Vasoconstriction is important during CPR because it will help increase blood flow to the brain and heart. Rhythm checks should be performed after 5 cycles of CPR. Limit rhythm checks to less than 10 seconds to minimize interruptions in CPR. Pulse checks should be performed when a rhythm check reveals a change in the rhythm to a rhythm that is organized and could be generating a pulse.
Amiodarone, lidocaine, and magnesium are antiarrhythmic medications that are used in the left branch of the Cardiac Arrest Algorithm. These medications were be reviewed in more detail in the previous lesson. Jeff, Thanks for the site. Profile Page. Cardiac Arrest Algorithm Diagram. Stable Vtach can be managed pharmacologically. Vfib is rapid totally incoordinate contraction of ventricular fibers; the EKG shows chaotic electrical activity and clinically the patient has no pulse.
Vtach is defined by QRS greater than or equal to. There are three clinical types: pulseless, hemodynamically unstable and hemodynamically stable.
If there is any doubt of polymorphic versus monomorphic Vtach in the hemodynamically unstable patient, treat like Vfib. If Vtach or Vfib, prepare for defibrillation. If pulse is present, attach EKG or defibrillator and evaluate rhythm. If patient is unstable and not polymorphic Vtach, prepare for synchronized cardoversion. Determine whether patients has pulse or not. As action to restore circulation begins, think of what caused the arrest. Vfib is defined by totally incoordinate contraction of ventricular fibers, reflected on EKG by chaotic electrical activity.
Wide complex tachycardia other than pulseless Vtach and Vfib needs to be separated into stable or unstable; regular or irregular. Hemodynamic instability examples include: altered mental status, ischemic chest discomfort, acute heart failure, respiratory distress, hypotension or other signs of shock. Wide complex tachycardia is defined as a QRS greater than.
Vtach diagnosis is supported by evidence of AV dissociation, wide complexes greater than ms, and axis is positive or negative in all leads.
Monomorphic Vtach has one morphology of QRS complexes. Polymorphic Vtach has progressive changes in QRS complex, which means multiple morphologies. Polymorphic Vtach with a prolonged QT greater than msec when heart rate corrected is called torsades de pointes Figure 1. Vfib is easily diagnosed by EKG; just do not forget to check EKG leads during the code to be sure they do not come unattached. A wide complex tachycardia that is regular could be Vtach, SVT with aberrancy, pre-excited tachycardia or a v-paced rhythm.
A wide complex tachycardia that is irregular may be atrial fibrillation with aberrancy, pre-excited atrial fibrillation, polymorphic vtach or torsades de pointes. If the etiology of the rhythm cannot be determined, the rate is regular and the QRS is monomorphic, then adenosine mg IV can be given. If SVT it will convert or slow; if no response then it is Vtach. Always have patient attached to defibrillator when giving adenosine in this clinical scenario.
Do not give adenosine to unstable patients or those with irregular or regular polymorphic wide complex tachycardias. In these scenarios adenosine could lead to Vfib. Biphasic defibrillation use to joules; it is acceptable to use maximum dose if unsure, For monophasic defibrillators use joules. After defibrillation continue CPR for 2 minutes before checking pulse. If no return to circulation, defibrillate again and check pulse in 2 minutes.
Asystole is a flat-line ECG Figure There may be a subtle movement away from baseline drifting flat-line , but there is no perceptible cardiac electrical activity. Sustained ventricular tachycardia often requires urgent medical treatment, as this condition may sometimes lead to sudden cardiac death. Treatment involves restoring a normal heart rate by delivering a jolt of electricity to the heart. This may be done using a defibrillator or with a treatment called cardioversion.
Ventricular fibrillation is more serious than atrial fibrillation. It diagnoses cardiac arrhythmias. Specifically, it detects an arrhythmia called ventricular fibrillation V-Fib or VF for short. For stable Vtach, IV antiarrhythmic drugs or elective cardioversion is recommended. Lidocaine has been found to be less effective than amiodarone, sotalol or procainamide. Procainamide and sotalol should be avoided with QT prolongation.
Procainamide should be avoided in CHF. Electrical cardioversion is used when the patient has a pulse but is either unstable, or chemical cardioversion has failed or is unlikely to be successful.
These scenarios may be associated with chest pain, pulmonary oedema, syncope or hypotension. In many patients with bradycardic circulatory arrest PEA , percussion pacing can replace chest compressions until pharmacological or electrical intervention shows its effect. The overall prognosis for patients with pulseless electrical activity PEA is poor unless a rapidly reversible cause is identified and corrected.
Most cases of torsades de pointes resolve on their own without treatment. However, it can develop into ventricular fibrillation, which can lead to cardiac arrest and may even be fatal. Register today for online ACLS certification! What are Shockable Rhythms? What are the Shockable Rhythms? There are two shockable rhythms and two non-shockable rhythms. The algorithm consists of the two pathways for a cardiac arrest: A shockable rhythm — displayed on the left side of the algorithm.
A non-shockable rhythm — displayed on the right side of the algorithm. Shockable Rhythm: Pulseless V-tach Ventricular tachycardia V-tach will usually respond well to defibrillation. Leave a Reply Cancel reply Your email address will not be published.
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