CARDIAC ARREST / COLLAPSED PATIENT

TIME IV line AED CPR Airway Scriber

00:00 Prepare IV/IO access Get CRASH TROLLEY/ AED Assess patient Response Get BAG VALVE MASK Write Patient Details
Blood Ix: Check Breathing Time the event
ABG/VBG Check Pulse (remind every 2 minutes)
RP
Cardiac enzyme
Urine toxicology
Vital signs:
BP
Temp (OC) If no pulse,
Dextrostix Start CPR ASAP,
HR, RR Apply ECG ASAP COUNT LOUND AND CLEAR Give Ventilation (30:2) Jot down every details
When ECG attached, STOP all activities and CHECK PULSE & ASSESS RHYTHM,
Shock only when VF & PULSELESS VT! PEA & ASYSTOLE continue CPR
Shock energy:
Monophasic 360J
Biphasic 120-200J
Presumably after first shock,
00:02 Check Blood Ix Restart CPR Ventilation Record details & time
Prepare 1mg Adrenaline Time of shock
Drug given
Ix result
00:04 ASSESS RHYTHM & SHOCK CHECK PULSE
Presumably after second shock,
Check Blood Ix Restart CPR Ventilation Record details & time
Administer 1mg Time of shock
Adrenaline during CPR Drug given
Prepare Ix result
1mg Adrenaline
300mg Amiodarone
(refractory VF/VT)
00:06 ASSESS RHYTHM & SHOCK CHECK PULSE
Presumably after third shock,
Check Blood Ix Restart CPR Ventilation Record details & time
Administer 1mg Time of shock
Adrenaline during CPR Drug given
Prepare Ix result
1mg Adrenaline
150 mg Amiodarone
00:08 ASSESS RHYTHM & SHOCK CHECK PULSE
Presumably after third shock,
Check Blood Ix Restart CPR & Ventilation Record details & time
Administer 1mg Time of shock
Adrenaline during CPR Drug given
Prepare Ix result
1mg Adrenaline Switch role if necessary
00:10 ASSESS RHYTHM & SHOCK CHECK PULSE
Presumably after forth shock, if intubation is required,
Check Blood Ix Restart CPR Ventilation Record details & time
Administer 1mg Prepare intubation set Time of shock
Adrenaline during CPR Drug given
Prepare Ix result
1mg Adrenaline
00:12 ASSESS RHYTHM & SHOCK CHECK PULSE INTUBATE IN LESS THAN
10SEC OR STOP!
Presumably after fifth shock and intubation successful,
Check Blood Ix CPR continuously for 2min Give a breath every 6sec Record details & time
Administer 1mg Get time from scriber Time of shock
Adrenaline during CPR Drug given
Prepare Ix result
1mg Adrenaline REMIND EVERY 2 MINUTES
The above sequence is repeated every 2 minutes, until
Return of Spontaneous Circulation (ROCS)
Stop the resuscitation, discuss with patients family

RETURN OF SPONTANEOUS CIRCULATION (ROCS)

TIME IV line AED CPR Airway Scriber
Treat hypotension (SBP<90) Repeat ECG Maintain SpO2 >94% Write Patient Details
20ml/kg bolus NS Assess Rhythm Time the event
Vasopressor
Noradrenaline IV
0.1-0.5mcg/kg/min
Adrenaline IV
0.1-0.5mcg/kg/min
Dopamine IV
5-10mcg/kg/min Inotropes
If no neurological recovery, Dobutamine IV
Induced hypothermia 2.5-15mcg/kg/min
(4OC fluid during bolus) Jot down every details
 TACHYCARDIA (150BPM) BRADYCARDIA (<50BPM)
STABLE UNSTABLE STABLE UNSTABLE
Vagal maneuvers (Carotid sinus Hypotension? Refer Cardiologist Hypotension?
massage) 5-10min Acute altered mental state? Acute altered mental state?
IV Adenosine Signs of shock? DONE Signs of shock?
Adenosine IV can be given 3 dose max Ischemic chest discomfort? Ischemic chest discomfort?
(6mg, 12mg, 12mg), short T1/2 Acute heart failure? Acute heart failure?
Rapid IV push with 10-20ml NS @
antecubital fossa/large veins Tx for unstable bradycardia:
Patient will anticipate DIZZINESS and Atropine IV 0.5mg bolus, repeat every 3-5min, maximum 3mg
feeling of heart stop for a moment Dopamine IV 2-10mcg/kg/min
Adrenaline 2-10mcg/min
Transcutaneous pacemaker (TCP) DONE
Tx for unstable tachycardia:
Medical treatment (IV Adenosine)
Mechanical treatment (Synchronized Cardioversion)
Before synchronized cardioversion was given, patient should be given:
Midazolam (1mg IV every 3-5min up to sedation/maximum 5mg cumulative dose) and
Fentanyl (50mcg increments)
Narrow regular (SVT) Narrow irregular (AF) Wide regular (VT)
50-100J Monophasic 200J 100J
Biphasic 120-200J