List the 5 priorities of ALS alglorithm.
Priority 1: CPR
Perform high-quality CPR for at least 2 minutes before the first rhythm check.
Avoid interrupting CPR unless it is for rhythm and pulse checks and/or shock delivery.
Priority 2: rhythm and pulse check
Attach monitors and/or defibrillator pads.
Pause CPR for no longer than 10 seconds for rhythm recognition in cardiac arrest.
Shockable rhythms (Vfib or pulseless VT): Proceed to defibrillation; draw up epinephrine PLUS either amiodarone OR lidocaine.
Nonshockable rhythms (PEA or asystole): Do not defibrillate; draw up epinephrine.
Repeat rhythm and pulse check every 2 minutes, resuming CPR in between each check.
Priority 3: defibrillation of shockable rhythms
Deliver a shock as soon as Vfib or pulseless VT is recognized.
Resume CPR immediately after shock and continue for 2 minutes until next rhythm and pulse check.
If a second attempt at defibrillation is unsuccessful, administer resuscitation medications.
Priority 4: resuscitation medications
Obtain peripheral IV/IO access and administer medications without interrupting CPR.
Nonshockable rhythms: Administer epinephrine 1 mg IV/IO as soon as possible; repeat every 3–5 minutes as needed.
Shockable rhythms
After 2nd unsuccessful cycle of defibrillation: administer epinephrine 1 mg IV/IO; repeat every 3–5 minutes as needed.
After 3rd unsuccessful cycle of defibrillation, administer:
Amiodarone 300 mg IV/IO once, then 150 mg IV/IO once after 3–5 minutes
OR lidocaine 1–1.5 mg/kg IV/IO once, then 0.5–0.75 mg/kg IV/IO once after 3–5 minutes
Reevaluate indications and dosage at each subsequent rhythm and pulse check.
Priority 5: Hs and Ts
Address these in parallel with CPR, defibrillation, and resuscitation medications.
Describe the endpoints.
ROSC identified during rhythm and pulse check: Begin postresuscitation care.
Termination of resuscitation decision is made: Follow procedure for declaration of death.
ALS algorithm (figure).
Describe shockable and nonshockable rhythms.
Describe the defibrillation.
Defibrillate as soon as possible once a shockable rhythm is recognized to maximize survival.
Set the defibrillator to unsynchronized mode.
Place the paddles or pads firmly on the patient's thorax.
Set energy dosage and press the charge button.
Resume CPR while the defibrillator is charging.
When fully charged, “clear” the patient, i.e., ensure no other personnel and equipment are in contact with the patient or pads.
Administer the shock.
Paddles: Simultaneously hold down both shock buttons located under each thumb.
Pads: Press the shock button on the defibrillator.
Resume CPR immediately after defibrillation for a full 2-minute cycle. [12]
Describe resuscitation medications.
Obtain peripheral IV access or IO access for medication administration without interrupting CPR. All resuscitation medications should be administered while CPR is ongoing to ensure their circulation to the heart and brain.
Epinephrine 1 mg IV/IO
First dose: after second unsuccessful defibrillation attempt
Repeat every 3–5 minutes.
Amiodarone 300 mg IV/IO (OR lidocaine 1–1.5 mg/kg IV/IO)
First dose: after third unsuccessful defibrillation attempt
An additional dose of 150 mg of amiodarone or 0.5–0.75 mg/kg of lidocaine can be given after 3–5 minutes.
Nonshockable rhythms: Administer epinephrine 1 mg IV/IO.
First dose: as soon as possible
List other causes of reversible causes.
Other causes include hypoglycemia, hypocalcemia, hypomagnesemia, anaphylaxis, and asthma.
Hs and Ts (table).
Describe the ROSC.
Indications of ROSC
Clear signs of life, e.g., breathing, coughing, or movement
Return of palpable pulse and blood pressure or presence of arterial waveform with intraarterial monitoring
An abrupt and sustained increase in expiratory CO2 measured with capnography
Management
Begin postresuscitation care.
Consult specialists for neuroprognostication.
Identify and treat complications of CPR and/or cardiac arrest.
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