CARDIAC ARREST CARD

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OBSTETRIC
PREGNANT
CARDIAC ARREST
+
CALL FOR HELP!
IMPORTANT PHONE NUMBERS:
NO PULSE
PREGNANT
CALL FOR CODE CART
2
START CPR IMMEDIATELY!
3 place HANDS HIGHER on sternum DURING CPR
BEGIN CPR
NEONATAL TEAM#:
ADULT CODE TEAM #:
no tilt & OR
LUD
HIGHER
onHANDS
pt’s LEFT-side
manual LUD
4
PUSH HARD!
≥ 2 INCHES DEEP
ALLOW COMPLETE
CHEST RECOIL
≥2”
30° Tilt
Place in 30° Lateral Tilt
ST
≥100
≥100 compressions/min
2’
EV
NG E
T TIMI
AR
PUSH FAST!
≥2”
Who’s the Leader? minimize BREAKS IN CPR
Identify the team leader
5
GET
SCALPEL!
IF...
DBP <20 mmHg or
ETCO2 <10 mmHg
IMPROVE CPR!
Assign timer/documenter ROTATE COMPRESSORS Q2 MIN
MONITOR CPR QUALITY
PREPARE FOR IMMEDIATE C-SECTION AT
SITE OF ARREST. IF NO ROSC WITHIN 4 MINS OF
ARREST, PROCEED TO IMMEDIATE C-SECTION!
ROSC = RETURN OF SPONTANEOUS CIRCULATION
AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
DX
1
CPR TIPS
CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
S
NT
1
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OBSTETRIC
PREGNANT
CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
IMMEDIATE
VENTILATION?
ASSESS RHYTHM
place AED pads and assess
ANTICIPATE
DIFFICULT
AIRWAY
AIRWAY & VENTILATION?
8
IV LINE
IO
IOLINE
LINE
PLACE ABOVE
DIAPHRAGM
ADEQUATE IV ACCESS? IF NOT-> consider humeral io line
ASSESS FOR SHOCKABLE RYHTHM. IF VT/VF SHOCK!
SHOCK
7
DRUGS
AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
6 ASSESS & PERFORM
ADEQUATE
PLACE AED
OR
DEFIBRILLATE
200 JOULES
(BIPHASIC ENERGY)
EPINEPHRINE 1MG IV
EVERY 3-5 MIN
IF POSSIBLE ASSIGN PERSON TO TIME & ADMINISTER DOSES
CONSIDER
VASOPRESSIN
40 UNITS IV
ONCE
VASOPRESSIN DOSE COULD REPLACE ONE EPINEPHRINE DOSE
Reference: 1) Part 12: Cardiac Arrest in Special Situations : 2010 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Vanden Hoek et al., Circulation.
2010;122:S829-S861. 2) Maternal CPR illustrations by Ms. Janet Fong, WWW.AIC.CUHK.EDU.HK/WEB8
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CARDIAC ARREST
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CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
≥100
≥100 compressions/min
MINIMIZE BREAKS IN CPR
R/O CAUSES
≥2”
ROTATE COMPRESSORS Q2 MIN
MONITOR CPR QUALITY
REPEAT CYCLE UNTIL RESUSCITATED
CPR + DEFIBRILLATE (IF VT/VF) EVERY 2 MINS + DRUGS
Stop Mg
Give Ca2+
100% O2
10/min
2+
Mg
2+
Ca
IF running, STOP MaG INFUSION, give 10% CaCl2 10CC IV
12
IF...
DBP <20 mmHg or
ETCO2 <10 mmHg
RESUSCITATED
IMPROVE CPR!
VENTilate 10 BREATHS/MIN
Deliver 100% Oxygen
FIRST RULE OUT COMMON TREATABLE CAUSES
PEA/ASYSTOLE
VF/VT
OTHER CAUSES
1) Bleeding
2) Drug Toxicity
Local Anesthetic, Mg, Oxytocin
3) High Spinal
4) Hypoventilation
5) Embolism
pulmonary, afe, vae
13
1) Hyperkalemia
2) Coronary Thrombosis
3) HypoMg or Torsades
Continue to #13 to rule out
other causes & TREATMENT
GUIDELINES.
TX: Consider Antiarrythmics
amiodarone 300 mg iv or
lidocaine 100 mg iv
Continue to #14 for VF/VT
treatment guidelines
14
13
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AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
TX
OTHER
11
REPEAT CYCLE UNTIL
8
10
2’
MIZE B
NI
MI
CONT.
CPRCPR
BEGIN
9
AK
RE S I
CARDIAC ARREST
PREGNANT
PR
NC
1
OBSTETRIC
OBSTETRIC
CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
FIND TREATABLE CAUSES – BEAU-CHOPS
AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
13
CROSS-CHECK POSSIBLE CAUSES WITH TEAM FOR DIAGNOSIS
BLEEDING/DIC
IF SUSPECTED THEN:
1) Rapid bolus IV Fluids.
2) Activate MTG.
3) Consider transfusion
of blood products.
4) Consider placement of
arterial line.
5) See Tab #14 - MTG
CARDIAC DISEASE
IF SUSPECTED CONSIDER:
EMBOLISM
IF PULMONARY EMBOLISM:
1) Consider TEE/TTE to rule
out RV failure.
2) Consider thrombolytic
therapy- discuss risk/
benefits with team.
