เวชบำบัดวิกฤตพื้นฐาน Fundamental in Critical Care

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1. Basic life supporl algorithm (uzuunfifi 1)

2. ACLS cardiac anest algorithm 1uo.ru4fifi e1
3. Bradycardia algorithm 1rrBru4fifr s)

Practical CPR algorithm 2010 @nluni nfrftnJS 49

4. Tachycardia algorithm (uNu{fifi 4)
5. Maternal cardiac arrest algorithm 1rroru4fifr S1
6. Acute coronary syndrome algorlthm 1rrarunfifr O1
7. Goals for management of patients with suspected stroke ([[Hu{fid Z)

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z. uiunrtrdrfi'rpra\t high cpR quality
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to. niuorTrdrdqlunlrelro{rhu post cardiac anest Tnstd post cardiac anest care

algorithm

11. a"nDnr;no{ algorithm uoncrno:tflu aborithm rruur6ludr u".,:fi circular algorithm
'lu BLS atgorithm uR; ACLS cardiac arrest atgorirhm d,r lda'jtirecr'rlfirfirJfr:i6rdrlnirudu

U:afiudrnqiifinr:ril6suu:laolu bradycardia atgorithm

t. rnrud'lunrt'ld bradycardia algorithm 6a heart rate rioun'jr so ni,lnrrfi

z. our:atri atropine ldlu exe 4nuuufirflu bradycardia

tg. nrnlrinolcuorrio nr:fnsrdr u avo pi ne'lfi rir nr.:,:-nurfi t transcutaneous pacin g

uia dopamine nio epinephrine rt lflunr:incrfr lfiar ryirni

50 r'lrrilfnenqadug'ru

utvrfiudrnqiifinr:tildsuuJaolu tachycardia algorithm

t. rnrutilum:'ld tachycardia algorithm 6o heart rate lrnnir tso ni.vurfi

z. rdolflr persistent tachyarrythmia firio'lfirfiearnr: 1 'lu s ri:cnr: trin, rfnurfi':u
nt:ui cardioversion rrnc'lut'tufitfu supraventricular tachycardia 1Sw) aT{r:ntfi adenosine

li rornrdrfrlrifi nr:}i adenosine)

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runrunr:anlr{honriot dqn
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lravrr;lurr.ln:d1

dafitmn basic life support algorithm

1. Basic life support algorjthm riu 1il161'firar n:nrrdru6indugrulvitiu nrnusifio.r
rjrhfl'fllu ACLS cardiac arrest atgorithm dtu

z. nr:rlduuu n,,:firirn'ryfio nr:r:-l6suern A-B-c sequence riu c-n-g sequence 6,i

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7, yiururrtjtunr:vrfllqdru self inflating bag (Ambu nag) tfiiiil:cfivlEnrn loutiru

7rvirdr:rranundu dnuradu tidal volume oJnn.) vrnvr:rtonl lu*r..rtri maintain airway d'tu

head tilt unJ chin lift fi1nd.tdu C-spine injury lirir jaw trust
a. nh'ir "shoct<" tuiiiirrrufi,r defibrittation
s. lun:fifitflu witness cardiac anest lunrfifiriu vF Hia pulseless w fiorltin

ifioii'aldrYufi niu lulafigdfi EKG monitor orm:nrir defibrillation ldr{ufi lnllrifioorirnr:nn
rfironriou

t o. n:diilfio cardiac arrest truvfiti.:lrilfiidviadrrvruh lfininr:nonri'ron so nftriou
rudri{tirunruto z ni.t n:rfiiirfln cardiac arrest 1tsuvfi{r-hu'ld endotracheal tube aqi nr:ilr self
inftating bag (Ambu bag) lrida.rdlr,Vuf,n-:-rnr:nostiran lrtrirun'ro'h e-to ni{oiaurfi rfiu'irilr
iinrir o n u n6"rnxu t6n td rtnr:rir hyperventi I ation

fiad{mo AGLS cardiac arrest algorithm
rfioifieau cardiac arrestldud'r fi$rfrn"'ry60 do.flrinr:inur cardiac anest Ftl algorithm

n5o11 ri::dor}in1:iflB'r reversible causes (5H, 5T)

doddra'rpda dordru rrc lfild uavdoruunlrtld'j, exc drfiuriu do.:ldfinr:rir

defibrillation vSohj r{T algorithm dru chockable rhythm fiiod1u non-shockable rhythm

iafi.rnn AGLS cardiac arrest atgorithm (shockable rhythm)

1. d'nuruvrat rxG firflu snocrable rhythm 6o ventricular fibrillation 0i F) t5o pulseless

venilicuter tachycardia (pulseless VI) nrlflfla{ vr 'firilified'tfl0uoa'ln heari raie fla{ EKG
monitor rdo'rqrnrvrsud'rrotfi'tr.inln:o rdadald niu so niitiaurfi iilarqfitfifilir cPR n{

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rlunaefirrdrsr$!o

mtr Em€rlency r€apofi'e t€tn

Stsft CPR

tl oxlEan |r ustibr

mx$tr{ de{ibrl$ator

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Efin€pftrire rll 3-5 trdl
i{1tfin ldtanced *T/ay,

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rhyrhrn !6old

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rhyrnm rdald
Edn€phrlne ln 3-5 lrai
ia, ro.l AdEnced airEy, CPF ? q16

inr1 feY".siblc ctu!€s

I0r shock bb r$g strataUe
ftylhm fitol
lh'lnm rlabl

d'{ri! si8n t8r nosc 1rJ lo rds u
ROSC lU FGt ca.rtbc afi'6t are

(pF t Hrfl

Arnlo(hro{|e

{mn Rcveidble caus€s

u$u{,fri 21 (rf,n\r ACLS cardiac anest atgoithm

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CPR quality

. nqfifilBndnadr,rriou e dr oqrrt5radr,oriot t oo nitruri binriron6uot'r

(f ully chest recoi l) 1n nitri ounefi fron ni.idor'lLl
:unrunr:nnrnfiran aufi4n

d ) uonr:rjruvriJ Iq rnlani,- ul! (avoid excessive ventilation)

ndn rh

. n:rfllrifi advanced airway lfinnvriron go Ft*'l caYurillnl:lirufirfl'le 2 et'r 1ao,z1

. n:rflfinnr drs capnography fl1neh Petco2 tlosn'ir to lr.r.rJ:on 'lfiuururrrJilrJlt

rl:sfiyr6nrfl'lunr:vt'1 cPR LilA high quality cPR

. n:nifismr dra intra-arterial pressure (A-line) fi1nFi'l diastolic blood pressure rioun'ir zo
uu. :ar'hir,ruruu ir luJ::fin6nrvrlunr:rir cpn'hild high quality cPR

Feturn ol spontaneous circulation 1noscl ifieduldlaa

. nnhdfl e: un rrh nrrr fi'ulafi n'td
. petcoz rdlduotirori'ufiri'uln lunnir 40 x. rar)

. ni?QTltl arferial pressure waveform lu A-line

Shock energy

. tiftBiphasic wavetorm tfildnf,.,rrubiflrnurir uu:rirtortnCoo 020-2oo ?n) firlrivr:l-r

eulqg\rqF airu:-rnr:6onntod z uo:n*.rdu1 tfitdrnrtru}iflrturotvirnittl:n arotd

lr dr,:ru}'1fl rrr nn'ir nt"r u:nld flrur'r rfl u

. Monophasic waveform 1frvroitlru}'|flr soo 3n

Drug therapy

. 1Epinephrine lV/lO n. 1n S-S urfi
. vasopres.sin lvllo 40 Hfi cur':nldumunr:1fi epinephrine c{tii r laiani-tfi z1d
. Amiodarone tv/to o{uutn soo n. si'id 2 150 tJn.

Advancad airrvay

. lild supraglottic advanced airway nia endotracheal intubation

. f uuiuol"rtturi,rrioriruvrulclnunrr'ld waveform fl a{ capnography
. riruvralc e- t o nir oiaurfi 1o alrifi'a': drriu:i'rfi nr:nsM{ra n

Reversible causes

. 5H : hypovolemia, hypoxia. hydrogen ion (acidosis). hypo-/hyperkalemia, hypothermia
. 5T: tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary),

thrombosis (coronary)

Practical CPR algoritlrn Z}tO @niufli ttfifrnJa tt

Adult Cardiac Arest H.CPPf,tdOr hua.r&d (:2 i,ach.s [5 ..n] rnd {:t00r*r) dtd dow corFeto
ctBst lecod
Shout for Hetp/Actilale EIrergienc-y Response . db
Fafurn ol Spaitanaou! . Mhhize InloFuptlms In com.rssidrs
. A\old sce6slv€ veotlaton
C 2010 Ar.dc.n tlsan A*ldrbo.t . Rolde cdrpressg every 2 mtrub6
. It no advanc€d aiway, 302 cdrptes€lrltvs{latidl
OlenliMv. ifav8lo.In c.Fognphy
- It PEr€or <10 rlln tb, qrdy
. |nta-rt€rd FEr€ afiernpt io imFe,s CpA

- ll rdaralbn pn.Ea (diastolk, prss$rs A0 lrm Hg, dBnpl !o
hprorE CPR qrrSty

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rnonndjE

.Sl8odi$(6Edlesf[yraflrhEliB eaommorxtatfi (120-200 4i tf |,1k1o$/n
u6€ mi{m|rF avallBbk, S{oond and $rbsso{*t dosEs siould b6
oqLivel*t, *d tigh€r doss
I nEy be co$ldeEd
Monoplr.llc 3€0 J

..OnEVA8poLTpEhtocprlfa|ifnlyn lYrO Do!.i 1 mg svBy3,s mhd6 or seord ditss
lVtO trotar ,{0 units am tophcs i|sl

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. l,|n&qp /|O Doc RS dose ot$ rq bd'6 S€.$d dc€e igO n€,

a.

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.
S$n€loltc advsr$€d !y 6 ondotr&heql anfuboton
lva!.6ldm cpmlradly to connftn {lid fionlE Fr ta€ daceand|t
nflir rorti|{totls dted comqEsddrs
8-10 brrdfB p€r marulo

narr|t&L Ci|!€ - fG(I*n F|aim$od
- rlpovd.rda - tamparwb. cer{lac
- lorirE
- ri,poxb - rno.nbod3, FlkrErwy
- rqdm$n lon (acldosb) - lhrombods, rcdtsy
- Hypc/tytErol€mia
- Xypolh€ftda

uau4fri ZS t!f,4\r ACLS cardiac atest circular argorithm

nr:r,rfi 2.+ rroflfnr:ins1 hyperkalemia

1. Stabilize myocardial cell membrane

| 10% calcium gluconate 15-30 A. UrU 2-5 Urfr tia tOyo calcium chtoride S_10 ufl. u.tl.l

zsurfr

2. Shift potassium into cells

. Sodium bicartf,onate S0 mEq yt.t,Jraan tfians'r uru S l.lrfr

. Glucose ZS ni:ldtlril regutar insulin tO gril lrlrooorr6ooriruru tS urfr
. Nebulized albuterol 10-20 ln. ril uru iS urfi

3. Promote Dotassium excretion

. Diuresis: furosemide 40,80 &n. lrolnootGoorir
. Kayexelate 1S-SO nilldunil sorlcitot yl,t.J 1flflioyttwr2,]:ytin
. Dialvsis

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rrnn'ir too n3.rnnfi

2. "Shock" rrrso'.t defibrillation fit{rir cPR fio.]n?xcfiolgtniat defibrillator lu
T:trur:Ltatotmu'jr rflurn{ar monophasic tio biphasic nl5'l'l.l paddle d,rc:fi z gl"lttvxi':60

tfi1.rd intercostat space fi S (fi1 x't,t:Jl.I nipple) dru paddle firfiuuir lsternunil rtu
l"r0il"6*rlrunru,jr'fiir't{lun::an stemum ttntrirro'tusl'r11fi 0 right parasternal area otjlfi 11'l

ronfi oaddte doufon ril 1-2-3 Tqptiu t tfira'tnulat riu Z trilot ufioudril{ru ri! S'tfitro.l

nura\tllg:lfraui1rl,rru6nnf,,rdau6on nalrirnr:6on tfirinr: chatge rrrn'.rmu:a]i'ld'lu:aurYo

}l rirnr:6o EKG monitor (Y1ndoufifildff/il CPR rirnr: analyze rhythm d1u paddle lead)

3, vn-.:rirnr: shock lrfix tfivri cpn dol:.triufi1nuri$'hifio,l analvze rhythm n:rfifi

'hi fi o'rrir cPR d o nru ll fl'.r nr:d a n 6 a {il r u fi uduiri'r 6

l. rirnr:tfln intravenous line (tU lnltiiorflu peripheral line l!ururtJt6oncl"rttu
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nnool6aoo"rd upper extremities l41n'hifidoliril lild1rflufio't rilo rflu central venous line

s. rdarir cPR at! z urfiudr 'lririrnr: analyze rhythm fi']nu".:lfl! VF uio pulseless W
o{'lfilir oefiorittation nrrdrunr:'lfim epinephrine 1 rn. cnrdrs NSS 1o-20 rlo. h{anrr.lJug',r

rdolfi uT r'ilr{ ceniral circulalion (vrnhjfi dofiu)

o. fiflqnrdalrf irriiadr Cpn n:r.r z urfittdr do,:nil't carotid putse r5o'lri urntflu vF

wlrifio-rnn'r carotid pulse tda.:trn'tu vr qvlrifi carotid pulse odtrfir vrntflu dotdrnr:

rutnrio'[rJ.jrrflu Wfrno'r putsel6rSo W dnrir putsel 16 rda.:q'rnnr:intrsir.rniu'lou pulseless

w 'lfui'rnt:inurnl ACLS cardiac arrest algorithm trnlflu w finrir putse '!{ ifirirnr:

fnutorTJ tachycardia algorithm

z. fisr:rurnr:16i advance airway {i,torltflu laryngeal mask (LMA) rionr:'ld

endoiracheal tube drdrulrnqjfltrunr:ld endotracheal tuoe'hinr:tfiutrnrfiunr:ld endotracheal

tube rnu to iurfi ilTnu"{'ldlrild tfirirnr: maintain airway lfifi#vfrnBnrw Li'i'rrfludawir

cricoid maneuver turruviilti endotracheal tube (16luuvrirtidrrfio,lmnflo.rriu aspiration)

