Advanced Cardiac Life Support

Relief of Foreign - Body Airway Obstruction

Cardiac Arrest Algorithm - 2015 Update

Key Points

CPR Quality

  • Push hard (at least 5 om) and fast (100 — 120/min) and allow complete chest recoil
  • Minimize interruptions in compressions
  • Avoid excessive ventilation
  • Rotate compressor every 2 minute, or sooner if fatigues
  • If no advanced airway, 30:2 compression- ventilation ratio
  • Quantitative waveform capnography — If PETCOi< 20mmHsg, attempt to improve CPR quality Intra-arterial pressure

– Ifrelaxation phase (diastolic) pressure <20mm Hg, attempt to improve CPR quality.

Advanced Airway

  • Endotracheal intubation or supraglottic advanced airway
  • Waveform capnography or capnometry to confirm and monitor ET tube placement
  • Once advanced airway in place, give 1 breath every 6 seconds (10 breaths / min) with continuous chest compressions

Shock Energy for Defibrillation

  • Biphasic: Manufacturer recommendation (eg: intial dose of 120-200J); if unknown, use maximum available
  • Second and subsequent doses should be equivalent, and higher doses may be considered
  • Monophasic: 360J

Drug Therapy

  • Epinephrine IVIIO dose: 1 mg every 3-5 minutes
  • Amiodarone IV/IO dose: First dose: 300mg bolus Second dose: 150mg

Return of Spontaneous Circulation(ROSC)

  • Pulse and blood pressure
  • Abrupt sustained increase in PETCO) (typically 240mmHg)
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Reversible Causes

  • Hypovolemia * Hypoxia * Hydrogen ion (acidosis) * Hypo-/hyperkalemiaHypothermia
  • Tension pneumothorax * Tamponade, cardiac * Toxins Thrombosis, pulmonary
  • Thrombosis, coronary

Fibrinolytic Therapy for STEMI
Contraindications for fibrinolytic use in STEMI consistent with ACC/AHA 2007 Focused Update*

Absolute Contraindications

  • Any prior intracranial hemorrhage
  • Known structural cerebral vascular lesion (eg, arteriovenous malformation)
  • Known malignant intracranial neoplasm (primary or metastatic)
  • Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
  • Suspected aortic dissection
  • Active bleeding or bleeding diathesis (excluding menses)
  • Significant closed head trauma or facial trauma within 3 months

Relative Contraindications

  • History of chronic, severe, poorly controlled hypertension
  • Severe uncontrolled hypertension on presentation
  • (SBP >180mmHg or DBP >110mmHg)+
  • History of prior ischemic stroke > 3months, dementia or known intracranial pathology not covered in contraindications
  • Traumatic or prolonged (>10 minutes) CPR or major surgery (s 3 weeks)
  • Recent (within 2 to 4 weeks) internal bleeding
  • Non-compressible vascular punctures

For streptokinase / anistreplase:

  • Prior exposure (>5 days ago) or prior allergic reaction to these agents
  • Pregnancy
  • Active peptic ulcer
  • Current use of anticoagulants: the higher the INR, the higher the risk of bleeding

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