Pre Arrest

VOMIT
Visualize: Objective assessment
Verbalize: Good Morning, Im How are you?
Vital Signs: HR, BP, RR, SPO2, Temp
Oxygen Support SPO2 <94
NC 2-4
FM 6-10
NRM 11-15
Monitor - Pads on chest, Identify rhythm I want a strip
I IV/IO Peripheral Vein preferably antecubital vein, R then L, if unsuccessful, use IO
IO sites distal femur, proximal tibia, distal tibia, superior anterior iliac spine
Treatment
SLOW
Sinus Bradycardia w/ bp >90/60 = observed coz hemodynamically stable
Sinus Bradycardia w/ bp <90/60
Atropine 0.5mg max of 3 mg (6 dose) q3-5mins
Transcutaneous Pacing (TCP) press 80 as heart beat, mamp at 40-50
Dopamine drip 2-10 mkg/kg/min
Epinephrine 2-10 mcg/min
FAST
Tachy cardic (SVT/VTach with pulse) w/ bp >90/60
Physiologic
Vagal maneuvers 1.carotid massage *not for 60 and above (5-10 secs of massage)
2.encourage patient to cough
Pharmacologic
Adenosine fast bolus 6mg/12mg/12mg q3-5 mins * give w/in 10 mins
Tachy cardic (SVT/VTach with pulse) w/ bp <90/60
Sedate Diazepam, Midazolam, Etomidate, Propofol
Synchronize Cardioversion
50 joules SVT/A.Flutter
100 joules Vtach
12 joules A fib

ARREST
1. Hard with depth of 2 inch/5cm

2. Fast with atleast 100 compressions per minute

3. I want a complete chest recoil
4. Limit interruption to chest compression on no more than 10 seconds
5. Avoid excessive ventilation
PETCO >10mmHg
Ratio 30:2
I want a strip!
Shockable (Vfib, Pulseless Vtach)
Class 1 HQ CPR
Class 2A 360 J
Class 2B No Meds

2 minutes

Stop...Analyze...Switch
(Vfib, Pulseless Vtach)
Class 1 HQ CPR
Class 2A 360J
2 minutes
Class 2B Epi 1 mg
1:10 dilution followed by 20 ml flush of PNSS- Alpha adrenergic
Stop...Analyze...Switch
(Vfib, Pulseless Vtach)
Class 1 HQ CPR
Class 2A 360 J
Class 2B Amiodarone 300 mg
Anti arrhythmic Class 4

1.Na, 2. Ca 3. K, 4. Beta BLOCKER

Unshockable (Asystole, PEA)

Class 1 HQ CPR
Class2 no shock
Class 2b Epi 1mg q 3-5 min
Treat underlying Cause (Hs and Ts)
Hypovolemia,
Hypoxia, Hydrogen ion (acidosis),
Hyper-/hypokalemia,
Hypothermia.
Toxins,
Tamponade(cardiac),
Tension pneumothorax,
Thrombosis (coronary and pulmonary)
Post Arrest
C
+ Pulse

Fluid Therapy
1-2 L PNSS/PLRS IV bolus

Inotropes
Dopamine 10mcg/kg/min
Epi 2-10 mcg/min
Norepi 2-10 mcg/min
BP ^
AB
(-) Spon Breathing
Advance Airway (ET Tube) Bag every 6-8 secs
1. 5-point auscultation
2. Qualitative colormetric device (Yellow in)
3. Quantitative (Continuous Waveform) Capmography. PetCO2 35-45mmHg
D (-response) GCS 3
INDUCE THERAPEUTIC HYPOTHERMIA
300cc/kg PNSS/PLRS @ 4C
Run at 12-24 H to maintain body temp of32-34C use esophageal thermometer
NGT
Portable CXR

12-Lead ECG
IFC
REFER TO INTENSIVIST