BLS- “CAB” not “ABC”• Activate EMS• Begin Chest Compressions-Rescue Breaths only with Medical Personnel –or two trained lay providers• Early Defibrillation
ACLS-New Airway Management• Quantitative Waveform Capnography is indicated for confirmation of ETT placement (PetC02 over 10 )and monitoring of CPR quality (PetC02 over 35).• Cricoid Pressure during intubation is no longer recommended• Passive ventilation with CPR may be adequate, although ACLS providers may continue with ventilation that does not interfere with chest compressions and defibrillation
ACLS-Airway Management 2• Advanced airway placement should not interfere with compressions/defibrillation• ETT or Supraglottic airway are alternatives for advanced airway management• Two ACLS providers may use concurrent compressions and breaths (100:8) instead of 30:2 after an advanced airway is placed.
SIMPLIFIED ARREST PROTOCOL• Compressions/Ventilation• Epinephrine 1mg every 3-5 minutes (Vasopressin alternative for first or second dose)• IF shockable rythym (VF/VT) Defibrillate every 2 minutes. Add Amiodarone for refractory shockable rythym.• Reversible Causes?
PEA• Atropine is no longer recommended• CPR, Epinephrine• Search for reversible causes
Bradycardias• Chronotropic infusions are alternatives to Pacing in symptomatic and unstable bradycardias• For unstable bradycardia, Atropine (0.5mg every 3-5 minutes up to 3 mg if an upper conduction system problem), Catecholamines, Pacing
Unstable Tachycardia• Cardioversion• Adenosine if narrow complex
Stable Wide Complex Tachycardia• Adenosine is recommended as a safe and potentially effective therapy for stable undifferentiated monomorphic wide-complex tachycardia.• If otherwise stable, can use Amiodarone, Sotalol, or Procainamide
Post Arrest Care• Consider Cardiac Cath in all patients• Therapeutic Hypothermia is recommended for ROSC without consciousness