V Emergency treatment: Cardiopulmonary Resuscitation:

V g
g maintain open airway, make sure tongue is not obscuring. Three techniques used
in opening airway are:
V {ead- tilt, Neck- tilt; {ead tilt, Chin lift; Jaw thrust.

V 
g   mouth to mouth resuscitation or ambu- bag via endotracheal tube

V Y
Y
g

V xne man resuscitation: 15 chest compressions to 2 quick lung compressions
( rate of 80/ min)
V Two man resuscitation: 5 chest compressions to 1 lung inflation after each 5 compressions
interposed between compressions (rate of 60/min)
V CPR works not by direct cardiac compression but by increasing intrathoracic pressure and
essentially squeezing blood from the pulmonary vasculature.
V CPR is done continuously without fail until a sustained heart rate is attained

V Definitive therapy:
identify cause of arrest: ECG, blood examination, IV line
V a
   cardiac muscles
contract independently at abnormal
speeds. Can occur in the atrial or
ventricular muscles.

V º


: 
V •hen the ventricular muscle fibers
contract independently. No QRS
complex an be identified and the
ECG is totally disorganized.
V As the patient usually have lost
consciousness by the time you have
realized that it is not just due to a
loose connection, the diagnosis is
easy.
V No P waves Ȃirregular
baseline
V Irregular QRS
complexes
V Normal shape QRS
complexes
V In V1ǯflutter-likeǯ waves
V defibrillation immediately with 200-300 joules ( 50- 100 for a
child)
V repeat defibrillation immediately if unsuccessful. Continue
CPR with out pausing, unless defibrillating
V epinephrine 5-10c (1: 10,000) Iv every 5 minutes to coarsen
ventricular fibrillation until restoration of heart rate .
V sodium bicarbonate 1 meq/kg IV; repeat at ½ dose very 10
minutes
V repeat defibrillation with 320-360 joules
V lidocaine 100mg (1.5mg/kg) IV bolus followed by IV drip
(500mg in D5 water at 1-3 mg/min) for intractable Vfib.
V repeat defibrillation with 320-360 joules.
V if still unsuccessful, reevaluate all factors, utilizing
electrolytes and blood gas analysis.
V If a focus in the ventricular
muscle depolarizes at high
frequency ( causing, in effect,
rapidly repeated ventricular
extrasystoles) Excitation has to
spread by an abnormal path
through the ventricular muscle,
and the QRS complex is wide
and abnormal.
V Note: No P waves. •ide QRS
complexes

V QRS complexes slightly

irregular and vary slightly in
shape.
Cardiovert with 200-300 joules of delivered energy
Do as with ventricular fibrillation
V Cardiopulmonary resuscitation
V Epinephrine 5-10 c (1:10,000) IV every 5 minutes prn for
asystole
V Atropine 1 mg IV every 5 minutes to maximum dosage of 2 mg
for bradycardia.
V sodium bicarbonate 1 meq/ kg IV; repeat at 12 every 10
minutes.
V Calcium chloride 5 cc (10%) every 10 minutes prn, not to be
given with bicarbonate.
V transverse pacemaker or isoprotenerol drip (if mg in 500cc run
at 1-2 cc/min or adjust rate to regulate heart rate at 60
beats/min.
V avoid cardiodepressant drugs (lidocaine, potassium)
V Abnormal rhythms arising in the atrial
muscle, the junctional region or the
ventricular muscle can be slow and
sustained or they an occur as single
beats(extrasystoles)
V DzFail-safedz mechanisms that will keep it
going if the SA node fails to depolarize,
or if conduction of the depolarization
wave is bloked
V Spontaneous depolarization frequencies
of about 50 per minute

V Î
 

V Administer atropine 0.5mg IV, repeat as
necessary every 5 minutes to total of 2.0
mg
V Start isoproterenol infusion at 2-20
ugtts/min
V if rate still below 50/min, insert a
pacemaker.