DOCSLIB.ORG

Council Guidelines 1992 (Abridged)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Council Guidelines 1992 (Abridged) Accordingly, compressions should be given at a target (mean) rate of 80/min. For assessment, however, a range of 60-100 compressions/min would be accept- able. This is the rate or speed at which compressions should be undertaken, not the absolute number of compressions delivered within a given minute. BMJ: first published as 10.1136/bmj.306.6892.1589 on 12 June 1993. Downloaded from It is essential to combine ventilation with chest compression in order that the blood, which is being artificially circulated, contains enough oxygen. In an unconscious adult the rescuer should aim to press down some 4-5 cm and apply only enough pressure to achieve this. At all times the pressure should be firm, controlled, and applied vertically. Erratic or violent action is dangerous. Try to spend about the same time in the compressed phase as in the released phase. As the chances are remote that effective spontaneous cardiac action will be restored by cardiopulmonary *@d~~~~ resuscitation without other techniques of advanced life taktw fou .,,seons Eac seuec of IO breaths:E support (including defibrillation),' time should not be wasted by further checks for a pulse. If, however, the wiltereor tae abo 40tto 60 econds casualty makes a movement or takes a spontaneous Theat tiin of exiato isnt crticAl wait fory* breath check the carotid to see whether the heart FIG 5-Method ofturning pulse casualty to recovery position is beating; take no more than five seconds. Otherwise do not interrupt resuscitation. before giving another inflation This should normally Much of the content of this article has been published in take two to four seconds. Each sequence of 10 breaths Resuscitation.2 will therefore take about 40 to 60 seconds. Members of the working group were: Stig Holmberg (Sweden; The exact timing of expiration is not critical; wait for chairman), Anthony Handley (England; secretary), Jan the chest to fall, then give another inflation. Bahr (Germany), Peter Baskett (England), Leo Bossaert (Belgium), Douglas Chamberlain (England), Wolfgang Dick CHEST COMPRESSION (Germany), Ank van Drenth (Netherlands), Lars Ekstrom There is no evidence that an initial precordial (chest) (Sweden), Rudolf Juchem (Germany), Dietrich Kettler thump improves survival in an unwitnessed cardiac (Germany), Andrew Marsden (Scotland), Oliver Moeschler arrest. On the other hand, a witnessed or monitored (Switzerland), Koen Monsieurs (Belgium), Paul Petit (France), Hribar Primoz (Bosnia), Jurgen Schuttler cardiac arrest may successfully be terminated by a (Germany). thump, and a thump is recommended as part of the advanced life support protocol.' 1 European Resuscitation Council Working Party. Adult advanced cardiac life There is no convincing evidence that success of support: the European Resuscitation Council guidelines 1992 (abridged). BMJ 1993;306:1589-93. cardiopulmonary resuscitation is influenced by the rate 2 Basic Life Support Working Party of the European Resuscitation Council. http://www.bmj.com/ of chest compressions within the range 60-100/min. Guidelines for basic life support. Resuscitation 1992;24:103-10. Adult advanced cardiac life support: the European Resuscitation Council guidelines 1992 (abridged) on 24 September 2021 by guest. Protected copyright. European Resuscitation Council Working Party The European Resuscitation Council, established in support at its first scientific congress in 1992. Three 1990, is committed to saving lives by improving principles were held to be important in the production standards of cardiopulmonary resuscitation across of the guidelines. The first was a willingness to review Europe and coordinating the activities of interested comprehensively the evidence justifying existing organisations and individuals. In this regard the recommendations. The second was an emphasis on council has successfully brought together physicians minimising delay in delivering defibrillating shocks and surgeons from eastern and western Europe to the victims of ventricular fibrillation. The third was and, in addition, has established relations with the need for simplicity in treatment algorithms. In the American Heart Association and equivalent addition, the guidelines were to be appropriate for organisations in Canada, Australia, and South semiautomated or automated defibrillators and for use Africa. A main objective ofthe European