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Rhythms associated with cardiac arrest are divided into two categories: indication for defibrillation rhythms (FV / TV no pulse) and rhythm without indication of defibrillation (asistola and pulsless electrical activity ) The main difference in management of both groups is the need for defibrilation in patients with FV / TV. Subsequent maneuvers including chest compression, airway management and ventilation, venous access, administration of epinephrine, identification and correction of potentially reversible causes, are common.
The most common onset of cardiac arrest rhythm is FV. Once confirmed cardiac arrest, is called support (including defibrillator) and CPR to initiate chest compressions followed by ventilation in 30:2 ratio. Apply padels and evaluate rhythm. If confirmed rate FV / TV load defibrillator and is given a single electric shock (150-200J two-phase or 360J monophasic). Immediately after the shock, without review pulse rate recommence CPR (30:2). Whatever the outcome rhythm is immediately after shock, CPR will be resumed and carried out for 2 minutes compression and ventilation!
CPRcontinues for 2 minutes, followed by checking the monitor: if all FV / TV applies second electric shock (200J two-phase or 360J monophasic). CPR resume immediately after the second shock for 2 minutes, followed by a brief pause to check the monitor: if the rate shown is all FV / TV, adrenaline is administered immediately followed by the third electric shock (200J two-phase or single phase 360J ) and the resumption of CPR Adrenaline is adm. 1 mg. before the third shock, A - shock - CPR 2 min then check rhythm on the monitor!
If FV / TV persists after the third electric shock administered a bolus of 300mg IV amiodarone ( a second dose of 150 mg). If the assessment made at 2 minutes after the administration of a shock, is currently a pace compatible with life, check central pulse. If the pace is change in one non-shockable (asystole or PEA) applies the protocol. Whatever the rhythm is adrenaline 1mg given on 3-5 minutes to restore blood circulation spontaneous; Adrenaline is given every 2 cycles CPR!
1 Xilina 1mg/kgc bolus, may repeat after 3-5 minutes, then infusion of 1-2 mg / min up to maximum dose of 3 mg/kgc/24h. Never manage xilina together or by amiodarone, it manages a single antiarrhythmic ! 2 Magnesium
Asystola , PEA
PEA is defined as cardiac electrical activity organized and the central pulse absent. PEA is often induced by reversible condition, identification and correction of these conditions are necessary. Survival after cardiac arrest by asystola or PEA is unlikely that these reversible causes are not identified and treated correctly. If the initial rhythm is PEA or asystola begin CPR with chest compressions and ventilation in relation to 30:2 and administer epinephrine 1mg.
3mg atropine is administered (the dose ensure maximum vagal blockade) the rate shown is asystola or PEA with low frequency <60/minute. After 2 minutes of CPR is reassessing the rhythm; asystola persists or if there is no change in the electrical aspect of AEP from the initial monitoring CPR is immediately resume. If a rhythm is displayed organized search the central pulse , in the absence of central pulse continues CPR with administration of adrenaline on every 3-5 minutes(2 CPR cycles ). If the pace is change during CPR from asystola or PEA to FV / FV apply protocol described above.
REVERSIBLE POTENTIAL CAUSES
The 4 H • Hypoxia can be avoided by ventilation with 100% O2; • Hypovolemia, a frequent cause of AEP, is usually induced by a severe haemorrhage. It requires rapid replacement of intravascular volume loss associated with surgical bleeding control. • Hyperkalaemia, hypokalaemia . • Hypothermia can be suggested by the clinical context before measurement of central temperature
The 4 T
needed is a rapid decompression on needle and inserting a chest drain. • Cardiac Tamponade: typical signs are hypotension and distended jugulars, signs may be masked by cardiac arrest itself. CA produced by penetrating chest trauma is highly suggestive of cardiac tamponade and is indicated by the needle pericardiocentesys or toracotomy . • Toxic: if no specific history of accidental or voluntary ingestion of toxic substances or drugs, certainty diagnostic is determined only by laboratory tests. When its possible, administer the antidote.
• Tension pneumothorax: therapeutic attitude that is
• massive pulmonary or coronary thrombosis