A Member of the

The Asian Representative of

Cardiac Arrest Rhythms

Ventricular fibrillation - disorganized electric activity Pulseless ventricular tachycardia - represents organized electric activity of the ventricular myocardium (Vtach without pulse) Asystole - absence of detectable ventricular electric activity with or without atrial electric activity Pulseless electrical activity - heterogeneous group of organized electric rhythms that are associated with either absence of mechanical ventricular activity or mechanical ventricular activity that is insufficient to generate a clinically detectable pulse.

Cardiac Arrest Rhythms

VF Pulseless VT
Asystole PEA

Manage as shockable rhythm

VF / Pulseless VT

CPR

CPR

CPR

CPR

Providers should give 1 shock rather than 3 successive shocks which were previously recommended in 2000

First shock success rate is high

Asystole / PEA

Epinephrine

CPR

CPR

FOR ASYSTOLE & PEA

JUST DO P-E

PUMP (CPR)

EPINEPHRINE

Asystole & Pulseless Electrical Activity (PEA)

Does not benefit from defibrillation attempts Perform high-quality CPR with minimal interruptions Continuous chest compressions 100/min Two rescuers should change compression roles every 2 minutes Epinephrine can be administered every 3-5 min

Medications for Arrest Rhythms VF/

Pulseless VT
Epinephrine Alpha-adrenergic effects can increase coronary & cerebral perfusion pressure during CPR Beta-adrenergic effects may increase myocardial work & reduce subendocardial perfusion No evidence to show that it improves survival Dose: 1 mg every 3 -5 min (2-2.5 mg via endotracheal route

Medications for Arrest Rhythms VF/ Pulseless VT

Vasopressin
Nonadrenergic peripheral vasoconstrictor that causes coronary & renal vasoconstriction No statistically significant differences between vasopressin & epinephrine for return of spontaneous circulation (ROSC), 24-hour survival or survival to hospital discharge Dose: 40 U IV/IO

Medications for Arrest Rhythms

Asystole & PEA
Vasopressors
May consider giving vasopressin for asystole but insufficient evidence in PEA Epinephrine 1mg every 3-5 min

Atropine
Reverses cholinergic-mediated decreases in heart rate, systemic vascular resistance & BP No prospective studies to support its use in asystole/ PEA Dose: 1 mg IV every 3 -5 min ( maximum of 3mg)

Medications for Arrest Rhythms Antiarrhythmics

Amiodarone
Affects Na, K and Ca channels as well as alpha and beta adrenergic blocking properties May be administered for VF or pulseless VT unresponsive to CPR, shock & vasopressor Dose: 300 mg IV/IO followed by 150 mg IV/IO

Medications for Arrest Rhythms Antiarrhythmics

Lidocaine
Alternative anti-arrhythmic to Amiodarone No proven short-term or long-term efficacy in cardiac arrest Initial dose: 1-1.5 mg/kg IV, then 0.5 0.75 mg/kg IV push every 5 -10 minutes ( maximum dose of 3 mg/kg)

Medications for Arrest Rhythms Antiarrhythmics

Magnesium
Effectively terminates torsades de pointes Not effective in irregular/ polymorphic VT in patients with normal QT Dose: 1-2 g in 10 ml D5W IV/IO push over 520min When with pulse, 1-2 g in 50-100 ml D5W

Check your Hs and Ts

Case

40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?

A. Get a complete history and physical

examination of the patient. B. call for a Code (MayDay; Code Blue) C. perform CPR D. hook to cardiac monitor

 On hooking to a cardiac monitor:

What do you do next?

A.Intubate the patient B.Insert an IV line C.Do chest compressions D.Defibrillate 360 J

 Because of your management, he converted to the following rhythm:

Case

40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?

A. Get a complete history and physical

examination of the patient. B. call for a Code (MayDay; Code Blue) C. perform CPR D. hook to cardiac monitor

 On hooking to a cardiac monitor:

What do you do next?

A.Intubate the patient B.Insert an IV line C.Do chest compressions D.Defibrillate 360 J

 Because of your management, he converted to the following rhythm:

Case

40 year old Male Brought to you in the ER, unconscious BP, HR, RR = Zero What do you do?

A. Get a complete history and physical

examination of the patient. B. call for a Code (MayDay; Code Blue) C. perform CPR D. hook to cardiac monitor

Vital Signs Zero

On hooking to a cardiac monitor:

What do you do next?

A.Intubate the patient B.Insert an IV line C.Do chest compressions D.Defibrillate 360 J

 Because of your management, he converted to the following rhythm:

The PHA Council on Cardiopulmonary Resuscitation