2005 ACLS concepts go are centered around excellent CPR. The reason CPR is done for 2min before a rhythm check is because you need to build up the intrathoracic pressure in order to increase cardiac output and therefore increasing perfusion to essential organs like the heart and brain. Think of this kind of like the whirlpool effect in a swimming pool, you need to move the water around the pool in an organized way for a while so the water will continue to move on its own when you stop. Short interruptions will make it easier to regain good intrathoracic pressure again, the longer the interruption the longer it takes to build up that pressure again.
Ideally, during the first two minutes a lot should be going on. Combo pads are placed on the chest (right upper and lower left chest or if there is a pacemaker anterior and posterior chest) Establish a good BLS airway and ensure good chest rise, if you have enough extra hands have someone maintain cric pressure and keep suction handy. And establish your first IV or IO and hang NS or LRS and get your code drugs ready. It may seem impossible to you right now to do all this in two minutes but you would be surprised what can happen if you take a logical and systematic approach to every cardiac arrest.
Once you confirm VF/VT defib once at 200J and immediately resume CPR (without a rhythm check) and administer 1.0mg epi or 40.0 units of Vasopressin and get your next drug of choice ready, check to ensure proper CPR is effective by checking femoral pulses with compressions and make sure airway is being maintained; of course all the while thinking about possible causes.
2 min is up again; check rhythm if still VF/VT defib once at 200J and restart CPR (without rhythm check) and administer either 300.0mg of Amiodarone or 100.0mg Lidocaine during CPR and again check for femoral pulses and check airway patency.
Think about your H’s and T’s check and treat as necessary (ie. BS, OD, tension pneumo ect.. I usually check for things I can fix right away first then go through all the rest of the H’s and T’s).
If you have enough time at this point go ahead and intubate but if its going to take too much time wait, remember VF/VT has the most potential to change to either a worse or better rhythm as opposed to asystole which is more likely to remain unchanged.
Also, remember things can change or you could find a treatable cause so you have to be flexible and be prepared to change your treatment plan.
- Important points to remember;
- Be sure to hang a CRI drip of whichever anti-arrhythmic you used last prior to conversion,
- ET intubation takes a back seat in the line of priorities as long as there is a good BLS airway, especially if you have someone to hold cric pressure (if not I personally bump it up a little).
- Limit interruptions of CPR and keep interruptions to an absolute minimum.
- Make sure CPR is being done effectively and redelegate if necessary.
O yea, this should go without saying but just incase; always confirm cardiac arrest yourself before starting or taking over care from someone by checking for a pulse!! Nothing is worse that jumping in at a nursing home where the nurses are freaking out and doing CPR on a living person. :excl:
