CPR review pt 2 Flashcards | Quizlet If a victim is unconscious/unresponsive, with absent or abnormal breathing (ie, only gasping), the lay rescuer should assume the victim is in cardiac arrest. Defibrillators (using biphasic or monophasic waveforms) are recommended to treat tachyarrhythmias requiring a shock. There are 2 different types of mechanical CPR devices: a load-distributing compression band that compresses the entire thorax circumferentially and a pneumatic piston device that compresses the chest in an anteroposterior direction. Cardiac arrest survivors, like many survivors of critical illness, often experience a spectrum of physical, neurological, cognitive, emotional, or social issues, some of which may not become apparent until after hospital discharge. These still require further testing and validation before routine use. 2. Is there a role for prophylactic antiarrhythmics after ROSC? If an advanced airway is used in the in-hospital setting by expert providers trained in these procedures, either a supraglottic airway or an endotracheal tube placement can be used. Historically, the best motor examination in the upper extremities has been used as a prognostic tool, with extensor or absent movement being correlated with poor outcome. Operationally, administering epinephrine every second cycle of CPR, after the initial dose, may also be reasonable. If no advanced airway, 30:2 compression-ventilation ratio. 6. It may be reasonable to administer IV lipid emulsion, concomitant with standard resuscitative care, to patients with local anesthetic systemic toxicity (LAST), and particularly to patients who have premonitory neurotoxicity or cardiac arrest due to bupivacaine toxicity. This approach recognizes that most sudden cardiac arrest in adults is of cardiac cause, particularly myocardial infarction and electric disturbances. The opioid epidemic has resulted in an increase in opioid-associated out-of-hospital cardiac arrest, with the mainstay of care remaining the activation of the emergency response systems and performance of high-quality CPR. Thus, we recognize that each of these diverse aspects of care contributes to the ultimate functional survival of the cardiac arrest victim. In the PRIMED study (n=8178), the use of the ITD (compared with a sham device) did not significantly improve survival to hospital discharge or survival with good neurological function in patients with OHCA. 1. The 2010 Guidelines recommended a 50% duty cycle, in which the time spent in compression and decompression was equal, mainly on the basis of its perceived ease of being achieved in practice. While you lift the jaw, ensure that you are sealing the mask all the way around the outside edge of the mask to obtain a good seal against the victim's face. ACD-CPR is performed by using a handheld device with a suction cup applied to the midsternum, actively lifting up the chest during decompressions, thereby enhancing the negative intrathoracic pressure generated by chest recoil and increasing venous return and cardiac output during the next chest compression. Prompt initiation of targeted temperature management is necessary for all patients who do not follow commands after return of spontaneous circulation to ensure optimal functional and neurological outcome. This topic last received formal evidence review in 2015.24, Hypoxic-ischemic brain injury is the leading cause of morbidity and mortality in survivors of OHCA and accounts for a smaller but significant portion of poor outcomes after resuscitation from IHCA.1,2 Most deaths attributable to postarrest brain injury are due to active withdrawal of life-sustaining treatment based on a predicted poor neurological outcome. In patients with atrial fibrillation and atrial flutter in the setting of preexcitation, digoxin, nondihydropyridine calcium channel antagonists, -adrenergic blockers, and IV amiodarone should not be administered because they may increase the ventricular response and result in VF. 2. Compression rate and compression depth, for example, have both been associated with better outcomes, yet these variables have been found to be inversely correlated with each other so that improving one may worsen the other.13 CPR quality interventions are often applied in bundles, making the benefit of any one specific measure difficult to ascertain. Current literature is largely observational, and some treatment decisions are based primarily on the physiology of pregnancy and extrapolations from nonarrest pregnancy states.9 High-quality resuscitative and therapeutic interventions that target the most likely cause of cardiac arrest are paramount in this population. Seizure prophylaxis in adult postcardiac arrest survivors is not recommended. Although there are no controlled studies, several case reports and small case series have reported improvement in bradycardia