Resuscita- both in hospital and in pre-hospital settings. tion Council is to produce guidelines for cardio- Draft guidelines were submitted for comment to European Resuscitation pulmonary and cerebral resuscitation, and in this representatives of national societies with affiliation to Council Members ofthe working paper members ofa working party of 14 experts from the European Resuscitation Council. After appropriate party are listed at the end of 11 countries set out an abridged version of the modifications they were approved by the executive this report. council's guidelines for adult advanced cardiac life committee of the council. The guidelines have been support. The council hopes that the guidelines and published in preliminary form,' 2 together with papers Correspondence to: accompanying algorithms will serve as a ready summarising the scientific evidence on which they Dr Douglas Chamberlain, use "how to do it" for ordinary practitioners and were based.3'2 This paper sets out an abridged version Royal Sussex County paramedics inside and outside hospital. of the guidelines for adult advanced cardiac life Hospital, Brighton support aimed at promoting their implementation. BN2 5BE. The European Resuscitation Council presented Abridged and complete versions will also be published BMJ 1993;306: 1589-93 guidelines for adult basic and advanced cardiac life in other European joumals. BMJ VOLUME 306 12 JUNE 1993 1589 The arrhythmias ofcardiac arrest 200 J, 200 J, and 360 J. Provided that these shocks can Cardiac arrest is the cessation of cardiac mechanical be delivered quickly (within 30 to 45 seconds), then activity, confirmed by the absence of a detectable the sequence should not be interrupted by basic life pulse, unresponsiveness, and apnoea (or agonal support measures. Ideally, for safety, the electrodes respirations). In adults the commonest cause is should be left on the chest when rapid sequences of BMJ: first published as 10.1136/bmj.306.6892.1589 on 12 June 1993. Downloaded from primary ischaemic heart disease. Cardiac arrest may be shocks are given. Some check of rhythm or pulse associated with any of four heart rhythms: ventricular must be made after each shock, the method depending fibrillation, pulseless ventricular tachycardia, asystole, on the type ofequipment being used. or electromechanical dissociation. With manual defibrillators a pulse should be sought. Ventricular fibrinlation is by far the commonest If it is absent the defibrillator should be recharged primary rhythm of cardiac arrest, especially in victims without waiting for the monitor tracing to return of sudden, unheralded cardiac death. Pulseless because the delay may be appreciable. Electrocardio- ventricular tachycardia may occur first, but usually graphic confirmation on the monitor is desirable, deteriorates rapidly to ventricular. fibrillation. The however, immediately before the next shock. With two conditions are treated identically. If managed automated defibrillators feeling the pulse delays the appropriately and promptly most patients with these diagnostic algorithm by introducing artefact. For most rhythms can survive to hospital discharge, but only shocks reliance should therefore be placed on the rarely can these conditions be met. Prospects for machine, which will indicate whether another shock is survival decrease by roughly 5% a minute even with required. Palpation is restricted to the start of each effective basic life support, and delay to defibrillation is loop-once every third defibrillator discharge. If the the most important determinant ofsuccess or failure. time to charge the defibrillator is unduly prolonged one Asstole is the primary rhythm in up to a quarter of or two sequences of basic life support (if there are two cardiac arrests in hospital and 10% of those outside rescuers: five chest compressions to one breath) should hospital. It is seen most commonly, however, as the be given between shocks. end result in patients with ventricular fibrillation who When the first three shocks are unsuccessful the have not been resuscitated successfully. prospects of recovery are not hopeless, and attempts Electromechanical dissociation is a term that implies should continue ifthis strategy is appropriate clinically. absence of mechanical activity or undetectable activity As restoration of coordinated rhythm will inevitably be in the presence of a continuing coordinated waveform delayed, if it occurs at all, the priority must change to in the electrocardiogram. It