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Adult Cardiac Arrest Management Algorithm

Adult Cardiac Arrest Algorithm

Figure 29

CPR Quality

  • Push hard (2-2.4″ (5-6 cm)) and fast (100-120 bpm) and allow chest recoil
  • Minimize interruptions
  • Do not over ventilate
  • If no advanced airway, 30:2 compression to ventilation ratio
  • Quantitative waveform capnography
    • If ETCO2 <10 mmHg, attempt to improve CPR quality

Shock Energy

  • Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses should be considered.
  • Monophasic: 360 J

Return of Spontaneous Circulation

  • Return of pulse and blood pressure
  • Sudden sustained increase in PETCO2 (typically ≥ 40 mmHg)
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

  • Supraglottic advanced airway or ET intubation
  • Absolute placement confirmation:

1. Negative Epigastric Auscultation
2. Positive Bilateral Chest Auscultation
3. Vocal Cord Visualization
4. Quantitative ETCO2

  • 10 breaths per minute with continuous chest compressions

Drug Therapy

  • Epinephrine IV/IO Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes after
  • Amiodarone IV/IO Dose: first dose is 300 mg bolus, second dose is 150 mg
  • Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

Reversible Causes

  • Hypovolemia
  • Hypoxia
  • H+(acidosis)
  • Hypothermia
  • Hypo-/hyperkalemia
  • Hypoglycemia
  • Tamponade, cardiac
  • Toxins
  • Tension pneumothorax
  • Thrombosis, pulmonary or coronary
  • Trauma
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