Professional Documents
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Syndromes: Cardiac
Arrest and Return of
Spontaneous Circulation
Presence Regional EMS
February 2014 ALS CE
Objectives
Heart Disease
Cardiac Arrest
Early CPR
Early Defibrillation
2010
AHA Guidelines
Adult CPR
1.
2.
3.
4.
Chest Compressions
Always start CPR with Compressions
First!
Push hard and fast
Rate should be at least 100 per minute
Provide 30 compressions then 2 breaths
Make sure the chest is allowed to re-expand
completely at the end of each compression
CPR
Adult CPR
5.
6.
7.
8.
ACLS Guidelines
Adult Cardiac Arrest
Reversible Causes Hs
and Ts
Region 6 Protocol
VAD (Ventricular Assist Device)
NOTE: Pulse may not be palpable, manual blood pressure often cannot be measured, and
pulse oximetry may be unreliable. The patients automated blood pressure will usually be
hypotensive and pulse pressure will be narrow.
CRITERIA:
Presence of a left, right, or bilateral ventricular assist device
Serious signs or symptoms, including:
Respiratory difficulty
Pulmonary edema
Chest pain
Signs or symptoms of shock
Potentially lethal dysrhythmia
Altered LOC/ syncope
FR/BLS TREATMENT:
1. INITIAL MEDICAL CARE.
2.
Call for intercept per INTERCEPT CRITERIA.
Region 6 Protocol
VAD (Ventricular Assist Device)
ILS/ALS TREATMENT:
1. Continue FR / BLS TREATMENT.
2. If stable, follow appropriate ILS/ALS protocol.
3. Auscultate heart. Continuous whirling noise indicates VAD is working,
but even a carotid pulse may not be palpable.
4. Monitor ECG. If there is a pulse, the rhythm may not correlate with it.
5. NS KVO or saline lock.
6. If patient is dehydrated and lungs are clear administer 250 ml fluid
bolus over 10 minutes. May repeat once, up to a total of 500ml or until
MAP > 65 mmHg.
7. Obtain 12 lead ECG. Follow appropriate protocol if STEMI or
dysrhythmia present.
8. Be sure patient brings back up power sources (batteries, charger, etc.),
and hand pump (if applicable).
9. Strongly consider transporting a VAD knowledgeable family member
with patient.
10.Inspect VAD control for model name and alarms. Use color code for
atlas. Controller will usually be located at the waist.
11.For VAD alarms or VAD malfunction, please see VAD Emergency Care
Guidelines.
4. CPR should NOT be performed on patients with Thoratec PVAD w/ TLC II.
5. If indicated, CPR may be performed on patients with: HeartWare HVAD, VentrAssist
LVAD, HeartMate II, or Jarvik 2000 FlowMaker.
6. If a VAD that features a hand pump (HeartMate XVE, or Thoratec PVAD w/ TLC II)
loses power or the motor fails and there is no flow on meter and no normal machine
sound over the precordium, hand pumping is indicated. The hand pumping rate
should be 60 to 90/minute. Foot pumping is acceptable.
Review
Scenario 1
Scenario 1
1. According to the Region 6 protocols, what
is the appropriate next step in treating this
patient?
A. Provide 2 minutes of CPR prior to
defibrillation.
B. Initiate CPR, secure the airway and
establish vascular access
C. Immediately defibrillate at 360j or
equivalent biphasic shock
D. Deliver a synchronized shock at 200j
Scenario1
2. True/False: After defibrillation you should
immediately resume CPR and continue for
2 minutes.
3. According to the Region 6 protocols, what
is the maximum dose of amiodarone that
may be given to this patient?
Scenario 2
Scenario 2
4. According to the Region 6 protocols, what
is the appropriate next step in treating this
patient?
A. Begin CPR, initiate vascular access and manage
the airway
B. Immediately defibrillate and then resume CPR
C. Begin CPR and prepare to pace the rhythm
D. Do not start resuscitation
Scenario 2
5. What is the appropriate ratio of
compressions to breaths in adult CPR with
2 rescuers?
6. What medication(s) would be appropriate
for treating this rhythm?
Answers
1.
2.
3.
4.
5.
6.
C
True
450mg
A
30:2
Epinephrine 1:10,000
Answers
7. Optimize ventilation and oxygenation,
treat hypotension, consider induced
hypothermia and coronary reperfusion
8. True
9. False