Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

278 Cardiac Arrest

General Measures

■Secondary ABCD survey:

■Airway: intubate as soon as possible

■Breathing: confirm tube placement by auscultation, pulse oximetry,

or end-tidal CO 2

■Circulation: establish IV access (peripheral is ok). Assess for ade-

quacy of compressions. Administer drugs according to specific algo-

rithm (see below).

■Differential diagnosis. Consider reversible causes of cardiac arrest

(see below).

specific therapy

■Pulseless VT/VF

➣Single shock (360 J for monophasic defibrillator, 150–200 J for

biphasic truncated exponential waveform, or 120 J for bipha-

sic rectilinear waveform), then resume CPR for one cycle before

checking for pulse and rhythm.

➣Organize therapies around 5 cycles (or 2 minutes) of CPR. Admin-

ister shock between therapies. Give drug therapies during CPR.

➣Epinephrine IV push q 3–5 min and/or vasopressin IV push (one

time only)

➣Consider antiarrhythmics:

Amiodarone: bolus IV over 10 min, then drip

Lidocaine: bolus

➣Consider buffers: Na-bicarbonate IV push

■Pulseless electrical activity (PEA)

➣Organize therapies around 5 cycles (or 2 minutes) of CPR.

➣Epinephrine IV push q3–5 min

➣If PEA rhythm slow, atropine IV push q3–5 min

➣Na-bicarbonate for tricyclic overdose, hyperkalemia, metabolic

acidosis, or prolonged arrest

➣Review most frequent reversible causes – “5Hs and 5Ts”

Hypovolemia (include hemorrhage, sepsis, anaphylaxis)

Hypoxia

Hydrogen ion (acidosis)

Hyper-/hypokalemia

Hypothermia

“Tablets” (i.e., drug overdose)

Tamponade

Tension pneumothorax