What is involved in the BLS primary survey?
ABCDs
In the “airway” of ABCs, how method is used to open the airway? What method if trauma is suspected?
Is the airway open? The airway should be opened using head tilt-chin lift or if trauma is suspected jaw thrust.
(If trauma is suspected, cervical immobilization must be maintained.)
In the ABCs, how long should circulation be assessed for prior to starting CPR?
5-10 seconds
In CPR, if no pulse is present, the rhythm should be assessed using a _________________.
defibrillator
manual defibrillator or AED
How is ACLS secondary survey different from BLS primary survey?
…More advanced
- A: In addition to head tilt-chin life, jaw thrust, use oropharyngeal airway, or nasopharyngeal airway (Endotracheal intubation most effective)
- B: Assess rise and fall of the chest, auscultate breath sounds (check if equal), look for absence of breath sounds over the epigastrum, monitoring end-tidal CO2 using capnometry or capnography
- C: Obtain IV or IO access, start pt on cardiac monitor
What is the acronym for ACLS drugs that are safe for endotracheal intubation administration?
NAVEL
Naloxone Atropine Vasopressin Epinephrine Lidocaine
Consider the ddx of causes of suspected cardiac arrest (especially potentially reversible causes).
- Hypovolemia
- Hypoxia
- Acidosis
- Hypothermia
- Tension pneumothorax
- Cardiac tamponade
- Electrolyte abnormality
- Overdose
- Trauma
- Acute Coronary Syndrome
What are some initial studies/labs to order with suspected cardiac arrest?
- EKG: (r/o cardiac ischemia, various toxin exposure, hyperkalemia)
- ABG: shows the acid-base and oxygenation status of the patient
- Electrolytes
- CXR
- Bedside US may be used to evaluate cardiac activity or the presence of pericardial effusions.
Almost all episodes of sudden cardiac death initiate from this rhythm.
What is ventricular tachydysrhythmia?
- Successful resuscitation is dependent on rapid defibrillation
ACLS recommends chest compressions should be interrupted only for _________, ___________, and ___________ since even a 5-10 second pause in compressions reduces the probability that the shock will terminate VF/pulseless VT.
ventilation, rhythm checks, and shock delivery
After shock administration, what should you do next? When should you check the rhythm?
CPR starting with compressions should be immediately initiated after the shock without performing a pulse or rhythm check for 2 minutes (5 cycles) of CPR.
The interruption in CPR to check the rhythm should not exceed ___ seconds.
10 sec
What are the shockable rhythms?
Not shockable?
V-tach, V-fib
not shockable: PEA, asystole
How much Joules of energy should you use in a shock?
200 Joules
Besides compressions, breathing, and shocks, what else should be administered, what dose, and how often?
- Obtain IV/IO access to administer epinephrine 1 mg q 3-5 min (start at first 2 min shock interval)
- Amniodarone 300mg, followed by 150mg as indicated every 3-5 min (start at 2nd 2 min shock interval)
In the past, what med could have been substituted for epi 1mg during CPR?
Vasopressin 40 U
- Substituted for the first or second dose of epinephrine. No vasopressor medications have been shown to improve the survival rate for PEA, but are recommended to improve aortic diastolic blood pressure and coronary artery perfusion.
Studies have shown that resuscitation efforts are unlikely to be successful after ___ minutes of combined BLS and ACLS.
20 min
In the past, this alternative medication should be considered for asystole or slow PEA and may be repeated every 3 to 5 minutes for a total of 3 doses. (not still recommended)
Atropine 1mg IV/IO
What is the rationale behind therapeutic hypothermia in CPR?
A large proportion of victims will suffer anoxic brain injuries. Initiation of mild hypothermia (cooling to 32-34 C) has been demonstrated to decrease the 6 month mortality rate and lead to improved functional recovery at hospital discharge.
Review inclusion criteria for therapeutic hypothermia.
- Patients resuscitated after out-of-hospital witnessed arrest with VT/VF as initial rhythm
- Resuscitation initiated by EMS within 5-15 minutes of arrest
- No more than 60 minutes from collapse to return of spontaneous circulation (ROSC)
- Persistent coma after ROSC
- Adult age
- Endotracheal intubation and mechanical ventilation
Review contraindications for therapeutic hypothermia.
- Severe cardiogenic shock (SBP<90 mmHg) despite fluids and inotropes
- Cause of coma other than cardiac arrest (overdose, CVA)
- Pregnancy
- Known coagulopathy
- Life-threatening arrhythmias
- Initial temperature <30 C
- Preexisting DNR status
- Pediatric patients
