Part 7.2: Management of cardiac arrest / v-59 PULSELESS ARREST Artach monitordefibrillator when available Check rhythm Shockable rhythm? VE/T Asystole/PEA ve 1 shock Oie s eretes ef CPR May give 1 dose of vasopressin 40 U IAO to replace first or second dose of epin Consider atropine 1 mg Ino Shockable rhythm? Continue CPR while defibrillator is charging ve 1 shock Manual biphasic device specific AED: device specif ressor during CPR (before or after the shock Repeat every 3 to 5 min May give 1 dose of vasopressin 40 U no to replace first or second dose of epinephrine 12 l asystole, go to Box 10 13 e pulse. If no pulse, got Shockable rhythm? Continue CPA while dehbritator is charging nsure full chest recoil 2 minutes wth rhythm checks Manual biphasic: device specific Minimize interruptions in chest A D: device specific One cycle of CPR: 30 compressions Avoid hy it ation Secure airway and confirm placement consider addtional 150 m0 once, then w ANer an airway in placed (1 to 1.5 mg/kg first dose, then doses or 3 mo/ko) af CPR. Give continous ct ium, loading dose Thrombosis (coronary or Give B to 10 breathe/minute Check After 5 cycles of CPR, ' got to Box 5 above rhythm every 2 minutes ACLS Pulseless Arrest Algorithm. Ventricular fibrillation/Pulseless seconds, the provider should turn on the defibrillator, place Ventricular Tachycardia adhesive pads or paddles, and check the rhythm(Box 2) The most critical interventions during the first minutes of VF If the healthcare provider does not witness the arrest in the or pulseless VT are immediate bystander CPR (Box 1)with out-of-hospital setting (eg, the emergency medical services minimal interruption in chest compressions and defibrillation [EMS] provider arrives at the scene of an arrest), the provider as soon as it can be accomplished( Class D). In cases of may give 5 cycles of CPR before attempting defibrillation. In itnessed arrest with a defibrillator on-site, after delivery of adults with a prolonged arrest, shock delivery may be more 2 rescue breaths the healthcare provider should check for a successful after a period of effective chest pulse. If the provider definitely does not feel a pulse within 10 For further information about the sequence of CPR firstVentricular Fibrillation/Pulseless Ventricular Tachycardia The most critical interventions during the first minutes of VF or pulseless VT are immediate bystander CPR (Box 1) with minimal interruption in chest compressions and defibrillation as soon as it can be accomplished (Class I). In cases of witnessed arrest with a defibrillator on-site, after delivery of 2 rescue breaths the healthcare provider should check for a pulse. If the provider definitely does not feel a pulse within 10 seconds, the provider should turn on the defibrillator, place adhesive pads or paddles, and check the rhythm (Box 2). If the healthcare provider does not witness the arrest in the out-of-hospital setting (eg, the emergency medical services [EMS] provider arrives at the scene of an arrest), the provider may give 5 cycles of CPR before attempting defibrillation. In adults with a prolonged arrest, shock delivery may be more successful after a period of effective chest compressions.32–34 For further information about the sequence of CPR first ACLS Pulseless Arrest Algorithm. Part 7.2: Management of Cardiac Arrest IV-59