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Pulseless Rhythms

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by

michael gatti

on 9 November 2013

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Transcript of Pulseless Rhythms

Pulseless Rhythms
Optimize Ventilations and oxygenation
Maintain O2 sat above 94%
Consider advanced airway and wave form capnography of 35-40 mmHg
DO NOT HYPERVENTILATE
10-12 breaths/min
Treat Hypotension
IV/IO bolus of 1-2L N/S or LR
Dopamine 5-10 mcg/Kg/Min
12 lead EKG
Consider treatable causes: H's and T's
H's and T's
Hypovolemia, hypoxia, acidoses, hypo/hyperkalemia, hypothermia, tension pneumothorax, cardiac tamponade, toxins, pulmonary/coronary thrombosis
Doses the patient follow commands
YES




NO
Stemi or AMI?
Advanced Critical Care
Transport to nearest hospital with a cath lab
Return of spontaneous circulation (ROSC)
Consider induced hypothermia using 4ºC/39.2ºF fluids
Coronary reperfusion
now what !
Chest Compressions
Push Hard and Push Fast
Allow the heart to recoil
Ratio=30:2
30 compressions and 2 ventilation's
RHYTHMS SHOCKABLE ?
What rhythm is our patient in?
Shout For Help!
If no pulse= START CPR!
Our Patient Needs O2
Check for a gag reflex and insert an OPA
Give 2 ventilation's for every 30 compressions
BVM- 15 lpm
Attach monitor/defibrillator to the patient
YES SHOCK !!!!!!!
Biphasic: Manufacturer Recommendation
Inital Dose =200 joulses
Increase joules each shock by same increment
CPR
CPR FOR 2 MINUTES
ESTABLISH IV/IO ACCESS
NO





YES
RHYTHM SHOCKABLE ?

YES

Increase Joules with shock
NO
Consider Advanced Airway
Supraglottic airway or endotracheal intubation
Waveform capnography to confirm & monitor ET tube placement
8-10 breaths per min w/ continuous chest compressions
Drug Therapy
Epinephrine: 1 mg IV/IO/
Primarily used for it's x adrenergic effects and vasoconstriction. Icreases cerebral and coronary blood flow

Vassopressin: 40 units - A nonadrenergic vasoconstricter. Similar Properties to Epinephrine


Rhythm Shockable

YES

Shock at a higher dose
IF Monophasic use 360 Joules
CPR
2 Minutes
Drug Therapy

Amioderone: 300mg
Antidysrhythmic which blocks sodium channels. Improves rate of ROSC.
Treat Reversible Causes
Hypovolemia
Hypoxia
Hydrogen Ion
Hypo-/hyperkalemia
Hypothermia
Tension Pneumothorax
Cardiac Tamponade
Toxins
Thrombosis
CPR
2 MINUTES
ACTIVATE THE EMERGENCY RESPONSE SYSTEM
VENTRICULAR FIBRILLATION
Never has a pulse and is grossly chaotic
Rhythm is irregular with no discernible p-waves or complexes
Rate cannot be determined
P-R Interval doesn't exist
QRS complexes are not discernible
VENTRICULAR TACHYCARDIA

May or may not produce a pulse
Rhythm is usually regular
Rate is 150-250 beats/minute
P-waves are not discernible
P-R interval doesn't exist
QRS is wide and bizarre
T-waves in opposite direction of R-waves
Ventricular Flutter
V-flutter is basically ventricular tachycardia that is over 250 beats/min.
Rate= 250-350
Has sinusoidal waveform
Clear view of QRS
Considered a possible transition into V-fib
Work Citied
MA OEMS. (2013, June 15). Massachusetts EMS Statewide Treatment of Protocols, Version 11.01.
Vallarand, A.H. & Sanoski, C.A. (2012). Davis' Drug Guide for Nurses, 13th Edition. Philadephia: FA Davis, pg. 494-500.
Caroline, N., Elling, B., Smith, M. (2013) Chapter 12: Emergency Medications. In Pollack, A. (Ed.), Nancy Caroline’s Emergency Care in the Streets. (7th ed.) (p. 1007-1010). Burlington, MA: Jones & Bartlett.
Ventricular Rhythm ECG Strips
Full transcript