Emergency Medicine is Hard

Determine if the patient is DNR. If no, you can proceed.

Priorities

• Focus on chest compressions. Think CAB (Circulation, Airway, Breathing), but prioritize the airway if you think that this was a respiratory arrest due to inadequate oxygenation (e.g. bad tube)
  • A LMA is an efficient and appropriate airway while chest compressions are being performed
• Get the pads on. You’re checking every 2 minutes for a shockable rhythm.
• Get a POC glucose (if this isn’t already a priority). Everyone already knows to get access and draw labs.
• Throw in a IO if no one can get access
• Determine if there are any reversible causes

The Role of Ultrasound in Identifying Reversible Causes for Cardiac Arrest

• Cardiac – no more guessing for cardiac activity or if there is a pulse; r/o tamponade, massive PE, dissection
• Lung – r/o tension pneumothorax
• FAST – determine if the patient is exsanguinating into their abdomen

Medications

• Epinephrine 1mg every 3-5 minutes
• Amiodarone 300mg bolus, and a subsequent 150mg dose for ventricular dysrhythmias
  • Do not give to patients with atrial fibrillation with an accessory pathway, polymorphic VTach
• Lidocaine 1-1.5mg/kg
  • Sodium channel blocker that suppresses ventricular ectopy
• Bicarbonate – only indicated for TCA overdose and hyperkalemia
  • Do not use for acidemia
• TPA
  • Only indicated if you think the patient arrested because of a massive PE
• Magnesium
  • Indicated for polymorphic VTach, or hx of prolonged QT
• Calcium
  • Indicated in patients with renal failure

ACLS Algorithm