ALS Resuscitation Pearls:
High
Quality CPR: Rate at least 100 per minute, Depth 5 – 6 cms, allowing full
elastic recoil, and minimizing interruptions.
Fine VF
that is difficult to distinguish from asystole should be treated as asystole
with good quality CPR
Atropine is
no longer recommended for PEA and Asystole (These rhythms are primarily due to
myocardial pathology and not due to increased vagal tone
Reversible
Causes:
4 H’s
Hypoxia, hypovolemia, Hypo/Hyperkalemia (Metabolic), Hypothermia
4 T’s Thrombosis (pulmonary/Coronary), Tamponade,
Toxins, Tension Pneumothorax
When
defibrillating the pre-shock pause should be kept to a minimum (less than 5
sec) by planning ahead, continuing chest compressions during charging, and
using a brief safety check
Adrenaline
1 mg should be given as soon as IV/IO access (endotracheal medications have
been de-emphasized) is gained in asystole/PEA and after the third shock in
VF/VT
Amiodarone
300 mg IV is given after the third shock after VF/VT
Capnography
should be used, if available, in an intubated patient to confirm and monitor
the tube placement, quality of CPR, and to provide early recognition of ROSC
If
thrombolysis is given for massive PE in cardiac arrest, CPR should be continued
for 60 – 90 mins
Therapeutic
hypothermia should be considered in comatose survivors of shockable and
non-shockable rythms.
(Courtesy: Victoria Stacey, 2011)
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