and hypotension after glucagon administration. The value of artifact-filtering algorithms for analysis of electrocardiogram (ECG) rhythms during chest compressions has not been established. Treatment of hemodynamically stable patients with IV diltiazem or verapamil have been shown to convert SVT to normal sinus rhythm in 64% to 98% of patients. cardiopulmonary resuscitation; EEG, electroencephalogram; ETCO2, end-tidal carbon dioxide; GWR, gray-white ratio; IHCA, in-hospital cardiac arrest; IO, This time delay is a consistent issue in OHCA trials. How to Do CPR: Steps, Guidelines, Speed, and More While hemodynamically stable rhythms afford an opportunity for evaluation and pharmacological treatment, the need for prompt electric cardioversion should be anticipated in the event the arrhythmia proves unresponsive to these measures or rapid decompensation occurs. 3. Circulation. 4. All lay rescuers should, at minimum, provide chest compressions for victims of cardiac arrest. Acute increase in right ventricular pressure due to pulmonary artery obstruction and release of vasoactive mediators produces cardiogenic shock that may rapidly progress to cardiovascular collapse. 3. Prompt systemic anticoagulation is generally indicated for patients with massive and submassive PE to prevent clot propagation and support endogenous clot dissolution over weeks. reliably checking a pulse, is initiation of CPR beneficial? Of the 250 recommendations in these guidelines, only 2 recommendations are supported by Level A evidence (high-quality evidence from more than 1 randomized controlled trial [RCT], or 1 or more RCT corroborated by high-quality registry studies.) 1. In addition, status myoclonus may have an EEG correlate that is not clearly ictal but may have prognostic meaning, and additional research is needed to delineate these patterns. Symptoms typically occur within minutes, and findings may include arrhythmias, apnea, hypotension with bradycardia, seizures, and cardiovascular collapse.1 Lactic acidosis is a sensitive and specific finding.2,3 Immediate antidotes include hydroxocobalamin and nitrites; however, the former has a much better safety profile. When oxygen-rich blood cannot get to the brain, brain damage can occur within minutes. The provision of rescue breaths for apneic patients with a pulse is essential. Part 7.1: Adjuncts for Airway Control and Ventilation AED indicates automated external defibrillator; ALS, advanced life support; BLS, basic life support; and CPR, cardiopulmonary resuscitation. 1. 1. Do neuroprotective agents improve favorable neurological outcome after arrest? 2. These procedures are described more fully in Part 2: Evidence Evaluation and Guidelines Development. Disclosure information for writing group members is listed in Appendix 1(link opens in new window). In the presence of known or suspected basal skull fracture or severe coagulopathy, an oral airway is preferred compared with a nasopharyngeal airway. One important consideration is the selection of patients for ECPR and further research is needed to define patients who would most benefit from the intervention. Precordial thump is a single, sharp, high-velocity impact (or punch) to the middle sternum by the ulnar aspect of a tightly clenched fist. Each of these resulted in a description of the literature that facilitated guideline development. return of spontaneous circulation. It is reasonable to immediately resume chest compressions after shock delivery for adults in cardiac arrest in any setting. In the current era of widespread mobile device usage and accessibility, a lone responder can activate the emergency response system simultaneously with starting CPR by dialing for help, placing the phone on speaker mode to continue communication, and immediately commencing CPR. Airway, ventilation, and oxygenation are particularly important in the setting of pregnancy because of increased maternal metabolism and decreased functional reserve capacity due to the gravid uterus, making pregnant patients more prone to hypoxia. The value of VF waveform analysis to guide the acute management of adults with cardiac arrest has not been established. Accurate neurological prognostication in brain-injured cardiac arrest survivors is critically important to ensure that patients with significant potential for recovery are not destined for certain poor outcomes due to care withdrawal. An RCT published in 2019 compared TTM at 33C to 37C for patients who were not following commands after ROSC from cardiac arrest with initial nonshockable rhythm. All victims of drowning who require any form of resuscitation (including rescue breathing alone) should be transported to the hospital for evaluation and monitoring, even if they appear to be alert and demonstrate effective cardiorespiratory function at the scene. Continuous compressions at a rate of 100-120/min Give 1 breath every 6 seconds (10 breaths/min) CPR Compression Rate. Case reports have rarely described damage to the heart due to external chest compressions. Recognition that all cardiac arrest events are not identical is critical for optimal patient outcome, and specialized management is necessary for many conditions (eg, electrolyte abnormalities, pregnancy, after cardiac surgery). At very elevated levels, hypermagnesemia can lead to altered consciousness, bradycardia or ventricular arrhythmias, and cardiac arrest.9,10 Hypomagnesemia can occur in the setting of gastrointestinal illness or malnutrition, among other causes, and, when significant, can lead to both atrial and ventricular arrhythmias.11, The ongoing opioid epidemic has resulted in an increase in opioid-associated OHCA, leading to approximately 115 deaths per day in the United States and predominantly impacting patients from 25 to 65 years old.13 Initially, isolated opioid toxicity is associated with CNS and respiratory depression that progresses to respiratory arrest followed by cardiac arrest. In cardiac arrest secondary to anaphylaxis, standard resuscitative measures and immediate administration of epinephrine should take priority. and 2. There are also no specific alterations to ACLS for patients with cardiac arrest from asthma, although airway management and ventilation increase in importance given the likelihood of an underlying respiratory cause of arrest. Healthcare providers should consider the possibility of a spinal injury before opening the airway. It can sometimes take the form of intubation. Injection of epinephrine into the lateral aspect of the thigh produces rapid peak plasma epinephrine concentrations. Poisoning from other cardiac glycosides, such as oleander, foxglove, and digitoxin, have similar effects. Does the use of point-of-care cardiac ultrasound during cardiac arrest improve outcomes? When the QRS complex of a VT is of uniform morphology, electric cardioversion with the shock synchronized to the QRS minimizes the risk of provoking VF by a mistimed shock during the vulnerable period of the cardiac cycle (T wave). 3. For patients with OHCA, use of steroids during CPR is of uncertain benefit. Techniques include administration of warm humidified oxygen, warm IV fluids, and intrathoracic or intraperitoneal warm-water lavage. What is the optimal temperature goal for targeted temperature management? In addition, 15 recommendations are designated Class 3: No Benefit, and 11 recommendations are Class 3: Harm. AED indicates automated external defibrillator; BLS, basic life support; and CPR, cardiopulmonary resuscitation. Part 2: Evidence Evaluation and Guidelines Development, Part 3: Adult Basic and Advanced Life Support, Part 4: Pediatric Basic and Advanced Life Support, Part 9: COVID-19 Interim Guidance for Healthcare Providers, Part 10: COVID-19 Interim Guidance for EMS, 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The Adult Cardiovascular Life Support Writing Group included a diverse group of experts with backgrounds in emergency medicine, critical care, cardiology, toxicology, neurology, EMS, education, research, and public health, along with content experts, AHA staff, and the AHA senior science editors. Epinephrine is the cornerstone of treatment for anaphylaxis.35, This topic last received formal evidence review in 2010.14. ILCOR Consensus on CPR and Emergency Cardiovascular If so, what dose and schedule should be used? Step 1: Power on the AED if needed - Follow the prompts (as a guide to next steps) Step 2: Choose adult pads for victim 8 years of age and older - Attack the adhesive AED pads to the victim's bare chest - Follow the diagrams on the pads Step 3: When AED prompts you, clear the victim during analysis. CPR involves performing chest compressions and, in some cases, rescue ("mouth-to-mouth") breathing. 2. This recommendation is based on expert consensus and pathophysiologic rationale. Much of the evidence examining the effectiveness of airway strategies comes from radiographic and cadaver studies. CPR should be initiated if pacing is not successful within 1 min. While an expeditious trial of medications and/or fluids may be appropriate in some cases, unstable patients or patients with ongoing cardiac ischemia with atrial fibrillation or atrial flutter need to be cardioverted promptly. Antidigoxin Fab antibodies should be administered to patients with severe cardiac glycoside toxicity. DWI/ADC is a sensitive measure of injury, with normal values ranging between 700 and 800106 mm2 /s and values decreasing with injury. It is reasonable to place defibrillation paddles or pads on the exposed chest in an anterolateral or anteroposterior position, and to use a paddle or pad electrode diameter more than 8 cm in adults. CPR with an Advanced Airway - National CPR Association