J .l LgU'ln ltfl ;fl 11.14L]1r!'fl o'l! ttJ' 0n'alD-

tuO\telnT'l

8, nru o-''1nr:td endotracheal tube ttdr 'h{drnrrfrua-ual"rrrnri,:to.':viotirutlrutc d.t

orc1iil6'Tnu

. fl..:rfiuralfir{rviariruvrulq Toufl,: 5 gfrtrfi ,r rf r rrvr.i,rfi 1 6o epigastric area lou

fi10{lnlrtr ldaifqou.jrriu esophageat intubation iliolri 6iorelfi8ut6ut rdotornlfiu'rord
rjru oor:dsejrurrf.r diaphragm un:1fi8ut61u.:mrrlnr:il Ambu uag ld tfiaoud quality flan
rfiure cl rufiouflutfisl push nlfiairu rue tuue n'rturri,rii 2 rav 3 6a upper chest r't 2 {rc

Pracrical CPR algorithm 2010 rBniunf nfrfiftfl 57

Tnufilori.rulrutunr:ril,:rvr'aEuuiu'jrvio:irurruioag'tu trachea viohj d.rurn'r uyli,ri 4 uny s 6a
lower chest e {rr Tnlfiooej,lrrilrurdoifiedfl.jrrflu one tung intubaticn rialri

. lunrrfifirir161fi0utr"ual'r ulvr]rvioriruvralelnflnrrtd capnography rfiarornnrrfl.r

rfiEr.ra1efifio!.r'aflarnldfi.:rfioviorirunruho{1u tracnea fiqyntJr:ner:rco-!frrrnrfrauloaon'lrrild

fi':o:iirudraanrr lilu end tidar cq d,r rflunr:irnzurir4rcrrSlouleroanlrdfia vrflleoonnau

qo lunrfidviotirunrfllead'luynonaryrt oro rrn4 end tidat co, turir,r 3-5 waves urn fir:
e:riou1 rd'uo,: ua:yrsl:J rda,:crnnrutu rr ro'uornr,:rioilrifi ventitation nrfifirrjrg,rrutofl-.r

lrifi capnograptrv l'fi fflilfio-rinnrftra rdo,rcrnorrJr:n6ufl-uer'r uvil.,ryiolirunrfllelfiInunr:fi,t

o riufir

Begin Inhalation

I

-gr

E
E

Begin Exhalation

ttli z.s uant capnograph dtfiunninnyrianlgludainlalcaon eit end tidat co, tfrunliindl

co. TuiNmttna'looanqa

g. ,fiarirdlunr:ld capnography n.t Acc/AHA 2010 60
t ) fiuuiuniunri.:vioriru ru'lc

2) il?! rfiuil:sfiilBnrvtlunr:ri'r cpn rda1fi16 high cpF quatity
S1 rirrlunr:ifioo"a return of spontaneous circulation (ROSC)

4) 6nnl ventilation'lu post cardiac arrest care

t o. nr unn"tifl d endotracheal tube ldudx nr:dr uyrutohi fi ardufiuf,rirlnr:nnyriron 1o n

rirufllflte s-to ni,reiourfi rfiu,rlyird :r{onundu lruci! Ambu bao 'tfirirnr:f.:rnqdru.ir

vr:r.ronr nduni o'hj nfi n rd u,rnr :rir hypervent j lation

t t. n:rfidhiotn:nriiotynoor6aerrirld'lu nccrnHl guidetine uuydltlirflo iniraosseous
line usinr:rio intraosseous ttne riulriorlr:nrirli4nd 'luvrrr!4^l-n'd..*u;fljrorrr:nlfiur
rr':rfin rdrrr.uiotiruvrrL'to (endotracheat tuoe; rfrahjorrur:nlfirr{finoerrdaoal'rld' !{uri

58 rxudlfninqnduslu

epinephrine (adrenaline). atropine, lidocaine (Xylocard) LLoY naloxone lfifiurnur 2-2.5 ti1
raururo:lnfid'ldr nooldoari.t louclgil'lu normal saline (ttss) rnio sterile water 5-10 a-

rftdrdalfiurrirq! aNeolar-capillary membrane n'::i:L Ambu bag'ifi inspired time urrn'jr:Jn6

fi 1ru 1.5-2 iurfi TouiutJ::u1 5-10 ni.: (u errop"un guideline lrirru:rjrlfiuurwio

rir unr s'h)

tz. rdolir CPR n?lJ z urfiufir'htrirnr: analyze rhythm 1nu*{tflu vF rio pulseless
w o{ lfirir detibrittation nr drunr:tfiur amiodarone 300 rn. nttd,lu NSS 10-20 iln. triEJn

[ttuq.,: rdotfiu'rr{r{ central circulation (vrn'lrifidofirl)

13. d'tniuu't amiodarone riu nrntflunln:ino{ Torsade oe point {i',ruurufi{ polymorphic

w iifi orc prolong do.r'ifi Msso. 1-2 niil liir wirrir 50% MgSo, 2-4 tJ0) tnrd?u NSS
nlt o-zo rn. lriarrrintfi amiodarone gll
algorithm ld lun:rfiso.: monomorphic ventricular

tachycardia drulvsttd amiodarone16 t{utloi'lu monomorphic ventricular tachycardia fifi QTc

prolong (111n ?'llJdgutfio cardiac arrest) n? fi MgSO4

t+. nfi'lu ACLS cardiac arest algorithm c:'lfifnur reversible causes (5H, s1 rfra}i

amiodarone vrr.rrjfrl-fiour:otrlnrrinur reversible ""u""" ldnt{usirirrr:n lrio'rrflufiol:a

ts. nrard.rnr:'1fi amiodarone ttlfltt".Jnltiu vF uia pulseless w dalil'hirirnr: snocr
uo:fior;rurlfi epinephrine drtiln.':tflu vr tio pulseless VT oial:J ttininr: st'oct ttovfior:rudfi

amiodarone riol

fig#lrnn ACLS cardiac arrest algorithm (not shockable rhythm)
1. EKe driu not shockable rhythm 6o asystole trflt pea (o"udeiottfir PEA lilltjni

ciruso.r EKG rfi u.rurirfl udruonrl:;rnn Mtiu)

2. Asystote ur.nsfic EKG drflurdu:rrl riaunr:trinr:ifildu asystole n.l:dl asystole
protocot rdoifioda[unr1nn11i tead yqo dwir]dlounr:fin EKG monitor 'lngius"udrii lead

adrlfiaa 2 leads unvrfir amplitude EKG ifiq':dqe

3. PEA (pulseless electrical activity) fi 1ufl\tum;dfi exC uoibjour':nnril putse lfi

d'rrfu exe 6tororfluoil:fltfi rdu normal sinus rhythm. sinus bradycardia, sinus lachycardia.

AV block, supraveniricular tachycardia, atrial fibrillation, atrial flutter rpi6ooll'1rj ventricular

tachycardia, ventrlcular fibrillation, asystole udoolrnfinr:intrTqutoltr:o$rrfir n-lriunrnrfu

tachycardia dnnir carotid puse trild i.rrflu pen ii.r'lriorlr:n1finr:fnrrrnr tachycardia
alogorithm'[d ('lilgrmrnlfi adenosine viorh cardioversion 1d1 lutruvrdurriunrn exc rfu

bradycardia frndr carotid putse.hi1d i'rlflu pee filrjor r:ninntntl bradycardia algorithm

16 tlilour:nlfi atropine viorir transcutaneous pacing ld)

Pradical CPR algorithm 2010 Laniukl ]frfrtxg 59

+, rdahin'r:ifiqii'u asystote'io pEAld'rd? trtrrirvrtr cpn r{ufi z urfi qrildrunr:'lfi
epinephrine 1 rn. mrldru NSS 10-20 n. unullug\rn1ufiolhfinrnlilfidorirr

s. fiqr:nrrtd advance airway niufi ldo,:crn asystotdpEA finr:ylurn:njl:n{i'tri6 6utiu
n"ruuri{viodrufirfllqlnunrrfl,i durYr capnography (fi1fi1nfi) tirafirflleloulilfiordufiufnir
nr:nnrdron

o. doulnnrir,lfreira'qeln Acc/AHA zoos 6a iunrrin'riJ' pen rate iaun.ir oo niloia
urS lrjfi dl,fu o.: atropine 6nrd aIil n.r:inur 6onr:'lfi eoineoh rine

z. rdani cpR R:1l z urfirrdr'lfininr: analyze rhythm ylnri{rflu asystole/pEA lfi
rinr: CpR oia}.t *fitu ACLS cardiac arrest l: uu:rir'1fifl1:fnu1 reversibte causes (5H.5T)

tudrrdfiqr.'l nruJfr:jficrr.n:n'lfinr:inur reversibte causes ldsrs,!t,drilu:n lri.l'tfludol:o

fiof,trnn ACLS cardiac arrest algorithm (tnterchange pathway)
'1. urntru;dr Cpn tfu eXC rdr.r lfiu Vf uio pulseless W nrafin',,rnr.i shock tia EKG

ndrrfu asystote fi?a pEA lfiri cpR da}Jn5aln"ltfi epinephrine rR:lnfliruE

2. mnrruvrir CpR flr EKG rfilrflu asystole uio pEA nruln-,:nr:1fi epinephrine EKG

naiUrliu vF uio putsetess Vf grm:nrirn.ninurld z i66o
t1 'bilirnr: shock udlnudran.nlfi epinephrine urnrirn,rrflu VF rtio pulsele*s VI

dn 'lfili, nr: shock rrn:'hi amiodarone lia

z1 lfininr: shock [d?n.]xd.tsnr'1fi amiodarone firnu-ln.,1riu VF uia oubetes.s
w- 6n lfidrnr: shock uai1fi epinephrine

frofrmor CPR quality

t. rnrur{'lunr:rir cpR 1fild cpR quatity n1rl AOLS cardiac anesl atgorithm'ldrn d

fla{ CPR quality 5 :J:vnr:ii'rJfln41u BLS atgorilhm d?xdu

. . n:dfinnlrJdru capnography mneil petco, riounir 1o r.:J:an 'lfiylururrJ

r.Jil:J1':rJr:frvrinrr'lunr:rir cpR

. n:gf,fioqr firu intra-arterial pressure (Aline) filn{d1 diastolic blood pressure
!fi o s nir 2o .:Jror trivrur lrrrJ iu:J1,lr.J:v fi rinrr'lunr:rir cpR

z. nrrfi n0rila'ru capnography orM:nidfi ost,tttrhvfiu6nrtllunwh Cpn lirdomrn
vrnfinrrni cpn odr':fi:Jrcfir6nrvr q:finr:ofr{nriusulnoonbri'c1n merabotism d,:rfluna

}|'rqrnnr:dfi cardiac output qrnn1.:1ir cpn d{rflunr:6crnrr|,irr6iaol.ifl oqrfiEJrv!ofl?ahj y'rn

Fi'r end tidat Co. rioun'Jr i0 rJx.:itflvl uopro,jr:J:vfirintriunr:rir cpR iit1il6 lfiryr'rr

tl::fiuintrnr:ni CPF quality s :.J:lnt:o",:d:J:tn41uru.ru4fi basic tife support algorithm

60 r?$drfioinqflClr51u

3. nrfifioq't dxu arterial line fn-rine) tufrfhi-ldnr.rrunmild{fld arterial line rr rd'l

CPR rlrifiulufi,:nrrf,dfi arteriat line orittdr fl1nri1 diastolic blood pressure fisun'ir zo 11. :ov

5'lfir'rurlu:Jir-rr.l1,,r'::fivr6nrutunr:lir cPR quality 5!n1l

frof,imn return of spontaneous circulation (ROSC)

t. rfio{qrnnrrif,edu Fosc lounr:nah carotid pulse finl nnletndouqt lu nccl

AHA 2010 i'ruiir lnrudiunr:ifi?du Rosc 6n z:hvnr:64

r Petcoz uiilduodr,tviufin'uta lrrnn'ir 40 ,1. rofl)
. 0ll?Qvl'u arterial pressure waveform lu arterial line

z- nr:d P"tco, rfiuduadr.rri'ufiri'u'lntiu tflunrnlrcrnnr:trir cardiac output odrmrot5r
lorurflu cardiac output 'fla,,l{Llxuto.t{itotmnn'jr cardiac output fi'ldcrnnr:dl cpn lourtrlil
lddrrrnnir +o rr.r.fiovt

3. srftqtlu arteriat pressure waveform'lu arterial line rflotcrntdodr Cpn culd Rosc

rjolfifilror fi.tour:ntfiu arterial pressure waveform lfi

fiofr.rrnn reversible causes
n'rurrnno'rr:vv'jr.rnrrnqiiinurld (reversible causesl 'lu Acc/AHA 2005 trat 2010

