Handbook Of Anesthesiology (2008)

Handbook of Anesthesiology 2008 Edition Mark R. Ezekiel, MD, MS © 2008 Mark R. Ezekiel, MD. All rights reserved. This book, or any parts thereof, may not be reproduced, photocopied, or stored in an information retrieval network without the written permission of the publisher. The reader is advised to consult the drug package insert and other references before using any therapeutic agent. No warranty exists, expressed or implied, for errors or omissions in this text. Resuscitation Algorithms (ACLS) Primary and Secondary ABCD Survey 1. Primary ABCD survey A. Airway: assess and manage the airway with noninvasive devices. B. Breathing: assess and manage breathing (look, listen, and feel). If the patient is not breathing, give two rescue breaths, 1 second each. C. Circulation: if no pulse, start chest compressions at 100/min D. Defibrillation: analyze rhythm; shock VF/VT once then resume CPR 2. Secondary ABCD survey A. Airway: establish appropriate airway management. B. Breathing: ventilate with O2; confirm effective oxygenation and ventilation. C. Circulation: establish IV/IO access; administer drugs appropriate for rhythm and condition; continue CPR; minimize chest compression interruptions. D. Differential Diagnosis: search for and treat identified reversible causes. A. Potentially reversible causes include: hypoxia, hypovolemia, hyperkalemia, hypokalemia and metabolic disorders, hypothermia, tension pneumothorax, tamponade, toxic/therapeutic disturbances, and thromboembolic/mechanical obstruction. Ventricular Fibrillation and Pulseless VT 1. Primary ABCs 2. CPR: continue CPR for 2 minutes prior to shock. 3. Assess rhythm: if VF or VT defibrillate 1 time only (360 J). 4. Resume CPR 5. Intubate, IV access, and prepare drugs. 6. Assess rhythm: if VF or VT defibrillate 1 time only (360 J). 7. Continue CPR for 2 minutes. 8. Epinephrine: 1.0 mg IVP, repeat every 3-5 minutes, or vasopressin 40 units IV, single dose, 1 time only. 9. Defibrillate: 360 J 1 time. 10.Continue CPR 11.Consider antiarrhythmics A. Amiodarone 300 mg IVP OR B. Lidocaine 1.5 mg/kg IVP, repeat x2 q5-10 minutes to a total loading dose of 3 mg/kg OR C. Magnesium sulfate 2 grams IV (especially if Torsade de pointes or suspected hypomagnesemic state or severe refractory VF). 12.Defibrillate: 360 J, 30-60 sec after each dose of medication. 13.Repeat Amiodarone 150 mg IVP (if recurrent VF/VT), up to max cumulative dose of 2200 mg IV in 24 hours 14.Consider bicarbonate 1 mEq/kg (if known preexisting bicarbonate responsive acidosis, overdose with tricyclic antidepressant, if intubated and continued long arrest interval, hypoxic lactic acidosis, or hypercarbic acidosis). Asystole 1. Prima