ADULT POST–CARDIAC ARREST CARE ALGORITHM
Assess appropriateness for clinical condition.
ROSC Obtained
es/Details
Dos
Manage airway
Early placement of endotracheal tube
Initial Stabilization Phase
• Airway management:
Manage respiratory parameters
Waveform capnography or
Start 10 breaths/min
capnometry to confirm and monitor
SPO2 92% to 98% endotracheal tube placement
PaCO2 35 to 45 mm Hg • Manage respiratory parameters:
Titrate FIO2 for Spo2 92% to 98%;
Manage hemodynamic parameters start at 10 breaths per min; titrate to
PaCO2 of 35 to 45 mm of mercury
Systolic blood pressure > 90 mm Hg
• Manage hemodynamic parameters:
Mean arterial pressure > 65 mm Hg
Administer crystalloid and/or
vasopressor or inotrope for goal
systolic blood pressure greater than
Obtain 12-lead ECG 90 mm of mercury or mean arterial
pressure greater than 65 mm of
mercury
Continued Management and
Consider for emergent cardiac intervention if Additional Emergent Activities
- STEMI present These evaluations should be done
- Unstable cardiogenic shock. concurrently so that decisions on
targeted temperature management
- Mechanical circulatory support required.
(TTM) receive
high priority as cardiac interventions.
• Emergent cardiac intervention:
Early evaluation of 12-lead
Follows commands?
electrocardiogram (ECG); consider
hemodynamics for decision on
NO YES
cardiac intervention
Comatose Awake • TTM: If patient is not following
• TTM Other critical care commands, start TTM as soon as
• Obtain brain CT management. possible; begin at 32 to 36 degrees
• EEG monitoring Celsius for 24
hours by using a cooling device with
• Other critical care
feedback loop
management • Other critical care management
– Continuously monitor core
temperature (esophageal, rectal,
bladder)
Evaluate and treat rapidly reversible etiologies – Maintain normoxia, normocapnia,
Involve expert consultation for continued management euglycemia
– Provide continuous or intermittent
electroencephalogram (EEG)
monitoring
– Provide lung-protective ventilation
H’s and T’s
ADULT BRADYCARDIA ALGORITHM
Assess appropriateness for clinical conditions.
Heart rate typically <50/min if bradyarrhythmia.
Identify and treat underlying causes
- Maintain patent airway; assist breathing as necessary
- Oxygen ( if hypoxemic )
- Cardiac monitor to identify rhythm; monitor blood
pressure and oximeter
- IV access
- 12 lead ECG if available; don't delay therapy
- Consider the possible hypoxic and toxicologic causes
Persistent
bradyarrhythmia causing:
NO - Hypotension?
- Acutely altered mental status?
- Signs of shock?
- Ischemic chest discomfort?
- Acute heart failure?
YES
Monitor and Observe
Atropine
If atropine is ineffective:
- Transcutaneous pacing
and/or
- Dopamine infusion
or
- Epinephrine infusion
Consider:
- Expert Consultation
- Transvenous pacing
es/Details
Dos
Atropine IV dose:
First dose: 1 mg bolus.
Repeat every 3-5 minutes.
Maximum: 3 mg.
Dopamine IV infusion:
Usual infusion rate is
5-20 mcg/kg per minute.
Titrate to patient response;
taper slowly.
Epinephrine IV infusion:
2-10 mcg per minute infusion.
Titrate to patient response.
Causes:
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
calcium-channel blockers,
beta blockers, digoxin)
• Hypoxia
• Electrolyte abnormality
(eg, hyperkalemia)
ADULT TACHYCARDIA WITH A PULSE ALGORITHM
Heart rate typically ≥150/min if tachyarrhythmia.
Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood
pressure and oximetry
• IV access
• 12-lead ECG, if available
• Vagal maneuvers (if regular)
• Adenosine (if regular)
Persistent
• β-Blocker or calcium channel blocker
tachyarrhythmia causing:
• Consider expert consultation
• Hypotension?
• Acutely altered mental status?
NO
• Signs of shock?
• Ischemic chest discomfort? NO Wide QRS?
• Acute heart failure?
≥0.12 second
YES YES
Synchronized cardioversion Consider
• Consider sedation • Adenosine only if
• If regular narrow complex, regular and monomorphic
consider adenosine • Antiarrhythmic infusion
• Expert consultation
If refractory, consider
• Underlying cause
• Need to increase energy level
for next cardioversion
• Addition of anti-arrhythmic drug
• Expert consultation
Doses/Details Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
Procainamide IV dose:
Synchronized cardioversion: 20-50 mg/min until arrhythmia suppressed, hypotension ensues,
Refer to your specific device’s QRS duration increases >50%, or max dose 17 mg/kg given.
recommended Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
energy level to max first shock success. Amiodarone IV dose:
Adenosine IV dose: First dose: 150 mg over 10 min. Repeat as needed if VT recurs.
First dose: 6 mg rapid IV push; follow Follow by maintenance infusion of 1 mg/min for first 6 hours.
with NS flush. Sotalol IV dose:
Second dose: 12 mg if required. 100 mg (1.5 mg/kg) over 5 min. Avoid if prolonged QT.
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ADULT CARDIAC ARREST ALGORITHM