6olu Acc/AHA 2010 ldn-ora1d1tfiq hypoglycemia tln: multiple trauma oonlj rir"lfirvfiorfiflt
stt. st qrnlfir 6H, 6t

nr ruqfior'n hypoglycemia uflv multiple traumas aonl ti,ilrirfludl:ru urit'o ttsituflr.l

rji:r"m^rituu:rirlfin5l{ capillary blood glucose (POCT glucose) luvtfiel cardiac anest Lfia.:lln
rfl uor rnqdinurldunvnuldriou

fia#{nnso.rarrffq sH, sr duuldrioa

1. Hypovolemia orrltqorerfio'ldtrnnr:tfiutfion rfiurir fi.lrdorfiq cardiac arrest 1;

do,r'hiar:riradr'r:rnt5r 1lr.rn*.rr'r rfludo'trirnr: push lv fluid vio blood component) li,tioxt

rYrtrinr:innr cardiac arrest dTu lufl:Jru cardiac arrest riu bi'r'r rfludo.:trlar:rirarj'r,: l5t1n

:ru lxua{fiuircrtrrq.io.r cardiac anest tfinaln hypovolemia lialri

2. Hypo{a 6l'l!fiqiinildrjoa rintfiootn secretion obstruction. severe lung parenchymal
disease. foreign body obstruction {i.rtfluo'r tlqaot cardiac arrest fifinr:ntlrn:nilrn6vrn

unrrl[nrtl n9TullYlIl{Yct

Pructical CPR algorirhm 2070 Lonfuni nfrfrwg 67

tun:rfifi {:Jrutd endotracheat tube o{ ar,:virnr: :;rfi ufi ruroro'j1fl.r!fl qna\: cardiac

anest rfiga1n endotracheal tuoe y6o1ri lerurirnrr:J:; lfiul'r"',od

1) f': tnfi n"lllfi 'l endotracheal tune riol'iro{tusl'r Ltyi.i,tfi lyrrcnrJyiolrj ofrunrjrvio

rirurnrflloturflflsrunr:o{d 22-24 at). unviu{nrfunrtaqjd zo-zz zu.fr upper incisor (drurrj.r
r0'r endotracheat tube olEnfl1rt rFdoulJmnd nrn{rJrufidrug.:dlrilfilrn:3ru1 filnaqdu alq
c: tflun:niyiadrElfirtlorird,ro:rqn vSorqnlJufir urno{finorolflu one tung intubation d.:ru-n

ldrlr': right bronchus
z1 r.rrnvlorirur'rruhe{iuoirur'njrdurlr:oludr 'lfirirnr:i:t sett inftating bag (Ambu

uagl'Ifi d.,r rn crjrvr:r.:o nr ti:tyi olri

3) fi,lnr:?{anl ruiurou llsirio*Jfio\fluiu0t'lr.t Ambu bag dfiu riu esophageat intubation
darrirnT :rorriadruyru't?d' 16!oonun:leiviorirurru'letuil tun,:riftriar:tdl6flt breath sound
tdorernarlfitafiounrolo uroflrv'lu{rJrudnrrleldrat (urnlrifti cardiac arrest) uri.jrrflu

esophageal intubation ficvtftf,,,r breath souno ldOua{ rdamrnrflurdurnrutffia,,rdrhflrdo.'lcrn

{ilruuruloldro.,r

+l nrnr:'r.ronlrhtil rnu 'lfinoldorir6nnir udrsrrildrunr:fi:l Ambu oag urnfiulrir{r
rnr riafluurnurn finrr:t 1:adnr:6ofir d'od

. Endotracheal tube obstruction
. Bilateral pleural lesion niu bilateral pneumothorax. bilateral hemothorax
o Severe lung parenchymal disease
. Refractorybronchospasm

lun:nidn, r:dda.,,:uunoonl:Jfiou6o endotracheal tube obstruction ii,,rgur:nificdu
ldlorunl:'l6inru endotracheat suction 1nldud?fin uiol*ldlrlqa 'hic.rdalSriau'jtiu enao-
tracheal tube obstruction firorlrfioorn{:JrufifirclrnrrJiurnrurn r3afiolu massive hemoptysis
ouvri}ifiou16ooqnviotirurru'h lfirirnr:oanvioritunru'loaonudrldyiadrsflru'hlmrj

5) nrdfifi! Ambu bag udrvr:roonrriudr rr,rldlur6u? finrr:dnr:6ofi.r60

. One lung intubation
. Left pleural lesion ltl] left pneumothorax. left hemothorax
. Left lung atelectasis

nmrdda,:runoonl:.Jrio16o one lung intubation d,,rdrrnsilfiodr.r:rolSrlqunr: orcir*y r
to-ryiatjruyruic rfiuln"l upper incisor trnfinlfininr:lrfllur,r'lfrlortn1: deftate endotracheal

cuff dou ttdrtdou endotracheal tube rfu euorur:nfi,1 breath sound dsi't* r,i.i lower chest ld
rvirniun",: 2 drt lrior:noor endotracheat tuoe udtldlyri rdo,:clnrfiurrarlnuhirrn

62 rernirtiainqndunrl

fi1nd1llfi ,,tyiotixufi1uhtfi 'r:fitJudr drutrr$finrflu left pleural lesion 6,lfindo':
rirnr:'tei intercostal drainage n:rf, left pneumothorax LLfls left hemothorax 'lfittuncrnfiulnu
nr:dr chest percussion Tsud t"ft pneumothorax l:rnr;'ld1rli.: siru left pneumothorax 1:
rnr:ldrflurfiu drunrrfldrflu teft tung atelectasis o1allune1fl left hemothorax urn orrdaltfr

nr:nn'ruuri.r trachea trnJnl?f,\t breath sound li1u

oy nrrfi fi fu Am bu bag ufi r r:r,'ranau"r drudr u tfi urdrutdur fi nrt:fr nrrn^ofi ,'r6a

. Right pleural lesion ttiu right pneumothorax, right hemothorax
. Right lung atelectasis

iun:rfidFofi': one lung intubation drdtlandrudruria0 tdooqrnTanrarfioldurn
dlunr:uun right pneumothorax. right hemothorax, right lung atelectasis rflubld'oriraimu

irrdu

3. Metabolic acidosis otrt:ndtnr:vror lvqldfaunr:uuntflu wide vio normal anion
gap il:;rduddrfr'tu6e lriar':lfi sodium bicarbonate rflurJ:;dr (routine) lufl,r-htl cardiac arrest

.4n:ru frtdao.r sodium bicarbonate lu cardiac arrest 6o
Hyperkalemia
o Previous metabolic acioosis neirrdajd't serum bicarbonate nia plt daurfio
cardiac arrest
o Tricyclic antidepressant overdose

4. Hyperkalemia artrqfilrrriauto,l hyperkalemia ttiu

. Acute kidney injury iifi:Jrcififloor?rosnfiagfita chronic kidney disease filri

'ldri1 hemodialysis

. tdIntravascular hemolysis DlC (9'ln infectious cause uflJ non infectious cause),

c-6-PD deficiency anemia with intravascular hemolysis

. Rhabdomyolysis a1ltn'o11n crush iniury, inlection u'r\ttll;rnt, nr:lfiiuarlrr

tl:;tRvt, acute arterial occrusron

. nr:ldfi potassium supplement rnrfiu}.1

ntsuldalrluftanruai'iubtfn#flnat hype*atemia N*r&ufraudlrnn tatt peak T
wave rymnfr fmtenf;tttuhnuzrtfin caaac anest frattu?uNrflun:nicc.fiilfu! au

peak I wave ttiz

tfiaailflntzc hyperkatemia udz'lfihnzina'tfifiTaubifraoroe anttnrtcannfro,t

fi ae..

tlpu h n N 8\, t1 n I Ani O AU n A 1U1U

Practical CPR algorirlrm 2Ot0 nniuni nfifrntg 63

flTi"nD1 hyperkatemia rfiarfisnr:ltjduuu oura.t e xc ud.: do,,r'tfi t o% catcium

gluconate nrtJ ACC/AHA guideline 2010 til.l,toul?on 10% calcium gluconate 6a tS-30 lo.

lritti ro un. odr,rfidurnariu orir,:l:fisrrlnr:1fi 10% catcium gtuconate to rn. fi'hifiairrflu

dofiornro odr.l'1:finrrttlrtnrr:fiarfludanrr::it'lunr:tri carcium gruconate Inurovrr:'lu digitaris

intoxication rfla.loTnnrrtrt catcium gtuconate otrirlfi Cigitatis ,i'lril tta-x-ATpase pump 1n

r*u d,r oigit"ti, lirfifirfirTuuetnr:d.r{.r1.rro\r pump d d,:nrnlfi hyperkatemia :uu:rr*urijo'lfr t o"z"

calcium gluconate

5. Hypothermia uildrloulu4rJruufr 1n"u, drowning), fi:Jrt sepsis fifiorurnfinru
o"r, {ilruii'ldiurrrwfio. fiilrudo{iuornrslfiutrn, 'luI:n uMnfl1 1lnflr1dluriarfl,:-Jrun'rfla

rn5o.r:liuornrfirEua"o lunrnifida^ld1 defibrilation h{rtruruir fia,rdrnr:rfad'r"hlufi''rriourir

defibrittation rdo,lcrnfllnti'rEiorflunfroro rfindun:rucrnn:; uo'tt{flrfiiodrurirld R.tx: hypo-
thermia fior:drnr:ufi'[? riio,rqrnrflunrrsdlrinolnua.:donr:dr defibri ation ufirflu Vr n6o

pulseless W nr:ufi'b hypothermia aurrnriid Z i66a

e Passive rewarming lfirirnr:noo rdofirfr rflunoon rnrflufi:-l.rueilfl virfir tdrnia.r

warmer

. Active rewarming orodr'ldloanrr irrigate NG, iffigate bladder, warm tv fluid.

hemofittration riru:run:rdunriu finuloourrnilnnrlficrnronor:firuurur.td

6. Tension pneumothorar omn'ofic'tu{rhu chest trauma, copo iifiornr:nol nrdou.
{il':ufrtdrnialrhuflrulcTnura r:nr:l$ eere rurog.r rda,:ernfiTanrardwoianr:rfin barotrauma.

nrur,rn".{nT'l6i central venous catheter drumj.,t internal jugular vein 1450 subclavian vein, n1U

ndtnr:vri thoracentesis nr:rrfi'hfio':vrhnr:1d tCo yio needle thoracenlesis udrun'i61yuos

rirlfi :r or r5r n'j'rriu un'tufi qo ri'a.,rtd tc D rfl uo

ludruto,r tension pneumothorax '1fi60fi.1 hemothorax drurc:la iirnr:6nfi-rlu{r-hu
chest trauma, trucyiafin"*trir CpR rrdrfi rib fracture, nrurri',rnr:'ld central venous catheter
nirutrj.r internat jugutar vein y5o subclavian vein nrlrfillfio,rnhnr:ld tco rnro'lrjour:ndr

pleural tapping 16

7. Cardiac tamponade nr:a':dutufiilru blunt chest trauma firn"r rry ,:1or trauma rtr
-trfr,
pericardiat effusion oqjriau'hld't pericardiocentesis ntufidll cpR yiovri
{r-l,ufifir.n:r?

open cardiac massage firoir tiJu

8. Toxin fidrd"rgld[fi organophosphate poisoning dofio,rid antioote 6o atropine un:

tricyclic antidepressant overdose d,,:do,rld antiOote 6a 7.5% sodium bicarbonate dtunr:Ifi
iuor:fi 16u1 lrifr nr*r:rsay16uolrnronor:drdurio.:

64 rlerdlfninqfidrrg1u

l9. coronary thrombosis lftirnr: cpR enr guideline rfrold nosc rrfir lfirir{

rjrutjr{r pCt (perculaneous coronary intervention) tollo nl:}i fibrinolysis nrlun',,:nr:tfin

cardiac arrest fi o rfl u{afitrlunrr;d
10. Pulmonary embolism nr:6etfl'rtu{rhtrd tflu deep vein thrombosis niofi:l:;ift

rdurrda hypercoagulable state tfi hn1r cPR'l nltJ nfi nr:lnturn:nil:nfinlri6

Adult b ra{tlrtanlh (tyith pulse)

Ur:lQrfnlrr! INnifl nlnsrrr

tlr?rl*rnaarnrr m€! m < o a*':/rnfl

. rte Ainray d?unrrwuln tereathtng) dlrthrfiu

. HosnArB {hn Hypoemia

. i,bnnor EKG, F, pube sdm€try
. rtn rv
. EKG t2 leads

rra:rtu nfirlftn . Hypotenshn
Atropine atjlr o.5 rn.ldl4n + . signs d shck
5 tlltl sma$rqi 3 xn, . che$ Fin
. Alteratlfri of conciousness
oopamlne rtnn 2-lo Ugkgfn in . Heart failure

Eplnephrine ?u1e 2-1o ggfmin ihbf AFodne $*{*r auauo.'r f,er:*nlfrnr
fnvro ritlnfu s rj::rfliiohJd
. tEns€u taneqJs pacing
. mp€mlne
. €pineph rlne

. qnrlqlrtu?tnr!

s.tuaugfiii ufrnn bradycardia algoithm

Practical CPR algorithm 2010 ranSrfli IfifrraS 65

dofr.rmn bradycardia algorithm

'1. fi'lflY'lu bradycardia do.rrirnr':ndr carotid pulse riaufl'rnnftr carotid putselrild fi0.,r

'lfinrrinur uur PEA lrifl1il1ro1li atropine liorir lranscutaneous pacing Id

2. rnrulflunr:r{r bradycardia algorithm 6a heart rate (HR) riaunir s0 nil,rurfi rf.rd

.lrj'ldn-nufltrTlrnrud'lunr:ifirdu
bradycardia difiod'urds HR fiaun.jr oo ni,:turfi o-rriuyrn

HR odtutirr so-oo ni.:/urfi fiarflu bradycardia finlrido.,rlfinr:inbln.trr bradycardia atgorithm

nI ACC/AHA guideline 2010 d

3. Bradycardia fifiarnr:fnutntl ACC/AHA zOtO riun'jr persistent bradyanyrthmia fi
rirtfirfioarnr: ii{fiortrn runiuldtrfi'r.r symptomatic bradycardia Ft'r ACC/AHA 20os d.lrrn
fi ornr:intufi s !r:n1?siolildi,fi rirnrrr-nrr

