Cardiac arrest resident survival guide: Difference between revisions
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
Line 79: | Line 79: | ||
{{familytree | | | | A01 | | | | | A01= '''Return of spontaneous circulation<br>(ROSC)'''}} | {{familytree | | | | A01 | | | | | A01= '''Return of spontaneous circulation<br>(ROSC)'''}} | ||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A02 | | | | | A02= '''Optimize ventilation and oxygenation'''<br>Maintain oxygen saturation ≥ 94%<br> Consider advanced airway and waveform capnography<br> Do not hyperventilate }} | {{familytree | | | | A02 | | | | | A02= '''Optimize ventilation and oxygenation'''<br> | ||
'''- Maintain oxygen saturation ≥ 94%'''<br><br> '''- Consider advanced airway and waveform capnography'''<br><br> '''- Do not hyperventilate'''<br> | |||
Start at 10-12 breaths/min<br> | |||
Titrate to target PETCO<sub>2</sub> of 35-40 mmHg}} | |||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A03 | | | | | A03= '''Treat hypotension (SBP<90 mmHg)'''<br> IV/IO bolus <br> Vasopressor infusion <br> Consider treatable causes <br> 12-Lead ECG}} | {{familytree | | | | A03 | | | | | A03= '''Treat hypotension (SBP<90 mmHg)'''<br> '''- IV/IO bolus'''<br> 1-2 L normal saline or lactated Ringer's <br><br> '''- Vasopressor infusion'''<br> | ||
Epinephrine IV infusion: 0.1-0.5 mcg/kg/min, or<br> | |||
Dopamine IV infusion: 5-10 mcg/kg/min, or<br> | |||
Norepinephrine IV infusion: 0.1-0.5 mcg/kg/min<br><br> '''- Consider treatable causes''' <br><br> '''- 12-Lead ECG'''}} | |||
{{familytree | | | | |!| | | | | | }} | {{familytree | | | | |!| | | | | | }} | ||
{{familytree | | | | A04 | | | | | A04= '''Follow commands?'''}} | {{familytree | | | | A04 | | | | | A04= '''Follow commands?'''}} |
Revision as of 00:01, 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 | |||||||||||||||||||||
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.