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Pulseless arrest PPT 2005

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Information about Pulseless arrest PPT 2005
Education

Published on July 16, 2009

Author: behdad16

Source: authorstream.com

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Pulseless Arrest : Pulseless Arrest Directed By: Behdad Bazargani M.D. Anesthesiologist Ali Shah Abbasi M.D. Anesthesiologist ACLS Pulseless Arrest Algorithm : ACLS Pulseless Arrest Algorithm First step when you are?!! : First step when you are?!! witness of an arrest. When definitely does not feel a pulse within 10 seconds, the provider should turn on the Defibrillator. not witness of an arrest. the provider may give 5 cycles of CPR before attempting defibrillation. Slide 4: Pulseless arrest BLS Algorithm: Call for help, give CPR Give oxygen when available Attach monitor/defibrillator when available Ventricular Fibrillation/ Pulseless Ventricular Tachycardia Check rhythm Shockable rhythm? Asystole / Pulseless Electrical Activity Shockable Not Shockable 1 2 3 9 Ventricular Fibrillation/Pulseless Ventricular Tachycardia : Ventricular Fibrillation/Pulseless Ventricular Tachycardia Slide 6: Give 1 shock Manual biphasic: device specific (typically 120 to 200 J) Note: if unknown, use 200 J AED (Automatic Electrical Defibrillator) Monophasic: 360 J Resume CPR immediately Ventricular Fibrillation/ Pulseless Ventricular Tachycardia Check rhythm Shockable rhythm? Give 5 cycles of CPR Shockable Not Shockable 5 3 4 GO to box 12 Ventricular Fibrillation/Pulseless Ventricular Tachycardia : Ventricular Fibrillation/Pulseless Ventricular Tachycardia 1-shock strategy has not been directly studied against a 3-shock strategy: The evidence is compelling that interruption of chest compressions reduces coronary perfusion pressure. The time required to charge a defibrillator, deliver a shock, and check a pulse can interrupt compressions for 37 seconds or longer . Ventricular Fibrillation/Pulseless Ventricular Tachycardia : Ventricular Fibrillation/Pulseless Ventricular Tachycardia Biphasic defibrillators use a variety of waveforms, and each waveform has been shown to be effective in terminating VF over a specific dose range. Ventricular Fibrillation/Pulseless Ventricular Tachycardia : Ventricular Fibrillation/Pulseless Ventricular Tachycardia Immediately after shock delivery Resume CPR (beginning with chest compressions) without delay and continue for 5 cycles and then check the rhythm Slide 10: Continue CPR while defibrillator is charging Give 1 shock (second shock) Manual biphasic: device specific (typically 120 to 200 J) Note: if unknown, use 200 J AED (Automatic Electrical Defibrillator) Monophasic: 360 J Resume CPR immediately When IV/IO available, give vasopressor during CPR (before or after the shock) Epinephrine 1 mg IV/IO Repeat every 3 to 5 min or May give 1 dose of vasopressin 40 U IV/IO to replace first or second dose of epinephrine. Check rhythm Shockable rhythm? Give 5 cycles of CPR Shockable Not Shockable 6 7 GO to box 12 Slide 11: Continue CPR while defibrillator is charging Give 1 shock (third shock) Manual biphasic: device specific (typically 120 to 200 J) Note: if unknown, use 200 J AED (Automatic Electrical Defibrillator) Monophasic: 360 J Resume CPR immediately Consider antiarrhyhmics: give during CPR (before or after shock) Amiodarone Lidocaine Magnesium 8 After 5 cycles of CPR, got to box 5 Antiarrhyhmic : Antiarrhyhmic If a perfusing rhythm is transiently restored but not successfully maintained between repeated shocks (recurrent VF/VT), the patient may be a candidate for early treatment with antiarrhythmic medications Antiarrhyhmic : Antiarrhyhmic In VF/pulseless VT persists after 2 to 3 shocks administering an antiarrhyhmic such as: Amiodarone Lidocaine Magnesium Asystole and Pulseless Electrical Activity : Asystole and Pulseless Electrical Activity ACLS Pulseless Arrest Algorithm : ACLS Pulseless Arrest Algorithm Asystole and Pulseless Electrical Activity : Asystole and Pulseless Electrical Activity PEA encompasses a heterogeneous group of Pulseless rhythms that includes: Pseudo-electromechanical dissociation (pseudo-EMD) Idioventricular rhythms Ventricular escape rhythms Post defibrillation idioventricular rhythms Brady systolic rhythms Asystole and Pulseless Electrical Activity : Asystole and Pulseless Electrical Activity PEA is often caused by reversible conditions and can be treated if those conditions are identified and corrected. The survival rate from cardiac arrest with asystole is dismal. Asystole and Pulseless Electrical Activity : Asystole and Pulseless Electrical Activity The focus of resuscitation is: To perform high-quality CPR Minimal interruptions Identify reversible causes Patients who have either asystole or PEA will not benefit from defibrillation attempts. Slide 19: Asystole / Pulseless Electrical Activity 10 Resume CPR immediately for 5 cycles When IV/IO available,give vasopressor Epinephrine 1mg IV/IO Repeat every 3 to 5 min Or May give 1 dose of vasopressin 40 U IV/IO to Replace first or second dose of epinephrine Consider atropine 1mg IV/IO For asystole or slow PEA rate Repeat every 3 to 5 min (up to 3 dose) 9 Slide 20: Check rhythm Shockable rhythm? Give 5 cycles of CPR Shockable Not Shockable 11 If asystole or Pulseless go to box 10 If pulse present,begin post resuscitation care Go to box 4 12 13 Medications for Arrest Rhythms : Medications for Arrest Rhythms Vasopressors: 1- Epinephrine 2- Vasopressin 3- Atropine Medications for Arrest Rhythms : Medications for Arrest Rhythms Antiarrhythmics: 1-Amiodarone 2-Lidocaine 3-Magnesium Fibrinolysis : Fibrinolysis It may be considered on a case-by-case basis when pulmonary embolus is suspected (Class IIa) Pacing in Arrest : Pacing in Arrest At this time use of pacing for patients with asystolic cardiac arrest is not recommended. Precordial Thump for VF or Pulseless VT : Precordial Thump for VF or Pulseless VT No recommendation can be made for or against its use by ACLS providers (Class Indeterminate). Routine Administration of IV Fluids During Cardiac Arrest : Routine Administration of IV Fluids During Cardiac Arrest There is insufficient evidence to recommend routine administration of fluids to treat cardiac arrest (Class Indeterminate). Good luck : Good luck

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