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AIRWAY AND BREATHING
Waveform capnography
1. Measures eha!e" #$%
%. Recommen"e" for a!! &n'u(a'e" pa'&en's
). Mos' re!&a(!e *ay 'o mon&'or pa'&en's resp&ra'&ons
+. #on'&nue 'hroughou' 'he per&, arres' per&o"
Reasons 'o use *aveform capnography
1. #onf&rm p!acemen' of 'he ET 'u(e
%. De'ec' R$-# (ase" on #$% changes
). Mon&'or #R /ua!&'y
-upp!emen'a! oygen 0espec&a!!y h&gh f!o*
1. No' nee"e" for $-# pa'&en's
W&'hou' resp&ra'ory "&s'ress
W&'h an -$% 23+4
%. T&'ra'e 'o ma&n'a&n -$% 2 3+4 &n hypo&c pa'&en's
). Hyper,oygena'&on &n R$-# pa'&en's
May re"uce cere(ra! (!oo" f!o* "ur&ng resusc&'a'&on
5ong 'erm may crea'e oygen 'o&c&'y
App!y oygen 'o pa'&en's *&'h A#- 'ha'6
Have an oygen sa'ura'&on 7 3+4
Are &n car"&ac or resp&ra'ory fa&!ure
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DE9IBRI55ATI$N AND #ARDI$8ER-I$N
8en'r&cu!ar 'achycar"&a
1. -'a(!e monomorph&c 8Tach : car"&over'
%. -'ar' a' 1;;< an" &ncrease s'ep*&se
). A (&phas&c "ose has (een a""e"
+. Trea' po!ymorph&c 8Tach *&'h unsynchron&=e"
shoc>
A,f&( an" A :f!u''er
1. Recommen"e" (&phas&c "ose A,f&( 1%; : %;; &ng 'he a&r*ay
In"&ca'&ons nconsc&ous pa'&en'
A(sence of a gag ref!e
-&=&ng
#orner of 'he mou'h 'o 'he ang!e of 'he
man"&(!e Inser'&on
ps&"e "o*n 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'
-&"e*ays 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'
Mus' (e f!ush *&'h 'he mou'h
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B5- AIRWAY MAINTENAN#E NA-$HARANGEA5
In"&ca'&ons
#onsc&ous or sem& consc&ous pa'&en'
a'&en' *&'h a gag ref!e
-&=&ng
Nose 'o 'ragus of 'he ear
Inser'&on
5u(r&ca'e *e!!
#hoose 'he !arges' nos'r&!
Gen'!y use a sp&ra! mo'&on 'o &nser'
#hec> pa'&en' ven'&!a'&on
If res&s'ance &s encoun'ere" remove an" 'ry 'he
o'her nos'r&!
#au'&on Do no' use on pa'&en's *&'h ser&ous hea" &n@ur&es
#on'ra&n"&ca'e" *&'h (as&!ar s>u!! frac'ures
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B5- AIRWAY MAINTENAN#E
-#TI$NING
-of' ca'he'ers Asp&ra'es 'h&n secre'&ons oro an" naso pharyn
erform&ng en"o'rachea! suc'&on&ng
-uc'&on 'hrough an &n p!ace a&r*ay
R&g&" ca'he'ers -uc'&on&ng oropharyn 'h&c> par'&cu!a'e ma''er
En"o'rachea! suc'&on&ng
se s'er&!e 'echn&/ue Inser' ca'he'er &n'o 'he en"o'rachea! 'u(e
se 'he !arges' 'u(e poss&(!e
Do no' &nser' (e!o* 'he en" of 'he ET 'u(e
Be sure open&ng &s no' occ!u"e" "ur&ng &nser'&on
App!y suc'&on&ng (y occ!u"&ng 'he
ca'he'er open&ng "ur&ng *&'h"ra*a!Do no' suc'&on !onger 'han 1; secon"s
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AD8AN#ED AIRWAY-
-RAG5$TI#
#om(&'u(e
&ng a&r*ay
5MA 0!aryngea! mas> a&r*ay
-A5T a&r*ay
NA-$TRA#HEA5 INTBATI$N
#onsc&ous or sem& consc&ous pa'&en's
Inser' &n !arges' nos'r&! 05u(r&ca'e *e!!
Do no' use a s'y!e''e
G!o''&c open&ng !oca'e" (y soun" an" vapor &n 'he
'u(e
Mos' usefu! &n pu!monary e"ema an" pa'&en's
una(!e 'o open 'he mou'h -'op &nser'&on &f res&s'ance &s encoun'ere"
#on'ra&n"&ca'e" &n hea" 'rauma
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AD8AN#ED AIRWAY-
END$TRA#HEA5 INTBATI$N
Essen'&a! for unconsc&ous pa'&en's
May (e use" on consc&ous pa'&en's *&'h R-I
0Rap&" se/uence &n'u(a'&on
erforme" *&'h
5aryngoscope
M&!!er (!a"e , s'ra&gh'
Mac&n'osh (!a"e : curve"
#hec> scope pr&or 'o &nser'&on
En"o'rachea! 'u(e
Tr&a! &nf!a'e 'he 'u(e cuff pr&or 'o &nser'&on
-'y!e''e
1; cc syr&nge
5u(r&can'
#onf&rm p!acemen'
Auscu!'a'&on
#apnography
#hes' ray
-ecure 'he 'u(e
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8ENTI5ATI$N 0B5-
Mou'h 'o mou'h an" mou'h 'o mas>
Does no' preven' "&sease 'ransm&ss&on
Mus' prov&"e a goo" sea!
De!&ver enough (rea'h 'o ma>e 'he ches' r&se
Your eha!e" (rea'h can on!y supp!y 1F4 oygen
Am(u (ag
-afes' me'ho" 'o preven' "&sease 'ransm&ss&on
#an supp!y 1;;4 oygen
$pen 'he a&r*ay
#omp!e'e!y sea! 'he mas>
De!&ver (rea'h vo!ume enough 'o ma>e 'he ches'
r&se
Each (rea'h shou!" (e 1 secon" "ura'&on
Re/u&res % rescuers 'o assure a goo" mas> sea!
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8ENTI5ATI$N 0A#5- Au'oma'e" pneuma'&c ven'&!a'ors
rov&"es au'oma'&c ven'&!a'&on 'o &n'u(a'e"
pa'&en's
-e's ra'e '&"a! vo!ume EE pressure 9&$% an"
m&nu'e vo!ume
#A
rov&"es EE 0pos&'&ve en" ep&ra'ory pressure
Re/u&res a mas> an" a #A mach&ne
Mos' usefu! for consc&ous pu!monary e"ema
pa'&en's Epan"s 'erm&na! (ronch& an" a!veo!ar sacs
BIA
rov&"es (o'h pos&'&ve &nsp&ra'ory an" ep&ra'ory
pressure
Mos' usefu! on as'hma'&c an" #$D an"
pneumon&a pa'&en's 'ha' re/u&re a""&'&ona!&nsp&ra'ory pressure suppor' *&'h EE.
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Why use *aveform capnography
#apnography measures #$% resu!'&ng from (rea'h&ng
I' &s 'he on!y accura'e *ay 'o assess (rea'h&ng
AHA re/u&res &' on a!! &n'u(a'e" pa'&en's
Ho* *aveform capnography *or>s
#$% &s a(sor(e" &n 'he IR a' +.) nm
Eha!e" (as passes 'hrough an IR a"ap'or a''ache" 'o
'he ET 'u(e
Th&s prov&"es an e!ec'r&ca! s&gna! 'o 'he car"&ac mon&'or
The mon&'or prov&"es eha!e" #$% resp&ra'&on ra'e an"
a capnograph&c *aveform ana!ys&s
Waveform capnography &s use" 'o
Measure #$% !eve!
De'erm&ne 'he resp&ra'&on ra'e
-ho* 'he capnography *aveform
In"&ca'e a m&sse" 'u(e
To &n"&ca'e a m&sse" &n'u(a'&on
WAVEFORM CANOGRAHY
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MANA5 M$NIT$R DE9IBRI55$R-
Genera!
