2. Fire . 1. Which statement is true regarding the administration of naloxone? If the plot of the reactant concentration versus time is nonlinear, but the concentration drops by 50%50 \%50% every 10 seconds, then the order of the reaction is You yell to the medical assistant, "Go get the AED!" The toxicity of cyanide is predominantly due to the cessation of aerobic cell metabolism. 2. This recommendation is based on the fact that nonconvulsive seizures are common in postarrest patients and that the presence of seizures may be important prognostically, although whether treatment of nonconvulsive seizures affects outcome in this setting remains uncertain. We recommend promptly performing and interpreting an electroencephalogram (EEG) for the diagnosis of seizures in all comatose patients after ROSC. In patients with -adrenergic blocker overdose who are in refractory shock, administration of high-dose insulin with glucose is reasonable. pharmacological, catheter intervention, or implantable device? and 2. She is 28 weeks pregnant and her fundus is above the umbilicus. Simultaneous compressions and ventilation should be avoided,2 but delivery of chest compressions without pausing for ventilation seems a reasonable option.3 The use of SGAs adds to this complexity because efficiency of ventilation during cardiac arrest may be worse than when using an endotracheal tube, though this has not been borne out in recently published RCTs.4,5, This topic last received formal evidence review in 2010.15, These recommendations are supported by the 2017 focused update on adult BLS and CPR quality guidelines.20. You and your colleagues are performing CPR on a 6-year-old child. Prompt initiation of targeted temperature management is necessary for all patients who do not follow commands after return of spontaneous circulation to ensure optimal functional and neurological outcome. 1. These recommendations are supported by the 2020 CoSTR for ALS.11, Recommendation 1 last received formal evidence review in 2010 and is supported by the Guidelines for the Use of an Insulin Infusion for the Management of Hyperglycemia in Critically Ill Patients from the Society for Critical Care Medicine.49 Recommendation 2 is supported by the 2020 CoSTR for ALS.11 Recommendations 3 and 4 last received formal evidence review in 2015.24. 7. Immediate resumption of chest compressions after shock results in a shorter perishock pause and improves the overall hands-on time (chest compression fraction) during resuscitation, which is associated with improved survival from VF arrest.16,48 Even when successful, defibrillation is often followed by a variable (and sometimes protracted) period of asystole or pulseless electrical activity, during which providing CPR while awaiting a return of rhythm and pulse is advisable. A wide-complex tachycardia is defined as a rapid rhythm (generally 150 beats/min or more when attributable to an arrhythmia) with a QRS duration of 0.12 seconds or more. Observational studies evaluating the utility of cardiac receiving centers suggest that a strong system of care may represent a logical clinical link between successful resuscitation and ultimate survival. In the absence of conclusive evidence that one biphasic waveform is superior to another in termination of VF, it is reasonable to use the manufacturers recommended energy dose for the first shock. If so, what dose and schedule should be used? TTM between 32C and 36C for at least 24 hours is currently recommended for all cardiac rhythms in both OHCA and IHCA. and 2. Case reports support the use of ECMO for patients with refractory shock due to TCA toxicity. Because any single method of neuroprognostication has an intrinsic error rate and may be subject to confounding, multiple modalities should be used to improve decision-making accuracy. Check for no breathing or only gasping and check pulse (ideally simultaneously). Symptomatic bradycardia may be caused by a number of potentially reversible or treatable causes, including structural heart disease, increased vagal tone, hypoxemia, myocardial ischemia, or medications. Excessive ventilation is unnecessary and can cause gastric inflation, regurgitation, and aspiration. You administered the recommended dose of naloxone. 2. CT and MRI are the 2 most common modalities. For each recommendation, the writing group discussed and approved specific recommendation wording and the COR and LOE assignments. The 2019 focused update on ACLS guidelines1 addressed the use of ECPR for cardiac arrest and noted that there is insufficient evidence to recommend the routine use of ECPR in cardiac arrest. Drug administration by central venous access (by internal jugular or subclavian vein) achieves higher peak concentrations and more rapid circulation times than drugs administered by peripheral IV do, Endotracheal drug administration is regarded as the least-preferred route of drug administration because it is associated with unpredictable (but generally low) drug concentrations. Table 1. These recommendations are supported by the 2019 AHA Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal CPR During Cardiac Arrest: An Update to the AHA Guidelines for CPR and Emergency Cardiovascular Care.12. CPR is the single-most important intervention for a patient in cardiac arrest and should be provided until a defibrillator is applied to minimize interruptions in compressions. Important considerations for determining airway management strategies is provider airway management skill and experience, frequent retraining for providers, and ongoing quality improvement to