' HyPotension
e Signs of shock
. Chest pain
. Alteration of consciousness
. Heart {ailure

q. fier:rurlfi atropine 'lulu persistent bradyarrythmia drir}irnqarnr: lqu nccz
AHA 2010 tfi o.s ln. udlurJ:: rflnlnfl ldo.roln atropine 1 viat fi o.o ln. tuvnlil4-ri6{.:1i

atropine nirtn: 0.6 un.lquurlyaanofif,riu antimuscarinic etrecr d.larm:nlfildrfu oraovcaroia

rlnrJ:vrnvrlorubifia.rn'rfi.,r'jtflu high grade AV btock nlolil ijt rfludoii unndrmrn Acc/AHA
2005 tufl'r'riliu$nr:1fi atropine'lu trrtoUitr type lt ua! 3" degree AV btock arelrinououo.,t
tfjo'rernrilu infranodat otocr lurru:fr avopine oonqrf,n:;{u nv nooe lrinr:lfirurn airopine

rioern'jrduuyrjr'l{ tfiotcrnororfi o paradoxicat bradycardia 1d

s. ilrntfi atropine ufirhjno!fli.lo.J 6a HR bjrfrrJduun;01n'lrd rnnc'ln bradycardia 1ri

falfllU "Lrrf"i .i , +q 3 U. ::n'lltl0,tl,:lAJUa t'in0llJc Un'l:lnu'lll tylUlJ tyllnU
1n1T:nB'l0U'l\t111.h10U'l{ lflLU

. Transcutaneous pacing

. Dopamine

. EPinePhrine

o. r6ilu Acc/AHA zoos nr:rir transcutaneous pacing 11ifi0 rflunr:inu'rdrn"rfiu'tu
Mobitz type ll ud; 3rd degree AV block un'tu ACC/AHA 2010 nr:rir transcutaneous pacing

aT rr:nrirlfflu exc lnrh:rnrdri, tfi rnn bradycardia lofllildo{drfirir rflu Mobitz rype u 5a

3rd degree AV block fitalri

z. lunrrrir transcutaneous pacing riu 'hivrinr:nJduu port Tnutd port fitdralrr:
efrviunr:rir transcutaneous pacing rioufilrir transcutaneous pacing hiGrJurdlthli{:hu

60 rltU',luolnqnnEuslu

vn-rviaur::Sl roriou drarelfiurdo'lild

. Diazepam 5-10 n. lV

o Midazolam 2-5 tJn. lV

r Fentanyl 25-100 lilInrniil lV

darirurir transcutaneous pacing'tfitdrd tx mooe lrrnfirJruier"r ottr:orfionlflu demand
moOe lfi1 #r output :-l::*rrru 200 mA ns': pacer rate lTrrJ'rru 60 af{A1fi (aTms.irirn'jrd

nrnfidorjrd rtiu lu{r-hufifi oTc prolong) rfiorirnr:fiar transcutaneous pacing nruo"r*nrjtufir
'hlno pacer srart'lfidrrnn EKG 'jre:da.rfin"nrru:ra.: spike druonvjr ventricte nnn::{u Inufi

EKG r:lflu wide QRS comptex uo; axis n:tdufiitotrfirrfio.,torn ventricle Qnnrv{u xn'{fln
rfi ri 'ru"u'lririlnr:nq output fl,iqun:rri'\r1rifi capture nn',,:ernriu}irlir output
20-25Vo

rd o riun :; rr o1r,lfl rqr n raia.r n n n.r

7!i e,z uan,t pacemeaker nytnm "lfi#,srnaitfr spike rilwluntr anr QFs complex ni'rcn)tJnfr

a. nr:bi do pam i ne riiadaon'r:'hhu'r nur tfl u u g/kglmin orur:nn'rurruldfl n gn:

ud/min : 6 x BW (kg) x dose (ug/kg/min)

100 x conc.

lunr:lfiur epinephrine ldofiotnr:'hfuurorrrrflu uglmin crur:on"rurruldorn4n:

ud/min = 6 x dose (ug /min)

100 x conc.

g. u:('jrlu bradycardia algorithm oclsild:cu'jrfio.rtlinr:inur reversibte causes upi
lumrojfirififidoltfin1iiflr1 reversibte causes Inflvtdlllnn 5H. 5T unv increased intracranial

Practical CPll algorithm 2010 @niufii nfrfil1J{ 67

pressure 6e rflulrul1.r.rfla\r Acc/AHA 200s frilildiou6o hypoxia, acute coronary syndrome,
hyperkatemia. metabotic acioosis 6,mrnhjldfrLnr:rrfilr nr?inu1 bradycarOia cy'lrj'ldaa

Adult tachycardra (wr'th Flse)

rJs: rlltn grurn,:nilnleu:rn
Tactryarryhmia lirirLilfinarnrr s:sfl HR rrrnn ir tso n{o^nfi

tJr:t[rua{nu}snfi u3nlfi n

. rOn Airway d?Bmsrrulo (Breathrng) tirrhrdu

rlrtroan€rrr 6rfi Hypo,(emia

. Monitsr EK6, BP. pulse oximety

Persislent bchyanythmra yhfi,lrfinarr nrr r synchronized cadioversion
..la
lr.r s lr:nr:dsirlilulalri ffl5nnbi sedatkm riax
. Hypotension rrn gKG rt* Regular
I signs ot $hock
. Chest paift narro,v comsex
. Atte€tion of conciousness
. Heart bilure lachycardia fll|1rolfi

Ademsine H

t!{u r roi IV, EKG 12 leads
| fi srl,t ndenosine rfl,{r;n:6drUtr
qRS compler ni1!^i1 o-12 la
Regular w*ie mnonrorohic
lmflslalri
bchrcardia lrhfu
l'.lln
. fi?TirmH Antiarr$hmic intusion drip
. rl]ff IV, EKG U leads r rHntr{risrrrtru
.a Vagal marEuvers

Aden6ine (nrr! Reguhr narror.i complex
bchlcard ia l

. Eeta-blocker r€o Calciun channei blocker
r Gnrn{idlr1inzu

unuqfiii 4.1 uflnn Tacttycardia atgoithm

fiadlrnq Tachycardia algorithm

1. filnvr tachycardia fiatythnr:ndr carotid pulse riaulrrnqair carotid puEehjlfi fi00
tfinr:inurrrul pen lriatn:n'hi adenosine riodr cardioversion ld

2. [n ?i'lun'lrrfil tachycardta algorithm 60 heart rate (HR) rj,]nn.jr 1s0 nftlurfi ri.,rd

hildg"e *ri.rni! ln rud'lunr:irica'u tachycardia difici:'urfio HR r.J..tnn.ir 100 n+.:/ulfi a'ariuyrn
HR odluri'r'r 100-tso n:'.tnnfi fiarflu tachycardia filrifia.rtfinr:inurnu rachycardia atgorithm

68 rrtdrrininqmdugru

l.zunu4fifi udo'r Tachycardia algorithm

Synchronized cardioversion

fl1.11ffvl R''{{1uldfl1ii rrl-ls ri1

. Regular narrow complex tachycardia 50-100 3a
. lnegular narrow complex tachycardia n:ni biphasic 120-200 ?R nlrfi monophasic 2OO 3n
. Regular wide complex tachycardia 100 3n
. t{lrregular wide complex tachycardia detibrillation dose ('hilfi synchronized mode)

tt-19u1 adenosine

. nlDose !!in 6 rn. ur':naa o 16oo oiro rir,r:rs rir (rapid lv push) dxu NSS flush

. Dose fiao'r rz rn, flun:dddrrflu;

Antiarnihmic intusion drip frlill staute wide complex tachycardia
. Amiodarone

Dose rnfinuln tso ln. orlr:nhi'ltrldrarnrfin w',$r
Maintenance dose tulo r rn-rurfi lu o drlr,rrr:n qt:firu 0.5 rn.lurfi lu ta dr1r.t n,:

lrirfiu z.zoo lndu
r Procainamide

Dose 25 50 n.Allfi oun:sfr',: arrhythmia notnl, tfin hypotension, ll-ln'jl QRS complex

duration rfindlrrnnir so% rrnraotdl nioldturnurfll{nda tz ln./nn.

Maintenance dose tula I-4 Nn./nn.

nr:r,rdn16aturnfi QTc prolong tr6afr congestive heart failure

. Sotalol

Dose 1oo (1.5 rflutenrurun'ir 5 urfi
nr:r6nrdr'']rnu.rnl' Q'!Tnc/npnro.)long

a, rrrl'jrlu tachycardia algorithm o:lilld:;:1'lrfiot}inrrinur reversible causes ttsi
luvrr.:ilfrri6fifiartrinr:tnur reversibte causes lourrarrrq sg. sr d.rrflurru?T1{to{ Acc/

AHA 2005 d$:idriorda hypoxia acute coronary syndrome, hypovolemia. severe bronchospasm,
high dose vasopressor donrnhjldirnr:ufil? nr:insr tachycardia evlilldsrn

fiadtrnn persistent tachyarrythmia fifi ornr:

1. Tachycardia d6o,:nr:inurnrr ACC/AHA eOtO rian'ir persistent tachyarfihmla fi

ririfilfiorarnr: dtfinruurrr niur6tlrfli.r unstabte tachvcardia o'lu Acc/AHA 2005 it{ir1flfi

alnrln'lufi s rlunrrda'lild}hirnlrinuld?un'uti1 cardioversion io adenosine (n:rfirfiu

supraventricular tachycardia)

Prucdcal CPll algorirhm 2010 nn?uni nfrfir1ig 69

' Hypotension
. Signs of shock
. Chest pain
. Alteralion of consciousness
. Heart failure

z. rfrarflu persistent tachyarrythmia ddo.:nrrnr:tnur tfiricrrruTjr EKG rflu supra-

ventricular tachycardia 1SW1 lSohj

tI nrnifirflu SW {irdrutnrlificduldcrn narrcw regutar eRS comptex tachycardia

iiilrifi p *"u" dr aur:nninr::-nrgroEira'loodr,ryd,ltu z :;nr: fia
. Cardioversion

. Adenosine

hidtrnn'jrnr:lfi adenosine d1N1?nhtr'lu persistent tachyarrythmia fifi arnr:
tfio,:crn adenosine fi hatf tife eiu niu lur{frufrfi hypotension r5o sign of shock {i.lrfludafi

unnsir.rlrn ACC/AHA 2005

z) n:rfifilllri Sw da.:nirnr:imlrT6 u nl:dr cardioversion

g. 'lunr:nh cardioversion riu dgorirnr:do monitor lead nod synchronized (sync.)

ir-r gain 'hirnio.r{r QRS comptex ldr,1n wave ly't-.,1fl'tu monitor teao lfifia{ld paddte yt1 gel
Ganun.,rmumrrriruuyrirnuuarunfifi +.2 'lfirirnr: sedare msolfiulrfirjrnriou Tnsravrr:dio

rr ra v ri{A1? o! .t.J
l11U1mA tUU
4lJXU?flnn?
. Diazepam 5-10 xln. lV

. lvlidazolam 2-5 n. lV

r Fentanyl 25-i0O1 Ta:fr:"rJ lV

rfro{rJrurri'l udr tr{rirnt: charge un-,r,:ru rirnr:fi 1-2-3 ua;nnlr shock

4. tu'rord.r.,rrub{flrfild'lunr:d'r cardioversion lfifin"r uuvrir'lituuErunfifi q.z 'hin,0rnsl
iryrnrilu atrial ftutter rrfly SVT ?:'lduti'',r,:rudoud'r,:rigu tru;d ventricular tachycardia'tdruro

ra",r'rruldflr:Jrunar,r drurir lflu atriat fibri ation ccfio,inr:fl6'{,r1u'lv.lflrruroo.l lruro Mr

defibrillation) rro:trif,: rnnsiolil'iryrn rflu atrial fibri ation filiu *io" ORS comptex rdu AF

with Wolff-Parkinson-White syndrome dolfitd o"tiorittation dose 6a tzo-zoo.1a Tou'lrildrir

synchronized cardioversjon

5. nr:'h4 adenosine tfirirnr'lfi'lnutd doubte syringe rdorern adenosine fi nar-tite du

mn (!fluiu'rfl Tofl syringe d r l{riu adenosine 6-12 rn. riru syringe ii 2 birflil NSS 10-20

ln. rfiarirnr:hl adenosine udr tfi ltss nru{ufi

70 !?rd'lfoanqflfrug'nl

o. lunruJfrri6 ufitflu persislent tachyarrythmia dfio1n'l:fido{d1 cardioversion ria'Ifi

oladenosine n1l.r tachycardia atgorithm ligtaufluo{don'r:inr*rdrui6ri'tneirr lnurour:lfro

ri.rfifleq-unriluanfrn:v{uvi'r}irfio persislent tachyarrythmia usu Hiu severe sepsis, severe
hypovolemia, high dose vasopressor, severe bronchospasm tun:cfldrir':rL:nlliLtil'leol?n0,t1i1
cardioversion 1:lrioild Ltdfi1nli't cardioversion t -z ni.rrrdrlrinol6[uo.r lria??dl cardioversion
rio nr:ritr-nurortnqfi rirtrirfi e tachyarrythmia ttu

d'roei,.r{:Jru:rlrffu exe riJl atriat fibrittation fi Hn radufi 180 6+.tnr1fi nrxe

drrnruvruiroqjtunl'rv hypovolemia urnlilrrilhore no.,ttit cardioversion tt'ttJ tachycardia

atgorithm ld urilrjnr:ao,r rfiu t-z ni.r nrnlrinaucua.tlrjnr:ni cardioversion dalJ nr:'lfinr:

inurnrrv hypovolemia lounrttfiar:ri, oia}l

z. nrrfi exc hilirfJu persistent tachyarMhmia firir'tfirnaornr: t lu s rl:vnr: 'hhir
nr:uunsiolj'i'r QRS comotex nir,:nir o.t z iurfr tiolri

fiofitmsr wide QRS complex tachyarrythmi" dl,rjrio"blrfi oarnr:
1. wide QRS complex tachyarrythmia tfru iachycardia frfi neart rate lnnil 150

nirtu.lfi dfi QRS comptex n{r.r rfiu o.te iurfi grrr':nttun'ldtilu regular uRJ iregular rhythm