IF AMNIOTIC FLUID
EMBOLISM:
1) See Tab #24 - AFE
HYPERTENSION
IF SUSPECTED CONSIDER:
1) Myocardial infarction - 1) Pre-eclampsia
consider percutaneous 2) Eclampsia
coronary intervention. 3) See Tab #12 Hypertension
2) Aortic dissection
- Consider cardiac
surgery consult
3) Congenital heart disease
- Consider cards consult
4) Pulmonary hypertension
- Consider NO.
5) Magnesium toxicity
- Consider CaC12 1gmIV
UTERINE ATONY
ANESTHETICS
ANESTHETIC
COMPLICATIONS INCLUDE:
1) Spinal shock from
regional anesthesia Tab #23
2) Local anesthetic toxicity
Tab #11
3) Loss of airway or
ventilation - Tabs #5,10
IF SUSPECTED CONSIDER:
1)
2)
3)
4)
5)
Oxytocin
Misoprostol
Methylergonovine
Carboprost
Bimanual fundal
massage
6) See Tab #27 - Uterine
Atony
SEPSIS
PLACENTA
IF SUSPECTED CONSIDER:
1) Placenta abruptio Tab #25
2) Placenta accreta Tab #26
IF SUSPECTED CONSIDER:
1) Goals: CVP ≥8-12mmHg,
MAP≥65mmHg, Urine
output≥0.5ml/kg/h,
MVO2 Sat≥65%.
2)
3)
4)
6)
Fluid therapy
Antimicrobial therapy
Removing source of sepsis
See Tab #32 - Sepsis
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CARDIAC ARREST
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OBSTETRIC
Continued
from
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CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
1
CROSS-CHECK POSSIBLE CAUSES WITH TEAM FOR DIAGNOSIS
PNEUMOTHORAX
ABG TO RULE OUT
CORONARY THROMBOSIS
HYPOXIA
SpO2
79
SUSPECT IF:
Unilateral breath
sounds, hneck veins,
[trachea
IF SUSPECTED:
Perform needle
decompression (Midclavicular line 2nd
intercostal space) and
chest tube.
CARDIAC TAMPONADE
SUSPECT IF:
RULE OUT:
1)
2)
3)
4)
5)
Hyperkalemia
Hypocalcemia
Acidosis
Hypoglycemia
Hypokalemia
IF SUSPECTED THEN:
IF SUSPECTED THEN:
TOXINS
POISON
1) Consider TEE
2) Consider emergent
revascularization or
cath lab.
3) Consider intra aortic
balloon pump
HYPO/HYPERTHERMIA
IF SUSPECTED CONSIDER:
1) hCVP, equalization of 1) Rapid Re-warming
Warm IV fluids,
right & left- sided
peritoneal lavage, ECMO
pressures.
or CPB
2) Consider TEE/TTE to rule
out pericardial effusion. IF >40°C THEN:
1) Rule out malignant
3) If present, perform
hyperthermia and treat
pericardiocentisis.
if found.
CONSIDER ALL MEDS
RECEIVED INCLUDING:
1) 100% FiO2. In OR: rule
out switched gas lines.
Use separate O2 tank.
2) Check connections
Re-confirm ET tube
placement.
3) Confirm bilateral breath
sounds.
4) Suction ET tube.
5) Rule out other causes
with TTE/TEE.
FOR A POISON EMERGENCY
IN THE UNITED STATES:
1) Call 1-800-222-1222
Existing infusions
Prescribed medications
Ilicit drug use
Syringe swaps or drug
errors
5) Poisoning
1)
2)
3)
4)
IF SUSPECTED THEN:
1) Contact poison control/
pharmacy
2) Administer appropriate
therapy/antidote
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AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
13
FIND TREATABLE CAUSES – BEAU-CHOPS
CARDIAC ARREST
PREGNANT
OBSTETRIC
CARDIAC ARREST
LARRY F. CHU, MD, MS, ANDREA J. FULLER, MD, STEVE LIPMAN, MD AND KYLE HARRISON, MD
CONSIDER
ANTIARRYTHMICS
VT/VFIB CONSIDERATIONS
AIM.STANFORD.EDU | OB ACLS V 0.1 3.2013 US 2.20.2013
14
AMIODARONE 300 MG IV OR
LIDOCAINE 100 MG IV
CORONARY
THROMBOSIS?
HYPERKALEMIA?
CHECK ABG:
>7.0 MMOL/L
LIFE THREATENING
6.1-6.9 MMOL/L
MODERATE
CONSIDER: INSULIN 10 UNITS IV WITH
GLUCOSE 40-60GM IV1
CONSIDER:
20 ML 10% CALCIUM-GLUCONATE IV
(OVER 5-10 MIN*, REPEAT IF NEEDED)2
ALSO CONSIDER: SALBUMETOL 0.5 MG IV1
IF PH<7.20 CONSIDER:
BICARBONATE 1-2 AMPS IV1
*INFUSE OVER 20-30 MIN IF PATIENT ON DIGOXIN
IF SUSPECTED THEN:
1)
2)
3)
1
CONSIDER TTE.
CONSIDER EMERGENT
REVASCULARIZATION/CATH
LAB.
CONSIDER INTRA AORTIC
BALLOON PUMP.
iMG OR TORSADES?
CONSIDER MgSO4 2GM IV
Ahee P. and Crowe A.V. The management of hyperkalemia in the emergency department. J Accid Emerg Med 2000;17:188-191
Allon M. Treatment and prevention of hyperkalemia in end-stage renal disease. Kidney Int. 1993;43:1197–209.
2
1
CARDIAC ARREST
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