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Algorithms
Determinants of Survival
from
Cardiopulmonary Arrest
1) Time until Discovery
2) Time until implementation of ACLS
3) Precipitating Cause
4) Mechanism of the Arrest
Mechanism
of
Cardiopulmonary Arrest
Definition
PRIMARY MECHANISM
SECONDARY MECHANISM
(Post-Conversion)
Prognostic Implications
of
Cardiopulmonary Arrest
Impact of the INITIAL Mechanism on Prognosis
Prognosis
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- Best Px
- Intermediat Px
- Poorest Px
Prognosis
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Ventricular Fibrillation
(Initial approach)
Ventricular Fibrillation
Ventricular Fibrillation
Additional ANTIFIBRILLATORY
measures :
Magnesium Sulfate (1-2 g IV over 1-2 min; may repeat)
Bretylium Tosylate (500 mg by IV bolus; may follow
with 10 mg/kg/ IV bolus up to 30 mg/kg)
IV Propranolol (0.5-1 mg by slow IV - up to 5 mg)
Amiodarone (150-500 mg IV)
Ventricular Fibrillation
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Ventricular Tachycardia
Determine HEMODYNAMIC Status !
Is There a Pulse ?
If NO - treat as for VF (unsynchronized SHOCK @
200-360 j)
If there IS a pulse : Is Pt Hemodynamically STABLE?
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Ventricular Tachycardia
Definition of HEMODYNAMIC STABILITY
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Ventricular Tachycardia
Is Patient Hemodynamically STABLE ?
Patient UNSTABLE
Immediately CARDIOVERT
(with 100-200j)
Patient STABLE
Lidocain / Procainamide
Bretylium / Cardioversion
Other measures (IV etablocker, Magnesium
Sulfate)
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Bradyarrhythmias
Treatment depends on:
Clinical setting
Specific type of bradyarrhythmias
sinus bradycardia
Mobitz I
Mobitz II
Slow IVR
etc
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Bradyarrhythmias
Control AIRWAY / Optimize VENTILATION
( Use PRESSORS ONLY if all else fails ! )
CPR ( if Clinically indicated - if Pt NOT perfusing)
ATROPINE (0.5 - 1 mg IV; up to 2 mg)
PACEMAKER Therapy (Apply external pacemaker ASAP;
transvenous pacer if / when available
Temporizing Therapy ( = Pressors of YOURCHOICE ) Stopgap measures - until Pacemaker is available
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Asystole
EPINEPHRINE - and then MORE Epi .
CPR
EPINEPHRINE
Initially consider SDE ( 1 mg by IV or ET )
RAPIDLY increase dose ( to HDE ) if no response !
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Asystole
Be SURE to check rhythm in several leads to rule
out fine VF
REMEMBER you cant overdose on EPI - early
pacing may beneficial
Sodium Bicarb could (?) be considered if other
measures fail
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Electromechanical Dissociation
(EMD)
There is NO pulse !!!
ECG rhythm is seen, BUT it is NOT associated with
palpable mechanical activity
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Electromechanical Dissociation
(EMD)
FIND & CORRECT (if at all possible) the
UNDERLYING Cause of EMD !!!
CPR
EPINEPHRINE
Initially consider SDE ( 1 mg by IV or ET )
RAPIDLY increase dose ( to HDE ) if no response !
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And / or
ADENOSINE (6 mg by IV push). Follow with saline
flush. If no response in 1-2 min, give 12 mg - and then a
final 12 mg (if needed)
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PSVT
Try vagal maneuver
VERAPAMIL (3-5 mg initially; may give 5-10 mg IV in
15-20 min if no response)
May repeat vagal maneuver
Consider Calcium pre-treatment (500-1000 mg IV)
And / or
ADENOSINE (6 mg by IV push). Follow with saline
flush. If no response in 1-2 min, give 12 mg - and then a
final 12 mg (if needed)
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PSVT
Other measures
Sedation
Digoxin / IV -blocker / Cardioversion
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Sinus Tachycardia
MAT
AF / A Flutter
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AF / A Flutter
IV -Blocker
CARDIOVERSION (Use 200j for AF 50j for A Flutter)
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