Page 91 - Radiology Book

ventricular fibrillation (vf)
Pulseless ventricular tacHycardia (pvt)
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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)
ACLS Healthcare Provider - 2015 Update
Immediately resume chest compressions after giving the 1st shock. Do not interrupt chest compressions to check circulation (rhythm or pulse) until after 5 cycles or approximately 2 minutes
of CPR. (This sequence may be modi ed at a physician’s discretion with in-hospital units when continuous monitoring is used).
No BREATHING No PULSE
Simultaneous check, no pulse felt within 10 seconds.
START COMPRESSIONS
VF/pVT ON MONITOR
ATTEMPT DEFIBRILLATION
· Biphasic: 120–200 J
· Monophasic: 360 J
· CPR for 2 minutes prior to next shock
· Epinephrine 1 mg every 3–5 minutes
Compressions First: give 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), 1 breath every 6 seconds with an advanced airway and no interruption of chest compressions
· Consider advanced airway, capnography De brillation: attach de brillator/ monitor
NO RHYTHM SHOCKABLE?
ATTEMPT DEFIBRILLATION
· Biphasic: 200–360 J
· Monophasic: 360 J
· CPR for 2 minutes prior to next shock · Epinephrine 1 mg every 3–5 minutes
NO RHYTHM SHOCKABLE?
· ATTEMPT DEFIBRILLATION
· Biphasic (200–300 J, device-speci c)
· Monophasic (360 J)
· Resume chest compressions/ventilation immediately after shock · CPR for 2 minutes after shock
· Consider antiarrhythmics:
· Amiodarone 300 mg IV/IO once; consider second dose of 150 mg IV/IO once
· OR Lidocaine 1–1.5 mg/kg rst dose, then 0.5–0.75 mg/kg IV/IO; max 3 doses or 3 mg/kg an an alternative to amiodarone that is unresponsive to CPR, de brillation, and vasopressor therapy
· Consider loading dose of Mg 1–2 g IV/IO for torsades de pointes · Continue de brillation attempts with rhythm checks and
secondary survey
· Look for reversible causes
RETURN OF SPONTANEOUS CIRCULATION (ROSC)
· Pulse and blood pressure
· Abrupt sustained increase in PETCO2 (typically ≥ 40 mmHg)
· Spontaneous arterial pressure waves with intra-arterial monitoring
POST-CARDIAC ARREST CARE
Get the latest algorithms before starting any treatment at https://eccguidelines.heart.org Adapted from Circulation. 2015;132[suppl 2]:S444–S464.
ACLS