A!! manua! mon&'or "ef&(r&!!a'ors prov&"e
'he same func'&ons
You mus' (ecome fam&!&ar *&'h 'he one
'ha' you use
Mo"es
Bas&c )+ !ea"s for rhy'hm &n'erpre'a'&on
A 1% !ea" capa(&!&'y
A "ef&(r&!!a'or mo"e
#ar"&overs&on : synchron&=e"
Def&(r&!!a'&on , unsynchron&=e"
A pac&ng mo"e
-e's 'he ra'e
Increases curren' 'o o('a&n cap'ure
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MANA5 M$NIT$R DE9IBRI55AT$R-
) + an" ? !ea" p!acemen'
) !ea" RA 0*h&'e 5A 0(!ac> 55 0re"
+ !ea" RA 0*h&'e 5A 0(!ac> 550re" R5 0green
? !ea" RA 0*h&'e 5A 0*h&'e 550re" R5 0green 81
0(ro*n
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1% 5EAD 5A#EMENT 5E9T -IDE
1% 5EAD 5A#EMENT RIGHT -IDE
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#ARDI$8ER-I$N #ar"&overs&on &s use" 'o 'rea' rap&" hear'(ea's 'ha'
are no' re!a'e" 'o a 'rea'a(!e cause an" comprom&se
hemos'as&s
To car"&over' 'he un&' mus' (e &n 'he DE9IB mo"e Be sure 'o push 'he -YN# (u''on (efore your &n&'&a!
"ose an" aga&n (efore each su(se/uen' "ose.
9a&!ure 'o push 'he -YN# (u''on *&!! resu!' &n
"ef&(r&!!a'&on
When 'he un&' &s &n 'he sync mo"e a !&gh' *&!! appear
over each R *ave as sho*n.
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#ARDI$8ER-I$N
If 'he pa'&en' &s consc&ous cons&"er se"a'&on
8a!&um or verse"
#harge 'he un&' 'o 'he appropr&a'e @ou!e !eve!
Be sure 'ha' 'he un&' &s &n 'he synchron&=e"
mo"e
Be sure 'ha' everyone &s c!ear or 'he pa'&en'
IM #5EAR Y$R #5EAR WERE A55 #5EAR
De!&ver 'he charge Ho!" 'he charge (u''on un'&! 'he R *ave cap'ures
If you &ncrease 'o 'he ne' @ou!e !eve! (e sure
'o re synchron&=e.
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ETERNA5 A#ING E'erna! pac&ng &s "one us&ng mu!'&func'&on pa"s
The an'er&or pos'er&or pos&'&on for pa" !oca'&on &s
mos' effec'&ve
-e"a'e 'he pa'&en' &f consc&ous
-e' a hear' ra'e of a' !eas' F; (ea's per m&nu'e
A"@us' 'he curren' un'&! (o'h e!ec'r&ca! an"
mechan&ca! cap'ure &s a''a&ne"
Mechan&ca! cap occurs *hen a caro'&" pu!se &s fe!'
'ha' ma'ches 'he se' ra'e
-*&'ch 'o 'rans ,venous pac&ng A-A
#on'ra&n"&ca'&ons
Asys'o!e
u!se!ess 8Tach
-&"e effec's
->&n (urns
#hes' musc!e con'rac'&on
#hes' "&scomfor'
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DE9IBRI55ATI$N
Ho* "ef&(r&!!a'&on *or>s
An e!ec'r&ca! charge &s p!ace" across 'he hear'
Th&s crea'es asys'o!e
E&'her 'he hear' *&!! rema&n &n asys'o!e or a ne*
rhy'hm *&!! occur
Rhy'hms 'ha' re/u&re ear!y "ef&(r&!!a'&on
8en'r&cu!ar f&(r&!!a'&on
u!se!ess ven'r&cu!ar 'achycar"&a
Mu!'& form ven'r&cu!ar 'achycar"&a 0Torsa"es
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DE9IBRI55ATI$N
a" con'ac'
Goo" pa" con'ac' &s essen'&a! for successfu!
"ef&(r&!!a'&on. Be sure 'o "ry 'he pa'&en' (efore app!y&ng 'he pa"s
-have ches' ha&rs &n pa" app!&ca'&on areas
Remove any n&'ro pas'e or o&n'men's
Avo&" pacema>er !oca'&ons
a" p!acemen'
a"s may (e p!ace" &n e&'her 'he an'er&or an'er&or or
'he an'er&or pos'er&or pos&'&on
The an'er&or pos'er&or pos&'&on &s preferen'&a! &f pac&ng &s
an'&c&pa'e"
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DE9IBRI55ATI$N
Def&(r&!!a'or opera'&on
-e' 'he un&' &n 'he "ef&(r&!!a'or mo"e
#harge 'he "ef&(r&!!a'or
#!ear 'he pa'&en' (efore a"m&n&s'er&ng 'he
shoc>
Th&s &nc!u"es any'h&ng 'ouch&ng 'he pa'&en'
IM #5EAR Y$R #5EAR WERE A55 #5EAR
De!&ver 'he shoc>
Remem(er
Do #R *h&!e 'he "ef&(r&!!a'or &s charg&ng
-'ar' #R &mme"&a'e!y af'er 'he shoc> &s
"e!&vere"
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GENERA5
The pharmaco!og&ca! approach
Wor>s *e!! for non, arres' pa'&en's
Is s!o*er ac'&ng &n arres'e" pa'&en's
9ac'ors con'r&(u'&ng 'o pharmaco!og&ca!
success
The /ua!&'y of #R
The "o*n '&me (efore me"&ca'&on
a"m&n&s'ra'&on
The con"&'&on of 'he pa'&en's ar'er&es
MEDI#ATI$N A##E-- R$TE-
In'ravenous
G&ve me"&ca'&ons 'hrough !arge (ore I8-
The preferre" s&'es are
An'ecu(&'a!
E'erna! @ugu!ar
Try 'o s'ar' I8- (efore arres' occurs
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MEDI#ATI$N A##E-- R$TE-
In'ra,osseous 0I$ access
D&rec' &n@ec'&on 'hrough 'he (one *a!! &n'o 'he
(one marro* venous p!e&s
-afe an" re!&a(!e
You can a"m&n&s'er f!u&"s co!!o&"s an" a!!
me"&ca'&ons
In"&ca'&ons for I$ access
Ina(&!&'y 'o ach&eve I8 access
rev&ous!y re/u&re" cen'ra! !&nes
Emergen' nee" for "rugs or f!u&"s
#ar"&ac arres' *&'hou' I8 access
#on'ra&n"&ca'&ons 'o I$
9rac'ure &n 'he e'rem&'y
rev&ous &nser'&on a''emp' &n 'he same (one Infec'&on a' 'he &n@ec'&on s&'e
Ina(&!&'y 'o !oca'e !an"mar>s or ecess&ve '&ssue
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In'ra,osseous "ev&ces
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INTRA,$--E$-
#onf&rma'&on of ca'he'er p!acemen'
#a'he'er &s f&rm!y sea'e" &n 'he (one
9!ash of (!oo" or (one marro*
ressur&=e" f!u&"s f!o* *&'hou' "&ff&cu!'y
harmaco!og&ca! effec's are no'e"
Af'er I$ &nser'&on
-'a(&!&=e I$
Remove 'rocar
Asp&ra'e 'he I$
A''ach a shor' connec'&ng 'u(&ng *&'h a ) *ay
s'opcoc>
9!ush I$ 'o &nsure pa'ency
ressur&=e" f!u&"s shou!" f!o* free!y
There shou!" (e no ev&"ence of e'ravas&on
9or consc&ous pa'&en's cons&"er !&"oca&ne for pa&n
9!ush *&'h 1;,%; cc N.-. af'er each me"&ca'&on
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END$TRA#HEA5 R$TE
5eas' effec'&ve rou'e of a"m&n&s'ra'&on
Me"s 'ha' can (e g&ven ET 0NA8E5
Narcan A'rop&ne
8asopress&n
Ep&nephr&ne
5&"oca&ne
Ru!es for ET a"m&n&s'ra'&on
se %,%.? '&mes 'he I8 "ose 0ecep'
vasopress&n
-'op compress&ons
se 1; m! 'o'a! vo!ume 0"&!u'e *&'h N.-. or
s'er&!e *a'er
8en'&!a'e severa! '&mes
Resume compress&ons
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MEDI#ATI$N- T$ -TIM5ATE THE HEART
EINEHERINE
In"&ca'&ons
#ar"&ac arres'
Bra"ycar"&a refrac'ory 'o a'rop&ne an" T#
Ac'&ons
Increases hear' ra'e con'rac'&!&'y au'oma'&c&'y an"
vasocons'r&c'&on
Dose
1,) mg every ),? m&nu'es
Infus&on
M& J mg ?;;m! &n D?W or N.-. Infuse a' %,1; mcgm&n for (ra"ycar"&a
Infuse a' J,+; mcg m&n for hypo'ens&on
Rou'e
I8 or I$
-&"e effec's
Tachycar"&a
Hyper'ens&on 8--
Increase" oygen "eman"
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MEDI#ATI$N- T$ -TIM5ATE THE HEART
8A-$RE--IN
#!ass&f&ca'&on
An'&"&ure'&c hormone
Non, a"renerg&c vasocons'r&c'or In"&ca'&ons
#ar"&ac arres' as an a!'erna'&ve 'o ep&nephr&ne
Ac'&ons
8asocons'r&c'&on, s'&mu!a'es smoo'h musc!e
recep'ors
Increases coronary perfus&on "ur&ng #R
Increases v&'a! organ (!oo" f!o* an" cere(ra!