is diagnosed infrequently preserving cerebral and myocardial perfusion by the in pre-hospital victims of cardiac arrest (except when best possible basic life support. caused by trauma), partly because a coordinated electrocardiographic waveform can persist only PROCEDURE WHEN FIRST THREE SHOCKS HAVE FAILED transiently in the absence of coronary flow. Patients If not achieved already, brief attempts should be with electromechanical dissociation or asystole usually made to intubate the patient and gain intravenous have a survival rate less than 5% when the condition is access. In most settings these procedures will be caused by heart disease. Higher survival rates have
Load more

Recommended publications
  • Commotio Cordis
    Commotio Cordis Background Sudden unexpected cardiac death that occurs in young people during sports participation is usually associated with previously diagnosed or undiagnosed structural or primary electrical cardiac abnormalities. Examples of such abnormalities include hypertrophic cardiomyopathy, anomalous origin of a coronary artery, arrhythmogenic right ventricular cardiomyopathy, and primary electrical disorders, such as congenital prolongation of the QTc interval and catecholaminergic, polymorphic ventricular tachycardia (CPVT). Sudden death due to ventricular fibrillation may also occur following a blunt, nonpenetrating blow to the chest, specifically the precordial area, in an individual with no underlying cardiac disease. This is termed commotio cordis. Much of our understanding of the clinical and pathophysiologic aspects of commotio cordis is the result of work by N.A. Mark Estes III, MD, and Mark S. Link, MD, from the New England Cardiac Arrhythmia Center at the Tufts University and School of Medicine in Boston, Massachusetts and data derived from the US Commotio Cordis Registry (Minneapolis, Minnesota). Relatively recent data from the registry of the Minneapolis Heart Institute Foundation show that commotio cordis is one of the leading cause of sudden cardiac death in young athletes, exceeded only by hypertrophic cardiomyopathy and congenital cornoary artery abnormalities.[1] Commotio cordis typically involves young, predominantly male, athletes in whom a sudden, blunt, nonpenetrating and innocuous-appearing trauma to the anterior chest results in cardiac arrest and sudden death from ventricular fibrillation. The rate of successful resuscitation remains relatively low but is improving slowly. Although commotio cordis usually involves impact from a baseball, it has also been reported during hockey, softball, lacrosse, karate, and other sports activities in which a relatively hard and compact projectile or bodily contact caused impact to the person's precordium.
    [Show full text]
  • Medical Memoranda MEDICAJHRNA Haemodynamic Effects of Balloon
    27 January 1968 Medical Memoranda MEDICAJHRNA 225 he had been after the myocardial infarction in March 1967. There- He was readmitted on 6 September again in supraventricular after he was maintained on lignocaine infusion 1 mg./min. to a tachycardia and with evidence of congestive failure. On three maximum of 500 mg. in 24 hours and remained in sinus rhythm for occasions over the next 48 hours a precordial thump converted this Br Med J: first published as 10.1136/bmj.1.5586.225 on 27 January 1968. Downloaded from 48 hours with only occasional extrasystoles. By this time the rhythm to sinus rhythm. On each occasion the procedure was infusion had been discontinued and he felt well, was in sinus performed with the patient monitored on the cardioverter, and with rhythm 80/min., and the blood pressure was 120/70. the shock paddles prepared and an intravenous drip available for At this time he suddenly relapsed to the original dysrhythmia- giving sodium bicarbonate or other drugs in the event of more supraventricular tachycardia with right bundle-branch block. On serious arrhythmia developing. In view of the continuing cardiac this occasion, as an alternative to further electrical cardioversion irritability with multifocal extrasystoles he was then put on a but while being monitored on the " cardioverter," he was given a procainamide continuous infusion, 4 g. in 24 hours, which had the sharp blow on the sternum with no effect. A similar heavy thump effect of almost clearing the ventricular ectopic beats. with the ulnar side of the clenched fist on the precordium at the cardiac apex immediately induced sinus rhythm with left bundle- COMMENT branch block (see Fig.).