There are no RCTs evaluating alternative treatment algorithms for cardiac arrest due to anaphylaxis. If termination of resuscitation (TOR) is being considered, BLS EMS providers should use the BLS termination of resuscitation rule where ALS is not available or may be significantly delayed. For each recommendation, the writing group discussed and approved specific recommendation wording and the COR and LOE assignments. Case reports support the use of ECMO for patients with refractory shock due to TCA toxicity. The precordial thump may be considered at the onset of a rescuer-witnessed, monitored, unstable ventricular tachyarrhythmia when a defibrillator is not immediately ready for use and is performed without delaying CPR or shock delivery. In cases of prehospital maternal arrest, rapid transport directly to a facility capable of PMCD and neonatal resuscitation, with early activation of the receiving facilitys adult resuscitation, obstetric, and neonatal resuscitation teams, provides the best chance for a successful outcome. bradycardia? 3. A patent airway is essential to facilitate proper ventilation and oxygenation. In the setting of head and neck trauma, lay rescuers should not use immobilization devices because their use by untrained rescuers may be harmful. An updated systematic review on several aspects of this important topic is needed once currently ongoing clinical trials have been completed. Delivery of chest compressions without assisted ventilation for prolonged periods could be less effective than conventional CPR (compressions plus ventilation) because arterial oxygen content decreases as CPR duration increases. IV Medications Commonly Used for Acute Rate Control in Atrial Fibrillation and Atrial Flutter, CPR & First Aid in Youth Sports Training Kit, Resuscitation Quality Improvement Program (RQI), Coronavirus Resources for CPR & Resuscitation, Advanced Cardiovascular Life Support (ACLS), Resuscitation Quality Improvement Program (RQI), COVID-19 Resources for CPR & Resuscitation, Claiming Your AHA Continuing Education Credits, International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, extracorporeal cardiopulmonary resuscitation, (partial pressure of) end-tidal carbon dioxide, International Liaison Committee on Resuscitation, arterial partial pressure of carbon dioxide, ST-segment elevation myocardial infarction. Digoxin poisoning can cause severe bradycardia, AV nodal blockade, and life-threatening ventricular arrhythmias. 2. For lay rescuers trained in CPR using chest compressions and ventilation (rescue breaths), it is reasonable to provide ventilation (rescue breaths) in addition to chest compressions for the adult in OHCA. Fist (or percussion) pacing is the delivery of a serial, rhythmic, relatively low-velocity impact to the sternum by a closed fist.1 Fist pacing is administered in an attempt to stimulate an electric impulse sufficient to cause myocardial depolarization. 1. cardiac arrest? 1. In some instances, prognostication and withdrawal of life support may appropriately occur earlier because of nonneurologic disease, brain herniation, patients goals and wishes, or clearly nonsurvivable situations. 2. Multiple case series have demonstrated potential benefit from mechanical circulatory support including ECMO and cardiopulmonary bypass in patients who are refractory to standard resuscitation procedures. Aggressive rewarming, possibly including invasive techniques, may be required and may necessitate transport to the hospital sooner than would be done in other OHCA circumstances.1 The specific care of patients who are victims of an avalanche are not included in these guidelines but can be found elsewhere.2, This topic last received formal evidence review in 2010.1, Between 1.6% and 5.1% of US adults have suffered anaphylaxis.1 Approximately 200 Americans die from anaphylaxis annually, mostly from adverse reactions to medication.2 Although anaphylaxis is a multisystem disease, life-threatening manifestations most often involve the respiratory tract (edema, bronchospasm) and/or the circulatory system (vasodilatory shock). How is cpr performed when an advanced airway is in place - Brainly These features make adenosine relatively safe for treating a hemodynamically stable, regular, monomorphic wide-complex tachycardia of unknown type. 4. These arrhythmias are common and often coexist, and their treatment recommendations are similar. We recommend that laypersons initiate CPR for presumed cardiac arrest, because the risk of harm to the patient is low if the patient is not in cardiac arrest. In hemodynamically stable patients, IV adenosine may be considered for treatment and aiding rhythm diagnosis when the cause of the regular, monomorphic rhythm cannot be determined. PDF Adult Advanced Cardiovascular Life Support
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