1. Management of cardiac arrest Ali Asgari, MD, PGY2 2005 American Heart Association www.circulationaha.org

2. ARREST Unresponse patient Unresponse patient A B C LookListenFeel Check pulse Check leads 2 rescue breathing

4. Breathing Adults >>> gasping = No breathing Ped >>> grunting & tachypnea = breathing Recommended maneuver for advanced healthcare provider : Jaw thrust TV = 6-7 cc/kg Ins. Time = 1 sec

5. circulation Check pulse: radial, brachial, femoral, carotid Which finger? 2 nd, 3 rd Max. time? check breathing & pulse, max 10 s. In hypothermia ->->-> 35 s. why?

6. start The patient Not monitored Monitored

7. Start CPR ( with BLS ) A B C A B C Airway Bre athing Circulation Jaw thrust 2 rescue B. Chest comp. Attach defibrillator as soon as possible A B C Airway Bre athing Bre athing Circulation Jaw thrust 2 rescue B. Chest comp. Attach defibrillator as soon as possibleCHESTCOMp

8. Breathing (BLS) Bag- mask ventilation C.T.V. ratio C.T.V. ratio 1 rescuer 2 rescuer Adult < 8 yr. 30 : 2 30:2 15:2 30 : 2 30:2 15:2CHESTCOMp

9. Breathing (ACLS) Advanced airway ET intubation ET intubation LMA LMA Combi tube Combi tube RR = 8-10 async Volume = 6-7 cc/kg max. 500-600cc Ins. Time = 1 sec Compress 1lit bag: half way 2 lit bag: 1/3 way 2 lit bag: 1/3 way CHESTCOMp

10. DON’T INTERRUPT CHEST COMPRESSION DON’T INTERRUPT CHEST COMPRESSION

11. Chest comp. Rate = 100 Without interruption Change hand Q 2 min / max. 5sec delay Push hard, Push fast Allow to enough chest recoil Compress 3-5 cm in adult 1/3 to ½ depth of chest in children 1/3 to ½ depth of chest in childrenCHESTCOMp

12. Advanced life support A B C CHESTCOMp

13. Defibrillator attached C H E S T C O M p

14. Check rhythm VT, VF PEA, Asystole.

15. Rhythm Shockable Nonshockable VF Asystole Pulseless VT PEA Pulseless VT PEA

16. Shockable rhythm VF, Pulseless VT Witnessed, early mins Late Witnessed, early mins Late 2 rescue breath 2 rescue breath 2 rescue breath 2 rescue breath First shock 2min chest copm. First shock 2min chest copm. then shock then shock CHESTCOMp

17. Shock ? Monophasic 360 J / at beginning Biphasic 120 J / then 200 J Children first 2 J/kg then 4 J/kg CHESTCOMp

18. 0- shock 0- shock chest comp chest comp check rhythm check rhythm 2- shock chest comp. 1 mg Epinephrine chest comp. 1 mg Epinephrine check rhythm check rhythm 4- shock chest comp, Amiodarone 300 mg chest comp, Amiodarone 300 mg check rhythm check rhythm 6- shock chest comp, Epi chest comp, EpiCHESTCOMp

19. Do not check pulse until The rhythm changed CHESTCOMp

20. 8- shock chest comp. chest comp. check rhythm check rhythm 10- shock chest comp, Epi chest comp, Epi check rhythm check rhythm 12- shock chest comp. chest comp. check rhythm check rhythm 14- shock chest comp. Epi chest comp. Epi check rhythm check rhythmCHESTCOMp

21. 16- shock chest comp, Amiodarone 150 mg chest comp, Amiodarone 150 mg check rhythm check rhythm 18- shock chest comp, Epi chest comp, Epi check rhythm check rhythm 20- shock chest comp. chest comp. : : :CHESTCOMp

22. Drugs Antiarrhythmics: Amiodarone : 300 mg first dose if needed after 15-20 min, 150 mg if needed after 15-20 min, 150 mg max, 450 mg max, 450 mg Lidocaine : 1.5 mg/kg first dose if needed Q 10 min--- 0.75 mg/kg if needed Q 10 min--- 0.75 mg/kg for 2 doses max. 3 mg/kg for 2 doses max. 3 mg/kg

23. Nonshockable rhythm after initial assessment after initial assessment 0- chest comp check rhythm check rhythm 2- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 4- chest comp check rhythm check rhythm ShockCHESTCOMp

24. 6- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 8- chest comp check rhythm check rhythm 10- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm 12- chest comp check rhythm check rhythm 14- chest comp, Atropine 1mg, Epi 1mg check rhythm check rhythm16………………………………………….CHESTCOMp

25. Vasopressors Epinephrine hydrochloride: S & NS rhythms 1 mg- IV, IO, ET 1 mg- IV, IO, ET Q 3-5 min/ cont to END Q 3-5 min/ cont to END Atropine: Only asystole & PEA with HR<60 1 mg- IV, IO, ET 1 mg- IV, IO, ET Q 3-5 min max. 3 mg Q 3-5 min max. 3 mg

26. Drug rout As a law: Drugs injections in CPR must be: Drugs injections in CPR must be: PUSH PUSH ETT administration: 2 - 2.5 times as IV doses 2 - 2.5 times as IV doses plus plus 5-10 ml distilled water 5-10 ml distilled water As a law: Drugs injections in CPR must be: Drugs injections in CPR must be: PUSH PUSH ETT administration: 2 - 2.5 times as IV doses 2 - 2.5 times as IV doses plus plus 5-10 ml distilled water 5-10 ml distilled waterCHESTCOMp

27. Chest comp

28. Prolonged CPR HypothermiaToxicityDrowningCHESTCOMpCHESTCOMp