    [Show full text]
  • Precordial Thump
    practical procedures resuscitation skills – part five Precordial thump phil Jevon, pGce, Bsc, rN, is tachycardia, asystole and resuscitation officer/clinical skills complete heart block where a lead, Manor Hospital, Walsall. precordial thump was delivered. The results were as follows: The precordial thump is a blow to l Ninety-one (49%) reverted to the lower half of the patient’s normal sinus rhythm; sternum using the lateral aspect l Seventy-seven (41%) had no of a closed fist. It can successfully change in rhythm; resuscitate the patient when l Nineteen (10%) were worse; given promptly following a l Overall, 90% of patients were cardiac arrest caused by either better or no change and Fig 1. check carotic pulse ventricular fibrillation (VF) or 10% were worse. ventricular tachycardia (VT) (Resuscitation Council (UK), 2006). Procedure This article describes the On discovering a collapsed procedure for delivering a unconscious patient: precordial thump. l Call out for help and activate the emergency buzzer; Mechanism of action l Lie the patient flat; The rationale for delivering a l Look, listen and feel for no precordial thump is that it longer than 10 seconds to generates a mechanical energy, determine if the patient is which is converted to electrical breathing normally (an occasional energy, which then may be gasp, slow, laboured or noisy sufficient to achieve successful breathing is abnormal) or has other cardioversion (Kohl et al, 2005). signs of life (Resuscitation Council Following the onset of VF, the (UK), 2006). If trained and threshold for successful experienced in assessing ill defibrillation rises steeply after a patients, a simultaneous Fig 2.
    [Show full text]
  • Part 3: Defibrillation
    Resuscitation (2005) 67, 203—211 Part 3: Defibrillation International Liaison Committee on Resuscitation The 2005 Consensus Conference considered ques- sic devices achieve higher first-shock success rates tions related to the sequence of shock delivery than monophasic defibrillators. This fact, combined and the use and effectiveness of various waveforms with the knowledge that interruptions to chest and energies. These questions have been grouped compressions are harmful, suggests that a one- into the following categories: (1) strategies before shock strategy (one shock followed immediately by defibrillation; (2) use of automated external defib- CPR) may be preferable to the traditional three- rillators (AEDs); (3) electrode-patient interface; (4) shock sequence for VF and pulseless ventricular use of the electrocardiographic (ECG) waveform to tachycardia (VT). alter management; (5) waveform and energy lev- els for the initial shock; (6) sequence after failure of the initial shock (i.e. second and subsequent Strategies before defibrillation shocks; and (7) other related topics. The International Guidelines 20001 state that Precordial thump defibrillation should be attempted as soon as ven- W59,W166B tricular fibrillation (VF) is detected, regardless of the response interval (i.e. time between collapse Consensus on science. No prospective studies and arrival of the AED). If the response interval have evaluated the use of the precordial (chest) is >4—5 min, however, there is evidence that thump. In three case series (LOE 5)2—4 VF or pulse- 1.5—3 min of CPR before attempted defibrillation less VT was converted to a perfusing rhythm by a may improve the victim’s chance of survival.
    [Show full text]
  • Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump
    Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump Authors: Sitelnissa Saeed Ahmed,1 *Gamal Abdalla Mohamed Ejaimi,2 Areeg Izzeldin Ahmed Yousif3 1. Intensive Care, Aseer Central Hospital, Abha, Saudi Arabia 2. Department of Anesthesia and Intensive Care, Sabah Al-Salem, Kuwait 3. Department of Anesthesia and Intensive Care, Ahmed Gasim Hospital Heart Surgery and Kidney Transplant Center, Khartoum North, Sudan *Correspondence to [email protected] Disclosure: The authors have declared no conflicts of interest. Received: 02.02.20 Accepted: 30.03.20 Keywords: Anaesthesia, cardiac arrest, cardiopulmonary resuscitation (CPR), intraoperative, postresuscitation care, pulmonary embolism (PE). Citation: EMJ. 2020;DOI/10.33590/emj/20-00024. Abstract Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole.
