Page 89 - Radiology Book

universal acls algoritHm
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PRIMARY SURVEY
1. Patient unresponsive
2. Call for help
3. Activate EMS
4. Get AED/de brillator
5. Attach monitor (when ready)
Person collapses, possible cardiac arrest
· Always assume victim is in cardiac and/or respiratory arrest until proven otherwise.
· “ARE YOU OK?”
· Call for help, activate EMS/CODE TEAM, and
start chest compressions.
No BREATHING No PULSE
· Simultaneous check, no
pulse felt within 10 seconds
START (CPR) COMPRESSIONS Rhythm Shockable?
High-Quality CPR
· Push hard and fast to a depth of ≥ 2 inches and deliver 100–120 compressions/minute.
· With advanced airway, 1 breath every 6 seconds (10/min) with continuous chest compressions.
· No advanced airway, compression-ventilation
ratio 30:2.
· Rotate compressor every 2 minutes or sooner. · Allow complete chest recoil and avoid
excessive ventilation.
· Quantitative waveform capnography: PETCO2
< 10 mmHg, attempt to improve CPR quality.
· ·
Push hard and fast Minimize interruptions
Compressions First: start chest compressions if no pulse
Airway: oxygen therapy, 2 breaths after full cycle of 30 compressions Breathing: 30:2 compression-ventilation ratio (with no advanced airway) De brillation: attach de brillator/monitor
YES RHYTHM SHOCKABLE? NO
VF/pVT
· ATTEMPT DEFIBRILLATION · CPR for 2 min prior to next shock
RHYTHM SHOCKABLE? NO YES
ATTEMPT DEFIBRILLATION
· CPR for 2 minutes prior to next shock
· Epinephrine 1 mg every 3–5 minutes
· Advanced airway, capnography
RHYTHM SHOCKABLE?
NO YES
ATTEMPT DEFIBRILLATION
· CPR for 2 minutes
· Amiodarone 300 mg, then 150 mg
· Look for reversible causes
Asystole or PEA
CPR for 2 minutes
· Epinephrine 1 mg every
3–5 minutes
· Advanced airway,
capnography
RHYTHM SHOCKABLE? YES NO
CPR for 2 minutes
· Look for reversible causes · Epinephrine 1 mg every
3–5 minutes
RHYTHM SHOCKABLE? YES NO
Return of spontaneous circulation
· Pulse and blood pressure
· Abrupt sustained increase in PETCO2 (typically ≥ 40 mmHg)
· Spontaneous arterial pressure waves with intra-arterial monitoring
POST-CARDIAC ARREST CARE
ACLS