Spreading Emergency Medicine Across the Globe ..
emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Qualities for a Good CPR
Chest compression ratio | 30:2 |
chest compression rate | 100 -120/minute . (AHA 2015 ) |
Depth | 2 inches (5cm ) to 2.4 inches (6cm) |
Ventilation | 2 breaths after 30 compressions, each breath delivered for 1 second |
Advanced Airway : 1 breath every 6 seconds | |
Interruption | <10 seconds |
In intubated patients, failure to achieve an ETCO2 of greater than 10 mmHg by waveform capnography after 20 minutes of CPR may be considered as one component of a multimodal approach to decide when to end resuscitative efforts but should not be used in isolation.
Vasopressin offers no advantage over adrenaline in cardiac arrest . Hence vasopressin is removed from ACLS 2015.
Post Cardiac Arrest Care
Emergency Coronary angiography is recommended for all with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected.
All comatose adult patients with ROSC after cardiac arrest should have Targeted Temperature Management with target temperature between 32 – 36C selected and achieved, then maintained constantly for at least 24 hours.
All patients who are resuscitated from cardiac arrest but who subsequently progress to death or brain death should be evaluated as potential organ donor.
REVERSIBLE CAUSES
|
|
DRUGS
Epinephrine 1mg IV/IO every 3 to 5 min.
Amiodarone for VF & pulseless VT (Arrest)
300mg IV/IO ; Second dose of 150mg IV/IO can be given after 3 to 5min.
Lidocaine
1 – 1.5mg/kg IV/IO ; Repeat a dose of 0.5- .75mg/kg IV after 5 -10 min if indicated to a maximum of 3mg/kg.
Magnesium
2gm IV in 10ml of 5% D over 5-20 min .Only if torsdes pointes is present.
Epinephrine , vasopressin, lidocaine, atropine & naloxone can be given via ET at dose 2-2.5 times the IV dose diluted in 5-10ml of sterile water or NS.
All drugs should be followed by 20ml NS flush & elevate the extremity above the level of heart for 10 -20 sec.
Defibrillator dose :
Biphasic : 120 -200 J
Monophasic : 360J
Airway Device | Ventilation During Cardiac Arrest | Ventilation During Respiratory Arrest |
Bag Mask | Adult : 2 breaths after every 30 compressions.
Child & Infants : 2 breaths every 30 compressions. 2 rescuer : 2 breaths every 15 compressions. | Adults :1 breath every 5 to 6 seconds (10-12 bpm)
Childrens : 1 breath every 3 – 5 sec. (12 – 20 bpm) |
Any advanced airway | 1 Ventilation every 6 to 8 sec (8 – 10 bpm) |
Advanced airway includes
Laryngeal mask airway
Laryngeal tube
Esophageal tracheal tube
Endotracheal tube.
In case of advanced airway is in place there is no need to synchronize breaths to compression.
Rationale & Other Important Points
|
Cardiac Arrest Rhythm and Outcome
|
Post Cardiac Arrest Care
Notes
In shockable rhythm adrenaline is given only after 2 shocks.
Never see the rhythm before 2 minutes.
Check pulse only if a organized rhythm is present.
Updated on 18/5/2015
Reference
Copyright 2020. emmedonline. All rights reserved.
Website is designed for desktop. Mobile user are advised use firefox for best results.
emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor