Phases of Cardiac Arrest - Montana EMSmontanaems.com/.../06/Phases-of-cardiac-arrest-CMEMS.pdf“As...
Transcript of Phases of Cardiac Arrest - Montana EMSmontanaems.com/.../06/Phases-of-cardiac-arrest-CMEMS.pdf“As...
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Phases of Cardiac Arrest
MICHAEL A. JASUMBACK M.D. FACEP
MEDICAL DIRECTOR
GREAT FALLS EMERGENCY SERVICES
BENEFIS MERCY FLIGHT
@JASUMBACK
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Faculty Disclosures
Michael A. Jasumback does not have any conflicts of interest (commercial, financial, or scientific) now or within the last 12 months related to this topic
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Why do I Care?It informs the sequence of events of a resuscitation
The phase of cardiac arrest determines the interventions most likely to result in successful resuscitation
It defines modern cardiac arrest management
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Etiology of Sudden Cardicac Death
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The phases
Electrical
Circulatory
Metabolic
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The Electrical Phase
0-4 Minutes
Defibrillation
Bystander CPR
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Electrical Phase:The Sequence
Early Defibrillation
AED
Bystander CPR
(Hands Only)
What if they are gasping?
GOOD prognostic indicator
START or RECOMMEND STARTING CPR!
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The Circulatory Phase
4-10 Minutes
CPR
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Circulatory Phase: The Sequence
CPR
Defibrillation
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Good CPR
Minimize interruptions in CPR
at all times
Correct rate –100/min
Correct depth (at least 5cm)
Ensure full chest recoil/decompression
CPR for at least 2 min prior to defibrillationin unmonitored arrest
CPR immediately post defibrillation, NO
reassessment of ROSC
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Why?
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Why?
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Metabolic Phase
10 Minutes and Beyond
Oxygenation
Ventilation
?Meds
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Metabolic Phase:The Sequence
Oxygenation/Airway
Ventilation/ NOT HYPERVENTILATION
Medications
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Oxygenation/Airway
Compared to BVM-No significant benefits from:
Endotracheal Intubation
Supraglottic Airway
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Ventilation
10 BPM!
Passive oxygenation?
End Tidal
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Medications
Epinephrine
Antiarrhythmics
Bicarbonate
Calcium
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Ultimately
“As noted in the ACLS portion of the 2010 guidelines,
CPR and defibrillation
are the only therapies associated with improved survival in patients with VF/pVT.”