oygen
Dosage : +; un&'s
Rou'e : I8 I$ ET
-&"e effec's :o'en'&a! vasocons'r&c'&on
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ANTI,ARRHYTHMIA MEDI#ATI$N-
AMI$DAR$NE 0#$RDAR$NE
#!ass&f&ca'&on : an'&,"ysrhy'hm&c
In"&ca'&ons
8T89 Rap&" a'r&a! arrhy'hm&as
Ac'&ons
ro!ongs recovery per&o" of car"&ac ce!!s
Affec's so"&um po'ass&um an" ca!c&um channe!s
Affec's a!pha an" (e'a
Dosage 0I8I$
#ar"&ac arres', );; mg &n 1; m! Repea' 1?; mg ),? m&n
erfus&ng pa'&en's 1?; mg over 1; m&n. Repea' &n 1; m&n.
Infus&on 03;; mg ?;; m!
1 mg m&n for F hours 'hen ;.? mg m&n for 1J hours
-&"e effec's
HTN (ra"ycar"&a A8 (!oc>s #H9 arrhy'hm&as
#on'ra&n"&ca'&ons
#ar"&ogen&c shoc>
-econ" or 'h&r" "egree hear' (!oc>s
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ANTI,ARRHYTHMIA MEDI#ATI$N-
5ID$#AINE
#!ass&f&ca'&on
An'&,"ysrhy'hm&c
In"&ca'&ons
8T 89 8#-
Ac'&ons
-o"&um channe! (!oc>er
Depresses ven'r&cu!ar &rr&'a(&!&'y an" au'oma'&c&'y
Dosage
#ar"&ac arres', 1,1.? mg>g repea' ha!f "ose 'o )mg>g
8T 8#- ;.?,;.K? mg>g L ?,1; m&n as nee"e"
Infus&on
Ma&n'enance : M& % gm ?;;m! 0+mgm!
Infuse a' 1,+ mgm&n 01?,F; m!hr
Rou'e
I8I$ET
-&"e effec's
Musc!e 'remors
se&=ures
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MEDI#ATI$N- T$ #$NTR$5 HEART RATE
ATR$INE
#!ass&f&ca'&on arasympa'he'&c (!oc>er
In"&ca'&ons -ymp'oma'&c (ra"ycar"&a
Ac'&on Increases hear' ra'e an" con"uc'&on
'hrough 'he A8 no"e
Dosage
;.? mg Repea' every ),? m&nu'es Ma&mum "ose ) mg
Rou'e I8I$ET
-&"e effec's Tachycar"&a "&!a'e" pup&!s ang&na
-ma!! "oses may cause (ra"ycar"&a
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MEDI#ATI$N- THAT #$NTR$5 HEART RATE
#ARDIEM 0DI5TIAEM
#!ass&f&ca'&on
An'&,"ysrhy'hm&c
In"&ca'&ons
-8T 0Espec&a!!y A,f&( an" A, f!u''er
Ac'&on
#a!c&um channe! an'agon&s'
-!o*s con"uc'&on
-moo'h musc!e "&!a'&on
Dosage G&ve ;.%? mg>g over % m&nu'es 01?,%; mg
May repea' ;.)? mg>g &n 1? m&nu'es
Infuse 1%? mg1;;m! a' ?,1? mghr
Rou'e
-!o* push fo!!o*e" (y an &nfus&on
-&"e effec's Bra"ycar"&a
Hypo'ens&on
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E5E#TR$5YTE- -$DIM BI#ARB$NATE
#!ass&f&ca'&on A!>a!&=er (uffer
In"&ca'&ons Me'a(o!&c ac&"os&s
Tr&cyc!&c an'&"epressan' over"ose
Hyper>a!em&a
Ac'&on Increases pH revers&ng ac&"os&s
Dosage 1 mE/>g &v push 'hen ;.? mE/>g every 1;
m&nu'es
May g&ve as an &nfus&on for cer'a&n over"oses
Rou'e I8 push or &nfus&on
-&"e effec's
Hyperna'rem&a hyperosmo!a!&'y Me'a(o!&c a!>a!os&s
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E5E#TR$5YTE- #A5#IM #H5$RIDE
#!ass&f&ca'&on E!ec'ro!y'e
In"&ca'&ons
Hypoca!cem&a Hyper>a!em&a
Hypermagnesem&a
#a!c&um channe! (!oc>er over"ose
Ac'&on Increase" &no'rop&c force an" con'rac'&!&'y
Dosage %,+ mg>g of a 1;4 so!u'&on. Repea' &n 1; m&n. &f
re/u&re"
sua! "ose &s ?;;mg 'o 1 gm
Rou'e I8I$
-&"e effec's Hyperca!cem&a
8en'r&cu!ar f&(r&!!a'&on
Eacer(a'es "&g&'a!&s 'o&c&'y
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E5E#TR$5YTE- MAGNE-IM -59ATE
#!ass&f&ca'&on An'&,"ysrhy'hm&c e!ec'ro!y'e
In"&ca'&ons Refrac'ory "ysrhy'hm&as
Torsa"es
Hypomagnesem&a
Ac'&on -'a(&!&=es '&ssue mem(ranes
Ra&ses magnes&um !eve!s
-moo'h musc!e re!aan'
Dosage 89 pu!se!ess 8T : 1,% gm over 1,% m&nu'es
8T *&'h pu!se : 1,% gm &n 1; m! over 1,% m&nu'es
Hypomagnesem&a *o ec'opy ;.?,1 mghr &nfus&on
Rou'e I8 or &nfus&on
-&"e effec's Bra"ycar"&a
Hypo'ens&on
#au'&on a'&en's *&'h !&''!e or no ur&ne ou'pu'
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8A-$RE--$R-
N$REINEHERINE 05E8$HED #!ass&f&ca'&on
8asopressor
In"&ca'&ons
Hypo'ens&on refrac'ory 'o "opam&ne
-B 7K; mmHg an" !o* per&phera! res&s'ance
Ac'&on
r&mar&!y a!pha
Dosage M& + mg%?;m! D?W or N.-.
Infuse a' ;.1,;.? mcg>gm&n
Rou'e
I8 &nfus&on on!y
-&"e effec's
Increase" myocar"&a! *or> !oa" an" $% "eman" -evere '&ssue necros&s &f &nf&!'ra'e"
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8A-$RE--$R-
D$BTAMINE 0D$BTERE #!ass&f&ca'&on
A"renerg&c s'&mu!a'or
In"&ca'&ons #H9 *&'h hypo'ens&on
Hypo'ens&on -B 7 K;,1;; mmHg *&'h no s&gns ofshoc>
Ac'&on r&mar&!y (e'a
Increase &n s'ro>e vo!ume *o &ncrease &n hear' ra'e
Dosage M& ?;; mg %?;m! D?W %;;; mcgm!
Infuse a' %,%; mcgm! 0average + m!hr
Rou'e I8 &nfus&on on!y
-&"e effec's Tachycar"&a
#hes' pa&ns
a!p&'a'&ons
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8A-$DI5AT$R- NITR$G5Y#ERINE 0N&'ros'a' Tr&"&!
#!ass&f&ca'&on An'&hyper'ens&ve
In"&ca'&ons Ang&na MI #H9
Ac'&on -moo'h musc!e "&!a'or
Re"uces pre!oa" an" af'er!oa"
Re"uces ar'ery spasm
Dosage Ta(!e' spray 1 -5 every ? m&nu'es
1 &nch of n&'ro pas'e
Infus&on : M& ?; mg &n %?; m!.
-'ar' a' 1; mcgm&n 0)m!hr
Rou'e -5 I8 &nfus&on pas'e
-&"e effec's Hypo'ens&on hea"ache 'achycar"&a
#au'&on Erec'&!e "ysfunc'&on "rugs
R&gh' s&"e" &nfarc'
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8A-$DI5AT$R- NITR$R--IDE 0NIRIDE
#!ass&f&ca'&on An'&,hyper'ens&ve
In"&ca'&ons Hyper'ens&on #H9 *&'h pu!monary e"ema
Ac'&on -moo'h musc!e "&!a'or
Decreases pre!oa" an" af'er!oa"
Wor>s more &n 'he ar'er&es 'han 'he ve&ns
Dosage Infus&on : M& ?; mg %?;m! D?W %;;mcgm!
