CARDIAC ARREST / COLLAPSED PATIENTTIME IV line AED CPR Airway Scriber 00:00 Prepare IV/IO access Get CRASH TROLLEY/ AED Assess patient Response Get BAG VALVE MASK Write Patient Details Blood Ix: Check Breathing Time the event ABG/VBG Check Pulse (remind every 2 minutes) RP Cardiac enzyme Urine toxicology Vital signs: BP Temp (OC) If no pulse, Dextrostix Start CPR ASAP, HR, RR Apply ECG ASAP COUNT LOUND AND CLEAR Give Ventilation (30:2) Jot down every details When ECG attached, STOP all activities and CHECK PULSE & ASSESS RHYTHM, Shock only when VF & PULSELESS VT! PEA & ASYSTOLE continue CPR Shock energy: Monophasic 360J Biphasic 120-200J Presumably after first shock, 00:02 Check Blood Ix Restart CPR Ventilation Record details & time Prepare 1mg Adrenaline Time of shock Drug given Ix result 00:04 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after second shock, Check Blood Ix Restart CPR Ventilation Record details & time Administer 1mg Time of shock Adrenaline during CPR Drug given Prepare Ix result 1mg Adrenaline 300mg Amiodarone (refractory VF/VT) 00:06 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after third shock, Check Blood Ix Restart CPR Ventilation Record details & time Administer 1mg Time of shock Adrenaline during CPR Drug given Prepare Ix result 1mg Adrenaline 150 mg Amiodarone 5-15mcg/kg/min (4OC fluid during bolus) Jot down every details . discuss with patient’s family RETURN OF SPONTANEOUS CIRCULATION (ROCS) TIME IV line AED CPR Airway Scriber Treat hypotension (SBP<90) Repeat ECG Maintain SpO2 >94% Write Patient Details 20ml/kg bolus NS Assess Rhythm Time the event Vasopressor Noradrenaline IV 0. until Return of Spontaneous Circulation (ROCS) Stop the resuscitation. if intubation is required. Check Blood Ix Restart CPR & Ventilation Record details & time Administer 1mg Time of shock Adrenaline during CPR Drug given Prepare Ix result 1mg Adrenaline Switch role if necessary 00:10 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after forth shock.5mcg/kg/min Adrenaline IV 0.5mcg/kg/min Dopamine IV 5-10mcg/kg/min Inotropes If no neurological recovery. Check Blood Ix Restart CPR Ventilation Record details & time Administer 1mg Prepare intubation set Time of shock Adrenaline during CPR Drug given Prepare Ix result 1mg Adrenaline 00:12 ASSESS RHYTHM & SHOCK CHECK PULSE INTUBATE IN LESS THAN 10SEC OR STOP! Presumably after fifth shock and intubation successful.1-0.00:08 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after third shock. Check Blood Ix CPR continuously for 2min Give a breath every 6sec Record details & time Administer 1mg Get time from scriber Time of shock Adrenaline during CPR Drug given Prepare Ix result 1mg Adrenaline REMIND EVERY 2 MINUTES The above sequence is repeated every 2 minutes. Dobutamine IV Induced hypothermia 2.1-0. repeat every 3-5min. patient should be given: Midazolam (1mg IV every 3-5min up to sedation/maximum 5mg cumulative dose) and Fentanyl (50mcg increments) Narrow regular (SVT) Narrow irregular (AF) Wide regular (VT) 50-100J Monophasic 200J 100J Biphasic 120-200J . 12mg. maximum 3mg feeling of heart stop for a moment Dopamine IV 2-10mcg/kg/min Adrenaline 2-10mcg/min Transcutaneous pacemaker (TCP) DONE Tx for unstable tachycardia: Medical treatment (IV Adenosine) Mechanical treatment (Synchronized Cardioversion) Before synchronized cardioversion was given. 12mg). short T1/2 Acute heart failure? Acute heart failure? Rapid IV push with 10-20ml NS @ antecubital fossa/large veins Tx for unstable bradycardia: Patient will anticipate DIZZINESS and Atropine IV 0.5mg bolus. TACHYCARDIA (≥150BPM) BRADYCARDIA (<50BPM) STABLE UNSTABLE STABLE UNSTABLE Vagal maneuvers (Carotid sinus Hypotension? Refer Cardiologist Hypotension? massage) 5-10min Acute altered mental state? Acute altered mental state? IV Adenosine Signs of shock? DONE Signs of shock? Adenosine IV can be given 3 dose max Ischemic chest discomfort? Ischemic chest discomfort? (6mg.