Pre – Arrest

VOMIT
Visualize: Objective assessment
Verbalize: Good Morning, I’m… How are you?
Vital Signs: HR, BP, RR, SPO2, Temp

Oxygen Support – SPO2 <94 NC 2-4

FM 6-10
NRM 11-15

Monitor - Pads on chest, Identify rhythm “I want a strip”

I IV/IO Peripheral Vein preferably antecubital vein, R then L, if unsuccessful, use IO

IO sites – distal femur, proximal tibia, distal tibia, superior anterior iliac spine

Treatment
SLOW
Sinus Bradycardia w/ bp >90/60 = observed ‘coz hemodynamically stable
Sinus Bradycardia w/ bp <90/60
Atropine 0.5mg max of 3 mg (6 dose) q3-5mins
Transcutaneous Pacing (TCP) press 80 as heart beat, mamp at 40-50
Dopamine drip 2-10 mkg/kg/min
Epinephrine 2-10 mcg/min

FAST
Tachy cardic (SVT/VTach with pulse) w/ bp >90/60
Physiologic
Vagal maneuvers 1.carotid massage *not for 60 and above (5-10 secs of massage) 2.encourage patient
to cough
Pharmacologic
Adenosine – fast bolus 6mg/12mg/12mg q3-5 mins * give w/in 10 mins

Tachy cardic (SVT/VTach with pulse) w/ bp <90/60

Sedate Diazepam, Midazolam, Etomidate, Propofol
Synchronize Cardioversion
50 joules SVT/A.Flutter
100 joules Vtach
12 joules A fib
 ARREST
1. Hard with depth of 2 inch/5cm
2. Fast with atleast 100 compressions per minute
3. I want a complete chest recoil
4. Limit interruption to chest compression on no more than 10 seconds
5. Avoid excessive ventilation
PETCO >10mmHg
Ratio 30:2

I want a strip!

Shockable (Vfib, Pulseless Vtach)

Class 1 HQ CPR
Class 2A 360 J 2 minutes
Class 2B No Meds

Stop...Analyze...Switch
(Vfib, Pulseless Vtach)
Class 1 HQ CPR
Class 2A 360J 2 minutes
Class 2B Epi 1 mg
1:10 dilution followed by 20 ml flush of PNSS- Alpha adrenergic

Stop...Analyze...Switch
(Vfib, Pulseless Vtach)
Class 1 HQ CPR
Class 2A 360 J
Class 2B Amiodarone 300 mg
Anti arrhythmic Class 4 1.Na, 2. Ca 3. K, 4. Beta BLOCKER

Unshockable (Asystole, PEA)

Class 1 HQ CPR
Class2 no shock
Class 2b Epi 1mg q 3-5 min

Treat underlying Cause (H’s and T’s)

Hypovolemia,
Hypoxia, Hydrogen ion (acidosis),
Hyper-/hypokalemia,
Hypothermia.

Toxins,
Tamponade(cardiac),
Tension pneumothorax,
Thrombosis (coronary and pulmonary)
 Post Arrest
C
+ Pulse Fluid Therapy
1-2 L PNSS/PLRS IV bolus
Inotropes
Dopamine 10mcg/kg/min
Epi 2-10 mcg/min
Norepi 2-10 mcg/min
BP ^

AB
(-) Spon Breathing

Advance Airway (ET Tube) Bag every 6-8 secs

1. 5-point auscultation
2. Qualitative colormetric device (Yellow – in)
3. Quantitative (Continuous Waveform) Capmography. PetCO2 35-45mmHg

D (-response) GCS 3
INDUCE THERAPEUTIC HYPOTHERMIA

300cc/kg PNSS/PLRS @ 4C
Run at 12-24 H to maintain body temp of32-34C – use esophageal thermometer

NGT

Portable CXR 12-Lead ECG

IFC

REFER TO INTENSIVIST