-'ar' a' ;.? : ;.J mcg>gm&n
Rou'e
I8 &nfus&on on!y
-&"e effec's Hypo'ens&on
Hea"ache
#yan&"e 'o&c&'y
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8A-$DI5AT$R-
A#E INHIBIT$R- 0Ena!apr&! #ap'opr&! 5&s&nopr&! #!ass&f&ca'&on
An'&,hyper'ens&ve
In"&ca'&on
Hyper'ens&on#H9 os' MI
Ac'&on reven's convers&on of ang&o'ens&on I 'o ang&o'ens&on II
-uppresses ren&n, ang&o'ens&on a!"os'erone sys'em
Dosage Ena!apr&!, ?,+; mg $
;.F%?,1.%?mg I8 over ? m&n. every F hours #ap'opr&! : 1%.?,?; mg $ BIDTIB
5&s&nopr&!, 1;,+; mg $ O"ay
Rou'e I8 $
-&"e effec's Hypo'ens&on
#hes' pa&n Tachycar"&a an" "ysrhy'hm&as
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DIERETI#- 9R$-EMIDE 05A-I
#!ass&f&ca'&on
5oop "&ure'&c
In"&ca'&ons u!monary e"ema
Ac'&on
8aso"&!a'&on : re"uce" venous pressure
Inh&(&'s rea(sorp'&on of so"&um &n 'he >&"neys
Dosage +; : J; mg0&ncrease &n %; mg &ncremen's
Rou'e
I8 s!o* push
-&"e effec's
Dehy"ra'&on
T&nn&'us
Hypo>a!em&a
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ANA5GE-I#- M$RHINE
#!ass&f&ca'&on Narco'&c ana!ges&c
In"&ca'&ons #hes' pa&n "ur&ng a -TEMI unre!&eve" (y
n&'rog!ycer&ne
u!monary e"ema
Ac'&on o'en' ana!ges&c
romo'es venous poo!&ng : re"uces pre!oa"
Re"uces an&e'y
Dosage %,+ mg &n % mg &ncremen's
Rou'e -!o* I8 push
-&"e effec's Resp&ra'ory "epress&on nausea an" hypo'ens&on
#au'&on : uns'a(!e ang&na non -T e!eva'e"pa'&en's 0mor'a!&'y
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ANA5GE-I#-
DI5ADID
#!ass&f&ca'&on
$p&o&" ana!ges&c In"&ca'&ons
#hes' pa&n "ur&ng a -TEMI unre!&eve" (yn&'rog!ycer&ne
u!monary e"ema
Ac'&on o'en' ana!ges&c much s'ronger 'ha' morph&ne
) mg D&!au"&" %; mg morph&ne
Re"uces an&e'y
Does no' a!'er (!oo" pressure
Dosage ;.? : 1 mg s!o* I8 push
Rou'e -!o* I8 push
-&"e effec's Resp&ra'ory "epress&on #au'&on *&'h e!"er!y pa'&en's
Rap&" push &n "oses a(ove 1 mg may (e a pro(!em
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BETA B5$#ER- #ommon (e'a (!oc>ers
Me'opro!o! 05opressor
-o'a!o! 0Be'apace
Esmo!o! 0(rev& (!oc>
In"&ca'&ons Dur&ng MI 'o "ecrease oygen consump'&on
-8T refrac'ory 'o o'her 'herap&es
Ac'&on Decreases
Hear' ra'e
-'ro>e vo!ume
Au'oma'&c&'y an" con"uc'&v&'y
Dosage Me'opro!o!, ? mg "ose L ? m&nu'es 0 1? mg ma
-o'a!o! : 1;; mg over ? m&nu'es for 8Tach
Esmo!o! : ?;; mg>g over 1 m&n. Then ?; mcg>gfor + m&nu'es
Rou'e $ra! I8
#on'ra&n"&ca'&ons #H9 hypo'ens&on (ra"ycar"&a hear' (!oc>s
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ANTI5ATE5ET-
A-IRIN
#!ass&f&ca'&on
An'&,p!a'e!e'
In"&ca'&ons
#ar"&ac ches' pa&n
ns'a(!e ang&na
Ac'&on
B!oc>s 'hrom(oane
reven's p!a'e!e' aggrega'&on
eeps p!a'e!e's from occ!u"&ng ar'er&es
Rou'e
$ra!
Dosage 1F%,)%? mg 0che*a(!e
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ANTI5ATE5ET-
#5$ID$GRE5 05A8I
In"&ca'&ons
-TEMI
H&gh r&s> -T "epress&on or T *ave &nvers&on
a'&en's *&'h p!anne" #I
a'&en's 'ha' canno' 'a>e asp&r&n
Ac'&on
Inh&(&'s g!ycopro'e&n
Dosage
);; mg $ fo!!o*e" (y K? mg $
#ons&"era'&ons
H&s'ory of (!ee"&ng
a'&en's *&'h &mpa&re" !&ver func'&on
!anne" surgery &n 'he near fu'ure
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ANTI5ATE5ET- INTEGRI55IN
#!ass&f&ca'&on G!ycopro'e&n II( IIIa &nh&(&'or
In"&ca'&ons #hes' pa&n -T "epress&on or e!eva'&on
ns'a(!e ang&na
Non,O *ave MI
Ac'&on B!oc>s en=yme essen'&a! 'o p!a'e!e' aggrega'&on
Dosage 1J; mg >g over 1,% m&nu'es
Infuse L % mcg>gm&n.
Decrease 'o ;.? mcg>gm&n pre ca'he'er&=a'&on
-&"e effec's B!ee"&ng 0&ncrease" *&'h hepar&n runn&ng
Nausea vom&'&ng
Hypo'ens&on an" (ra"ycar"&a
#on'ra&n"&ca'&ons Ac'&ve &n'erna! (!ee"&ng
!a'e!e's 7 1;;;;;
-ys'o!&c B 21J;
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ANTI#$AG5ANT- HEARIN
#!ass&f&ca'&on
An'&coagu!an'
In"&ca'&ons a'&en's un"ergo&ng ang&op!as'y
-e!ec'e" pa'&en's rece&v&ng f&(r&no!y'&c 'herapy
MI pu!monary em(o!&sm D8T
Ac'&on
reven's convers&on of pro'hrom(&n 'o 'hrom(&n
Dosage Bo!us "ose of F;; un&'s>g
Infus&on of 1% un&'s>ghr
-&"e effec's
Hemorrhage
Throm(ocy'open&a
#on'ra&n"&ca'&ons Ac'&ve (!ee"&ng pep'&c u!cers hepa'&c "&sease
Hemoph&!&a
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9IBRIN$5YTI#-
In"&ca'&ons Ac'&ve MI !ess 'han 1% hours
1% !ea" *&'h -T e!eva'&on &n % con'&guous !ea"s
Ne* (ranch (un"!e (!oc> Acu'e &schem&c s'ro>e 7 ) hours
Ac'&on 5ys&s of f&(r&n ho!"&ng 'oge'her 'hrom(& (!oc>&ng 'he ar'ery
A!!o*s (!oo" f!o* 'o "&s'a! ar'er&es (!oc>e" (y 'he c!o'
Dosage TN : -&ng!e (o!us );,?; mg I8 push over ? m&n.
