ADULT POST–CARDIAC ARREST CARE ALGORITHM ADULT BRADYCARDIA ALGORITHM ADULT TACHYCARDIA WITH A PULSE ALGORITHM

Assess appropriateness for clinical condition.

Heart rate typically ≥150/min if tachyarrhythmia.
Assess appropriateness for clinical conditions.
ROSC Obtained Heart rate typically <50/min if bradyarrhythmia.
es/Details
Dos Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
Manage airway Identify and treat underlying causes • Oxygen (if hypoxemic)
Early placement of endotracheal tube - Maintain patent airway; assist breathing as necessary • Cardiac monitor to identify rhythm; monitor blood
Initial Stabilization Phase - Oxygen ( if hypoxemic )
• Airway management: pressure and oximetry
Manage respiratory parameters - Cardiac monitor to identify rhythm; monitor blood • IV access
Waveform capnography or
Start 10 breaths/min pressure and oximeter • 12-lead ECG, if available
capnometry to confirm and monitor
SPO2 92% to 98% endotracheal tube placement - IV access
PaCO2 35 to 45 mm Hg • Manage respiratory parameters:
- 12 lead ECG if available; don't delay therapy • Vagal maneuvers (if regular)
Titrate FIO2 for Spo2 92% to 98%; • Adenosine (if regular)
- Consider the possible hypoxic and toxicologic causes Persistent
Manage hemodynamic parameters start at 10 breaths per min; titrate to • β-Blocker or calcium channel blocker
PaCO2 of 35 to 45 mm of mercury
tachyarrhythmia causing:
Systolic blood pressure > 90 mm Hg • Consider expert consultation
• Manage hemodynamic parameters: • Hypotension?
Mean arterial pressure > 65 mm Hg
Administer crystalloid and/or • Acutely altered mental status?
Persistent NO
vasopressor or inotrope for goal • Signs of shock?
bradyarrhythmia causing:
systolic blood pressure greater than • Ischemic chest discomfort? NO Wide QRS?
Obtain 12-lead ECG 90 mm of mercury or mean arterial • Acute heart failure?
pressure greater than 65 mm of NO - Hypotension? ≥0.12 second
mercury - Acutely altered mental status? YES YES
Continued Management and - Signs of shock?
es/Details Synchronized cardioversion Consider
Dos
Consider for emergent cardiac intervention if Additional Emergent Activities - Ischemic chest discomfort?
• Consider sedation • Adenosine only if
- STEMI present These evaluations should be done - Acute heart failure? • If regular narrow complex, regular and monomorphic
- Unstable cardiogenic shock. concurrently so that decisions on consider adenosine • Antiarrhythmic infusion
targeted temperature management YES
- Mechanical circulatory support required. Monitor and Observe • Expert consultation
(TTM) receive Atropine Atropine IV dose:
high priority as cardiac interventions.
If atropine is ineffective: First dose: 1 mg bolus.
• Emergent cardiac intervention:
Early evaluation of 12-lead Repeat every 3-5 minutes.
Follows commands? - Transcutaneous pacing If refractory, consider
electrocardiogram (ECG); consider Maximum: 3 mg.
hemodynamics for decision on and/or Dopamine IV infusion: • Underlying cause
NO YES • Need to increase energy level
cardiac intervention - Dopamine infusion Usual infusion rate is
Comatose Awake • TTM: If patient is not following or 5-20 mcg/kg per minute. for next cardioversion
• TTM Other critical care commands, start TTM as soon as - Epinephrine infusion Titrate to patient response; • Addition of anti-arrhythmic drug
• Obtain brain CT management. possible; begin at 32 to 36 degrees
taper slowly. • Expert consultation
• EEG monitoring Celsius for 24
hours by using a cooling device with Epinephrine IV infusion:
• Other critical care 2-10 mcg per minute infusion.
feedback loop Consider:
management • Other critical care management Titrate to patient response.
– Continuously monitor core Causes: Doses/Details Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
- Expert Consultation Procainamide IV dose:
temperature (esophageal, rectal, • Myocardial ischemia/
bladder) - Transvenous pacing Synchronized cardioversion: 20-50 mg/min until arrhythmia suppressed, hypotension ensues,
infarction
Evaluate and treat rapidly reversible etiologies – Maintain normoxia, normocapnia, Refer to your specific device’s QRS duration increases >50%, or max dose 17 mg/kg given.
• Drugs/toxicologic (eg, recommended Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
Involve expert consultation for continued management euglycemia
calcium-channel blockers, energy level to max first shock success. Amiodarone IV dose:
– Provide continuous or intermittent
electroencephalogram (EEG) beta blockers, digoxin) Adenosine IV dose: First dose: 150 mg over 10 min. Repeat as needed if VT recurs.
monitoring • Hypoxia First dose: 6 mg rapid IV push; follow Follow by maintenance infusion of 1 mg/min for first 6 hours.
– Provide lung-protective ventilation • Electrolyte abnormality with NS flush. Sotalol IV dose:
H’s and T’s (eg, hyperkalemia) Second dose: 12 mg if required. 100 mg (1.5 mg/kg) over 5 min. Avoid if prolonged QT.
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ADULT CARDIAC ARREST ALGORITHM

