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Cardiac Arrest: Difference between revisions
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When the AED is attached during BLS let the AED assess the rhythm. Do not manipulate the person while the AED assess the rhythm to prevent motion artefact disturbing the detection algorhythm. Follow the instructions of the AED, this can be either a shock of no shock. After shock or non-shock immediately continue with chest compressions and rescue breaths. Continue with cardiopulmonary resuscitation until the AED rechecks the rhythm. | When the AED is attached during BLS let the AED assess the rhythm. Do not manipulate the person while the AED assess the rhythm to prevent motion artefact disturbing the detection algorhythm. Follow the instructions of the AED, this can be either a shock of no shock. After shock or non-shock immediately continue with chest compressions and rescue breaths. Continue with cardiopulmonary resuscitation until the AED rechecks the rhythm. | ||
==Advanced Life Support== | ==Advanced Life Support (ALS)== | ||
BLS the cornerstone to the treatment of cardiac arrest. Early and high quality CPR is critical to survival. In the hospital setting trained expert en technical equipment can facilitate cardiac arrest management. The only intervention besides proper BLS and early defibrillation to increase survival is the administration of adrenaline. The ALS protocol deviates into two strategies encountered in the setting of cardiac arrest; a shock protocol and no-shock protocol. During both protocols it is important to establish intravascular access as soon as possible, as an alternative intraosseous injection of drugs can be performed. Furthermore assessment of airway management and ventilation is essential. Oxygen should be administered as soon as possible and be titrated tot the arterial blood oxygen saturation. Tracheal intubation is the optimal method of providing and maintaining a clear and secure airway. Intubation should be performed by experienced personnel to reduce complications and delay between intubation and chest compressions. When there is return of spontaneous circulation the resuscitation team should stabilize the patient to prevent recurrence of cardiac arrest. | |||
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[[File:ALS.jpg]] | [[File:ALS.jpg]] | ||
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====Shock protocol==== | |||
When a shockable rhythm is detected, it is important to minimize the time between chest compressions and defibrillation. When the shock is delivered immediately resume with chest compressions to minimize delay. Even after successful shock the heart can be stunned and effective circulation can only be maintained through chest compressions. After the first round of shock and compressions reassess rhythm and act according to the protocol. After the third shock has been given, adrenaline 1mg and amiodaron 300mg can be administered intravenously. Further adrenaline 1mg can be administered every 3-5 minutes, there is no further indication for anti-arrhythmic drugs during resuscitation. | |||
====No-shock protocol==== | |||
When asystole or pulseless electrical activity is detected CPR should be started immediately simultaneously with 1mg intravenous adrenaline. Assess the rhythm after 2 minutes of chest compressions and continue according to the rhythm. Continue with adrenaline injections every 3-5 minutes if no return of spontaneous circulation has been achieved. There is no place for further medical intervention. | |||
====Post-cardiac arrest treatment==== | |||
==Special circumstances== | ==Special circumstances== | ||