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Changes in Cardiac Arrest Management

Changes in Cardiac Arrest Management. Pathophysiology of V-Fib Arrest. Defibrillation. No more stacked shocks Takes too long All shocks maximum energy. EMS probably should not use AED’s Biphasic increases efficacy. Defibrillation. Primary treatment for V-fib at 3 minutes and under

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Changes in Cardiac Arrest Management

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  1. Changes in Cardiac Arrest Management

  2. Pathophysiology of V-Fib Arrest

  3. Defibrillation • No more stacked shocks • Takes too long • All shocks maximum energy. • EMS probably should not use AED’s • Biphasic increases efficacy

  4. Defibrillation • Primary treatment for V-fib at 3 minutes and under • Should be delayed until good CPR for 2 minutes if down time over 3 minutes • Biphasic should be used • AED’s good in 3 minutes, bad after • One shock only with no pulse checks after

  5. Pulse Checks • Deadly!! • Only check pulses when rhythm appears to have converted thru CPR on ECG or signs of life • ECC says check before shock delivered after 5 cycles of 30:2 CPR

  6. Vascular Access • Avoid ET drugs whenever possible • Peripheral IV’s OK • Central IV’s slightly better, but compression interruption frequent with placement • Interosseous recommended when peripheral IV’s not obtainable

  7. Pharmacology • No improvements evident based on science with drugs to improve outcome • Epinephrine every 5 minutes • No added benefit to Vasopressin • Amiodarone and Lidocaine equal effectiveness

  8. What about intubation? • In first 6 minutes, not a priority (V-fib) ASAP in PEA and Asystole. • Understand that positive pressure breaths decrease cardiac output. • Some air exchange from CPR plus gasping. • Once intubated, 1 second breaths,six per minute. NO MORE.

  9. Airway Combitube or ET equivalent RSA Mentality-view and see cords place ET, otherwise immediate Combitube first try.

  10. Recommendations Bystander CRR program 911 CRR phone instruction Defib in first 2-3 minutes CRR before shocks otherwise

  11. Recommendations • AED’s in community, not on ambulance • 200 uninterrupted compression • No airway first 3 rounds of CRR • Immediate vascular access- IO if needed • Epinephrine 1mg as soon as possible

  12. Recommendations • When airway is placed, use non-visualized airway or RSA technique if intubating • No pause to put in airway • Never a pause after defib to check pulse or rhythm.

  13. Testimony and Example • A great example

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