoil Minimize interruptions in Avoid excessive ventilation Rotate compressor every minutes If no advanced airway, 0: compressionventilation ratio Quantitative waveform If Petco <0 mm Hg, attempt to improve CPR quality Intra-arterial pressure If relaxation phase (diastolic) pressure <0 mm Hg, attempt to improve CPR quality Return of Spontaneous Circulation (ROSC) Pulse and blood pressure Abrupt sustained increase in Petco (typically 0 mm Hg) Spontaneous arterial pressure waves with intra-arterial monitoring Energy Biphasic: Manufacturer recommendation (eg, initial dose of 0-00 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered. Monophasic: 0 J Drug Therapy Epinephrine IV/IO Dose: mg every - minutes Vasopressin IV/IO Dose: 0 units can replace first or second dose of epinephrine Amiodarone IV/IO Dose: First dose: 00 mg bolus. Second dose: 0 mg. Advanced Airway Supraglottic advanced airway or endotracheal intubation Waveform to confirm and monitor ET tube placement -0 breaths per minute with continuous chest

2 Cardiac Arrest PEA/Asystole Learning Station Checklist VF/VT Epinephrine every - min Amiodarone 00 American Heart Association Adult Cardiac Arrest Shout for Help/Activate Emergency Response Start CPR Give oxygen Attach monitor/defibrillator 0 9 If no signs of return of spontaneous circulation (ROSC), go to 0 or If ROSC, go to Post Cardiac Arrest Care Asystole/PEA Epinephrine every - min Go to or CPR Quality Push hard ( inches [ cm]) and fast ( 00/min) and allow complete chest recoil Minimize interruptions in Avoid excessive ventilation Rotate compressor every minutes If no advanced airway, 0: compressionventilation ratio Quantitative waveform If Petco <0 mm Hg, attempt to improve CPR quality Intra-arterial pressure If relaxation phase (diastolic) pressure <0 mm Hg, attempt to improve CPR quality Return of Spontaneous Circulation (ROSC) Pulse and blood pressure Abrupt sustained increase in Petco (typically 0 mm Hg) Spontaneous arterial pressure waves with intra-arterial monitoring Energy Biphasic: Manufacturer recommendation (eg, initial dose of 0-00 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered. Monophasic: 0 J Drug Therapy Epinephrine IV/IO Dose: mg every - minutes Vasopressin IV/IO Dose: 0 units can replace first or second dose of epinephrine Amiodarone IV/IO Dose: First dose: 00 mg bolus. Second dose: 0 mg. Advanced Airway Supraglottic advanced airway or endotracheal intubation Waveform to confirm and monitor ET tube placement -0 breaths per minute with continuous chest

3 Immediate Post Cardiac Arrest Care Learning Station Checklist Adult Immediate Post Cardiac Arrest Care Consider induced hypothermia Coronary reperfusion Return of Spontaneous Circulation (ROSC) Optimize ventilation and oxygenation Maintain oxygen saturation 9% Consider advanced airway and waveform Do not hyperventilate Treat hypotension (SBP <90 mm Hg) IV/IO bolus Vasopressor infusion Consider treatable causes -Lead ECG Follow commands? STEMI high suspicion of AMI Advanced critical care Ventilation/Oxygenation Avoid excessive ventilation. Start at 0- breaths/min and titrate to target Petco of -0 mm Hg. When feasible, titrate Fio to minimum necessary to achieve Spo 9%. IV Bolus - L normal saline or lactated Ringer s. If inducing hypothermia, may use C fluid. Epinephrine IV Infusion: mcg/kg per minute (in 0-kg adult: - mcg per minute) Dopamine IV Infusion: -0 mcg/kg per minute repinephrine IV Infusion: mcg/kg per minute (in 0-kg adult: - mcg per minute) 00 American Heart Association

4 Bradycardia Learning Station Checklist Adult Bradycardia (With Pulse) Assess appropriateness for clinical condition. Heart rate typically <0/min if bradyarrhythmia. Identify and treat underlying cause Maintain patent airway; assist breathing as necessary Oxygen (if hypoxemic) Cardiac monitor to identify rhythm; monitor blood pressure and oximetry IV access -Lead ECG if available; don t delay therapy Monitor and observe Persistent bradyarrhythmia causing: Hypotension? Acutely altered mental status? Signs of shock? Ischemic chest discomfort? Acute heart failure? Atropine If atropine ineffective: Transcutaneous pacing Dopamine infusion Epinephrine infusion Atropine IV Dose: First dose: 0. mg bolus Repeat every - minutes Maximum: mg Dopamine IV Infusion: -0 mcg/kg per minute Epinephrine IV Infusion: -0 mcg per minute Consider: Expert consultation Transvenous pacing 00 American Heart Association

5 Tachycardia Learning Station Checklist Adult Tachycardia (With Pulse) Assess appropriateness for clinical condition. Heart rate typically 0/min if tachyarrhythmia. Identify and treat underlying cause Maintain patent airway; assist breathing as necessary Oxygen (if hypoxemic) Cardiac monitor to identify rhythm; monitor blood pressure and oximetry Persistent tachyarrhythmia causing: Hypotension? Acutely altered mental status? Signs of shock? Ischemic chest discomfort? Acute heart failure? Wide QRS? 0. second IV access and -lead ECG if available Vagal maneuvers Adenosine (if regular) ß-Blocker or calcium channel blocker Consider expert consultation Synchronized cardioversion Consider sedation If regular narrow complex, consider adenosine IV access and -lead ECG if available Consider adenosine only if regular and monomorphic Consider antiarrhythmic infusion Consider expert consultation 00 American Heart Association Synchronized Cardioversion Initial recommended doses: Narrow regular: 0-00 J Narrow irregular: 0-00 J biphasic or 00 J monophasic Wide regular: 00 J Wide irregular: defibrillation dose (NOT synchronized) Adenosine IV Dose: First dose: mg rapid IV push; follow with NS flush. Second dose: mg if required. Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia Procainamide IV Dose: 0-0 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >0%, or maximum dose mg/kg given. Maintenance infusion: - mg/min. Avoid if prolonged QT or CHF. Amiodarone IV Dose: First dose: 0 mg over 0 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of mg/min for first hours. Sotalol IV Dose: 00 mg (. mg/kg) over minutes. Avoid if prolonged QT.