Re'ep!ase, 1; un&'s fo!!o*e" (y 1; un&' (o!us ); m&n apar'
A!'ep!ase,1? mg (o!us 'hen ;.K? mg>g over ); m&nu'es
-&"e effec's B!ee"&ng
A!!erg&c reac'&ons
Reperfus&on arrhy'hm&as
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9IBRIN$5YTI#-
#on'ra&n"&ca'&ons Ac'&ve (!ee"&ng
Hemorrhag&c s'ro>e In'racran&a! neop!asm
Aor'&c "&ssec'&on
Hea" 'rauma or pr&or s'ro>e ) mon'hs
-u(arachno&" hemorrhage
ncon'ro!!e" B 21J? sys'o!&c or 11; "&as'o!&c
!a'e!e' coun' 7 1;;;;;mm or INR 21.K
#T "emons'ra'es mu!'&p!e &nfarc'&ons
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TYE- $9 -TR$E- Ischem&c
#ause" (y an occ!us&on of an ar'ery &n 'he (ra&n
Accoun's for JK4 of a!! s'ro>es
5&>e!y can"&"a'es
D&a(e'&cs
H&s'ory of a'herosc!ero'&c "&sease
H&s'ory of c!o''&ng a(norma!&'&es
H&s'ory of ph!e(&'&s
H&s'ory of a'r&a! f&(r&!!a'&on
Hemorrhag&c
#ause" (y a rup'ure of a (!oo" vesse! &n 'he (ra&n
Accoun's for 1)4 of a!! s'ro>es
TA &s con'ra&n"&ca'e"
A non con'ras' #T &s re/u&re"
5&>e!y can"&"a'es
H&s'ory of hyper'ens&on
Afr&can Amer&cans
H&s'ory of A8 ma!forma'&ons H&s'ory of aneurysms
H&s'ory of # or coca&ne use
STRO!E "CVA
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-TR$E 9$#-
RE,H$-ITA5
Rap&" s'ro>e &"en'&f&ca'&on
Rap&" 'ranspor'
IN H$-ITA5
Rap&" "e'erm&na'&on of f&(r&no!y'&c e!&g&(&!&'y
Non con'ras' #T scan
Ec!us&on cr&'er&a
T&ne from s'ro>e onse'
A"m&n&s'ra'&on of a f&(r&no!y'&c agen'
In&'&a'&on of 'he s'ro>e pa'h*ay
A"m&ss&on 'o a s'ro>e un&'
STRO!E "CVA
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-TR$E -IGN- AND -YMT$M- In&'&a! assessmen' 0#&nc&nna'& sca!e
A!*ays chec> (!oo" g!ucose
9ac&a! "roop non symme'r&ca! sm&!e
Arm "r&f' : affec'e" arm "r&f's "o*n*ar"
A(norma! speech
-!urre" *or"s
Wrong *or"s
Ina(&!&'y 'o spea>
-econ"ary neuro!og&ca! assessmen' Num(ness &n 'he e'rem&'&es
up&!!ary response s&=e an" eye movemen'
8&s&on 'rou(!e 0one or (o'h eyes B&!a'era!!y e/ua! gr&p s'reng'h
E/ua! e'ens&on an" prona'&on of (o'h fee'
5eve! of consc&ousness
-u""en confus&on
er&o"s of aphas&a
Trou(!e *a!>&ng ga&' "&s'ur(ances
D&==&ness !oss of (a!ance -evere hea" ache 0*ors' hea"ache I ever ha"
STRO!E " CVA
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I-#HEMI# -TR$E
a'ho!ogy
$ccurs *hen a cere(ra! ar'ery (ecomes occ!u"e"
Th&s causes an area of 'he (ra&n 'o &nfarc'
The &nfarc'e" area &s surroun"e" (y a !arger
&schem&c area ca!!e" 'he penum(ra
The goa! of s'ro>e managemen' &s 'o preven' 'he
penum(ra from &nfarc'&ng *orsen&ng the stroke.
ro'ec'&on of 'he penum(ra
The (es' *ay 'o save 'he penum(ra &s 'o open 'heocc!u"e" vesse! *&'h TA.
TA mus' (e g&ven *&'h&n ) hours of 'he onse' of
s'ro>e symp'oms
Beyon" ) hours 'he r&s> of g&v&ng TA "oes no'
ou'*e&gh 'he (enef&'s
Before g&v&ng TA a!! pa'&en's mus' (e g&ven a noncon'ras' #T scan.
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I-#HEMI# -TR$E
Inc!us&on cr&'er&a
An &schem&c s'ro>e caus&ng measura(!e
neuro!og&c "amage
$nse' of symp'oms 7 ) hours (efore (eg&nn&ng'rea'men'
Age 2 1J years
Ec!us&on cr&'er&a
Hea" 'rauma or s'ro>e &n 'he prev&ous ) mon'hs
-ymp'oms of a su(arachno&" hemorrhage
H&s'ory of a prev&ous &n'ra,cran&a! hemorrhage
ncon'ro!!e" B 21J? sys'o!&c or 11; "&as'o!&c
!a'e!e' coun' 7 1;;;;; mm or INR 21.K
#T "emons'ra'es mu!'&,!o(a! &nfarc'&on
STRO!E " CVA
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I-#HEMI# -TR$E
os' TA managemen'
Mon&'or pa'&en' for (!ee"&ng
Mon&'or EG
#on'ro! B 'o ma&m&=e perfus&on.
Avo&" ecess&ve (!oo" pressures
#on"uc' fre/uen' neuro!og&ca! chec>s
Every 1? m&nu'es for 'he f&rs' hour
Every ); m&nu'es for 'he ne' hour
Then every % hours
Mon&'or coagu!a'&on fac'ors
A"m&' pa'&en' 'o a s'ro>e cen'er
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HEM$RRHAGI# -TR$E a'ho!ogy
$ccurs *hen a (!oo" vesse! &n 'he (ra&n rup'ures
The rup'ure" vesse!
5ea>&ng (!oo" &s &nf!amma'ory Th&s crea'es an &ncrease &n cere(ra! sp&na! f!u&"
Th&s &ncreases &n'racran&a! pressure
Managemen'
A rap&" non con'ras' hea" #T &s essen'&a!
In'u(a'e 'he pa'&en' as soon as poss&(!e
A''ach 'he pa'&en' 'o a ven'&!a'or
eep 'he #$% !eve! 'o %?,); 'o hyper oygena'e
Hyper oygena'&on cons'r&c's 'he cere(ra! ar'er&es
Th&s he!ps con'ro! (!ee"&ng
#on'ro! (!oo" pressure 'o !o*es' !eve! 'ha' *&!!
ma&n'a&n a"e/ua'e organ perfus&on
#ons&"er mann&'o! as an osmo'&c "&ure'&c
Transpor' rap&"!y 'o a neurosurg&ca! opera'&ng
fac&!&'y
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STRO!E " CVA ALGORITHM
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STRO!E ALGORITHM
#UIC! VIEW
BP EKG- SPO2
HISTORY PHYSICAL EXAM
IV BGL - LABS
NON CONTRAST CTISCHEMIC HEMORRHAGIC
NEUROSURGERYFIBRINOLYTICS
IF LESS THAN3 HOURS
FROM ONSET
FREQUENT NEURO
EVALUATIONS
SYMPTOMS
IMPROVING
(TIA)
FREQUENT NEURO
EVALUATIONS
ONSET TIME O2 IFREQUIRED
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a'hophys&o!ogy
An acu'e coronary syn"rome occurs *hen a
coronary ar'ery (ecomes par'&a!!y or 'o'a!!y
(!oc>e".