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DOSES/DETALS FOR CARDIAC ARREST ALGORITHM

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Cardiac Rhythms

Lif

ion
1 Start CPR PA N
CPR Quality KISTA
• Give oxygen • Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow
• Attach monitor/defibrillator complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
YES NO
Rhythm shockable? • Change compressor every 2 minutes, or sooner if fatigued.
• If no advanced airway, 30 to 2 compression-ventilation ratio.
9 • Quantitative waveform capnography
2
VF/pVT Asystole/PEA -If PETCO2 is low or decreasing, reassess CPR quality. Normal Sinus Rhythm
Shock Energy for Defibrillation
3 Shock Epinephrine • Biphasic: Manufacturer recommendation (eg, initial dose of 120-200
ASAP Joules); if unknown, use maximum available. Second and subsequent doses
4 should be equivalent, and higher doses may be considered.
CPR 2 minutes 10 CPR 2 minutes
• IV/IO access • IV/IO access • Monophasic: 360 Joules
• Epinephrine every 3 to 5 minutes. Drug Therapy
• Epinephrine IV/IO dose: 1 milligram every 3 to 5 minutes
Mono Morphic Ventricular Tachycardia
• Consider advanced airway,
NO capnography • Amiodarone IV/IO dose: First dose: 300 mg bolus. Second dose: 150mg.
Rhythm shockable?
OR
YES Lidocaine IV/IO dose: First dose: 1-1.5 mg per kg. Second dose: 0.5-0.75
5 Shock YES
Rhythm shockable? mg per kg.

6 NO Advanced Airway
CPR 2 minutes 11
• IV/IO access • Endotracheal intubation or supraglottic advanced airway. Ventricular Fibrillation
CPR 2 minutes. • Waveform capnography or capnometry to confirm and monitor ET tube
• Epinephrine every 3 to 5 minutes.
• Consider advanced airway,
• Treat reversible causes. placement.
capnography • Once advanced airway in place, give 1 breath every 6 seconds (10 breaths
per minute) with continuous chest compressions
NO Rhythm shockable?
Rhythm shockable? Return of Spontaneous Circulation (ROSC)
NO YES • Pulse and blood pressure.
YES • Abrupt sustained increase in PETCO2 (typically greater than or equal to 40 Atrial Fibrillation
7 Shock mm of mercury)
• Spontaneous arterial pressure waves with intra-arterial monitoring.
8 CPR 2 minutes
• Amiodarone or lidocaine. Reversible Causes
• Treat reversible causes. • Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
12
• Hypo-/hyperkalemia Atrial Flutter
• If no signs of return of Go to 5 or 7 • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
spontaneous circulation
(ROSC), go to Box 10 or Box 11
• If ROSC, go to Post–Cardiac
Arrest Care
• Consider appropriateness of LIFESAVERS FOUNDATION PAKISTAN
continued resuscitation (+92-51) 8493015 lifesaversfoundation@gmail.com lifesaverspaksitan.com
Supraventricular Tachycardia