1) Regular wide QRS complex tachyarrythmia

. ventricutar tachycardia rfl unlnqfiuurlouiiqn
o SVT with aberrant conduction
r SW with preexisting bundle branch block
o SW with preexcitation syndrome niu sw drfinirlrrfl Wolff-Parkinson-White

syndrome d.:rflu antidromic conduction nairrForflu sw iin:ctto1ilfl1n{yn'r bypass tract
(Kent's bundle) riou udrn:vua-hiflT 6dulJmt normal pathway lnml'rl:i HR qcrlrtJrn leu

nt'rl ovriurnnir eoo ni.:eiourfi ttfl:o']a u detta wave

2) lrregular wide ORS complex tachyanytnmia n:fid rtryttrm rdugruo:tfu arriat

tibrillation n:rfifi Hn r5x'.nnr ororo.,tcrn surface EKe ldurn o'muororndlmtta,t EKG monitor

ju'nr:rlduuu n.illrrvia.lri mnfinr:r aturrlltjollilrr rdu 200-180- 190-165-zos d'.rdrirrv

lflu inegular rhythm d'trfuriiavrr inegular wide QRS complex tachyaryhmia 6., ri6qfi.: ventricular

tachycardia ldatqtn ventricular tachycardia tiu ventricular rate da.tarittolta

o AF with aberrant conduction
o AF with preexisting bundle branch block

r AF with preexcitation syndrome ttiu Rf firfigririlfi! Wolff -Parkinson-White

syndrome ttttiu antidromic conduction ndtdatflu AF dnr:rra}',lflrowrr{ bypass tract (Kent's
bundte) dau udrn:vuolv{flT 6,rdu1'rlvn.: normal pathway lotrrfi":'tl HR q:t5r rn lnurtr\r.lq:

Practical CPR algorithm 2010 nnTuni nfrfisiI|S 7L

tirlrnnir zoo nirsiaurfi rrflso.rorrll delta wave

3) lu tachycardia atgorithm uuyf'irrior:rurtri adenosine'lunrfidrfu regular wioe
QRS comptex tachycardia d.,:rduuoqjtunho"rriounrthi antiarMhmic drug infusion nr:'h{
adenosine lu wide QRS complex regular tachycardia r:1drua611 sw with aberrant conduction

ttff: sw with preexcisting bundle branch blocr tulruvfi ventricular tachycardia o;l*ino:.1

cuolrionr:'hi adenosine ii.,rriofior:curnrrl::lroriflurrJa-:nrrrfin anhythmia :hJ[Rrdudr nl

'jrrfioqrn ventricurar tachycardia mnfiqo o".rriu{ldartrqdruln{6rfinrrll rfiu.jrnr:tr{nrr

fnuruu:r venlricular tachycardia riau *dr6,:rdou6nfi.,r sio sw with aberrant conduction rrni

SW with preexcisting bundle branch block 'lunrayn'*t

z. ur#fitr'ldtu wolff-parkinson-white syndrome lfio,rernfiqvrdnonr:rirrrurat AV node

rirbinryuolv{flro.r bypass tracr (Kent's ounale) urndu ldud

adenosine

o$ beta-blocker

.Li calcium channel blocker

o! digitalis

3. lu tachycardia algorithm uu;rjrtfi antianythmic infusion r4,,r'lu guideline uu:drgr
3 n"260 amiodarone, procainamide, sotalol tuurr n':j6fiultd amiodarone orjr.:ro'ur

4. nulour amiodarone rflul:Jdrnhuu:rir rraru4n'i +.2 nrn riJu"hJ'ldor:n:?c thyroid

function test riou'hi amiodaron" rda.:q'rn amiodaron6 finnsionr:vri,,rru:ro{doillvr:oud Lrfi,ir

amiodarone ir'rtJ1Tnlfilu tachyarrtnmialdfia!flnrh:nr lrffl sw with preexcitation syndrome

frnrrr:nldld urdfrflanr:::t:lunr:'lfiur amiodarone 6a 'lriaryr:o'hitu anhvthmia ii'fi eTc
interval in'l fi nriilouldufi

. Potymorphic W fifi OTc protong dtriun.ir Torsade de point
. Monomorphic W fifi eTc prolong

crrnqdvllrioulo,r er protong 6o sr arr:.ra'et:Jnfuo,: rnfioui uornrrufio n6

1o\t myocardium tudrulalnrufinrJndlo,,rrnfioujii'n::riau6a hypokalemia, hypomagnesemia,

hypocatcemia ftlun{lftrinrrtfi amiodarone djo{qrnurdrht eT intervat umoon d{q:d{fi
rnn ventricular tachycardia lrndurrwntlfiur amiodarone lun{ldnr:hi magnesium surfate

unvruibnrryrr

fradrmn narrow QRS complex tachyarryrthmia dlrjriohirfi narnr:
1. Narrow QRS comptex tachyarrythmia rfll tachycardia dfi neart rate lnn.j1 150

n'frrurfi fifi eRS compex lrirfiu o.te iurfi olrr:ouunldrfll regurar un; irregurar rhythm

72 rrrlhdninqnduslu

1) Regular nanow QFS complex tachyarMhmia

. Supraveniricular tachycardia (SVf)
o Atrial flutter
. sinus tachycardia: :Jnfi heart rate lu sinus tachycardia c:lrit5xtfiil 220-olq 6)

2) Inegular narrow QRS complex tachyanythmia

o Atrial fibrillation
. Multifocal atrial tachycardia
. Atrial flutter with varying degree AV block

2, tttrld1'tfiili vagal maneuvers d':arc1iildva1ui6 tdu carotid sinus massage, ice
cold pack. Valsava maneuver Toufl'r|:Jf,utJdr carotid sinus massage riaudt carotid sinus
m.rssage da.,rfi.t carotid bruit ns.'J 2 ir.:riou xlnl;lildfia1iiliofiulunr:rir tfia.rlrnfilonra
ldu,,:donr:rfio svokeld fi1nIrififiofi1il 'lfirirnr:urou?trru carotid sinus 6oo;0flfr bifurcation
to{ common carotid artery fl.ltnn EKG monitor fl1n heart rate Srn'r trhirm:nqnuln

e, niru;rirlu tachycardia algorithm luntnifil* adenosine rrdrlrinalauol rrfir'lfi
beta-blocker ttio calcium channel blocker r?u fi'a.rlirfirunr, u::rin:ct"'l tfia'lflnurriou{r,l
dun:ru tunrriidoto'ld amiodarone ld nrnlrifi{ofitr (erlun:ldunl n'lr1,tfi 4-3)

Ea #lfilunr:hi adenosine errr Acc/AHA 2olo
1. 'lu Sw io atrial flutter (regular narrow complex tachycardia) dfiarn,: t lu s

1;n'l?

2. 'lu wide QRS complex tachycardia dtrifiornr: t lu s r.l::nrr loutfitl:ruda.:fu

SVT with aberrant conduction uia SVT with preexcisting bundle branch block

3. lu narrow QRS complex tachycardia dlrifiornr: t tu s ::nr:

Pracrical CPR algorithm 2010 $niuni qfrfrrtJg 73

nr:rtfi 4.3 rtonrtrfilflunr:inr+rrTrlerdurfr utltl supraventricutar tachvarMhmia

nudarr

Adenosine r nlroofiQvrf,: endogenous purine nucleoside fiqlf,

na SA node *nc AV node rir'hirir'hrfiudrauirn:rr

rursnaanrfiao

. 1,,0u,tt

1. Slable. narrow complex regular tachycardia

2. Unstable nanow complex regular tachycardia lumu:n5ultafih cardioversion

3. Stable. regular. monomorphic. wide comptex tachycardia lotldrflunr:
ifird'uua:nr:inur

6fll.I'rsu't : n. mr,rfiaoorFosoirodr,rr5r n1u6ru ttss zo ra.'hidrlule 12 s]r].

1,:nnosrfioso:'r

Radl't!ficJn : hypotension, bronchospasm, chest discomfort

{oet::tr",:

1. fi ru asthma

z- lu{ilru atriat fibrittation drfiotorn Wotft-parkinson-white syndrome "htrniul1
rnia,,r oetiorittator lihin5ol

Diltiazem, 3. analrnurn,r'lufid1u post cardiac transptantation
verapamrl
+. tu{rl, trfi"ldlr dipyridamote ria carbamazepine

. il'll00flqv{[d. : tluu1fi6itJ non-dihydropyridine calcium channel blocker 0ofl6lv]i
1. fibt AV conduction fr1a{
Z. rfil nV node reJractorines.s

s. aonqn6'lunr:aurrnoaa16ao

q. osnrri!gTrso.tli:la (negative inotropes)
. loll.tg

1. Stable, narrow comptex tachycardia lun:rfifrlriorr.rr:nnrl4r:'ldnrtlrrn'rnr:}i

adenosine nionrur.ta'..rnr:yir vagal maneuvers rian:fid S\rt ndi!rflud1
2. R?!q ventricular rare lun:rfi atrial fibriltation 1450 atrial flutter
. flU'l9lU'l

1. Diltiazem

. rJiNrulnu'r 15 20 n. (0.25 n.inn.) flr{snoqr6onrir rflunoruru 2 urfr
. oiaLflriruror 20-25 &n. (O-35 n/nn.) urcrooordaon'rrilu!,to1u.tu 15 u1fi
. rjl.l1ou'r maintenance 5-15 n./r . flln aoslfiosGir titrate lurourlfi'ld rate

control

2. Verapamil

. ri fluloul 2.5-5 rlfl. lnunaqrfioorir rflurroruru 2 utfi
. ulfifrldsurq s-10 fl. yn\rnflaordorrr{r rs-go urfi ru.roul:-;

20-30 n_

74 r?uri,rfnlnqdduslu

nrnrii +.g tgn.turfildhnrrinr+rrir'htfiurSlrul supravenlricular tachyarrythmia (tb.l

Diltiazem, andrsr6u : hypotension, bradycardia, n:v{ulfirfio heart Jailure
verapamil (oia) donr:rvi':

Atenolol, esmolol, t, }ira rslu narrow complex tachycardia (regular or irregular)
metoprolol,
propanolol z. ndnrduilu{:Jra heart lailure, pre-excitation syndrome tu atrial

fibrillation, ventricular tachycardia

. nr:aanqrf,: ulnfj beta-blocker

1, fls heart rate loanor AV conduction

2. flo blood pressure
3. nFnl:ii!d"'t1lanf?9.1.te (negative inotropes)

. {ori.d

1. Stable nanow complex tachycardia rialriotalnria,,rdo n1:rh cardio-

version rialriqoreuo'lrionlr'hi adenosine un:fi sw nffitfluttr
2. n1uefl venlricular rate lu atrial fibrillation !tn! atrial fluller
3. Polymorphic ventricular tachycardia drfindrlril acute myocardial

ischemia, familial long QT syndrome. catecholaminergic

. nl-l'lOtl1

51. Atenolol (beta-1 specific blocker) fll-l1q n. vn,trnoot6oq,t'r Lflu
r,:n'ru'ru s ufi 1'h{rld6n s rrn.'lu to urfi nrnu".tfiti'r'hrdufiod.:nrv

2. Esmolol (beta-1 speci{ic blocker) nulq 0.5 n./nn. nr':nnantfiootrir
u'r1.1 1 u1fr n1 d':u 0.05 rn-rnn. fir'lri!]alsuo't "lfi1ure 0.5 n,/nn. u'11.1
t urfi rrnrnirttlrrfl o.1 r.Jn,hn. 1u1quTfl'rds 0.3 !n/nn-

53. Metoprolol (beta-1 specific blocke0 1|1.r'ls n. !1u r-z urfi lfidrld

fln 5 u1fi !1-l'r9d\r619 15 r.Jn.

