The Zombie CPR instructional video
c_asystole
Table of Contents
choking / cardiac arrest / BLS / ALS / CPR
introduction
- mortality from in-hospital VF arrest:
- “30%” if VF occurs and immediate defibrillation is perfomed
- >95% if defibrillation delayed by > 12 minutes
- mortality from Out-of-Hospital cardiac arrest (OHCA):
- VF arrest - 66-96%
- depending on bystander CPR, availability of early defibrillator use
- likelihood of survival largely determined by return of spontaneous output by the time patient arrives in ED.
- asystole - >99%
- thus prevention is far better than the cure!
- in-hospital Medical Emergency Team (MET) to attend and manage critically ill ward patients ASAP
- timely assessment and Mx of patients presenting to ED with early senior doctor input to detect at risk patients.
- community awareness of chest pain and need for ambulance transfers ASAP
Mx of choking victim
- call for help
- if effective cough:
- implied mild airway obstruction thus encourage coughing and get help, remain with victim
- ineffectual coughing:
- implies severe airway obstruction
- conscious:
- call for help
- give up to 5 back blows
- if not effective, give up to 5 chest thrusts
- if no relief but remains conscious, repeat above
- unconscious:
- call for help
- commence CPR as below
summary of Basic Life Support (BLS) for cardiac arrest
7 components of BLS:
- D: remove from danger
- R: assess patient responsiveness
- S: send for help
- A: clear airway
- head tilt-chin lift if non-trauma, or jaw thrust if trauma
- remove vomitus using suction if possible
- recognition and relief of foreign body airway obstruction
- B: restore breathing although no longer the priority in adult out-of-hospital arrest
- cardiac compressions alone (no ventilations) recommended for adult, out-of-hospital primary cardiac arrest (not respiratory) if witnessed, and with shockable rhythm or short period (<4 minutes) of untreated arrest
- cardiac compressions alone also recommended if bystander not trained in CPR, or not confident in their ability
- breaths (in hospital or those trained in CPR):
- bag and mask if available (and oxygen at 15L/min to deliver 85% oxygen if available)
- 2 effective breaths every 30 compressions with a 1 second inspiratory time (except neonates, give 40-60 breaths/min)
- if unprotected airway, pause compressions during breaths
- if protected airway (eg. ETT in situ), don't pause compressions, and rate should 1 breath every 15 compressions (2 breaths in children every 15 compressions)
- bag size:
- > 18kg or > 5yrs old, use a 1600ml adult bag
- infant, use a 500ml bag
- neonate, use a 240ml bag or neonatal circuit
- C: establish circulation:
- checking for pulses is unreliable, instead start compressions if no signs of life, for instance:
- unresponsive or unconscious
- not breathing or the occasional gasping breath
- not moving
- cardiac compressions over mid-sternum to a depth of 1/3rd chest (eg. 4-5cm in an adult) at a rate of 100 per minute for all ages, stopping to allow 2 breaths every 30 compressions if unprotected airway
- early cardiac compressions may:
- prevent VF deteriorating into asystole
- increase the chance of successful defibrillation in VF
- add to the preservation of brain and cardiac function
- D: availability of semi-automatic external defibrillators:
- defibrillation as soon as possible provides the best chance of survival in victims with VF or pulseless VT
- C/I to SAED (await ALS team instead):
- children < 8yrs age or < 25kg
- unsafe environment
- conscious and breathing normally
- if cardiac arrest occurs in the obviously pregnant woman, place in a left lateral tilt by placing a pillow or wedge under the right buttock - this will reduce compression of IVC and aid venous return.
summary of Advanced Life Support (ALS) for cardiac arrest
- consider and correct:
- hypoxia
- hypovolaemia
- hyperkalaemia, hypokalaemia and other metabolic disorders
- tension pneumothorax
- tamponade
- toxins
- thrombosis (PE/AMI)
- continues the principles of BLS but then splits depending on:
- shockable rhythm
- non-shockable rhythm (asystole or PEA)
- if asystole:
- adrenaline / epinephrine 1mg (10mcg/kg) boluses stat then every 2nd 2 minute CPR cycle
- return of spontaneous circulation (ROSC)
- see also:
- if likely poisoning or toxin then consider specific therapies:
- good CPR (cardioversion/defibrillation unlikely to help)
- call an expert on toxicological arrests ASAP if possible
- give boluses iv sodium bicarbonate 1-2mEq/kg every 1-2 minutes until return of perfusing rhythm
- intubate and hyperventilate
- give adrenaline as per usual cardiac arrest protocol
- avoid amiodarone
- consider 20% intralipid 100ml over 1 minute, repeat once or twice in 3-5 minute intervals if required, followed by an infusion
- keep doing CPR
- beta adrenergic blocker overdose or calcium channel blocker overdose then consider atropine and high dose insulin and dextrose Rx
- Acetylcholinesterase inhibitor poisoning - then high dose atropine and perhaps pralidoxime
- digoxin toxicity - Fab fragments
- tricyclic antidepressant overdose or other sodium channel blocker - consider sodium bicarbonate
- local anaesthetic agents overdose - iv lipid emulsion therapy - 1.5ml/kg bolus of 20% lipid emulsion, then 0.25-0.5ml/kg/min infusion1)
- Envenomation and bites - consider antivenom
further airway management if still unconscious
- intubation should not interrupt chest compressions for more than 20 seconds
- avoid hyperventilation as risk of complications from increased intrathoracic pressure, and decreased coronary and cerebral perfusion.
- ventilation rate once intubated should usually be 8-10 breaths/minute, without pausing for chest compressions (rate 15:1)
- confirmation of correct endotracheal tubbe placement - eg. end-tital CO2
references and other resources
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- recommendations: Resuscitation 2005; 67 (Suppl 1):S1-S190
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and for fun
1)
Clin. Toxicol. (Phila.) 2010; 48(1):1-27
c_asystole.txt · Last modified: 2019/01/05 07:19 by wh
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