The syn"romes &nc!u"e
ns'a(!e ang&na
-TEMI an" non -TEMI a''ac>s
-u""en car"&ac "ea'h
ACUTE CORONARY
SYNDRONES
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In&'&a! eva!ua'&on
-ymp'oms sugges'&ve of &schem&a or an MI
5$# 1% !ea" EG v&'a! s&gns -$% oygen
hys&ca! eam h&s'ory 0'hrom(o!y'&c can"&"a'e
I8 access e!ec'ro!y'es car"&ac mar>ers
coagu!a'&on #hes' ,ray
In&'&a! 'rea'men'
$ygen 0&f -$% 7 3+4
Asp&r&n 1F;,)%? mg
N&'rog!ycer&ne : -5 or spray
Morph&ne I8 &f pa&n &s no' re!&eve" (y )
n&'rog!ycer&ne
1% !ea" &n'erpre'a'&on
-T e!eva'&on or ne* !ef' (ranch (un"!e (!oc>
-TEMI : h&gh r&s>
-T "epress&on or T *ave &nvers&on
In"&ca'es &schem&a h&gh r&s> uns'a(!e ang&na
Norma! or non "&agnos'&c changes 0-T or T *ave
5o*er r&s> re/u&res mon&'or&ng
ACUTE CORONARY
SYNDROMES
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-TEMI 7 1% H$R-
H&gh r&s>
-T e!eva'&on &n % or more re!a'e" !ea"s
Ne* !ef' (ranch (un"!e (!oc>
Trea'men'
I8 n&'rog!ycer&ne
An'&p!a'e!e' an'&coagu!an's
Hepar&n
In'egr&!&n
5oveno
!av&
repare for #I-TENT #ABG
7 3; m&nu'es "oor 'o 'a(!e
9&(r&no!y'&cs &f #I &s "e!aye"
7 ); m&nu'es EM- 'o "rug '&me
A#E &nh&(&'ors af'er F hours
Be'a (!oc>ers *hen s'a(!e
ACUTE CORONARY
SYNDROMES
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N$N -TEMI HIGH RI- A#- -T "epress&on
T *ave &nvers&on
ns'a(!e ang&na
Trea'men' I8 n&'rog!ycer&ne &f (!oo" pressure uncon'ro!!e"
#on'ro! c!o''&ng
An'& p!a'e!e's
!av&
In'egr&!&n
An'& coagu!an's
Hepar&n
5oveno
A#E &nh&(&'ors 0af'er F hours
Be'a (!oc>ers *hen s'a(&!&=e"
#ar"&ac ca'he'er&=a'&on
#I or #ABG &f &n"&ca'e"
ACUTE CORONARY
SYNDROMES
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A#- A5G$RITHM
ACUTE CORONARY
SYNDRONES
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ACS ALGORITHM
#UIC! VIEW
VITALS BP EKG SPO2 HXEXAM
IV 12 LEAD O2 IF REQUIRED
OXYGENNITROGLYCERINE
ASA MORPHINE IF
REQUIRED
STEMINON STEMHIGH RISK
CATH PCI STENTCABG
ST ELEVATION 2LEADS
NE!LEFT BBB
IV NITROGLYCERINEHEPARIN
INTEGRILINBETA BLOCKERS
(STABLE)
ST DEPRESSION
T!AVE INVERSION
UNSTABLE ANGINA
IV NITRO HEPARIN
INTEGRILIN BETA
BLOCKERS ACE
INHIBITORS
CATH PCI STENTCABG
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ULMONARY EDEMA
#UIC! VIEW
FO!LERS POSITION"O2
BP EKG SPO2
PHYSICAL EXAM "
HOSTORY " LABS
BIPAP " CPAP IF CONSCIOUSINTUBATE IF UNCONSCIOUS
NITROGLYCERINE IF BP#1$$
MORPHINE 2-% &' SLO! IVPUSH
LASIX $-1 &'"*' +, .#1$$
CHF !ITH
HYPOTENSION
DOPAMINE -2-2$
&/'"*'"&+0
DOBUTAMINE
2-2$MCG"KG"MIN
CHF SYSTOLIC
BP #1$$
NITROGLYCERIN1$-
2$ &/'"&+0
NITROPRUSSIDE $- &/'"*'"&+0
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HYOTENSION ALGORITHM
#UIC! VIEW
-ymp'oma'&c *&'h sys'o!&c B 7 3; mmHg
ADMINISTER OXYGEN
EKG SPO2 MONITOR
IV LABS
PHYSICAL EXAM "HISTORY
FLUID BOLUS 1-2 L
IF LUNGS CLEAR
REASSESS BP
DOPAMINE DRIP-2$ &/'"*'"&+0
SBP $SIGNS OF
SHOCK
NOREPINEPHRINE
SBP #$
EPINEPHERINE
2-1$ &/'"&+0
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-YMT$MATI# BRADY#ARDIA-
-&nus
ers
-ymp'oma'&c (ra"ycar"&as &nvo!ve perfus&on
&na"e/uac&es.
-ome s&gns &nc!u"e
Decrease" !eve! of consc&ousness
Hypo'ens&on
Dyspnea
a!e co!or
D&aphores&s
Genera!&=e" *ea>ness
BRADYCARDIAS
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BRADY#ARDIA A5G$RITHM
BRADYCARDIAS
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SYMTOMATIC BRADYCARDIA
#UIC! VIEW
EVALUATERHYTHM
NO
ATROPINE $ &'3&' &45
TCP 6 7$-$ BPM
D8.4&+09 "9.+09.:;+09
I0,9 /8&.?95
20> 8; 3;> >9';99 HB
MAY TRY ATROPINE
TCP 6 7$-$
BPM
D8.4&+09 "9.+09.:;+09
I0,
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Tachycar"&as &nc!u"e
-&nus 'achycar"&a
-upraven'r&cu!ar 'achycar"&a
A'r&a! f&(r&!!a'&on f!u''er
8en'r&cu!ar 'achycar"&a *&'h a pu!se
Asymp'oma'&c 'achycar"&as
B HR -$% s'a(!e *&'h goo" perfus&on
a'&en' consc&ous an" fu!!y a!er'
-ymp'oma'&c 'achycar"&as
A!'ere" !eve! of consc&ousness
Ina"e/ua'e perfus&on
#hes' pa&n
Dyspnea
-&nus 'achycar"&as
$ccur from a revers&(!e cause
9ever an&e'y shoc> s'ress s'&mu!an's eer'&on
Are 7 1?; (ea's per m&nu'e
Trea' 'he cause 'rea' 'he 'achycar"&a
TACHYCARDIAS
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-8T A5G$RITHM
TACHYCARDIAS
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TREATMENT ALGORITHM
STABLE SVT
#UIC! VIEW
Hemo"ynam&ca!!y s'a(!e a(sence of ches' pa&n
5$# EG 8--$% $% &f nee"e"
hys&ca! eam an" h&s'ory R$ non car"&ac causes
I8 access !a(s car"&ac mar>ers #R
@
8aga! maneuvers
@A"enos&ne Fmg rap&" push f!ush
A"enos&ne 1% mg rap&" push f!ush
@#ar"&=em ;.%?mg>g 'hen ;.)?mg>g &n 1? m&n
$R8erapam&! %.?,?mg repea' ?,1;mg 1?,); m&n
@Me'opro!o! ?mg over ? m&n repea' ?m&n %
$R
A'eno!o! ?mg over ? m&n may repea' &n 1; m&nu'es
@#ar"&over', ?;,1;; < (&phas&c &n&'&a! "ose &ncrease &n&ncremen's
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TREATMENT ALGORITHM
UNSTABLE SVT
#UIC! VIEW
Hemo"ynam&ca!!y uns'a(!e A5$# orunconsc&ous
@
5$#. EG 8- -$% $% &f re/u&re"
Br&ef h&s'ory eam R$ non car"&accauses
@
I8 I$ access "o no' "e!ay car"&overs&on
-e"a'&on &f consc&ous an" B a!!o*s
@-ynchron&=e" car"&overs&on
?;,1;;< &n&'&a! "ose (&phas&c &ncrease &n&ncremen's
@
If unsuccessfu! com(&ne *&'hpharmaco!og&ca! 'rea'men' use" for
s'a(!e -8T
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ATRIA5 9IBRI55ATI$N 95TTER
-'a(!e *&'h R8R 7 +J hours
Hemo"ynam&ca!!y s'a(!e no ches' pa&n INITIA5
5$# EG 8- -$% oygen &f re/u&re"
hys&ca! eam an" h&s'ory R$ non car"&ac causes I8 !a(s car"&ac mar>ers ches' ,ray
TREATMENT
#on'ro! ra'e : #a!c&um channe! (!oc>er 0choose 1 #ar"&=em ;.%? mg>g 'hen ;.)? mg>g &n1? m&n. &f re/u&re"
8erapam&!, %.?,? mg repea' ?,1; mg 1?,); m&n &f re/u&re"
Be'a (!oc>er 0choose one
Me'opro!o! ? m" over ? m&n. repea' ? mg %
$'her (e'a (!oc>ers :!a(e'a!o! a'eno!o! so'a!o! esmo!o!
#ar"&over' &f "rug 'herapy &s unsuccessfu! ?;,1;; @ou!es (&phas&c &n&'&a! "ose. Increase &n &ncremen's
#ons&"er an'&coagu!an' 'herapy
N$TE A,f&( A f!u''er shou!" (e 7 11; (ea's m&n'o (e cons&"ere" con'ro!!e".
TACHYCARDIAS
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A,9IB A 95TTER 2 +J H$R-
-'a(!e *&'h R8R no ches' pa&n
INITIA5
5$#EG-$% oygen &f re/u&re"
hys&ca! eam an" h&s'ory R$ non car"&accauses
I8 !a(s car"&ac mar>ers ches' ,ray
TREATMENT
De!ay car"&overs&on un!ess uns'a(!e ns'a(!e : oor perfus&on # A5$#
#on'ro! ra'e *&'h
#a!c&um channe! (!oc>ers
Be'a (!oc>ers
a'&en' nee"s 'o (e curren' *&'h an'&coagu!an'
'herapy
R$ em(o!& for + *ee>s (efore car"&overs&on
TACHYCARDIAS
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A,9IB A, 95TTER N-TAB5E WITH R8R
Hemo"ynam&c &ns'a(&!&'y ches' pa&n a!'ere" !eve!
of consc&ousness unrespons&ve
In&'&a!
