Cardiac arrest resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}} | {{familytree | | | | | | | | | | | Q01 | | | | | | | | | | | Q01='''If no signs of return of spontaneous circulation:'''<br>Go to box C or box D<br><br>'''If return of spontaneous circulation:'''<br> Start post cardiac arrest care}} | ||
{{familytree/end}} | {{familytree/end}} | ||
''Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.''<ref name=" | ''Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.''<ref name="pmid20956224">{{cite journal| author=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.| title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S729-67 | pmid=20956224 | doi=10.1161/CIRCULATIONAHA.110.970988 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956224 }} </ref> | ||
===Acute Immediate Post-Cardiac Arrest Care=== | ===Acute Immediate Post-Cardiac Arrest Care=== | ||
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{{familytree | |`|-| A08 | | | | | A08= '''Advanced critical care'''}} | {{familytree | |`|-| A08 | | | | | A08= '''Advanced critical care'''}} | ||
{{familytree/end}} | {{familytree/end}} | ||
''Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 9.''<ref name="pmid20956225">{{cite journal| author=Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M et al.| title=Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S768-86 | pmid=20956225 | doi=10.1161/CIRCULATIONAHA.110.971002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956225 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 00:08, 11 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% | |||||||||||||||||||||
Treat hypotension (SBP<90 mmHg) - IV/IO bolus 1-2 L normal saline or lactated Ringer's - Vasopressor infusion Epinephrine IV infusion: 0.1-0.5 mcg/kg/min, or - 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 | |||||||||||||||||||||
Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 9.[3]
References
- ↑ Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
- ↑ Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW; et al. (2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
- ↑ Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M; et al. (2010). "Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S768–86. doi:10.1161/CIRCULATIONAHA.110.971002. PMID 20956225.