ADVANCED LIFE SUPPORT Cardiology Service of Hospital San Juan de Dios de La Plata Leonardo F.

Mancini Advanced CPR I - PRIMARY ABCD A - B Open air - Ventilation: Positive pressure ventilation - C Circulation: chest compressions D - Defibrillation unit: automatic or semiautom atic II - SECONDARY ABCD A - Airway: endotracheal intubation B - Ventilation: oxygen C - Circulation: EV-way - identify rhythm - appropriate drug D - Differential Di agnosis: search and treat reversible causes PCR â ¢ Forms of presentation: 1) VF / pulseless VT 2) Non VF / VT: PEA Asystole VF / pulseless VT Active Response Rate missing SEM primary ABCD basic CPR and defibrillation defib rillator Ask A - Airway B - Ventilation: 2 ventilations C - D Perform 15 chest c ompressions - defibrillator: evaluating FV / TV (200 - 200/300 - 360 J) Rhythm a fter 3 downloads FV / TV persistent or recurrent secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - Secure the ETT B - Confirm effec tive oxygenation and ventilation C - Estabezca via EV D - Differential Diagnosis : search and Epinephrine causes associated question 1 mg / 3-5 min single dose V asopressin 40 U defibrillator after 30-60 sec with 360 J defibrillation after 30 -60 sec with 360 J Dallas 2000 - AHA Antiarrhythmics Amiodarone (II b) Lidocaine (indeterminate) Consider Magnesium Buffers VF / pulseless VT Active Response Rate missing SEM primary ABCD quality basic CPR and defibrillati on defibrillator Ask A - Airway B - Ventilation: 2 ventilations C - D Perform 30 chest compressions - defibrillator: evaluating FV / TV 360 J (monophasic wavefo rm) and 120 - 200 J (biphasic) CPR between shocks (5 cycles = 2 min) FV / TV per sistent or recurrent secondary ABCD A - Intubate as soon as possible B - B Confi rm tube placement - Secure the ETT B - Confirm effective oxygenation and ventila tion C - Estabezca via EV D - Differential Diagnosis: search and try to causes a ssociated with Epinephrine 1 mg / 3-5 min single dose Vasopressin 40 U defibrill ator after 30-60 sec with 360 J defibrillation after 30-60 sec with 360 J 2005 Guidelines for CPR - AHA Antiarrhythmics Amiodarone (II b) Lidocaine (indeterminate) Consider Magnesium Buffers Defibrillation Clinical benefits of biphasic: â ¢ Efficacy equivalent to monophasic waveform, wit h no significant change in baseline dysfunction ST â ¢ Less post - Download â ¢ Less power with less arrhythmia post - Download â ¢ Evidence of improved performance w ith antiarrhythmic drugs â ¢ Evidence better performance with long-term PV Asystole ABC ABCD Focus on basic primary and defibrillation - Evaluate non-response - Act ivate the SEM - Ask defibrillator A - Airway: open airway B - Ventilation: posit ive pressure ventilation C - Start chest compressions C - Confirm asystole D - d

efibrillator: Evaluate VF / VT (200 - 200/300 - 360 J) * The 5 H: Hypothermia Hy poxia Hypovolemia Hyper / hypokalemia hydrogen ions (acidosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (pneumothorax) PTE secondar y ABCD A - Intubate as soon as possible B - B Confirm tube placement - Secure th e ETT B - Confirm effective oxygenation and ventilation C - Estabezca via EV C Identify rhythm monitor C - Medications appropriate for rhythm and condition D - Differential Diagnosis: search and try reversible causes Epinephrine 1 mg EV c / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum dos e: 0.04 mg / kg MCP transitory use it immediately if you have persistence of asy stole: continue or discontinue CPR ? Dallas 2000 - AHA Asystole Primary ABCD ABC Focus on basic quality and defibrillation - Evaluate non-respon se - Activate the SEM - Order defibrillator A - Airway: open airway B - Ventilat ion: positive pressure ventilation C - Start chest compressions C - Confirm asys tole D - defibrillators : assess FV / TV (360 J) * The 5 M: Hypoxia Hypovolemia hypothermia Hyper / hypokalemia hydrogen ions (acidosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (pneumothorax) PTE secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - Secure the ETT B - Confirm effective oxygenation and ventilation (CO2) C - Estabezca via EV C Identify rhythm monitor C - Medications appropriate for rhythm and condition D - Differential Diagnosis: search and treat causes Epinephrine 1 mg EV reversible w / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum d ose: 3 mg Persistence of asystole: continue or stop CPR? AHA - ACC 2005 AESP ABC ABCD Focus on basic primary and defibrillation - Evaluate non-response - Act ivate the SEM - Ask defibrillator A - Airway: open airway B - Ventilation: posit ive pressure ventilation C - D Begin chest compressions - defibrillator: evaluat ing FV / TV ( 200 - 200/300 - 360 J) * The 5 H: Hypothermia Hypoxia Hypovolemia Hyper / hypokalemia hydrogen ions (ac idosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (p neumothorax) TEP Secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - S ecure the ETT B - Confirm effective oxygenation and ventilation C - Estabezca vi a EV C - Identify rhythm monitor C - Medications appropriate for rhythm and cond ition * D - Differential Diagnosis: search for and treat reversible causes Epine phrine 1 mg EV c / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum dose: 0.04 mg / kg Dallas 2000 - AHA AESP Primary ABCD ABC Focus on basic quality and defibrillation - Evaluate non-respon se - Activate the SEM - Ask defibrillator A - Airway: open airway B - Ventilatio n: positive pressure ventilation C - D Begin chest compressions - defibrillator: evaluating FV / TV (360 J) * The 5 H: Hypothermia Hypoxia Hypovolemia Hyper / hypokalemia hydrogen ions (ac idosis) The 5 T: Tablets (drug) Coronary Thrombosis Cardiac tamponade Tension (p neumothorax) TEP Secondary ABCD A - Intubate as soon as possible B - B Confirm tube placement - S ecure the ETT B - Confirm effective oxygenation and ventilation C - Estabezca vi

a EV C - Identify rhythm monitor C - Medications appropriate for rhythm and cond ition * D - Differential Diagnosis: search for and treat reversible causes Epine phrine 1 mg EV c / 3-5 min single dose Vasopressin 40 U Atropine 1 mg EV c / 3-5 min Maximum dose: 3 mg 2005 Guidelines for CPR - AHA