Management of cardiac arrest Ali Asgari, MD, PGY American Heart Association

ARREST Unresponse patient Unresponse patient A B C LookListenFeel Check pulse Check leads 2 rescue breathing

Breathing Adults >>> gasping = No breathing Ped >>> grunting & tachypnea = breathing Recommended maneuver for advanced healthcare provider : Jaw thrust TV = 6-7 cc/kg Ins. Time = 1 sec

circulation Check pulse: radial, brachial, femoral, carotid Which finger? 2 nd, 3 rd Max. time? check breathing & pulse, max 10 s. In hypothermia ->->-> 35 s. why?

start The patient Not monitored Monitored

Start CPR ( with BLS ) A B C A B C Airway Bre athing Circulation Jaw thrust 2 rescue B. Chest comp. Attach defibrillator as soon as possible A B C Airway Bre athing Bre athing Circulation Jaw thrust 2 rescue B. Chest comp. Attach defibrillator as soon as possibleCHESTCOMp

Breathing (BLS) Bag- mask ventilation C.T.V. ratio C.T.V. ratio 1 rescuer 2 rescuer Adult < 8 yr. 30 : 2 30:2 15:2 30 : 2 30:2 15:2CHESTCOMp

Breathing (ACLS) Advanced airway ET intubation ET intubation LMA LMA Combi tube Combi tube RR = 8-10 async Volume = 6-7 cc/kg max cc Ins. Time = 1 sec Compress 1lit bag: half way 2 lit bag: 1/3 way 2 lit bag: 1/3 way CHESTCOMp

DON’T INTERRUPT CHEST COMPRESSION DON’T INTERRUPT CHEST COMPRESSION

Chest comp. Rate = 100 Without interruption Change hand Q 2 min / max. 5sec delay Push hard, Push fast Allow to enough chest recoil Compress 3-5 cm in adult 1/3 to ½ depth of chest in children 1/3 to ½ depth of chest in childrenCHESTCOMp

Advanced life support A B C CHESTCOMp

Defibrillator attached C H E S T C O M p

Check rhythm VT, VF PEA, Asystole.

Rhythm Shockable Nonshockable VF Asystole Pulseless VT PEA Pulseless VT PEA

Shockable rhythm VF, Pulseless VT Witnessed, early mins Late Witnessed, early mins Late 2 rescue breath 2 rescue breath 2 rescue breath 2 rescue breath First shock 2min chest copm. First shock 2min chest copm. then shock then shock CHESTCOMp

Shock ? Monophasic 360 J / at beginning Biphasic 120 J / then 200 J Children first 2 J/kg then 4 J/kg CHESTCOMp

0- shock 0- shock chest comp chest comp check rhythm check rhythm 2- shock chest comp. 1 mg Epinephrine chest comp. 1 mg Epinephrine check rhythm check rhythm 4- shock chest comp, Amiodarone 300 mg chest comp, Amiodarone 300 mg check rhythm check rhythm 6- shock chest comp, Epi chest comp, EpiCHESTCOMp

Do not check pulse until The rhythm changed CHESTCOMp

8- shock chest comp. chest comp. check rhythm check rhythm 10- shock chest comp, Epi chest comp, Epi check rhythm check rhythm 12- shock chest comp. chest comp. check rhythm check rhythm 14- shock chest comp. Epi chest comp. Epi check rhythm check rhythmCHESTCOMp

16- shock chest comp, Amiodarone 150 mg chest comp, Amiodarone 150 mg check rhythm check rhythm 18- shock chest comp, Epi chest comp, Epi check rhythm check rhythm 20- shock chest comp. chest comp. : : :CHESTCOMp

Drugs Antiarrhythmics: Amiodarone : 300 mg first dose if needed after min, 150 mg if needed after min, 150 mg max, 450 mg max, 450 mg Lidocaine : 1.5 mg/kg first dose if needed Q 10 min mg/kg if needed Q 10 min mg/kg for 2 doses max. 3 mg/kg for 2 doses max. 3 mg/kg

Nonshockable rhythm after initial assessment after initial assessment 0- chest comp check rhythm check rhythm 2- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 4- chest comp check rhythm check rhythm ShockCHESTCOMp

6- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 8- chest comp check rhythm check rhythm 10- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 12- chest comp check rhythm check rhythm 14- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm16………………………………………….CHESTCOMp

Vasopressors Epinephrine hydrochloride: S & NS rhythms 1 mg- IV, IO, ET 1 mg- IV, IO, ET Q 3-5 min/ cont to END Q 3-5 min/ cont to END Atropine: Only asystole & PEA with HR<60 1 mg- IV, IO, ET 1 mg- IV, IO, ET Q 3-5 min max. 3 mg Q 3-5 min max. 3 mg

Drug rout As a law: Drugs injections in CPR must be: Drugs injections in CPR must be: PUSH PUSH ETT administration: times as IV doses times as IV doses plus plus 5-10 ml distilled water 5-10 ml distilled water As a law: Drugs injections in CPR must be: Drugs injections in CPR must be: PUSH PUSH ETT administration: times as IV doses times as IV doses plus plus 5-10 ml distilled water 5-10 ml distilled waterCHESTCOMp

Chest comp

Prolonged CPR HypothermiaToxicityDrowningCHESTCOMpCHESTCOMp