5$#EG -$% oygen &f re/u&re"
Br&ef h&s'ory
I8 I$ access. D$ no' "e!ay car"&overs&on
Trea'men'
#ar"&over'
A'r&a! f!u''er ?;,1;; @ (&phas&c &n&'&a! "ose
Increase &n &ncremen's
A'r&a! f&(r&!!a'&on : 1%;,%;; @ (&phas&c &n&'&a! "ose
Increase &n &ncremen's
harmaco!ogy 0&f car"&overs&on &s unsuccessfu!
Am&o"arone : 1?; mg over 1; m&nu'es
D&go&n : 1;,1? mg>g 0;.?,1.; mg
Rap&" an'&coagu!a'&on
TACHYCARDIAS
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-TAB5E 8 TA#H WITH A 5-E
W&"e comp!e 2 1?; (m&n
no *aves no a'r&a! f&(r&!!a'&on
INITIA5
5$# EG -$% $% &f re/u&re"
a'&en' eam an" h&s'ory
I8 !a(s car"&ac mar>ers ches' ,ray
#ons&"er a"enos&ne
TREATMENT
An'&,"ysrhy'hm&c
Am&o"arone : 1?; mg over 1; m&nu'es May repea'
5&"oca&ne ,;.?,1;? mg>g repea' a' ha!f "ose 'o ) mg
roca&nam&"e : %;,?; mgm&n &nfus&on
Magnes&um 1,% gm
-o'a!o! : 1;; mg over ? m&nu'es
#ar"&over' 0If pharmaco!ogy &s unsuccessfu! 1;;%;;);;)F; @ou!es monophas&c
1%;,%;;
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N-TAB5E 8TA#H WITH A 5-E
Ra'e 21?;
Decrease" 5$#
Hypo'ens&on *&'h ches' pa&n
oss&(!e pu!monary e"ema
INITIA5
5$#EG8--$% $% &f re/u&re"
I8I$ access
Br&ef h&s'ory &f poss&(!e
Do no' "e!ay car"&overs&on
TREATMENT
#ar"&overs&on
-e"a'&on &f respons&ve
1%;,%;; @ou!es (&phas&c
1;;,)F; @ou!es monophas&c
harmaco!ogy
se 'he same as for s'a(!e 8Tach &f car"&overs&on &s
unsuccessfu!
TACHYCARDIAS
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CARDIAC ARREST
ASYSTOLE " EA
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ULSELESS ELECTRICAL
ACTIVITY AND ASYSTOLE
#UIC! VIEW
Beg&n #R
A''ach mon&'or "ef&(r&!!a'or
#on'&nue #R &n % m&nu'ecyc!es
In'u(a'eI8 I$ access
@
A"m&n&s'er vasopressor
Ep&nephr&ne 1 mg
8asopress&n +; un&'s
@
#on'&nue #R
@
5oo> for revers&(!e causes 0?Hs an" Ts
HYPOXIA
HYPOVOLEMIA
HYDROGEN ION
(ACIDOSIS)
HYPERKALEMIA
HYOPKALEMIA
HYPOTHERMIA
TOXINS
THROMBUS
PULMONARY
THROMBUS
CORONARY
THROMBUS
CARDIAC
TENSION
PNEUMOTHORAX
TAMPONADE
H
T
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CARDIAC ARREST VFIB
ULSELESS V TACH
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VENTRICULAR FIBRILLATION
ULSELESS VTACH
#UIC! VIEW
Beg&n #R
-H$# 0 %;;< (&phas&c )F;< monophas&c
#on'&nue #R 'hroughou' en'&re co"e
-ecure a&r*ay an" s'ar' I8I$ *&'h N- or 5R
@Drug 8asopressor +;
Ep&nephr&ne 1mg every ),? m&nu'es "ur&ng co"e@
-H$# 0ma. "ose P%;; @ (&phas&c )F; @monophas&cQ
@Drug An'&,arrhy'hm&c
Am&o"arone );;mg
5&"oca&ne 1.? mg>g
@-H$# 0ma "ose P%;; @ (&phas&c )F; @ monophas&cQ
@Repea' "rug shoc> se/uence
Am&o"arone 1?;mg
5&"oca&ne : 1.?mg>g 'o )mg ma
@5oo> for revers&(!e causes ? Hs an" ? Ts
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#$N-IDERATI$N- BE9$RE ARRE-T
The non arres'e" pa'&en'
Recogn&=e a cr&'&ca! pa'&en'
I' &s eas&er 'o preven' an arres' 'han 'o resusc&'a'e
$('a&n 'he fo!!o*&ng as ear!y as poss&(!e 1% !ea" EG
8&'a! s&gns &nc!u"&ng -$% an" 'empera'ure
$('a&n a comp!e'e h&s'ory (efore an arres' occurs
Dra* !a(s #T scans ,rays (!oo" 'ype &f nee"e"
Ma&n'a&n hemo"ynam&c an" resp&ra'ory s'a(&!&'y
#ons&"er ? Hs an" Ts (efore arres'
Hypo&a To&ns
Hypovo!em&a Throm(os&s 0pu!monary
Hy"rogen &on 0ac&"os&s Throm(os&s 0coronary
Hyperhypo>a!em&a Tampona"e
Hypo'herm&a Tens&on pneumo'hora
ARREST CONSIDERATIONS
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Wha' causes EA u!monary em(o!&
Ac&"os&s
Acu'e myocar"&a! &nfarc'&on
Hyper>a!em&a
Drug over"ose
Trauma neumo'hora
Tampona"e
Hypovo!em&a
Hypo&a
Wha' causes asys'o!e Hypo&a
Hypo'herm&a Hypohyper>a!em&a
Ac&"os&s
Hypog!ycem&a
Drug over"ose
Trauma neumo'hora
Tampona"e
Hypovo!em&a
Hypo&a
ARREST CONSIDERATIONS
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Bas&c arres' managemen' 'rauma
-'ar' an" con'&nue #R
Ma&n'a&n h&gh /ua!&'y #R 'hroughou'
A''ach mon&'or an" "ef&(r&!!a'e A-A &f &n"&ca'e"
#on'ro! 'he a&r*ay 0a"vance" a&r*ay
5arge (ore I8 or I$ G&ve "rugs per 'he appropr&a'e a!gor&'hm
Trea' hypo&a
In'u(a'e 0cr&co'hyro'omy or 'racheo'omy
neumo'hora
#hes' "ecompress&on
#hes' 'u(e
Tampona"e
er&car"&a! cen'es&s
Trea' hypovo!em&a
#on'ro! (!ee"&ng
% 5arge (ore I8s or I$s *&'h a crys'a!!o&"
Rap&" (!oo" 'ype an" 'ransfus&on
In an emergency 'ype $ nega'&ve (!oo" can (e use"
A!*ays cons&"er 'he ?Hs an" Ts
ARREST CONSIDERATIONS
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E!ec'ro!y'e un(a!ance
Rena! "&a!ys&s Ac&"os&s
Hyper>a!em&a
Hypog!ycem&a
D&a(e'&cs
Ac&"os&s Hypog!ycem&a
Hyper>a!em&a
Hypo>a!em&a
A!coho!&cs Hypo>a!em&a
Hypog!ycem&a
Hypomagnesem&a #ons&"er a (ra&n (!ee" from a fa!!