4. Propanolol (nonselective beta-blocker) 0.5-1 n. ultl 1 urff turnur
r? d{flq 0.1 !n/nn.

aradr,ttdtN : hypotension. bradycardia n:v{u'hirfin heart failure

ionr::si.J

1, Asthma, obstructive airway disease

2. Decompensated heart disease

3. Pre-excited atrial fibrillation/ atrial fluller

Practical CPR algori*rm 2010 Lon?ur1i nfrfir{S 75

m'n{d 4.3 ttf,rl,tfl1dtd'hn,]:inurri, arduriruu! supraventricutar ta chyanTnhmta (fio)

Procainamide : Sodium/ Dotassium channel blocKer
Amiodarone
dari\td : Pre-excited atrial fibri ation

1u'rFtu'r:2O-s0 lnyurfr vialhuro 100 rn. qn 5 l]1fi euntJflr.l
arrhythmia M1ul / hypotension/ eRS duration rdilarln.jrr6r sos6t ld
1u1qU',tf,:fl}] 17 n./nn.

ruorirltdt,: : Eradycardia/ hypotension/ torsade de point

. {anr:r:i,r : nr:ndnrda, 1l{rhu eT protong $flr congestive heart

. fllra0nqYl6 : N4ultichannel blocker (sodium, potassium, catcium) t|,ay

non-competitive alpha-bela blocker

. 1lorna

'1. Stable inegular nanow complex tachycardia (atrjal fibrillation)
2. Stable regular nanow complex tachycardia

S. 'ldnrrqr ventricular rate 'lu atrial arrhythmia fifi pre-excitation
syndrome tlio accessory bypass tract

uurqal : 150 rln. ur{raaordaq0i.luru to urfi 'hirtrdr"irrflu onlJdell

t lnylrfi rnlnnanrdaortii'rlru 6 rirlu,r 0n d?B o.s n.tu1fi
rurosr:ulu 24 d{il,ilil!fi! 2,200 n.

s.Jadr.ttff ir.l : bradycardia, hypotension, phlebitis

. nlroonqrf : cardiac gtycoside= loaoonqnfrflu positive inotropes, y'l'hl

AV conduction drn,ltdosernnr:n,rcfiur;llll!r;crfl parasympathetic

. 901'Jt

1. Stable narrow complex regular tachycardia rfiaLinr rro:"nu{d'lsu

vagat maneuver tlio adenosine niafi sw n6'lriJuttr

n2. nx ventricular rate'h atrial {ibrittation flia atriat flutter
. ?urou'r,6 aurs e-tzl la:ni inn. notturnolnro,ryfi,: tsosdt riofio,:

}i"itr unyossursarrr.rfio 2s% louhiln a-a rr.

. nadrlrfiao : bradycardia

. {oqtt:rr".:, uraonquf,druo:irl:vRr6nrror'r lrirrrr:aririnnrn'ldinur

acute arndhmia

76 rrrrjtioinqndugru

n1:1'tii 4.4 uflo,:uldld'hnlrdnurn'rterdurS:Lt!u ventricular tachyarrythmia

pracainamide : sodium/ ootassium channel blocker
Amiodarone i.O,l rjtfr ; n:.n'llt\lln[luuLnao
Lidocaine : monomorphic ventricular tachycardia
fl9'1flf,lfl

d
n\lYl

?JU'tOUl:

1. ru'ror 20-50 n/urfi flr{MaaFru6oooirqun::fl"'J arrhythmia fi1ul fiio

rfionrr Fl'u1ofiflq'r nio eRs u1xdu lnn'i1 50% fiiorulourf,yf,ei6

17 rJfi./nn.

2. llu'ts 1oO rn. rr,ounoo16onoir rflurrnruru 5 urfi oun:vfr'.:

arrhythmia rl'rul iamsorrunulnfinn'r nia QRS umduMnn'j1 50%

riaruroarava d 17 !n./nn.

. atn{rtt6ul : bradycardia" hypotension. torsade de point

rlaor::: r-'r : udn 16 u.rlu {rh udfi QT prolong nialu {rJr a heart .fai I ure

. nl:a0nflYl6 : Multichannel blocker (sodium. potassium. calcium)

non-competitive alpha-beta blocker

.1o-,i!'lt

1. Monomorphic ventracutar tachycardia frr.ronrooinrr'hntiuu16onn,0fi

2. Polymorphic ventricular tachycardia fi OT ilnf,

r1l1qul : 150 n- rJflnaq rSooeiruru 1o urfi 'lfit'trfir.i1fru mrrdts
1 rn./nn. v1{flaa0r6oqriruru o r?rfu.r nrldra 0.5 n/txr. auoar:ulu

24 d{sr,i.l rfiu 2.200 n.

Bn{r':tdEJt : bradycardia, hypotension. phlebitis

. nl:oonny; : ootassium channel blocker tlflY non-selective beta brocKer
{orird, monomorphic ventricular tachycardia filrnnrnnflunr:lvariau

[flaqenvt

lurcu, : lu{rJerrdnlfillro 1.s rn./nn.'hiuru s urfi odr.:l:finrr us
*u:u"rtfi urdrl lnu'hiurun'ir s rirfu c

na{r'tt6at :bradycardia, hypotension, torsade de point

{onr::vio : rtdnrdstlufirhufifi QT prolong nialu{ilra heart failure

. n1:o0nq1l6 : relative weak sodium channel blocker
. {ori,rd : monomorphic venlricular tachycardia fi uanroqflunrr'hatictu

taasF{vi

lurour : 15 :ruroril .5'1-1 n./nn. flr$raaorfioqoir 'trittrlurq o.s o.zs

3rn.hn. mr.rynaorfioqriryrn 5-.10 urfr turoc:argrqo n./nn. fli'rnrJ'r

s{orda.! (maintenance dose) 1-4 !n,/!1fi (30-50'hTqini /nn./ulfr)

nrnfir,:rdse : 1ndr. 6rn.r, iin. rir'la rfrudr

Pra('ti(af CPR alForirhm 2010 Lan'Tuni nfrfimn 77

nT1{fi 4.4 ttca.rurfi'ldtunr:inr*rrielordur5T ur-ru ventricutar tachyanythmia (siB)

l\4ag nesium . n1:aanqflf, : rflu cofactor fl0.1n't:ril{ru:yeiurrad'lunr:tudt sodium rrnv

I potassrum
I
I . {ari.rd , Polymorphic ventricular tachycardia fifi et protong
I
I (Torsade de point)

. 1U10tl1 : 1-2 n5}]yl't{fiRoo16osFth uru t5 urfi
. fln{1r16u{ : 6't1 dulnfifrori riufi:reia::Lrrl:sRtr nffn1fl41u1a
. danr:::r".1 : 6l:Aonix::fi'! magnesium riabiur auraSotfiurulu log

ravrT r"lufirleafifi nr:rir.rrlnra ooso.l

Maternal card€c arrest

{d2t ruurn

. 11* uat€rft€l cErdbc aaf€6t Eam algatrithm
.
r Docurn€nt {rarfidh Cardbc arrest
r {r itrrririollqriuolno, rr
ritrrir chest cornpaEgsim i,rs aLS
eroior! sternrm trJ*runrl,rtii"n?rU/*dnrlo{,

{d'ru.|.d.ltj

raabrrBl IntenrenAoal O. bt6ht tric inte.vention ls{lrl?t9 c.rvld utgrus
teft utenr€ disdaceri€it (LUo) .fio€.
l..r.{ntrlt1hirirllflailfxElrndrml€tri.urrrb:rrc.rf.ir|llr'lnurarhtlrin6oiahnlrsatrlitmdllsi@ralf$*,trr%.i.{a1droaoiflxcisfEl,meo.a}er!t]lngtoAroiiF.fiLtlhsrmfirr
. Aonocaval c6t4ressim aon
.o1 Inle{nd/ extg.nal fetal rnqlitor
lhr:nfl

fapnograpiy wa\€fonn f|&(l{nrnrluq:fi {qtrrrrrrhdte*r*rtorltf r
Fost-cardiac afrest care
. E.ml€l'rralgdffll cy cesarHn rectbn
Rgsc rnslir 4 $-!inar$d$
ttalErnel .nodlticatidl Re$l$citaticn fi n"fi oirh Emerg€nqy cesaretn
.
. atli W li.r€ ,t!!rr.ti,n$Iori1 Oiaphragm seclroal

Ur-|fBi.|f, HyFsvol€mia l*al|i u14f, . rfrta!|'lnro.r Delllery lonrriu 5 rJlirtildlit
Hypordemb f, !rr,Ei*fl irh
. tiflrrfift! Resl citatbn
Flor.rrnfin<L, Offic|',t air$iay

o rfrrrriozullfv ltagnesium t}t'nrli t{aSncriurn lC ttrlratrq

lO% cakiurn chloride rO r.€o rO% cabiqn Gravd ulerus
'.la-
Elucdrale 30 rrrntrllcreqndf lrralnqlxotirfi &htt. aort€aval
o hh, r{nu,"{l.E'1rt61.ltir cpff fahj (chest
cofi9aes9on
csnptessbn, p6ilionin8. defb.illalion, dn€s,
0rxd) rdlcqasfihtrii cesd€Bn seclion

Ek€din8/ OIt

Embolism : co.onary/ pulnonary/ amniotic iui, emboEsn

Anosthelic cdmdlcEtlons

llErrt€ abny
fordiE dis€€6e (MI/ bch€rnia/ sortjc diss€ctiony' cardFmioFthy)

Bypenengom/ recLa.npsia/ ecl€m96i8

othersr diflerenli€l dbgnosis b slaodard ACLS gutdelirE

Flacenta €bruphoy' p.evra

5aruuafrii ufln\t matemal cardiac anest atgoithm

78 lrrlridninqnillnlu

Acub commry syftlr0me

omrflirlf,ilu tschernia #o infarction

Ells a3s€6${nelt 8nd cale ard h6piu prelaration

. l!hnrb., ABC $3lrl*r C?R !!# oe{ibrilbtbn

. lil Aspiria finrmlll crygen, nitrogiFerine, mrphirn firirrfil
r ril EK6 la tea& afufo sr elevatron hls*,rft'rnrnnad{ud'rris rllfitrrar*,rdl

(onsetl uuornrsdrfir*t
r hwuurnfiiudoio{nglwftxm{*fnurtl#snfi r.r{unr:fnur sT el6rati0n MI
o lflnfio'rlfi Fihirdl4lc &ug &ifirrrrurmr FiMnoly{b drug check lisr

rn:dr:rfir.flfroCfifu k to rnfil . h ory8en saluratisl *njr g* *rtnrnli[
ho Vital signs, ory$n saturation
.r0r$ o{t8en

. dniJr;illft r#r r&fi lndNn1rl o Asfrin 160-325 xn. (rnnr&lrfl,firnriorr)
. r,!'l28 Fihinolytic ch€cldbb
. t{i@lyc€rine su$ingual rto spray
hufi mondorhfr *da*nrli (r$neffl Ls)
. i51{ cardiac rHkers, ele€fdybs, ccsgulogram d0. iiorphirE rni ch€st discomf0rt

. Forhbh chest x-.ay {< 30 $fi} fuhnruhrdaid nitrogbceine

EKC iflteDrebtior

unqfrfi O.t udnt Acute coronary syndrome atgotithm

Practical CPR algorithm 2010 @fliufii nfrfrrlJT 79

ST devaifun !o [$v/ 8T depression xls oyn8mb T SI segmerf I $ave
Pre$Bmstty re* LB68
$|aw inrcrsion lrlYr-inlerm6rtirtsri$k
$risFciuo€ fo. injury su3ficious fur i$chemig
Sr-€brdt&r fsrEMi, ACS
HEh-tEk unstaw enginal na -
. ttr Adiuncliy€ the€py Srehralion NI {UN SfEt J ldmit Ix rh€3l Fin u||it

dafr{ori,rf fl$lo High rbk Fthnl . SfrBl tardiac rnark€r
7.5, 7.71 ir1tofl ssfli . lir l(6 fri s{rbl SI segnEit
. d'l ReperiLsiofi
fidiihtt . MEcbry tschemic ched ftonibrig

. go0r b i6llffii hdagoo disco.nhrt . fi${$.l ttdirn6Er€ di{r6tic

{PCII 8o{l : So |l1ll . Fecurredu pe6i$enl sT est
.0oorb.reeddte
deYistrsl

. Wntdcd,r bch}card€
. lgnodyrEmic inslabdat

. rBt l8iLrc

ldjunctive |rrrim?nt rb[rtl . tlinical hiEh dsk teatures
. oytamr EX6 chang€s
. Nitrogtyceine
. t*Frin (uFH flts Lxtfir) firtrlEfu rxtremir
r 8et!-blocler (orall
. dopdogrtl r rmpolin in6,r
. Glrrotd€in I$.|IIIE iifiihb.
flilnro Drs{harEe
fttAss{Js canfiac sl|tus Es:r,Hrnvnrintnioti
r.E, r.rl fi AsA

. ACEI/ ARg
. rlMG CoA reduchse inhib,itot

{sraijn thetrdpy}

aatlu!fri 6.2 uflal acute coronary syndrome atgorithm

80 r?inilfninqnfru$1rr

&roud r dnhiflmflftJxrhonrntrnd'l t5 urtl uitimrsfu re *ill'rdolrl

€KG idnlnslod slEltt nfa tc* (or presunraHy ne$.) ISEB

'dlolrl

furodl z S6o**&osfir1fi FiMimlysb nisbi
firnltoftrf, sldorsrli1 1d' fi oir(Nortrmo.rmrlrt titinolysls

. sysblic bM tressure $nnil l8&2s $.Ur0n 16o giaddic blood plessure

rnn.Hl l@-llo ttt.rliofi

. qisblic BP lo$Bo.&s$Gurlnnrhofi.l|1nnh 15 nr. ssn
r firjq:firoslsnllr*uuu*fltd:t.na1{
. f,rjr:ll Oos€d head traurn !o Ffiial bauma riour?rilr drjnrrl

o FriEll sfioke mnndr s fiI*i ldofisun'h s tloil

. ftJrrll iiaix fauna, s Eery {r?xl{ lrs€r eye surgqy}, 6l/zu ble€ding
. firj*{l lntrdctrnial h€riofihage
. f,dsll Bleeding, ch ing problerm
r srloiurrtr{
. sFtsmic disease dlrglr.t (**dd*ltfiru, tsrdtyllnhlipn:*l

dtna*d r

nnnFfoh6orduardr ld' $di{&uld6taflrdd}h Psli

r ilxrrrrnrrh too #Vt rfi ** sgp rlounir too fir. :an
. Pulmcfwy edema
r fiSnvoonont9nuoumrian
| fi{Dthr nrl{ Fibrirro|ylics
I $lrdnmudio'rrfr cm

uau4fifi a.S uf,nn prehospitat fibinowc checktist

Practical CPR al€iorirhm 2010 nnfuni nfrfrftr 81

n15']"fi 6.4 l|aqnflir ftriufr tu ST segment etevation l,rio new/ presumably new LBBB rfjaiu

n1:{n!1fi1u repertusion

[?n']fitfinatn1l

nn?x1'rtllrf,faiuUs'J,rlFuina'nlllllntfUiolOSTlUelfeibvraintioolynsli\,s4
r?f, {un1:d,r0i0ftJxa}Jri.,rnnrudfi crlr:nn'r pct lfi
!unoqi z tdeniBnrrdr reoerfusion
tun:ridfiornr:riosn'ir g drltrunyotn:nrir pct ld nrtdonnl:inn{os fibrinotvsis fi5an.n

vr:r pct lrifi nrrr uorn oir.:liu

.errtfi annr:inuldru {ibrinotysis rdo
i ar nr:rio un'irn6 a rrir rT! s d'rIrl,t

. nr:ni pct "lriaur:nrirld lniu luonrriudlilrirulru fi3oniflri vascutar access frldurn)
fiI.0nSnidvltrtJfl11a'rs'l
1) Medical contact to balloon time rio door to balloon time lrnn'jr 90 urfi

