Asystole may 4e discovered durin# the primary A5C! survey. It may develop in a previously monitored patient. If the patient is a candidate for resuscitation, then proceed (ith the secondary survey.
Asystole may 4e discovered durin# the primary A5C! survey. It may develop in a previously monitored patient. If the patient is a candidate for resuscitation, then proceed (ith the secondary survey.
Asystole may 4e discovered durin# the primary A5C! survey. It may develop in a previously monitored patient. If the patient is a candidate for resuscitation, then proceed (ith the secondary survey.
then lets have a cup of TEA. A Intervention Comments!ose T Transcutaneo us "acin# $TC"% &nly e'ective (ith early implementation alon# (ith appropriate interventions and medications. )&TE* )ot e'ective (ith prolon#ed do(n time. E Epinephrine + m# I, -./0 min. A Atropine + m# I, -./0 min. $ma1. dose 2.23 m#k#% Consider termination of e'orts if asystole persists despite appropriate interventions. Asystole may 4e discovered durin# the primary A5C! survey after attachin# a monitor, or it may develop in a previously monitored patient. In either case, it is essential that asystole 4e con6rmed in another lead (ith properly functionin# e-uipment. If the patient is in true asystole and is a candidate for resuscitation, then proceed (ith the secondary A5C! survey. Ventricular Fibrillation (VF)/ Pulseless Ventricular Tachycardia (PVT) The follo(in# mnemonic directs A7A accepted actions after the primary survey ABCs "lease 8hock/8hock/8hock, E,ery4ody 8hock, And 9ets :ake "atients 5etter Chant Intervention )ote "lease "recordial Thump :ay 4e performed immediately after determinin# pulselessness in a (itnessed arrest (ith no de64rillator immediately availa4le. Check pulse after thump. 8hock ;22<= If ,> or ,T is sho(n on monitor, shock immediately, do not lift paddles from chest after shockin#, simultaneously char#e at ne1t ener#y level and evaluate rhythm. 8hock ;22/.22<= If ,> or ,T persists on monitor, shock immediately, do not check pulse, do not continue C"?, do not lift paddles from chest after shockin#, simultaneously char#e at ne1t ener#y level and evaluate rhythm. 8hock .@2<= If ,> or ,T persists, shock immediately. Implement the secondary A5C! survey. !o not continue (ith this al#orithm if an intervention results in the return of spontaneous circulation. )&TE* Ahen #ivin# meds, do so in a dru#/shock/dru#/shock se-uence. Continue C"? (hile #ivin# meds, and shock (ithin .2/@2 seconds. Evaluate the rhythm and check for a pulse in the period immediately after shockin#. Every4ody Epinephrine + m# I, -./0 min. or e,ery4ody ,asopressin 32 B I,, one time dose.$(ait +2/;2 minutes 4efore startin# epi% If ,>",T persists, C!"#$%&'( antiarrhythmics and sodium 4icar4. CA)T$!"* Bsin# more than one antiarrhythmic may result in pro/arrhythmic dru#/dru# interactions. And Amiodarone $>irst Choice% .22m# I, push. :ay repeat once at +02m# in ./0 min. $ma1. cumulative dose* ;.;# I,;3hrs.% 9ets 9idocaine +.2/+.0 m#k# I,. :ay repeat in ./0 min. $ma1. loadin# dose* . m#k#% :ake :a#nesium 8ulfate +/; # I, $; min. push% for suspected hypoma#nesemia or torsades de pointes. "atients "rocainamide ;2 m#min, or +22 m# I, - 0 min. for refractory ,>. $ma1. loadin# dose* +C m#k#% Consider 4u'ers 5etter 5icar4onate + mE-k# I, for pree1istin# hyperkalemia, 4icar4/ responsive acidosis, some dru# overdoses, protracted code $intu4ated%, or return of spontaneous circulation after lon# code (ith e'ective ventilation Bradycardia All Trained !o#s Eat Iams $The se-uence reDects interventions for increasin#ly severe 4radycardia% Al#rth Intervention Comments!ose All Atropine 2.0/+.2 m# I, push - ./0 min. $ma1. dose 2.2./2.23 m#k#% Traine d TC" Bse Transcutaneous "acin# $TC"% immediately (ith severely symptomatic patients. !o#s !opamine 0/;2 E#k#min. Eat Epinephrine ;/+2 E#min. Iams Isoproterenol ;/+2 E#min. #table Tachycardia Think &/:/I, $pronounced oh my% &1y#en/:onitor/I,, even 4efore you start your primary and secondary A5C! surveys. After the failure of one antiarrhythmic dru#, electrical cardioversion is usually the ne1t treatment of choice. If the rate is F+02 andor the patient is unsta4le (ith serious si#ns and symptoms due to the rhythm, prepare for immediate electrical cardioversion. )ote that amiodarone is listed for most of the sta4le tachycardias. Gno(in# the e1ceptions for the use of amiodarone (ill aid in the implementation of the sta4le tachycardia al#orithms. Atrial Fibrillation/Flutter $(ith(ithout C7>% 'ate Control diltiaHem 'hythm Conversion * )onemer#ent chemical or !C cardioversion should 4e avoided, and (hen indicated, should only 4e performed 4y an e1perienced health care provider after careful evaluation and throm4oem4olic precautions are taken. +ol,-Par.inson-+hite $(ith(ithout C7>% $avoid adenosine, 4eta 4lockers, calcium channel 4lockers, di#o1in% 'ate Control amiodarone 'hythm Conversion )onemer#ent chemical or !C cardioversion should 4e avoided, and (hen indicated, should only 4e performed 4y an e1perienced health care provider after careful evaluation and throm4oem4olic precautions are taken. "arro/ Comple0 Tachycardias ,a#al maneuvers Adenosine 1unctional Tachycardia/&ctopic or 2ultifocal Atrial Tach (/ith//ithout C3F) Amiodarone $no Cardioversion% Paro0imal #upraventricular Tachycardia "o C3F4 ,erapamil !C Cardioversion Amiodarone +ith C3F4 !C Cardioversion di#o1in amiodarone diltiaHem +ide-Comple0 Tachycardia/)n.no/n Type $(ith(ithout C7>% $avoid 4eta 4lockers, calcium channel 4lockers, di#o1in% !C Cardioversion or amiodarone Ventricular Tachycardia !C Cardioversion or trial of medication 2onomorphic $(ith(ithout C7>% amiodarone I synchroniHed cardioversion Polymorphic Evaluate for electrolyte a4normality or dru# to1icity and treat accordin#ly J )ormal KTI 9on# KTI Amiodarone ma#nesium cardioversion overdrive pacin# P&A "ulseless Electrical Activity may 4e discovered durin# the primary A5C! survey (hen a monitor is attached to a pulseless patient and a rhythm is sho(n. As part of the secondary A5C! survey, a doppler should 4e used to con6rm pulselessness. Interventions for pulseless electrical activity are #uided 4y the letters "/E/A* Al5orth Comments/%ose "ro4lem 8earch for the pro4a4le cause and intervene accordin#ly. Epinephrin e + m# I, -./0 min. Atropine Aith slo( heart rate, + m# I, -./0 min. $ma1. dose 2.23 m#k#% #ynchroni6ed Cardioversion #ynchroni6ed &lectrical Cardioversion It is essential that AC98 "roviders kno( the indications for synchroniHed electrical cardioversion and receive proper trainin# on the e-uipment their institution uses 4efore attemptin# to perform this intervention. The follo(in# mnemonic directs preparations for synchroniHed electrical cardioversion* !h #ay $t $snt #o :nemoni c "reparation &h &; saturation monitor 8ay 8uction e-uipment It I, line Isnt Intu4ation e-uipment 8o 8edation and possi4ly anal#esics #ynchroni6ed &lectrical Cardioversion &ner5y 7evels4 Bnless other(ise speci6ed in the ta4le 4elo(, successive ener#y levels are =+22<, and up to =;22<, =.22<, =.@2<, if needed. If the patients condition 4ecomes critical and your e-uipment (ill not synchroniHe, then proceed (ith immediate unsynchroniHed shocks. 'hythm #pecial "otes4 "olymorphi c ,/tach Treat polymorphic ,/tach like ,/64, i.e., successive unsynchroniHed shocks at =;22<, and up to =;22/.22<, =.@2<, if needed. "8,T, A/ Dutter start (ith =02< "ote* If ,/64 develops, immediately de64rillate follo(in# the ,> al#orithm. =&r 4iphasic e-uivalent