Page 90 - Radiology Book

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SECONDARY SURVEY: CABD
Compressions: high-quality CPR, gain IV access, identify rhythm Airway: place airway device
· Endotracheal tube or supraglottic advanced airway
Breathing: con rm and secure device placement by exam plus a device Breathing: con rm effective oxygenation and ventilation De brillation: coordinate between shocks and compressions
Use 5-point auscultation post-intubation: left and right anterior, left and right midaxillary, and over the stomach. Con rm oxygenation and ventilation using end-tidal CO2 monitor and saturation.
High Quality CPR
· Minimizechestcompressioninterruptions.
· Continuouschestcompressionsafteradvanceairwayplaced.
· Chest compressions to a depth ≥ 2 inches or 5 cm while avoiding
excessive chest compression depths (≥2.4 inches or 6 cm).
· If PETCO2 <10 mmHg, attempt to improve CPR quality.
· If the Intra-arterial pressure relaxation phase (diastolic) pressure <20
mmHg, attempt to improve CPR quality.
Shock Therapy
· Biphasic: initial dose 120–200 J; if unknown, use maximum. Subsequent doses should be equivalent; higher doses may be considered.
· Monophasic: 360 J Drug Therapy
· Epinephrine IV/IO dose: 1 mg every 3–5 minutes
· Amiodarone IV/IO dose: 1st dose, 300 mg bolus; 2nd dose, 150 mg bolus Advanced Airway
· Endotracheal intubation or supraglottic advanced airway.
· Con rm and monitor ET tube placement with waveform capnography or
capnometry.
· Give 1 breath every 6 seconds (10 breaths per minute) with continuous
chest compressions.
Post Cardiac Arrest
· Optimize ventilation and oxygenation
· Maintain oxygen saturation ≥94%
· Donothyperventilate
· Treat hypotension (SBP <90 mmHg, MAP <65)
· IV/IO bolus, pressors, look for treatable causes
· GetEKG,IfSTEMIorhighsuspicionofAMI,considercoronaryreperfusion
· TargetedTemperatureManagement(TTM)recommendedbetween320C
and 360C for comatose patients post cardiac arrest with ROSC.
Most Frequent Causes in Differential Diagnosis
5 Hs
· Hypovolemia
· Hypoxia
· Hydrogen ion (acidosis)
· Hypo-/hyperkalemia
· Hypothermia
Adapted from Circulation. 2015;132:S444-S464
5 Ts
· Toxins (drugs; OD or accidental) · Tamponade, cardiac
· Tension pneumothorax
· Thrombosis, coronary (ACS)
· Thrombosis, pulmonary embolism
Southfield16
ACLS