minimize airway management complications. During manual CPR, rescuers should perform chest compressions to a depth of at least 2 inches, or 5 cm, for an average adult while avoiding excessive chest compression depths (greater than 2.4 inches, or 6 cm). stabilization of the emergency when plans and personnel necessary to the recovery are developed and identified. Other pseudoelectrical therapies, such as cough CPR, fist or percussion pacing, and precordial thump have all been described as temporizing measures in select patients who are either periarrest or in the initial seconds of witnessed cardiac arrest (before losing consciousness in the case of cough CPR) when definitive therapy is not readily available. No RCTs of TTM have included IHCA patients with an initial shockable rhythm, and this recommendation is therefore based largely on extrapolation from OHCA studies and the study of patients with initially nonshockable rhythms that included IHCA patients. The value of VF waveform analysis to guide the acute management of adults with cardiac arrest has not been established. The value of artifact-filtering algorithms for analysis of electrocardiogram (ECG) rhythms during chest compressions has not been established. Before appointment, writing group members disclosed all commercial relationships and other potential (including intellectual) conflicts. There is no proven benefit from the use of antihistamines, inhaled beta agonists, and IV corticosteroids during anaphylaxis-induced cardiac arrest. Pharmacological treatment of cardiac arrest is typically deployed when CPR with or without attempted defibrillation fails to achieve ROSC. For cardiac arrest with known or suspected hyperkalemia, in addition to standard ACLS care, IV calcium should be administered. These recommendations are supported by the 2020 CoSTR for ALS,4 which supplements the last comprehensive review of this topic conducted in 2015.7. 1. It may be reasonable to actively prevent fever in comatose patients after TTM. We do not recommend routine use of magnesium for the treatment of polymorphic VT with a normal QT interval. Central venous access is primarily used in the hospital setting because it requires appropriate training to acquire and maintain the needed skill set. What should you do? Precharging the defibrillator during ongoing chest compressions shortens the hands-off chest time surrounding defibrillation, without evidence of harm. It is reasonable that selection of fixed versus escalating energy levels for subsequent shocks for presumed shock-refractory arrhythmias be based on the specific manufacturers instructions for that waveform. No adult human studies directly compare levels of inspired oxygen concentration during CPR. In addition, status myoclonus may have an EEG correlate that is not clearly ictal but may have prognostic meaning, and additional research is needed to delineate these patterns. Because pregnant patients are more prone to hypoxia, oxygenation and airway management should be prioritized during resuscitation from cardiac arrest in pregnancy. neuroprognostication? 1. Vagal maneuvers are recommended for acute treatment in patients with SVT at a regular rate. 3. 1. CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycardia; and VF, ventricular fibrillation. When Mr. Phillips shows signs of ROSC, where should you perform the pulse check? Limitations to their prognostic utility include variability in testing methods on the basis of site and laboratory, between-laboratory inconsistency in levels, susceptibility to additional uncertainty due to hemolysis, and potential extracerebral sources of the proteins. Furthermore, the resource intensity required to begin and maintain an ECPR program should be considered in the context of strengthening other links in the Chain of Survival. Therefore, the management of bradycardia will depend on both the underlying cause and severity of the clinical presentation. 1. arrest with shockable rhythm? Circulation. What is the optimal timing for head CT for prognostication? Biphasic and monophasic shock waveforms are likely equivalent in their clinical outcome efficacy. Persons who enter the Main Accumulation Areas test the system by initiating a two-way conversation with Security each time they enter. In patients who remain comatose after cardiac arrest, it is reasonable to perform multimodal neuroprognostication at a minimum of 72 hours after normothermia, though individual prognostic tests may be obtained earlier than this. Recommendations for management of torsades de pointes are also presented in Torsades de Pointes. Delivery of chest compressions without assisted ventilation for prolonged periods could be less effective than conventional CPR (compressions plus ventilation) because arterial oxygen content decreases as CPR duration increases. 2. 3. ECPR indicates extracorporeal cardiopulmonary resuscitation. Which patients with cardiac arrest due to suspected pulmonary embolism benefit from emergency Amiodarone or lidocaine may be considered for VF/pVT that is unresponsive to defibrillation. Based on the training of the rescuers, and only if scene safety can be maintained for the rescuer, sometimes ventilation can be provided in the water (in-water resuscitation), which may lead to improved patient outcomes compared with delaying ventilation until the victim is out of the water. Some treatment recommendations involve medical care and decision-making after return of spontaneous circulation (ROSC) or when resuscitation has been unsuccessful.
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