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Emergency treatment: Cardiopulmonary Resuscitation:

AIRWAY:maintain open airway, make sure tongue is not obscuring. Three techniques usedin opening airway are:

Head- tilt, Neck- tilt;Head tilt, Chin lift; Jaw thrust.

BREATHING: mouth to mouth resuscitation or ambu- bag via endotracheal tube

CIRCULATION:

One man resuscitation: 15 chest compressions to 2 quick lung compressions( rate of 80/ min)

Two man resuscitation: 5 chest compressions to 1 lung inflation after each 5 compressionsinterposed between compressions (rate of 60/min) CPR works not by direct cardiac compression but by increasing intrathoracic pressure and

essentially squeezing blood from the pulmonary vasculature. CPR is done continuously without fail until a sustained heart rate is attained

Definitive therapy:identify cause of arrest: ECG, blood examination, IV line

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Fibrillation: cardiac musclescontract independently at abnormalspeeds. Can occur in the atrial or

ventricular muscles.

Ventricular fibrillation: 67

When the ventricular muscle fiberscontract independently. No QRS

complex an be identified and theECG is totally disorganized. As the patient usually have lost

consciousness by the time you haverealized that it is not just due to aloose connection, the diagnosis iseasy.

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No P waves irregularbaseline

Irregular QRScomplexes Normal shape QRS

complexes

In V1flutter-like waves

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defibrillation immediately with 200-300 joules ( 50- 100 for achild)

repeat defibrillation immediately if unsuccessful. Continue

CPR with out pausing, unless defibrillating epinephrine 5-10c (1: 10,000) Iv every 5 minutes to coarsen

ventricular fibrillation until restoration of heart rate . sodium bicarbonate 1 meq/kg IV; repeat at dose very 10

minutes repeat defibrillation with 320-360 joules lidocaine 100mg (1.5mg/kg) IV bolus followed by IV drip

(500mg in D5 water at 1-3 mg/min) for intractable Vfib. repeat defibrillation with 320-360 joules. if still unsuccessful, reevaluate all factors, utilizing

electrolytes and blood gas analysis.

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If a focus in the ventricularmuscle depolarizes at highfrequency ( causing, in effect,rapidly repeated ventricularextrasystoles) Excitation has tospread by an abnormal paththrough the ventricular muscle,and the QRS complex is wideand abnormal.

Note: No P waves.Wide QRScomplexes

QRS complexes slightlyirregular and vary slightly inshape.

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Cardiovert with 200-300 joules of delivered energyDo as with ventricular fibrillation

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Cardiopulmonary resuscitation Epinephrine 5-10 c (1:10,000) IV every 5 minutes prn for

asystole Atropine 1 mg IV every 5 minutes to maximum dosage of 2 mg

for bradycardia. sodium bicarbonate 1 meq/ kg IV; repeat at 12 every 10

minutes. Calcium chloride 5 cc (10%) every 10 minutes prn, not to be

given with bicarbonate. transverse pacemaker or isoprotenerol drip (if mg in 500cc run

at 1-2 cc/min or adjust rate to regulate heart rate at 60beats/min.

avoid cardiodepressant drugs (lidocaine, potassium)

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Abnormal rhythms arising in the atrialmuscle, the junctional region or theventricular muscle can be slow andsustained or they an occur as singlebeats(extrasystoles)

Fail-safe mechanisms that will keep itgoing if the SA node fails to depolarize,or if conduction of the depolarizationwave is bloked

Spontaneous depolarization frequenciesof about 50 per minute

Management:

Administer atropine 0.5mg IV, repeat asnecessary every 5 minutes to total of 2.0mg

Start isoproterenol infusion at 2-20ugtts/min

if rate still below 50/min, insert apacemaker.