. 2) Door to balloon time finaandrs door to needle time mnn'jr t drh,:

bifi{ofirrra,r fibrinotysis
nr':r6onnr:innrdru Pcl da

. r:'arnr:rrnn'ir g rirh,r
. fl rir ect fi rinuy rfi er.lrla unyfi d'or urvr rie ou'hlnrr rtir u ru fiar,trn rfi orlqlrr

. Medical contact to balloon time uia door to balloon time fiBunil 90 l,llfi
. Door to balloon time rtnoandru door to needle time riotrnir t drTlr.:
. fidarit:ro,:nrrhifibrinotysis:rrrn',:firJradfinrralrfrtrtior6osoon,irauoyr6oooonlun:lunnfi:sr
. firhufiiorrlrf,u{d,r (congestive heart faiture. Kittip class > 3)
. lriuulqdrnr:ifiqa'u ST etevarion vt 6lndo,rnialri

.High likelihood 1fi arnr:otjr,ltnodr.lud,rria}Jd1

::rT : rirn5ouriumhonfiiyl fiornr:irrtluriu.firsdL{rldriu angina. irJ:rifrrotT:anaoar6oqfi?h

. 0rl'tql1'tnla: transient MR murmur, hypotension. diaphoresis, pulmonary edema, crepitation
. EKG : New (presumably new) transient ST-segment deviation fiia T wave inversion'lu precordial

leads n'lg leads

. Cardiac marter: finr:rfir.rdlran TnT. Tnl nia CX-tr,tg

.Intermediate liketihood (lrifin"nBruyrsr high tikelihood uavfin-nuruvsdr, oadr,rnd'rsi0hd)

tj:rifi : r6uriaurilnlronfiir'lriiornr:irrljuludrl orqlrnn'ir 70 f, r]r6r'lu niarflurururru
. nl1?i,l.Jfl1u : extracardiac vascular otsease
. 1EKG: fixed O wave, ST depres$ion 0,5-1,0 uu. ria T wave inver$ion 'tnn'i1
. Cardiac marker: nf, '.l,

Low likelihood {rjfin'nuru:1ar high/ intermediate tiketihood ltntfidn$ leiol ur)

. :l:tr'fi :nr:riltrirondhivuutl intermediate ttt<etihood, fil1:ti6ld cocaine rrriouv{rd
. nfleirnnru : iornr:rilniranrdona:rrirrrumhon
. EKG :T wave flattening/ inversion {otrn'ir 1 u. lu lead dfi R wave rtiu. EKG rjnfi
. Cardiac marker: n6

rllJUlUOXnfl9tlr S'tU

mfl.td 6.6 !li[q.t TlMl risk score 'lu{rhu unstable angina traY non-ST-elevation Ml

orurtrnn'irfiSor rn-! 6S fl . firl::i6 cno n:orndr
fi:lqqiuldu.na-t cno rrnn'ir . arud'u1afior$.,r
niarvirftr 3 flciurfiur
. ltniuqr Oypercholesterolemia)
lfi aspirin ludrr z r"uriou
. !:.111111u
a1nltt1llxu'tanlu[lt,t (recent. . fl!!fiA; (cunent smoker)
severe symptoms of angina)
cardiac marker filldn fi angina urnn'juioMrrfu z qi.llud?l z+
ST deviation r.rr n n'irvi o rvir rTU
frlr.l,rfinirur.rr
0.5 r.Jr.J.
ldrir cr-i,,|e r5o troponin

. sT depression mnn'ir 0.5 rru. fio'irfinr.ln6

. Transienl sT elevalion lrnn'irvSotrirfitj

0.5 ru. rffunorrloan'ir zo urfi'tr{inurnrfiou

nei:.r sr depression un:lfi{oodlunri high

fi coronary artery stenosis . ST elevation r.J1nn'ilris ryilfi! 1 ur. rflu
lnriournn'irn5o r?i1n"lt 50%
lrntnnn'ir 20 urfr 'hiinurryfi ounail sTEtvl

urllrirnrrdarnrrriau

n'rurnr TlMl ic{slds.:ii rnn'ir f,ftllMo0n'l1lILf,Er:
risk score fliorviT nfu I las
f,fltnn primary end

point dioundr niowhriu r+ e"u

sVo Low risk status

8% Low risk status

13% Intermediate risk status

20% Intermediate risk status

260/o High risk status

I lio']ul1ifr : Primaw end ooint l1lllflf,{ dea$. neM recurent Ml need for uroent revascularization

Practical CPlt algoriftm 2010 @n?uvi nfrfiflT 83

n1fl{d 6.7 [6[6{n1lr6ann']rdnr1{t1u non-sr elevation Acs lvfl'j1,r invasive strategy uflJ

conservative strategies

Invasive fi orn r: 15undra n rfl u#rlul ru:n-nni olurrnrvdvrifi qiq:rfi uo r6 nfi o a
Conservative luuru:d1fi nr:insrdra ur ufi r

Tfi cardiac marker flodu (troponin 50 troponin t)

New (presumably new) ST depression

fi atnt:rrasornr:rrnor.rro,ttilhrla tiofi mitral regurgitation tfioi'u

lnri/ udn.:nirt6er
finr:n:rs jJfifinrrltdgrfl.scrn noninvasive testing

noorcninr:lnarlau16onlrio.rfi

fi ventricular tachycardia fi rfl uarinaao
'16{rnr:vir pct 'hrix,l o re'aufiiruur

finllrducc.l fitMt, cBAcE)

rir'lofi orrir,rdrurir,:lunan,r (LVEF < 40%)

. finrrrrduosr'r [Il\4t, cRAcE)
. a1'uJLriuro{r[r.ryrriniofirheiun:nifi"lriinnrcu:drduoco

n1?r,td 6.s uoo,:darirrrornr:tri Jibrinotytic therapy

Ab€olute cofltraindicaf o'r . :: r"6 nr u,a'ul nfi n g,:fi:u u:,r riurruru LrnrnlLn

i:.1::i6 intracraniat hemorrhage 161il6

niStructural CNS lesion AVM . nr rr o'ulafiq q,:#lriorrrrnnrlar'[6' (SBp > 180

Malignant intracranial neoplasm ur.rj:or n5o DBP > 110 rj .thau)
(primary/ metastatic)
fl'lfru aortic dissection . ty1"6 ischemic stroke tJ'lflfl'il 3 rdau, gr.ro,:rfr0ru nio

Active bleeding, bleeding :au1rnluoHoofiLidrdr absotute contraindication

renqency . lt:cifildirlailfrrNar riarir cpR lrun'ir to urfi u5o

tltclfi closed head trauma flio ldiunr:irn"ehqj s d nlfriou?fird
Internal bleeding 'ludr,r z-+ drlnti
facial trauma lu'dr,e s r6ou

Noncompressible vascular puncture

dinitlul streptokinase. antistreplase : lditlgrrfi6ird

'lutir.: s 'r-uriau riofi :r':-6ur{ur rveird

11^fU! \:fi\ln::n

urun'lun:t tlr: arur: (active peptic ulcer)
ldi! |

anricoagutanr lstrfieir tttR flc viordu,roiorfio I

'fiT*rloun _|

84 r2nd'rtitinqnd sT

Adult suspected stroke
rtrmni,ria, m:uacolmrusn\tuo0{ ?uddsfo 'hrfltJ stroke

u{oflurnntiqntftr

r ngc hio oninldrdrrflu
. bl ffiiospibl slroke dsessment (fachl drmgarm

. d rift-abnormal speech)
ivqr?a1fi{5flso0msrtlno'lrnrh,ff,ilgr.

. Cnf}5ondtrulddo sfoke center
I u{'rll"ifiu'lafi fifi,?u sroke
r nrrc*fiufima (fna, mrorhlf,)

.Immediale gen€f,al assessment and stabalazation
dilrfi,ll ABc, vital signs

o bloantrog lhfi hypoxemia
. rUe Iv d*ianmrrnrorlarufi$nnrt
rr
n:m**;firorn hlnrr{nurrtiofidotioi
u{r sboke bam
. dlrir2t efiergency cT scan rfla MRI aa',d'|at
. ri1 Efi6 lz l€ads

Immediatr nerrologb assessment trrs sboke teafi/ designe€
r nun'lurh:lE{ilru
r 0lrhc:sr#oduto,l m:rllnor m:bif ntou

r l:?o*rlrnunru*ujd5:flrn (NIH strd(e scale./ canadbn Neurological scale)

rr scan fldnururo$ tiemorrhage nl6b.i

suafri l.t ndn,trfltnutu'luntzinad taia,t{ui'trffu stroke

Pracrical CPR iilgorirhm 20t0 @n?uni nfrfiffiy 85

Adult Sllspected Sfoke

fl scan fifinurll:ao.r

Hemonttage u€olrl

rir*rdr tschemic slrd<e €crmnhi t6oc1di:fi i${nd^Jsarniarrurriti
/ rJ*audaaunnd
tibfimlytic ttEr"py

. nflraoud'rfi Sorh$loonr:hl ribrinotvtic

tfrenpy r€dil (f1nili a.s,al)

. i:1t*rtnGtn'tllw r:mn*r :

drJranf uf, u{nrr:rJnfr orhunarh r€oli

{rJT ur}'rn Crt*IuurinnmrU
Fibrinoly,tic UHapy rfi oIil

Hirl la$Frrarlnf, ahsarr{u r $nLiorr{sarlr stroke/ hemorhage
r lil Rt-PA
] Lf,ti Antipbtslet ulo p6tr$ay

Mticrc8 iant t*unfiT z+ ${$t . dmit {d?ulu Sfoke unit rqs rcu

I rix Post-rt+A sfioke patbvlEy
. Monibr BP Flx P{obcol (*r:rofi e.s.

8.51 ffi !oifi irrnni4Judrcfindtrda,t

r Admit ttbuh strote unit sqah lcu

twugfri t.z uso,trfllntnu'luntzinwfilauda.t{aittfiu stroke

86 retrirriainqndunru

nr.nrd z.g uao,rn-nuruvdrfludori.rduat{arirlaoo{,:Jrldnr:ldiurt-pn nrutu s t'rl .t1iuueiL+ fiornr:

lnclusion criteria

o iieds ischemic stroke

. llnlii!+ ia1n1:qufi.rdf, un1iinr1fi ounir 3 iixltJ.t
. olqr,lnndln5atdrrirj rs fl

Exclusion criteria

. ldiloihrnniifiru:riai stroke riounrird g r6ou

fi 06{ subarachnoid hemorrhage

fi ntiun:r u dsun os r6aq rs.rlu:l6 tr ruflriar r:n nsldria fi rird z'r"u

fi :J::r"fita,l intracranial hemonhage

. nrr&d'ulnfino{ (sBP > 185 url. :sr rio DBP > 110 rJx. :afl)
. fiun'ngruro.r active bleeding ernnl:nrredt':nrcr
. d:.lr a fi rd aq ao ndr u

Rr.t) rnfior6anra3rnir 1oo,ooo .

