Management of Cardiac Arrest

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Management of Cardiac Arrest : 

Management of Cardiac Arrest Galveston College EMS Paramedic 2010

Management of Cardiac Arrest (1 of 2) : 

Management of Cardiac Arrest (1 of 2) Cardiopulmonary arrest “Code” Most have evidence of atherosclerosis or other underlying cardiac disease. Can also occur after electrocution, drowning, and other types of trauma 2

Management of Cardiac Arrest (2 of 2) : 

Management of Cardiac Arrest (2 of 2) Management Requires you to deploy a great many of the advanced life support (ALS) skills that you have learned Very difficult to think clearly in such stressful circumstances Essential for you to follow an orderly, systematic approach to cardiac arrest emergencies 3

BLS: A Review (1 of 2) : 

BLS: A Review (1 of 2) Techniques and sequences of BLS Should be very familiar Guidelines Concentrate on high-quality compressions. Avoid excessive inflation pressures in artificial ventilation. Keep your compressions smooth, regular, and uninterrupted. 4

BLS: A Review (2 of 2) : 

BLS: A Review (2 of 2) Guidelines (continued) As a single rescuer, give 30 compressions to two ventilations at a rate of 100 compressions per minute. Do not interrupt CPR compressions except for advanced airway placement, defibrillation, or moving the patient. 5

Advanced Cardiac Life Support (1 of 9) : 

Advanced Cardiac Life Support (1 of 9) What is ACLS? Effective and minimally interrupted chest compression Use of adjunctive equipment for ventilation and circulation Cardiac monitoring for arrhythmia recognition and control 6

Advanced Cardiac Life Support (2 of 9) : 

Advanced Cardiac Life Support (2 of 9) ACLS (continued) Establishment and maintenance of an IV infusion line Use of definitive therapy Transportation with continuous monitoring 7

Advanced Cardiac Life Support (3 of 9) : 

Advanced Cardiac Life Support (3 of 9) The universal algorithm The approach to every patient in cardiac arrest will start with the same steps, the BLS Healthcare Provider Algorithm. Carry the defibrillator, a portable oxygen cylinder, and a “jump kit”; if you have enough help bring the intubation kit, the IV equipment, and the drug box as well. 8

BLS Healthcare Provider Algorithm : 

BLS Healthcare Provider Algorithm 9

BLS Healthcare Provider Algorithm : 

BLS Healthcare Provider Algorithm 10

BLS Healthcare Provider Algorithm : 

BLS Healthcare Provider Algorithm 11

Advanced Cardiac Life Support (4 of 9) : 

Advanced Cardiac Life Support (4 of 9) One paramedic should ready the monitor-defibrillator while the other carries out the following steps: Assess responsiveness. Assess circulation. Check for a pulse, and check the rhythm on the monitor. 12

Advanced Cardiac Life Support (5 of 9) : 

Advanced Cardiac Life Support (5 of 9) Treatment for V-fib or pulseless V-tach Most likely to be successfully resuscitated Check the ABCs. Perform CPR for 2 minutes while the defibrillator is being attached. Confirm V-fib or V-tach on the monitor-defibrillator. Confirm absence of a pulse. Resume CPR while charging the defibrillator. Clear the patient and then defibrillate. 13

Advanced Cardiac Life Support (6 of 9) : 

Advanced Cardiac Life Support (6 of 9) If a rhythm other than V-fib or V-tach appears after fibrillation Identify the new rhythm. If there is no pulse, move to the asystole-PEA pathway and resume CPR immediately. If there is a pulse, move to the appropriate algorithm for the new rhythm. 14

Advanced Cardiac Life Support (7 of 9) : 

Advanced Cardiac Life Support (7 of 9) If the rhythm is persistent V-fib or V-tach Resume CPR while charging the defibrillator. Clear the patient and then defibrillate. Consider an advanced airway. Start an IV with normal saline. Consider establishing IO access. 15

Advanced Cardiac Life Support (8 of 9) : 

Advanced Cardiac Life Support (8 of 9) Treatment for pulseless electrical activity Identify the cause of PEA in a specific case. Immediately resume CPR. Consider an advanced airway. Start an IV line with normal saline. Consider establishing IO access. Administer a vasopressor drug. 16

Identify Possible Causes : 

M – Myocardial Infarction-fibrinolytics? A – Acidosis-give O2, ensure adequate ventilation T – Tension pneumothorax—needle decompression C – Cardiac Tamponade—pericardiocentesis H – Hypovolemia—replace volume H – Hypoxia—give oxygen, ensure adequate ventilation H – Hypo/Hyperthermia—warm or cooling measures H – Hypokalemia—correct electrolyte abnormalties H – Hyperkalemia—correct electrolyte abnormalties E – Embolism (pulmonary)—anticoagulants? Surgery? D – Drug overdose—antidotes/specific therapy 17 Identify Possible Causes CONTRIBUTING CAUSES

Advanced Cardiac Life Support (9 of 9) : 

Advanced Cardiac Life Support (9 of 9) Asystole treatment Rule out other causes of a flat-line. Immediately resume CPR. Consider an advanced airway. Start an IV with normal saline. Consider establishing IO access. Administer a vasopressor drug. 18

Postresuscitative Care (1 of 2) : 

Postresuscitative Care (1 of 2) Make sure that the rhythm stays restored. Stabilize the heart rate. Stabilize the cardiac rhythm to the degree possible. Ameliorate the effects of cardiac arrest on the brain (hypotension). 19

Postresuscitative Care (2 of 2) : 

Postresuscitative Care (2 of 2) Complex Best carried out in an intensive care unit Transportation should not be delayed. Only when transportation will be significantly prolonged should postresuscitative measures be started in the field. 20

When to Stop CPR (1 of 2) : 

When to Stop CPR (1 of 2) Not permitted In many communities Only a physician is authorized to pronounce a person dead. Fewer than 1% of patients survived who were not successfully resuscitated in the field and transported to the ED. 21

When to Stop CPR (2 of 2) : 

When to Stop CPR (2 of 2) Gaining permission Doesn’t make your life easier Delicate issues are involved. Enormous pressure from bystanders to continue as long as possible Difficult to tell the patient’s family that the patient is dead 22

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