Adult Cardiac Arrest ‘Shout for Help/Activate Emergency Response: Twn scenes Epinephrine very 35 ints (PR auatty ‘Buch har 2 ches on ar tt (100i) and alow complete + Miran rvs in compresions 1 Rotate composer ory 2 rire 1 Olmntatve wavelorm canopy 5 re io, stato pore OP ay rameter pra stole prose 2m Hp. atompt 2 ror OFF aul ctr of Spontaneous Creation BOSC) rit stained rene n Pero, tay 0 mm Hh 1 Sporianecur ate prec waves a ater etoog ‘Shock Energy Gohan Mana recent (120-200 # unkown, ‘se maura avalabs, Second and subeeqont Sons shuld bo + onopnesi 2607 rag Therapy Epnmpeine VO Dose: 1m wary 95 mints repapene + pmiodrone U0 Dose: is dos 300 9b. Second ose: 5018 ‘Advanced Airway Sopp sdvancedseway or endotacoainubaton {nets ciongaty ry ae moter be pact Reversble Causes Ppovcomis = Teion pneumotorac = hao < Tareensce cave = Hyarogennfacdossy = Tours = hizo hyponaema Trombods purmonay = pce = Tronbece SonaReturn of Spontaneous Circulation (ROSC) Optimize ventilation and oxygenation ‘+ Maintain oxygen saturation 294% * Consider advanced airway and waveform capnography Dona nae Doses/Details Vontiation/Oxygenation [Avoid excessive ventiation Start at 10-12 breaths/min and tate to target PETCO, of 35-40 mm Ha Treat hypotension When feasible, trate Fio, (SBP <90 mm Hg) to minimum necessary to IVAO bolus achieve Spo, 294%. Vasopressor infusion V Bolus Consider treatable 1-2 L normal saline causes o- lactated Ringor®. ‘{2-Lead ECG if inducing hypothermia, may use 4°C fluid Epinephrine 1V infusion: 04-015 meg/kg per minute (in 70-kg adult: 7-35 meg por minute) Dopamine IV Infusion: 5-10 meg/kg per minute Norepinephrine IV infusion: 0.1-0.5 meg/kg per minute {in 70-kg adult: 7-35 meg Follow commands? per minute) erfusion : Reversible Causes fees a = Hypovolemia ~ Hypoxia = Hydrogen ion (acidosis) ~ Hypo-/hyperkalemia = Hypothermia ~ Tension pneumothorax = Tamponade, cardiac ical care = Toxins = Thrombosis, pulmonary ~~ Thrombosis, coronary ‘Advanced ctte er Gr ® is OnOijr ‘Adult Suspected Stroke‘Adult Bradycar (With Pulse) ‘Assess appropriateness for clinical condition. Heart rate typically <50/min if bradyarrhythmia. Identify and treat underlying cause ‘+ Maintain patent airway; assist breathing as necessary ‘Oxygen (if hypoxemic) ‘Cardiac monitor to identify rhythm; monitor blood pressure and oximetry Waccess * 12-Lead ECG if available; don't delay therapy Persistent bradyarrhythmia ‘causing: Hypotension? Acutely altered mental status? + Signs of shock? += lachemic chest discomfort”? Acute heart faiure? Doses/Details ‘Atropine IV Dose: First dose: 0.5 mg bolus Repeat every 3-5 minutes Maximum: 3 mg Dopamine V Infusion: 2-10 megrkg per minute Epinephrine IV Infusion: 2=10 meg per minute Consider: ‘Export consuttation ‘= Tranevenous pacing (©2010 amercan Hest Associatonmero Re oe ‘Assess appropriateness for clinical condition. Heart rate typically >150/min if tachyarrhythmia, Identify and treat underlying cause '* Maintain patent airway; assist breathing as necessary ‘+ Oxygen (if hypoxemic) '* Cardiac monitor to identify rhythm; monitor blood pressure and oximetry Doses/Details ‘Synchronized Cardioversion Initial recommended doses: * Narrow regular: 50-100 J * Narrow irregular: 420-200 J biphasic or Persistent 200 J monophasic tachjentarthana + Wide regular: 100 J eee + Wide irregular: ‘Synchronized efibillation dose + Hypotension? cardioversion (NOT synchronized) * Acutely altered + Consider sedation ff Adenosine IV Dos ‘mental status? * Iregular narrow {First dose: 6 mg rapid IV push; * Signs of shock? ‘complex, consider [J follow with NS flush. * lechemic chest adenosine Second dose: 12 mg discomfort? if required. * Acute heart A failure? Antiarrhythmic Infusions Meee So tor Stable Wide-aRS Tachycardia it available conten ee Soe 20-50 mg/in until adenosine only Wide ORS? Rieguerand armhythmia suppressed, 20.12 second monomorphic | yBotension ensues, GAS uration increases >50%, or Consider : maximum dose 17 ma/kg antarhythmic J gv, Maintenance ntuston infusion “1-4 mg/min. Avoid if prolonged Consider expert aT or CHE eo ‘Amiodarone IV Dose: First dose: 150 mg over Biv ania aes 10 minutes. Repeat as ech a needed if VT recurs. Follow by maintenance infusion of 1 mgjmin for fst 6 hours. ‘= Vagal maneuvers: ‘= Adenosine (if regular) * B-Blocker or calcium Sotalol IV Dose: ‘channel blocker 100 mg (1.5 mg/kg) over 5 minutes. Avoid if * Consider expert consultation RianPotential Cause of PEA Treatment Hypovolemia (most common cause) Normal Saline 1-2 liters IV/IO Secure airway and ventilate Sodium Bicarbonate 1 mEq/kg IV/1O Hyperkalemia (end stage renal disease) Sodium Bicarbonate 1 mEq/kg IV/IO Calcium chloride 1 gram 1V/IO Hypothermia Active rewarming Toxins (drug overdose) See below Tamponade, cardiac Normal Saline 1-2 Liters IV/1O Expedite transport Tension pneumothorax Needle thoracostomy Thrombosis, coronary Expedite transport Thrombosis, pulmonary Expedite transportventricular fibrillation - ECGrepia.orG.