ALGORITHMS



•  Compressions and circulation


• Check for a pulse


• If a pulse is present, continue rescue breathing


• Reassess pulse every 2 min


• If a pulse is not present within 10 sec or pt shows signs of poor perfusion, begin chest compressions


• Chest compressions (should now be before airway/breathing)


• Initiate immediately


• Minimize interruptions between compressions


• Adult, child, and infant


• Continuous ventilation @ 8–10 breaths/min


• Continuous compressions @ 100/min


• Resume CPR immediately after defibrillation


• Complete chest recoil between compressions


• If 2 rescuers present, switch roles every 2 min to prevent fatigue


• Continue cycles of CPR until a defibrillator or additional help arrives


• Rhythm checks should not be longer than 10 sec


• Should be done after 5 cycles of CPR have been completed (2 min)


• Pulse checks should be done only if an organized rhythm is restored


• Drug administration and definitive airway placement should minimally interrupt compressions



•  Airway/breathing


• Maintain patent airway, give supplemental oxygen


• Place advanced airway


• Minimize interruptions of chest compressions during placement


• Continuous waveform capnography should be used for confirmation & maintenance of ETT placement


• After airway placed, 2 providers should administer continuous CPR (not in cycles)


Intravascular access should be obtained


• Intravenous—peripheral or central (faster med onset, but may interfere with CPR)


• Intraosseous (IO) access—may be safely used if difficult IV access


• Endotracheal route—not desirable, last resort if IV or IO cannot be obtained


• Dose: 2–2.5 × standard IV dose diluted in 5–10 mL NS


• Drugs OK via ETT → lidocaine, atropine, epi, vasopressin, narcan


•  Defibrillation


• Prompt defibrillation is critical when a patient displays a shockable rhythm


• Initial dose for biphasic is 120–200 J; monophasic is 360 J; 2 J/kg in peds (1–8 yrs)


•  Differential diagnosis—diagnose and treat throughout resuscitation


Figure 34-1. ACLS: Adult cardiac arrest.



Figure 34-2. ACLS: Adult cardiac arrest.



Figure 34-3. ACLS: Bradycardia algorithm.



Figure 34-4. ACLS: Tachycardia with a pulse algorithm.




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Aug 28, 2016 | Posted by in ANESTHESIA | Comments Off on ALGORITHMS

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