PALS AHA MAJIDY EMERGENCY MEDICIN RESIDENT CPR 3/23/2010 1 MAJIDI ALIREZA EMR

BRADYCARDIA SUPPORT ABC OXYGEN ATTACH MANITORING 3/23/2010 2 MAJIDI ALIREZA EMR

BRADYCARDIA STILL COUSING CARDIOPULMONARY COMPROMISE NO Yes SUPPORT ABC OXYGEN OBSERVE CONSIDER EXPERT CONSULTATION PERFORM CPR IF DESPITE OXYGENATION AND VENTILATION HR< 60/MIN WITH POOR PERFUSION 3/23/2010 3 MAJIDI ALIREZA EMR

RIMINDERS GIVE EPINEPHRIN -IV;IO 0.01 mg/kg (0.1 cc/kg ;1:10.000) ENDOTRACHEAL TUBE 0.1 mg/kg ( 0.1 cc/kg ; 1: 10,000 REPEAT EVERY 3-5 MIN - 3/23/2010 4 MAJIDI ALIREZA EMR DURING CPR PUSH HARD AND FAST(100/MIN) ENSURE FULL CHEST RECOIL MINIMIZE INTERRUPTIONS IN CHEST COMPRSSIONS SUPPORT ABC…. SECURE AIRWAY IF NEEDED; CONFIRM PLASMENT SEARCH FOR AND TREAT POSSIBLE CONTRIBUTING FACTORS: -HYPOVOLEMIA -HYPOXIA OR VENTILATION PROBLEMS HYDROGEN ION(ACIDOSIS) -HYPO-HYPERKALEMIA -HYPOGLYCEMIA -HYPOTHERMIA -TOXINS -TAMPONADE;CARDIAC -TENSION PNEUMOTHORAX -THOROMBOSIS (CRONARY OR PULMONARY) -TRAUOMA (HYPOVOLEMIA, INCREASED ICP

GIVE ATROPINE; FIRST DOSE:0.02 Mg/kg (minimum dose=0.1 mg) (maximum dose=1 mg) consider cardiac paicing IF INCREASED VAGAL TONE OR PRIMARY AV BLOCK IF PULSLESS ARREST DEVELOPS,GO TO PULSLESS ARREST ALGORITHM 3/23/2010 5 MAJIDI ALIREZA EMR

TACHYCARDIA with pulses and poor perfusion -assess and support ABCs as needed -Give oxygen -Attach monitor/defibrillator Evaluate rhythm with 12-lead EKG or monitor Evaluate QRS duration possible Ventricular Tachycardia probable SINUS TACHYCARDIA(ST) probable SUPRAVENTRICULAR TACHYCARDIA (SVT) -compatible history consider with known cause -P waves present/normal -variable RR; constant PR -infants:Rate usually <220 -children:Rate usually <180 -Compatible hystory (vague,nonspesific) ;hystory of abrupt rate chenges -P wave absent/abnormal -HR not variable -Infant HR>220/min -Children HR>180/min Wide QRS (>0.08 sec) Narrow QRS (<0.08 sec) symptom persist search for treat cause consider vagal maneuvers(no delay) 3/23/2010 6 MAJIDI ALIREZA EMR

-IF IV ACCESS READILY AVAILABLE: Adenosin 0.1 mg/kg(max 1 dose 6mg 2 dose 12 mg)Rapid bolus -or SYNCRONIZED CARDIOVERSION: 1 j/kg;if not effective 2 j /kg sedate if possible but do not deley cardioversion 3/23/2010 7 MAJIDI ALIREZA EMR

VT SYNCRONIZED CARDIOVERSION: 0.5 – 1 j/kg if not effective increase to 2 j/kg sedate if possible but don’t delay cardioversion -May attempt adenosine if it don’t delay cardioversion EXPERT CONSULTATION ADVIZED; Amiodarone 5 mg/kg Iv over 20-60 min OR procainamide 15 mg/kg IV over 30-60 min Don’t routinely administer amiodarone and procainamide together 3/23/2010 8 MAJIDI ALIREZA EMR

DURING EVALUATION -secure ,verify airway and vascular access when possible -consider expert consultation -proper for cardioversion TREAT POSSIBLE CONTRIBUTING FACTORS HYPOVOLEMIA -HYPOXEMIA -HYDROGEN ION(ASIDOSIS) -HYPO-HYPERKALEMIA -HYPOGLYCEMIA -HYPOTHERMIA -TOXINS -TAMPONADE CARDIAC -TENSION PNEUMOTHORAX -THROMBOSIS(CORONARY) -TRAUMA(HYPOVOLEMIA) 3/23/2010 9 MAJIDI ALIREZA EMR

PULSLESS AREST -BLS algorythm:cont CPR -oxygen when available -attach monitor /defibrillator when available CHECK RHYTM SHOCKABLE RHYTM? SHOCKABLE VF/VT NOT SHOCKABLE ASYSTOL /PEA Resume CPR immediately give EPINEPHRINE repeate every 3-5 min -IV;IO 0.01 mg/kg (0.1 cc/kg ;1:10.000) ENDOTRACHEAL TUBE 0.1 mg/kg ( 0.1 cc/kg ; 1: 10,000 3/23/2010 10 MAJIDI ALIREZA EMR

give 5 cycles of CPR check rhythm shock able NO (Asystoles) YES IV;IO 0.01 mg/kg ADRENALIN (0.1 cc/kg ;1:10.000) ENDOTRACHEAL TUBE 0.1 mg/kg ( 0.1 cc/kg ; 1: 10,000 Resume CPR immediately give EPINEPHRINE repeat every 3-5 min GIV 1 SHOCK -manual:2 j/kg -AED:>1year of age =pediatric system (1 -8 year of age) RESUME CPR IMMEDIATLY 3/23/2010 11 MAJIDI ALIREZA EMR

PULSLESS ARREST VF/VT shock able NOT shock able CHECK RHYTHM shock able rhythm? GIV 1 SHOCK -manual:2 j/kg -AED:>1year of age =pediatric system (1 -8 year of age) RESUME CPR IMMEDIATLY GIVE 5 CYCLE OF CPR yes 3/23/2010 12 MAJIDI ALIREZA EMR 1

cont CPR while defibrillator is charging GIVE 1 SHOCK -Manual :4 j/kg -AED : 1 year >age < 8 year RESUME CPR IMMEDIATELY (EPINEPHRIN) CHECK RHYTHM shock able rhythm? IV;IO 0.01 mg/kg (0.1 cc/kg ;1:10.000) ENDOTRACHEAL TUBE 0.1 mg/kg ( 0.1 cc/kg ; 1: 10,000) REPEAT EVERY 3 -5 MIN GIVE 5 CYCLE OF CPR YES 3/23/2010 13 MAJIDI ALIREZA EMR 2

cont CPR while defibrillator is charging GIVE 1 SHOCK -manual 4 j/kg -AED : 1 year >age< 8 year consider ANTIARRYTHMICS (e.g. amiodarone or lidocaine or magnesium sulfate) TORSADES DE POINTES 1 mg/kg iv-io 5 mg/kg iv-io 25-50 mg/kg max 2g 3/23/2010 14 MAJIDI ALIREZA EMR 3

SHOCK CPR DRUG SHOCK CPR DRUG SHOCK CPR DRUG DRUG DRUG GIVE 5 CYCLE OF CPR MODEL MODEL 3/23/2010 15 MAJIDI ALIREZA EMR

END 3/23/2010 16 MAJIDI ALIREZA EMR