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{| class="wikitable"
{{familytree/start}}
 
{{familytree | | | | | | A01 |-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150%; height: 17em; width: 28em "> ❑ '''High Quality CPR'''<br> '''Compressions:'''
|-
: Push hard (>2 inches) & fast (>100/min)
 
: Minimize interruptions; rotate compressor every 2 mins <br>
! Agent
'''Airway:''' Open airway <br>
 
'''Breathing:'''
! Dosage
: Pressure ventilation; 2 breaths every 30 compressions
 
: Bagmask also acceptable
|-
----
----
 
❑ '''Attach monitor/defibrillator'''<br> ❑ '''Check rhythm'''
! Direct FXa inhibitors
</div>}}
 
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
|-
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
 
{{familytree |border=0 | | | | | | C01 | | | C03 | | | | | C02 | | | | | | | | | | | | | |C01= '''↓''' |C02= '''↑''' |C03= Continous CPR every 2 mins}}
| [[Argatroban]]
{{familytree |border=0 | | | | | | D01 | | | | | | | | | | D02 | | | | | | | | | | | | | |D01= '''↓''' |D02= '''↑''' }}
 
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
| Bolus: None <br> Continuous infusion: <br>
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
: ♦ Normal organ function: 2 μg/kg per minute
{{familytree | | | | | | |!| | | | | E01 | | | | |!| | | | | | | | | | | | | | | |E01=<div style="float: left; text-align: left; line-height: 150%; width: 30em; height: 33em ">'''Drug Therapy''' <br> ❑ Establish IV/IO access (do not interrupt CPR) <br> ❑ Vasopressor:  
: ♦ Liver dysfunction (total serum bilirubin 1.5 mg/dL), heart failure, postcardiac surgery, anasarca: 0.5-1.2 μg/kg per minute
:♦ '''[[Epinephrine]]''' '''1 mg IV q3-5 min''' (or 2 mg via ETT)
 
:♦ '''[[Vasopressin]]''' '''40 U''' can replace 2nd or 3rd doses of epinephrine)
|-
❑ Antiarrythmic:
 
:♦ '''[[Amiodarone]]''' '''300 mg''' IV bolus + '''150 mg 3-5 min later'''
| [[Lepirudin]]
:♦ '''[[lidocaine]]''' '''1-1.5 mg/Kg IV, max 3mg/Kg'''
 
| Bolus:0.2 mg/kg (only for life- or limb-threatening thrombosis) <br> Continuous infusion: <br>
: ♦ Cr < 1.0 mg/dL: 0.10 mg/kg per hour
: ♦ Cr 1.0-1.6 mg/dL: 0.05 mg/kg per hour
: ♦ Cr 1.6-4.5 mg/dL: 0.01 mg/kg per hour
: ♦ Cr > 4.5 mg/dL: 0.005 mg/kg per hour
 
|-
 
| [[Bivalirudin]]
 
| Bolus: None <br> Continuous infusion: <br>
: ♦ Normal organ function: 0.15 mg/kg per hour
: ♦ Renal or hepatic dysfunction: dose reduction may be appropriate
 
 
 
|-
----
----
 
'''Consider advanced airway:'''<br> ❑ Endotracheal intubation or supraglottic advanced airway <br> ❑ Assess : Bilateral chest expansion & breath sounds <br> ❑ Check tube placement <br> ❑ 8-10 breaths per min with continous compressions
! Indirect FXa inhibitors
----
 
'''Treat reversible causes:'''<br>
|-
❑ [[Hypovolemia]]: Volume    ❑ [[Tension Pneumothorax]]<br>
 
❑ [[Hypoxia]]: Oxygenate      ❑ [[cardiac tamponade|Tamponade]]: Pericardiocentesis<br>
| [[Danaparoid]]
❑ H+ ions: NaHCo3            ❑ Toxins<br>
 
❑ Hypo/Hyper K: Replace  ❑ Thromb. ([[Pulmonary embolism|PE]])<br>
| Bolus: <br>
❑ [[Hypothermia]]: Warm        ❑ Thromb. ([[Acute coronary syndrome|ACS]])
: < 60 kg: 1500 U
</div>}}
: ♦ 60-75 kg: 2250 U
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
: ♦ 75-90 kg: 3000 U
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
: ♦ > 90 kg: 3750 U <br>
{{familytree |border=0 | | | | | | F02 | | | F03 | | | | | F01 | | | | | | | | | | | | | | |F01= '''↑'''| F02= '''↓''' |F03= Continous CPR every 2 mins}}
Accelerated initial infusion: 400 U/hour X 4 hours, then 300 U/hour X 4 hours <br>
{{familytree |border=0 | | | | | | G02 | | | | | | | | | | G01 | | | | | | | | | | | | | | |G01= '''↑'''| G02= '''↓'''}}
Maintenance infusion: <br>
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
: ♦ Normal renal function: 200 U/hour
{{familytree | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | }}
: ♦ Renal insufficiency: 150 U/hour
{{familytree | | | | | | K01 |-|-|-|-|-|-|-|-|-|-|'| | | | | | | | | | | | | | | |K01=<div style="float: left; text-align: left; line-height: 150% ">❑'''Shockable rhythm? ([[VF]]/[[Pulseless VT]])''' <br> Deliver shock (120-200 J biphasic; 360 J monophasic)
 
----
|-
❑ '''Rhythm not shockable? ([[Asystole]]/[[PEA]])'''<br> Resume CPR
 
----
|}
❑ On Return of spontaneous circulation (ROSC)
:::::: ↓
:::: [[Post-arrest care]] </div>}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree/end}}

Revision as of 15:30, 7 January 2014

 
 
 
 
 
High Quality CPR
Compressions:
Push hard (>2 inches) & fast (>100/min)
Minimize interruptions; rotate compressor every 2 mins

Airway: Open airway
Breathing:

Pressure ventilation; 2 breaths every 30 compressions
Bagmask also acceptable

Attach monitor/defibrillator
Check rhythm

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continous CPR every 2 mins
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Drug Therapy
❑ Establish IV/IO access (do not interrupt CPR)
❑ Vasopressor:
Epinephrine 1 mg IV q3-5 min (or 2 mg via ETT)
Vasopressin 40 U can replace 2nd or 3rd doses of epinephrine)

❑ Antiarrythmic:

Amiodarone 300 mg IV bolus + 150 mg 3-5 min later
lidocaine 1-1.5 mg/Kg IV, max 3mg/Kg

Consider advanced airway:
❑ Endotracheal intubation or supraglottic advanced airway
❑ Assess : Bilateral chest expansion & breath sounds
❑ Check tube placement
❑ 8-10 breaths per min with continous compressions


Treat reversible causes:
Hypovolemia: Volume ❑ Tension Pneumothorax
Hypoxia: Oxygenate ❑ Tamponade: Pericardiocentesis
❑ H+ ions: NaHCo3 ❑ Toxins
❑ Hypo/Hyper K: Replace ❑ Thromb. (PE)
Hypothermia: Warm ❑ Thromb. (ACS)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Continous CPR every 2 mins
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shockable rhythm? (VF/Pulseless VT)
Deliver shock (120-200 J biphasic; 360 J monophasic)

Rhythm not shockable? (Asystole/PEA)
Resume CPR


❑ On Return of spontaneous circulation (ROSC)

Post-arrest care