ro!onge" vom&'&ng Dehy"ra'&on
Ac&"os&s
Hypo>a!em&a
ro!onge" "&arrhea Dehy"ra'&on
Ac&"os&s
Hypo>a!em&a
Hypomagnesem&a
ARREST CONSIDERATIONS
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Trea'men' of e!ec'ro!y'e un(a!ances Hyper>a!em&a
erform s'an"ar" A5- an" B5-
#a!c&um ch!or&"e : ?;;mg,1 gm 'o s'a(&!&=e ce!!s
-o"&um (&car(ona'e : ?; mE/ 'o sh&f' po'ass&um&n'o ce!!s
M& %? gm g!ucose an" 1; un&'s &nsu!&n &nfuse over1? m&nu'es
Hypomagnesem&a erform s'an"ar" B5- an" A5-
Mos'!y foun" &n a!coho!&cs "ehy"ra'&on an"ma!nour&she" pa'&en's
sua!!y presen's as po!ymorph&c 8Tach 0Torsa"es
G&ve 1,% gm magnes&um I8 (o!us
Me'a(o!&c ac&"os&s E'en"e" per&o" of arres' an" over"oses
Trea' per appropr&a'e B5- an" A5- pro'oco!s
9&rs' a''emp' 'o correc' *&'h #R an" &n'u(a'&on
se 1 mE/ >g "ose of so"&um (&car(ona'e Repea' a' ha!f "ose &f re/u&re"
AREST CONSIDERATIONS
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REGNAN#Y ARRE-T-
Bas&c B5- an" A5- per a!gor&'hms
9or suspec'e" em(o!us : f&(r&no!y'&cs
9or magnes&um over"ose 1 gm ca!c&um
ch!or&"e
May a!so use ca!c&um g!ucona'e
INTBATED ATIENT-
D$E A5G$RITHM D&s!o"ge" 'u(e
$(s'ruc'e" ET 'u(e
neumo'hora
E/u&pmen' fa&!ure
ARREST CONSIDERATIONS
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TREATMENT- D$NE T$ RE8ENT ARRE-T- I' &s a!*ays (e''er 'o 'rea' 'o preven' an arres' 'han 'o "ea! *&'h an
arres' s&'ua'&on
Anaphy!a&s per&,arres's 5arge (ore I8 EG 8- -$% oygen &f re/u&re"
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
A"m&n&s'er ?; mg "&phenhy"ram&ne I8
A"m&n&s'er 1 mg ep&nephr&ne or +; un&'s vasopress&n A"m&n&s'er up 'o +,J ! crys'a!!o&" 1 !&'er a' a '&me
#ons&"er 1%? mg -o!u,Me"ro! I8
As'hma per&,arres's 5arge (ore I8 EG 8- -$% h&gh f!o* oygen
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
M& %.?mg a!(u'ero! an" ;.?mg A'roven' ne(u!&=e"
May con'&nue a!(u'ero! ne(u!&=e" 'rea'men'
A"m&n&s'er 1 mg ep&nephr&ne -O
In'u(a'e &f severe an" pu' pa'&en' on a ven'&!a'or
#ons&"er -o!u,Me"ro! 1%? mg
u!monary e"ema per&,arres's 5arge (ore I8EG8--$% oygen &f re/u&re"
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
If pa'&en' &s consc&ous use #A or BIA A-A
If pa'&en' &s unconsc&ous &n'u(a'e an" suc'&on
#on'ro! (!oo" pressure *&'h NTG or n&'ropruss&"e
Ins'a! a 9o!ey ca'he'er
A"m&n&s'er +;,J; mg 5as& I8
ERI$ARREST SITUATIONS
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$ver"oses
#oca&ne 5arge (ore I8EG8--$% 'empera'ure oygen
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
A"m&n&s'er a (en=o "&a=epam
ressure ven'&!a'e" oygen for pu!monary e"ema
#on'ro! (!oo" pressure N&'rog!ycer&ne N&pr&"e
hen'o!am&ne 0a!pha (!oc>er
An'&,"ysrhy'hm&c as re/u&re"
Tr&,cyc!&c an'&"epressan's -ymp'oms
#onvu!s&ons
#oma
#ar"&ac arrhy'hm&as Ac&"os&s
Hypo'ens&on
Trea'men' 5arge (ore I8EG8- -$% $YGEN I9 REOIRED
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
Non,arres',ac'&va'e" charcoa! 07 1 hour
Ben=o "&a=epam for se&=ures
-o"&um (&car(ona'e for ac&"os&s 9!u&" (o!us NA#5 for hypo'ens&on
Arres',a"m&n&s'er 1 mE/ >g so"&um (&car(ona'e
ERI$ARREST SITUATIONS
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$8ERD$-E-
#a!c&um channe! (!oc>ers I8 EG 8- -$% chec> BG5 oygen &f re/u&re"
9!u&"s for hypo'ens&on N- ?;;,1;;; m!
Ac'&va'e" charcoa! 7 hour of &nges'&on
Insu!&n for &mprove" energy
Ep&nephr&ne &nfus&on %,1; mg m&n
#a!c&um ch!or&"e ;.% mE/>g or ca!c&um g!ucona'e ;.) mE/ >g
ac&ng for (ra"ycar"&as
Be'a (!oc>ers -ame 'rea'men' as ca!c&um channe! (!oc>ers ecep' g&ve ),1; mg
g!ucagon IM or I8
Narco'&cs I8 EG 8- -$% oygen &f re/u&re"
A"m&n&s'er %,+ mg Narcan may have 'o repea'
Ben=o "&a=epams
I8EG 8- -$%. oygen &f re/u&re" Roma=&con, on!y &f a >no*n (en=o "&a=epam over"ose
If uncer'a&n a!!o* pa'&en' 'o na'ura!!y process
HY$THERMIA #R
Ho!" "ef&(r&!!a'&on un'&! core 'empera'ure &s 2)) "egrees #
Warm *&'h (!an>e's *arm I8s or per&'onea! !avage
When *arm 'rea' per appropr&a'e a!gor&'hm
They are no' "ea" un'&! 'hey are *arm an" "ea"
ERI$ARREST SITUATIONS
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Reasons 'o 'erm&na'e resusc&'a'&on
Re'urn of effec'&ve spon'aneous
c&rcu!a'&on
#r&'er&a for &rrevers&(!e "ea'h
Ehaus'&on of 'he hea!'h care prov&"er
A va!&" DNR
Au'hor&=a'&on (y a phys&c&an
Transfer 'o a h&gher !eve! of care
If pa'&en' rema&ns &n arres' af'er repea'e"
a''emp's *&'h h&gh /ua!&'y #R an" A#5-
TERMINATE
RESUSCITATION
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Hemo"ynam&c s'a(&!&'y
Bas&c
1% !ea" car"&ac mon&'or
An'&,arrhy'hm&c "r&p as re/u&re"
$ygen 'o >eep -$% 23+4
Ra'e con'ro!
#on'ro! ra'e per A#5- pro'oco!s
B!oo" pressure con'ro! 9!u&"s are 'he f&rs' !&ne
8asopressors are 'he secon" cho&ce
un!ess f!u&"s are con'ra&n"&ca'e" (y
'he pa'&en's con"&'&on.
OST ARREST
MANAGEMENT
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Hemo"ynam&c an" ven'&!a'&on op'&m&=a'&on
se 1;;4 oygen &n 'he &n&'&a! resusc&'a'&on
T&'ra'e &nsp&re" oygen 'o ma&n'a&n -$% 2 3+4
Avo&" ecess&ve ven'&!a'&on 'o re"uce &n'ra'horac&cpressure
Recommen"e" ven'&!a'&on ra'es 1;,1% BM ET#$ : )?,+;
a#$% ,+;,+?
A"m&n&s'er f!u&"s an" vasoac'&ve "rugs 'o
$p'&m&=e (!oo" pressure
Improve car"&ac ou'pu'
$p'&m&=e sys'em&c perfus&on
M&!" hypo'herm&a se" on a!! pa'&en's unrespons&ve af'er R$-#.
reven's (ra&n "e'er&ora'&on "ue 'o g!o(a! &schem&a
Tempera'ure goa! &s )%,)+ "egrees #
T&me a' hypo'herm&a 1%,%+ hours
Trea' hypo'ens&on *&'h f!u&"s 01,% !&'ers
8asopressors may (e use" &f f!u&"s "o no' *or> Targe' g!ycem&c con'ro! 'o 1++,1J; mgm!
Imme"&a'e coronary reperfus&on *&'h a #I
OST ARREST
MANAGEMENT
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MANAGEMENT
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OST ARREST ALGORITHM
#UIC! VIEW
OPTIMIE
VENTILATION
AND
OXYGENATION
OPTIMIE
CARDIAC
FUNCTION
ADVANCED
CRITICAL CARE
12 LEAD
PCI
INAPROPRIATE
NEUROLOGICA
L
MILDHYPOTHERMI
A
INTUBATE
RATE 1$ BPM
OXYGEN SAT
%-
CO2 3-%$
&&H'
RATE # 7$
RHYTHM
INFUSION
BLOOD
PRESSURE
FLUIDS
VASOPRESSORS
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Ro!e of 'he 'eam !ea"er
$rgan&=es 'he group
Mon&'ors performance of 'eam mem(ers
Bac>s up 'eam mem(ers
Mo"e!s ece!!en' 'eam (ehav&or
Tra&ns an" coaches
9ac&!&'a'es un"ers'an"&ng
9ocuses on comprehens&ve pa'&en' care
Ro!e of 'eam mem(ers
#!ear a(ou' ro!e ass&gnmen's
repare" 'o f&!! 'he&r ro!e ass&gnmen's We!! prac'&ce" &n resusc&'a'&on s>&!!s
no*!e"gea(!e a(ou' 'he a!gor&'hms
#omm&''e" 'o success
Team mem(er ass&gnmen's
#ompressor #R
A&r*ay managemen'
I8 I$ me"&ca'&ons
Mon&'or "ef&(r&!!a'or
$(server recor"er '&me >eeper
TEAM CONCET
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TEAM CONCET
TYI#A5 #$DE 5AY$T
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