    [Show full text]
  • Commotio Cordis Barry J
    The new england journal of medicine review article Medical Progress Commotio Cordis Barry J. Maron, M.D., and N.A. Mark Estes III, M.D. entricular fibrillation and sudden death triggered by a blunt, From the Hypertrophic Cardiomyopathy nonpenetrating, and often innocent-appearing unintentional blow to the Center Minneapolis Heart Institute Foun- dation, Minneapolis (B.J.M.); and the chest without damage to the ribs, sternum, or heart (and in the absence of New England Cardiac Arrhythmia Center, V Cardiology Division, Tufts University underlying cardiovascular disease) constitute an event known as commotio cordis, which translates from the Latin as agitation of the heart. This term was first used School of Medicine, Boston (N.A.M.E.). 1-6 Address reprint requests to Dr. Maron at in the 19th century, although the occurrence of commotio cordis was described Minneapolis Heart Institute Foundation, earlier, in accounts of the ancient Chinese martial art of Dim Mak (or touch of death), 920 E. 28th St., Suite 620, Minneapolis, in which blows to the left of the sternum caused sudden death in opponents.7 An MN 55407, or at [email protected]. absence of structural cardiac injury distinguishes commotio cordis from cardiac N Engl J Med 2010;362:917-27. contusion, in which high-impact blows result in traumatic damage to myocardial Copyright © 2010 Massachusetts Medical Society. tissue and the overlying thorax. Beginning in the mid-1700s, sporadic accounts of commotio cordis appeared in the medical literature, mostly in the context of workplace accidents,8-10 and through the mid-1990s, the disorder was noted only occasionally in case reports, going largely unrecognized, except by the forensic pathology community and the Con- sumer Product Safety Commission.6,11-14 Since then, however,1 both the general public and the medical community have become increasingly aware of commotio cordis as an important cause of sudden cardiac death.
    [Show full text]
  • CLINICAL PRACTICE GUIDELINES to All Registered Emergency Care
    CLINICAL PRACTICE GUIDELINES To All Registered Emergency Care Providers This document serves to inform all emergency care providers that the below Clinical Practice Guidelines (CPGs) and related capabilities and medications have been adopted by the Professional Board for Emergency Care (PBEC) for use and implementation by all registered emergency care providers. It is the responsibility of all registered persons to a.) familiarise themselves and b.) undergo learning/training activities related to the contents of the document. In addition to familiarisation, it is important that as far as possible, and where relevant, the related clinical practice guideline is used during all clinical encounters. Where not applicable, all reasonable, locally contextual standards of care apply to clinical encounters. The deadline for the adoption of the revised list of capabilities and medications by registered persons is the 31st of December 2018. It is, however, acknowledged that the learning/training activities required to perform procedures and administer medications not currently on the scope of practice, will extend beyond this deadline. Emergency care providers are directed to the revised list of capabilities and medications which are attached as an Annexure to the guidelines. The revised list of capabilities and medications (read together with the requirements linked to the performance and/or administration of such skills/medications) are applicable as per the above-mentioned deadline date. It must, however, be noted that the medications not currently on the scope of practice await final regulatory approval. Further communication will follow in relation to the approval of these medications. Emergency care providers acting outside of the revised list of capabilities (and mandatory training to perform such procedures) will be considered to be acting outside of the relevant scope of practice.
