Cardiac arrest resident survival guide: Difference between revisions
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===Acute Immediate Post-Cardiac Arrest Care=== | ===Acute Immediate Post-Cardiac Arrest Care=== | ||
{{familytree/start |summary=Post-Cardiac arrest care}} | {{familytree/start |summary=Post-Cardiac arrest care}} | ||
{{familytree | | | | A01 | | | | | A01= }} | {{familytree | | | | A01 | | | | | A01= '''Return of spontaneous circulation<br>(ROSC)'''}} | ||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A02 | | | | | A02= }} | {{familytree | | | | A02 | | | | | A02= '''Optimize ventilation and oxygenation'''<br>Maintain oxygen saturation ≥ 94%<br> Consider advanced airway and waveform capnography<br> Do not hyperventilate }} | ||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A03 | | | | | A03= }} | {{familytree | | | | A03 | | | | | A03= '''Treat hypotension (SBP<90 mmHg)'''<br> IV/IO bolus <br> Vasopressor infusion <br> Consider treatable causes <br> 12-Lead ECG}} | ||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A04 | | | | | A04= }} | {{familytree | | | | A04 | | | | | A04= '''Follow commands?'''}} | ||
{{familytree | B01 |-|(| | | | | | B01= }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | |!| | A05 | | | | | A05= }} | {{familytree | B01 |-|(| | | | | | B01= No}} | ||
{{familytree | |!| | |!| | | | | | }} | |||
{{familytree | |!| | A05 | | | | | A05= Yes}} | |||
{{familytree | |!| | |!| | | | | | }} | |||
{{familytree | B02 | |!| | | | | | B02= Consider induced hypothermia}} | |||
{{familytree | |!| | |!| | | | | | }} | |||
{{familytree | |`|-| A06 | | | | | A06= '''STEMI''' <br>Or<br> '''High suspicion of AMI'''}} | |||
{{familytree | | | | |!| | | | | | }} | |||
{{familytree | B03 |-|(| | | | | | B03= Yes}} | |||
{{familytree | |!| | |!| | | | | | }} | |||
{{familytree | |!| | A07 | | | | | A07= No}} | |||
{{familytree | |!| | |!| | | | | | }} | {{familytree | |!| | |!| | | | | | }} | ||
{{familytree | | {{familytree | B04 | |!| | | | | | B04= Coronary reperfusion}} | ||
{{familytree | |!| | |!| | | | | | }} | {{familytree | |!| | |!| | | | | | }} | ||
{{familytree | |`|-| A08 | | | | | A08= }} | {{familytree | |`|-| A08 | | | | | A08= '''Advanced critical care'''}} | ||
{{familytree/end}} | {{familytree/end}} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 23:46, 10 August 2013
For cardiac arrest physician extender algorithm click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby
Synonyms and keywords: cardiorespiratory arrest, cardiopulmonary arrest, circulatory arrest
Definition
A cardiac arrest is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.[1]
Causes
Cardiac arrest is a life threatening condition which results in immediate death if not treated.
Common Causes
Reversible Causes
H's
- Hypovolemia
- Hypoxia
- Hydrogen ions (acidosis)
- Hyperkalemia or Hypokalemia
- Hypothermia
- Hypoglycemia or Hyperglycemia
T's
- Tablets or Toxins (tricyclic antidepressants, phenothiazines, beta blockers, calcium channel blockers, cocaine, digoxin, aspirin, acetominophen)
- Cardiac Tamponade
- Tension pneumothorax
- Thrombosis (myocardial infarction)
- Trauma (hypovolemia)
Management
Cardiac Arrest Care
Adult Cardiac Arrest | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Start CPR Give oxygen Attach monitor/defibrillator | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
VF/VT | Asystole / PEA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Box A: CPR 2 min IV/IO access | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Box B: CPR 2 min Epinephrine every 3-5 min Consider advanced airway and capnography | Box C: CPR 2 min IV/IO access Epinephrine every 3-5 min Consider advanced airway and capnography | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rhythm shockable? | No | Rhythm shockable? | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
CPR 2 min Amiodarone Treat reversible causes | Box D: CPR 2 min Treat reversible causes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Go back to box A | No | Rhythm shockable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Shock Then, go to box A or box B | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
If no signs of return of spontaneous circulation: Go to box C or box D If return of spontaneous circulation: Start post cardiac arrest care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.[2]
Acute Immediate Post-Cardiac Arrest Care
Return of spontaneous circulation (ROSC) | |||||||||||||||||||||
Optimize ventilation and oxygenation Maintain oxygen saturation ≥ 94% Consider advanced airway and waveform capnography Do not hyperventilate | |||||||||||||||||||||
Treat hypotension (SBP<90 mmHg) IV/IO bolus Vasopressor infusion Consider treatable causes 12-Lead ECG | |||||||||||||||||||||
Follow commands? | |||||||||||||||||||||
No | |||||||||||||||||||||
Yes | |||||||||||||||||||||
Consider induced hypothermia | |||||||||||||||||||||
STEMI Or High suspicion of AMI | |||||||||||||||||||||
Yes | |||||||||||||||||||||
No | |||||||||||||||||||||
Coronary reperfusion | |||||||||||||||||||||
Advanced critical care | |||||||||||||||||||||
References
- ↑ Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
- ↑ O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C; et al. (2010). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S787–817. doi:10.1161/CIRCULATIONAHA.110.971028. PMID 20956226.