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POST-CARDIAC ARREST

Based on AHA ECC 2015 Guidelines

Optimize Ventilation and Oxygen


 Maintain SaO2 >94 –99 % TACHYCARDIA
 Consider advanced airway and ETCO2 (35-40)
 Avoid hyperventilation HR typically > 150 BPM

UNIVERSAL ASSESSMENT REVERSIBLE CAUSES


Reversible Causes? H’s & T’s H’s & T’s
Hypovolemia
 Airway? BVM as necessary Hypoxia
TREAT HYPOTENSION  Oxygen if Hypoxic Hydrogen Ion (H+)
 IV/IO BOLUS (1-2 L)  Pulse, and Blood Pressure Hypo/hyperkalemia
Hypothermia
 Cardiac Monitor
 Vasopressor Infusion Toxins
 IV Access Tamponade
 Treatable causes H’s & T’s  12 Lead EKG. DO NOT delay therapy Tension Pneumothorax
 12 Lead EKG Thrombosis
Pulmonary
Coronary
Persistent tachyarrhythmia
with HYPOPERFUSION:
 Hypotension
Consider  Altered Mental Status YES SYNC Cardioversion
Induced FOLLOW  Consider Sedation
 Shock
Hypothermia COMMANDS?  If regular narrow
NO  Ischemic Chest Pain/
32—36° C discomfort complex, consider
>24 hours  Acute heart failure
adenosine
YES
NO
STEMI
Or  Consider Adenosine if regular
Wide QRS? YES and monomorphic
High Suspicion of AMI > .12 second
PCI  Consider antiarrhythmic infu-
Reperfusion YES sion
NO  EXPERT CONSULTATION
NO

REVERSIBLE CAUSES  Vagal Maneuvers


H’s & T’s  Adenosine (SVT)
Hypovolemia 6mg IV Bolus
Advanced Hypoxia
12mg IV Bolus
Wide Complex Antiarrhythmic Infusion
Critical Hydrogen Ion (H+)
Hypo/hyperkalemia  β-Blocker or Calcium
 Procainamide - 20-50 mg/min
Care Hypothermia Channel Blocker  Amiodarone - 150 mg over 10 min
Toxins
Tamponade  EXPERT  Sotalol - 100 mg (1.5 mg/kg) over 5
Tension Pneumothorax CONSULTATION min
Thrombosis
Pulmonary
Coronary
CARDIAC ARREST ALGORITHM
REVERSIBLE CAUSES
H’s & T’s
Hypovolemia
HELP—ACTIVATE EMERGENCY RESPONSE

BRADYCARDIA WITH A PULSE Hypoxia


Hydrogen Ion (H+)
Hypo/hyperkalemia START High Quality CPR
Hypothermia 30:2
Heart Rate typically < 50 BPM with complaint
Toxins 100—120 per minute
Tamponade Compression Fraction > 60—80 %
Tension Pneumothorax C
UNIVERSAL ASSESSMENT Thrombosis  Give Oxygen
O
Reversible Causes? H’s & T’s Pulmonary  Attach Monitor/Defibrillator
 Airway? BVM as necessary
Coronary N
 Oxygen if Hypoxic T
 Pulse, and Blood Pressure I
 Cardiac Monitor N
 IV Access
CHECK
RHYTHM
U
O
U
VF/VT S
Persistent bradyarrhythmia with

RE-EVALUATE RHYTHM
AT 2 MINUTE CYCLE—
HYPOPERFUSION:
 Hypotension SHOCK C
Monitor and Observe
 Altered Mental Status P
Expert Consultation R
 Shock
NO Drug Therapy
 Ischemic Chest Pain/discomfort

YES
IV/IO Access
Epinephrine 1 mg 3-5 min
Amiodarone 300 mg VF/VT
—E
M T
O C
CONSIDER ATROPINE CONSIDER ADVANCED AIRWAY N
Atropine Dose: O
- First Dose: 0.5 mg IV Bolus TREAT I 2
- Repeat Dose: 0.5 mg IV Bolus REVERSIBLE T
Repeat every 3 - 5 minutes CAUSES
Max total dose: 3 mg O
If Atropine is not effective: H’s & T’s R
- Transcutaneous Pacing M
OR A
- Dopamine infusion - 2-20 mcg/kg/min C P
OR
- Epinephrine infusion - 2-10 mcg min ROSC P
NO R

YES
Consider:
Expert Consultation
Transvenous Pacing POST CARDIAC ARREST CARE

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