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DOSES/DETALS FOR CARDIAC ARREST ALGORITHM

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Cardiac Rhythms

Lif

ion
1 Start CPR PA N
CPR Quality KISTA
• Give oxygen • Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow
• Attach monitor/defibrillator complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
YES NO
Rhythm shockable? • Change compressor every 2 minutes, or sooner if fatigued.
• If no advanced airway, 30 to 2 compression-ventilation ratio.
9 • Quantitative waveform capnography
2
VF/pVT Asystole/PEA -If PETCO2 is low or decreasing, reassess CPR quality. Normal Sinus Rhythm
Shock Energy for Defibrillation
3 Shock Epinephrine • Biphasic: Manufacturer recommendation (eg, initial dose of 120-200
ASAP Joules); if unknown, use maximum available. Second and subsequent doses
4 should be equivalent, and higher doses may be considered.
CPR 2 minutes 10 CPR 2 minutes
• IV/IO access • IV/IO access • Monophasic: 360 Joules
• Epinephrine every 3 to 5 minutes. Drug Therapy
• Epinephrine IV/IO dose: 1 milligram every 3 to 5 minutes
Mono Morphic Ventricular Tachycardia
• Consider advanced airway,
NO capnography • Amiodarone IV/IO dose: First dose: 300 mg bolus. Second dose: 150mg.
Rhythm shockable?
OR
YES Lidocaine IV/IO dose: First dose: 1-1.5 mg per kg. Second dose: 0.5-0.75
5 Shock YES
Rhythm shockable? mg per kg.

6 NO Advanced Airway
CPR 2 minutes 11
• IV/IO access • Endotracheal intubation or supraglottic advanced airway. Ventricular Fibrillation
CPR 2 minutes. • Waveform capnography or capnometry to confirm and monitor ET tube
• Epinephrine every 3 to 5 minutes.
• Consider advanced airway,
• Treat reversible causes. placement.
capnography • Once advanced airway in place, give 1 breath every 6 seconds (10 breaths
per minute) with continuous chest compressions
NO Rhythm shockable?
Rhythm shockable? Return of Spontaneous Circulation (ROSC)
NO YES • Pulse and blood pressure.
YES • Abrupt sustained increase in PETCO2 (typically greater than or equal to 40 Atrial Fibrillation
7 Shock mm of mercury)
• Spontaneous arterial pressure waves with intra-arterial monitoring.
8 CPR 2 minutes
• Amiodarone or lidocaine. Reversible Causes
• Treat reversible causes. • Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
12
• Hypo-/hyperkalemia Atrial Flutter
• If no signs of return of Go to 5 or 7 • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
spontaneous circulation
(ROSC), go to Box 10 or Box 11
• If ROSC, go to Post–Cardiac
Arrest Care
• Consider appropriateness of LIFESAVERS FOUNDATION PAKISTAN
continued resuscitation (+92-51) 8493015 [email protected] lifesaverspaksitan.com
Supraventricular Tachycardia