    [Show full text]
  • 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
    Circulation Part 3: Adult Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care TOP 10 TAKE-HOME MESSAGES FOR ADULT Ashish R. Panchal, MD, CARDIOVASCULAR LIFE SUPPORT PhD, Chair 1. On recognition of a cardiac arrest event, a layperson should simultaneously Jason A. Bartos, MD, PhD and promptly activate the emergency response system and initiate cardiopul- José G. Cabañas, MD, monary resuscitation (CPR). MPH 2. Performance of high-quality CPR includes adequate compression depth and Michael W. Donnino, MD rate while minimizing pauses in compressions, Ian R. Drennan, ACP, 3. Early defibrillation with concurrent high-quality CPR is critical to survival PhD(C) Karen G. Hirsch, MD when sudden cardiac arrest is caused by ventricular fibrillation or pulseless Peter J. Kudenchuk, MD ventricular tachycardia. Michael C. Kurz, MD, MS 4. Administration of epinephrine with concurrent high-quality CPR improves Downloaded from http://ahajournals.org by on November 6, 2020 Eric J. Lavonas, MD, MS survival, particularly in patients with nonshockable rhythms. Peter T. Morley, MBBS 5. Recognition that all cardiac arrest events are not identical is critical for opti- Brian J. O’Neil, MD mal patient outcome, and specialized management is necessary for many Mary Ann Peberdy, MD conditions (eg, electrolyte abnormalities, pregnancy, after cardiac surgery). Jon C. Rittenberger, MD, 6. The opioid epidemic has resulted in an increase in opioid-associated out-of- MS hospital cardiac arrest, with the mainstay of care remaining the activation of Amber J. Rodriguez, PhD the emergency response systems and performance of high-quality CPR. Kelly N.
    [Show full text]
  • Cardiopulmonary Resuscitation: Update, Controversies and New Advances
    Arq Bras Cardiol ZagoUpdate et al volume 72, (nº 3), 1999 Cardiopulmonary resuscitation. Controversies and new advances Cardiopulmonary Resuscitation: Update, Controversies and New Advances Alexandre C. Zago, Cristine E. Nunes, Viviane R. da Cunha, Euler Manenti, Luís Carlos Bodanese Porto Alegre, RS - Brazil Cardiopulmonary arrest is a medical emergency in Academy of Sciences—National Research Council held a which the lapse of time between event onset and the ini- new meeting in which the first steps of cardiopulmonary tiation of measures of basic and advanced support, as well arrest (CPA) management were standardized, creating the as the correct care based on specific protocols for each protocols, also known as guidelines 1,2. clinical situation, constitute decisive factors for a success- This article aims to examine the new concepts, physio- ful therapy. logical mechanisms and therapeutical measures involving Cardiopulmonary arrest care cannot be restricted to cardiopulmonary resuscitation; to point out and discuss the hospital setting because of its fulminant nature. This relevant controversies, based on available studies; and to necessitates the creation of new concepts, strategies and analyze the new advances documented in experimental structures, such as the concept of life chain, cardio- studies in humans and animals. pulmonary resuscitation courses for professionals who The last guideline published by the AHA in JAMA 3 work in emergency medical services, the automated is the primary landmark of the aims cited above. external defibrillator, the implantable cardioverter- In 1992, the AHA and the American College of Cardio- defibrillator, and mobile intensive care units, among logy (ACC) established a classification of the therapeutical others.
    [Show full text]
  • Advanced Cardiac Life Support Overview Learning
    ADVANCED CARDIAC LIFE SUPPORT OVERVIEW LEARNING OBJECTIVES: The student will have an understanding of the general guidelines for resuscitation as updated October 2015. Many of the treatment guidelines for Advanced Cardiac Life Support (ACLS) are unchanged from 2010. Those that have significant changes in content or application have been highlighted in RED. Changes in the Way Science is Reviewed and Released Rather than five year updates the Guidelines have been posted in a Web Based Format and will be updated continuously. This will help to ensure that new science that may impact mortality and morbidity reach patient care professionals more rapidly. GOALS OF THE AMERICAN HEART ASSOCIATION • Double bystander CPR rates by 2020 • Double cardiac arrest survival rates by 2020 Ethics: • Goal is Neuro Intact Discharge not ROSC • Respect for the individuals ability to make their own medical decisions • Withholding and withdrawing care during resuscitation are equivocal • Withholding resuscitation is acceptable if; o The safety of the rescuers is in question o Obvious signs of death are present o There is a valid advanced directive from the patient • Use of ECPR (ECMO, Fem – Fem) is acceptable for a short time in patients who have a condition that is fixable in a relative short amount of time • Multiple variables should be used to decide to stop resuscitation. o PETCO Less than 10 in the intubated patient is a poor prognostic indicator for surivival • The phase “limitations of care” has been replaced with “limitations of interventions.” BASIC LIFE
    [Show full text]
  • The Management of Cardiac Arrest
    CHAPTER 6 The management of cardiac arrest LEARNING OBJECTIVES In this chapter you will learn: • How to assess the cardiac arrest rhythm and perform advanced life support 6.1. INTRODUCTION Cardiac arrest has occurred when there is no effective cardiac output. Before any specific therapy is started effective basic life support must be established as described in chapter 4. Four cardiac arrest rhythms will be discussed in this chapter: 1. Asystole 2. Pulseless electrical activity (including electro mechanical dissociation) 3. Ventricular fibrillation 4 Pulseless ventricular tachycardia 47 THE MANAGEMENT OF CARDIAC ARREST The four are divided into two groups: two that do not require defibrillation (called “non- shockable”) and two that do require defibrillation (“shockable”). The cardiac arrest algorithm is shown in Figure 6.1 Stimulate and assess response Open airway Check breathing 5 rescue breaths Check pulse Check for signs of circulation CPR 15 chest compressions 2 ventilations ShockableAssess Nonshockable Asystole and VF/VT rhythm PEA Ventilate with high DC Shock 4J/kg concentration O2 2 min CPR, Intubate, High flow O Intubate 2 Continue CPR check monitor IV/IO access IV/IO access Consider Adrenaline DC Shock 4J/kg 4 Hs Hypoxia 10 mcg/kg IV or IO Hypovolaemia 2 min CPR, Intubate Hyper/hypokalaemia / Metabolic 4 min CPR Check monitor check monitor IV/IO access Hypothermia every 2 minutes Adrenaline then 4 Ts DC Shock 4J/kg Tension pneumothorax Cardiac Tamponade 2 min CPR, Toxic substances check monitor Thromboembolic phenomena Amiodarone then Consider alkalising agents DC Shock 4J/kg 2 min CPR, check monitor Adrenaline then DC Shock 4J/kg 2 min CPR, check monitor DC Shock 4J/kg 2 min CPR, check monitor Adrenaline dose 10 mcg/kg Amiodarone dose 5mg/kg Figure 6.1.
    [Show full text]
  • Termination of Ventricular Fibrillation and Pulseless Ventricular Tachycardia Using the Precordial Thump
    Research Article Annals of Clinical Anesthesia Research Published: 05 May, 2017 Termination of Ventricular Fibrillation and Pulseless Ventricular Tachycardia Using the Precordial Thump Athanasios Chalkias1,2*, Anastasios Koutsovasilis3, Athanasios Gravos4, Konstantinos Sakellaridis4, Alexandra Avraamidou4, Katerina Nodarou4, Thomas Nitsotolis4, Spyros Vaggelis4, Georgios Tzanoudakis4, Konstantina Katsifa4, Barbara Grammatikopoulou4, Drosos Venetoulis4, Martha Kelesi5, Athanasios Prekates4, Paraskevi Tselioti4, Eugenia Vlachou5 and Theodoros Xanthos2,6 1University of Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece 2Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece 3Department of Internal Medicine, Nikaia General Hospital, Piraeus, Greece 4Intensive Care Unit, Tzaneio General Hospital of Piraeus, Piraeus, Greece 5Technological Educational Institute of Athens, Athens, Greece 6European University Cyprus, School of Medicine, Nicosia, Cyprus Abstract Background: Although the effectiveness of precordial thump is controversial, it remains a common strategy during cardiopulmonary resuscitation. We investigated the effectiveness of precordial thump in the treatment of monitored ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. Methods: A total of 922 patients were categorized according to their first-line treatment into the defibrillation group and the precordial thump group. In the defibrillation group, we included all monitored victims who were immediately defibrillated
    [Show full text]