Page 18 - Emergency medicine for students ebook

Cardiac arrest
Symptoms:
Ø Unconscious, no carotid/femoral pulse (for 10secs), not breathing ------------------------------------------------------------------------------------------------------- Pre hospital aid:
• Check danger, assess responsiveness, call help, look/listen/feel, tell help there is cardiac arrest and get defibrillator and call 999
• Start CPR: 2 breaths for 30 compressions -------------------------------------------------------------------------------------------------------
Hospital treatment:
• Continue BLS- compressions and bag-valve-mask ventilation
• Remove/cut clothing from upper body
• Apply defibrillation pads: one to right of upper sternum below clavicle,
other mid axillary line LHS, pause compressions get rhythm
• Get IV access at same time
• If VF/VT rhythm, remove O2, stand clear, defibrillate at 150J (if biphasic
defibrillator)
• Resume compressions for 2 mins then reassess rhythm.
• If defibrillation not available- give single precordial thump: tightly
clenched fist, deliver one direct blow from 20cm height to lower half of
sternum
• Drug administration
v Adrenaline after 3 shocks in VF/VT every 3-5 mins, adrenaline straight away if asystole/PEA
Example of VT, VT/VF and VF waves on an ECG http://slideplayer.com/slide/5687622/
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