2)ldilr heparin riouvrhri +a :t'rTrr ua: aPTT tJrnnilril{{qolo,:rir nfi

3) ldir anticoagutant loun:ra INF '[fur']nn'j1 t.z nia pt r.nnn'ir ts iurfi

. :cqildrrno'lurfioorioBnir 50 xn/aa. (2.7 fiflfiINflifinr)

. cT brain rrdn{a-ns t hypodensity fifruiilrnn'ir 1/3 tJB't cerebral hemisphere

Relative exclusion criteria

. 0'rn1fl fl r-tr6nf aunioarnr:66uarir'rr':etircurruafi yr

. fiornr:dnorY'tusirirfiornr:uavfinrrrfiq nfilo,t:sutj::outo'ttm6oa{nruv#adn
. ldiunr:airdohdrioldir.roffi rrqluu:criauurird t+ riu
. fi 16ooaonqtnrr.rLduo'l't1:fi5acinur':tduiaorr:riouv rfi zt iu

fi:l:sifr acute myocardial infarction riaultrirduru 3 t6ou

Practical CPR algorirhm 2Ot0 nn?un€ }frfis|S 8T

n1?Nfi 7.4 LrflFr{ffn1jtuvdrij1rdaLir6'un:doriusas{rJruiinr:1fi:':r rt-pn nru'lu s-q.s rrrl ,jrirufi

nddlJNfllnt:

Inclusion criteria

o ifira's ischemic stroke

. rrariildrfi ornr:oufiiriaunr:inrratilu:ir.l s-+.s lidil.,r

[er"r"".. *it.* fl -|
| ' oru rnnir eo
(NHSS rJtnn.il 25)
. Severe stroke

. 'lfrfiJ anticoagutant

l""l. fi :ci6rtlrfirrutLfiy stroke lrriauuri,rd
| rlofl{rnn
| . ciruu:rfrrirli! r,rrtrqrn originat FDA criteria utrtifirdurtrrg'lunr:inur stroke f,1 1ln I

rjirr fierun'ruuyrhfld I

. rrnrfi r?rfiornr:u"runinordfiridrrnqyuerufio:ln6nsotjiornnarqorlrafifiarnrlJn6
. lu{rtrudldil anticoagutant n3o heparin nlrlli rt-pA arlr:n1$l6 urnint:vqenr:hfi rt-ea
I n6to.rrio,::JfiriGnr:riu1rfia tt'tn rrnnir r.z uia pr rrnnirrir
.i

1u{nrufi1rifirl:veTrn6or6onn'r our:o'lfinr:innrdrtr rr pn lddou'lfrnan:rorirrn6ordao

|I
nu.ru.urior:nuor rt-pe ffiolnfiqrfiaqoirnir roo,0oo

I]

ryy 1,*gylttno.u.l1'0""1^nr{q acute ischemic srroke Iufirtrflfi'ld rt pn

1. n:oinrr Fr-lTnfind{ni1 18s/i10 rr. ror'irinr:inur6ru
. Labetatot 10-20 ylnraaorfiorrriruru 1-2 urfi aurrntfiddd t Fr*.r fiia
. Nicardipine 5 tJf'iJ"n/r. - vl't\:14fffl016oool'r nrl'rrntfi dfray z.S ln,rtil, ytfl s-15 u1fi s!1o

fl,Jf,q 1s n./ar. riiolfinrralri'ulofiqsnrdo,:nr:ufir aoturosrnrfio 3 rn,rrru. uia

. E,1du (Lti hydralazine, enatapritat)

ntaiiianadulafintifltifiosnint?ashfiy 1 gs/ 1 1 0 uNilan bi'lrt rt-pn

2. nr::-nrrnrrI6'uTofi nd{s t/niufi n',rlttr rt-pA

fionrrnrro'ulafinyn t5 ulfilfiulxa1 z rirlloriluoirdu}i rt pA sioll6cnl nrrrd'u1nfinrnn

30 urfr rflunor 6 t-d ': uncfienr eruq-u1afinnn t rirfuc rfrulrnr to drh,:
1) fil SBp 'tgo 230 lrJ. loyt 5a oep i05-120 rtx., rar hinr:inurdru

. Labetalol 1O rJn. yn,tfifloo!6aqoi qTJdraruro 2-g rJn./arJ.
. 5Nicardipine n./rrJ. yt1\rrnaqr6ono:r tduuroUrn'u Z.S n.lnN. Tn 5-1S utfi rulo

ftlt\:ttflvqt 15tC lttnt-r-/1/a]tt..

I ey nrtfi1ilour:on':rqrRrua'ulnfiorlfiqr r:lrrr.ns u?a ogp rurnnir 140 ruN. :afl fic1irul
I lii nitroDrusside

88 rrrnirrininqndugtr

. ll'fisr:rurnnnrud'uTofinlufiilru acute ischemic strot<e tfio sBp lrnn'ir 220 rol uia

DBP fl{ni1 120 lJ.tlloll

. fier:ru'toqnl ot"'tllnfigttiiafi acute myocardial infarction, congestive heart failur€, acute

aortic dissoction

. rirrururorn'unna'nldulnfiqda 15%-2596 nrutuiuu':n

[oflg1?arra{

1. 2O1O American H€art Association Guidelines for Cadiopulmonary Resusciialion and Emergency Cardlo\"dscular

Care. Circulation 2010J22:S640-946.

Post-Cardiac Arrest Care

(/-n-' 1Tn-- ua 9.t.. j afalt?a a o1nn lflJIrJa. ilqrlmo' n 1T

e{u?€J?tTo

y4 U at n TWToItIQlfl 14 g A o f 'lU ,
n(U 1J?{ Vl 1
A \: )

aia$ naoagi

firh ufi:;lilrna rltrulafinnniurrirlruud,r'ldilnr:rjrufiinorn:Jfr:t-dnrr{6nri,,:finrrl

rdrtgriia: rfiufiiolosralrrynru'lu 24 drfu,:n:n rircrnl:nvr'riuorrrqfifl-nflo{R11s cardiac arresl

tot tra;lrnnr:r duut[ 4,]ro{ir{nrufirfioqrltn,:nrr:y'rleyuFrrfiufiriun:rrfi'u.lr post-cardiac

arrest syndrome nr:gun{rht'ludr,r:cu: nn.rd6,tfinrrllrirfiry lflrodrr€i.,rtunr:rfirTonrotaodin
to,lfirJru rc{,rfla.rrYunrrsuvr:n6ou{.iararfiodu :r r rY,r rd rulo nr o'trtdta o6i sr c-r n.0 fin.r:dr,r rur o,r
:vrlrl:vornodtu:yrilfi6nooufirirufir .r:nd.r rnulo.rld' ufrobil::qfirr-mq!::a,rdd',rneim nr:

qna{rhr post,cardiac arrest q'r::no:.tfirunr:fiqr:rurd{siafidrurdr6innrunflrt.lrnfifi

d'nunrrrfifl,r1rorfiotrfififiu16irnr:gun'luloEgiiclrr:nhinr:nunfio"rrfluurifiilruld nr:fnur

ltian.ranrunr:rir,rruaa,rt;r.tdva riuulofiollnv:yllyratcfirr r;n (optimize cardiopulmonary

function) rfifl.rrafrq:d'r 16oa lloyoonirou'bJqj:rllofurvnir,rlfio'rrfluoianr:o'r:''r6yl (virat organ

function) nr:Snurrrijoonnrtl.lrdu,no.'rnr:lfiooiust:'trJsiotyu:Jar-ur;n't.r1Tnt ralrrv:: !rJ:ydtyl
nr:5ludunror nnnra\rn'r':; cardiac arrest o'uc;rir}idni:fnltfin:{eFr rrnyflotniunr:lfionrry

fvix.,lefi uorferl-laylo'rltn-ngY1 (prevent recurrent arrest)

lurvrnrrllfi'c:1dnoimfi.,r:run:rduolaonr:inur fi ru post-cardiac arrest lotdrri.,r

qrlfirrrucd']fl4'' 2010 American Heari Association Guidelines for Cardiopulmonarv Resuscitation

and Emergency Cardiovascular Care

90 rlclilfnlnqndrnru

1. nrfielffuldoeiofirJeurfirfirnr;ns{uf,olunsruraiififinsnrurfi srfl a

niamrnnr:qrrn{rhu post-cardiac arresl dotordunll.tdrufiota,'rr1nn1n:rtntu::eli
:rl.rfir"irrfufior'ldqrJn:nirr.onr:uulri niu rniooriranrult tnta.'rn:roiorvd'lnrrl.ro'ulofinodr.l
siordo,r nr:n:rondulvifltr'rlqsio rfia'r nrrtfinr:n:ratta;ificdtlnlr:nfiril rdarirlqaro rfiotr
16ulyrri'u:ubifi,rnrrinurnrr;d'tnrjrrdruiinrrluruvnan rfionrirloiiqnci'udru:jnguttntaanrn
n"hdu lpercutaneous coronary intervention) {:Jrufrfinrrvr,lr'levqo lduuonl:tlu'l:J'rfl (oulof-
hospitat cardiac anestl {itfiorurqn'jrSoun: 80-90 e1nn1?vfioonrrfioorYrtrqooYulfiuurf,ul'.1
nr:ldfinr:airdrllinrrlul:trrrururafififnunrutunr:rirfimonr:n-,lndt rYtdar:fitr:rurmrr.r
:vuvr'tcrun:i6nr:rduurr'bJqicnruvrtnuredfidnunrndrtr drril{ilrurir'louqntduluT:.tnurlrn
ydrldirnr:tirufinlouil$r$nT:flfiudrrirudr nrildi!nr:nrrnsiorda.:1u1a$g{ilrufinr r:n

n:ro6nnrrdryryrru6vr lnurqr'rrvnfiulv{flrrirlcoejr.rsiordo.llfi rrlbfi,rntuf,urtnlunr:gttn

fl:-trufrrfio.':ldirnr:tirrivr "ledrurnia'lrirunrfl'lq ttacnt:Ft:tcfieetrrnr:vti,:tutto'l':v:.tilnoriuu
Tafinarir,rsiordo.:6,:nr:oit{rJrrrflrirnr::-nurtulofigdrtflubli rftdrioultn;tuvn'rnr:tn6ou
flrafiil':unr:trinr:inurnrr{lrldru rdo}i:v:li[vn6uuTnfifiEi{n.ifr{'ruodr.rriorfia':1oufirfl'rvr.rrs

ruio,rdu'' 6o :vfi:.rnmroulofinra6fl t os finfrrlsr:ri:ar nio:;nirnrrrn'u6aTnhn r 90 fin6trst:

:or::dtt oxygen saturation saturatjon > e+"re ltrn{rhulrifafinn:ldiunr:ldviorjluvruh

ruavrirorru'le drurerio.rrjrfl rulo in?:o"x Petco, Tou1fr capnogr.phy tfiag'lilrYd'! 35-40
fiofir sn :ovl

2. nrin:r1 rdocfi :.:nr:rirtrusaffcu:ilrn riun1af; n$as?cuuil1utctfid'ht1u"lu
f udtl tfi il1cf,il (optimize card iopu I m onary f u nction) rfiatfitvu:r oftrrvii

rfrd'oJfiiurdoo$avoanfi [eilodr.:tfi a*ttna (adequate vital organ perfusion)12

1. :sl:rrncrhuuralcua:tlao (pulmonary system)
nlrftn:Jnfirat:;rurnr,r rfiuuru'tr:rrdr:loora;vna a r6ootto,Jq o,,i andrlr:ntflu

atuqraum:r,t'rtouqnrfiurduutaiu (cardiac arred) ld rdu nt:fionr:qoduso$nr{ t6urrulc

(airway obstruction) n'rrfiailidudo.':rdorirrlootfiofi[lnou (tension pneumothorax) n1:fi
nrlsrdaenroaan€rquii rfioqrnlooo'ntoradr.tluu:r uanernfnrutaonr::Jfrl'finr:rirufru6ufivr
ri,:orcrfionrrrJfto nBros:vlrrvrslrrfia16 ld6nlriirc; lfluornd'uo:ru rt,tnn (mechanical iniury)

qrnnr:nFrvrironarodr'lfin::qndlnr,rri'n rrtn{.rn::gnfirinorqfrllirfinn'rrvnrir'lutjo,:rlan tio

nrr;rlaor#rnrwtn',:nrr:iurirlo (lung contusion) nr:firirluq.:arrJan ttildu 1pulron"ry edema)

nr:.ryfi'onr:finrlrs'u'turTr'lqfio,i!ufirurfi du rdo0ernnrr;nfirilrdan*e'lefia,l6iradrurirtrufin:JnF

(left ventricular dysfunction) nr:tfinnrr: non cardiogenic pulmonary edema slttJt4o"{

n:vrrunrm:v{un'ndntdunr'#rrnru (systemic inf lammatory respond syndrome, SIRS) n1T
rfinnr':; anlriturueY? (atetectasis) rrnnr:'ldviodrurrulofinrirlillunaaoor.njoodrulprdrunfi.'r

Post-Cxrdiac Aresr Carc aiart non{ 91

(one lung intubation) rflufiu nr ru4nirrlrfisirdq'rrflufioildd:rnr:ifioagunyinuroti'r.,:r{uyirufi

y|t'rdurncrn nr:q:rcir.rnruoEironrrduourfir nrtnllenr riruf,:fila,rrloofi:J:;lusriotir,olrn'lu

nr:riruifiodunrr;oir.,rr o"lnrir':

firhufi:aafiiorornil{'ffim:fl6nudruoiri.rlrifco'nr:ldiunr:'kirio,rirafiruterfjorilunr:ri]o

ill,rrfiuvru'lrtfiTdr un:nr:1fi:lunr:tjrufiru'lesdrr0iardordrurniofliru ruh ri..rdrfiolfi{rhu

ldir-roonfirluodr.:rfiu.,rua nr:rn'nfionrlnr:vrhlrurot::rj! rn'lcardunr:n:refio"rdrp s rl:;n.rr

i. nr:fn:roilnrrrrdrdura,:aanireu'lu16aotuolsirurn?o,,r capnograpny rfiarflunr:

6uriu'jrviodruvlu'lqaaluvrr.rrdunru'lcoair'rrniq?r unvnr:tjruvrfltqeu:;o'l eetco, orilurir,r
gs-ao finfiriln: :ailtfiotrlrfifl,lyroficr :-uo nnnrrcnrru rflun:ooirrtur6ao'h{oEJ'lulnru{ilnfi

2, nr:'l"n::d'lnrrr:rflrudula,roonSuqu'lu16oo rro*rTouordu rn?ooiooon6rquiiilnrudr
(pulse oxymetry) firflrvrrrslfi:;a"l oxygen saiuration fia"rlrnn.irn?o Mrn-liouny g+ rrdoifi
ruulo'ir a r*ur ; d r,: 1 l a.rir,r n r aldfi o o n6 rcu rfi !.rl,r o

3. nl:fi:?a arteriat btood gas lnAG) rdonhnr.:n:lo::d'uoonf leu :yd'lnr5loulooonlrd

uo:nrr;n:orcirorat 16ono tir.,rnnda.r*riudr rda,,rqrnnr:n:rl:;olaan6reud'rt raiot putse
oxymetry orrfienr nnrqrndould lquroilrcrrndrhflfinrr: aaorfiooairu arunnn-.:xrn yia
fi :;d'!nrrilqlTafi no{'r iln'nrinr:n:rofi uuiud.tunr:r?-lt ABG

drnil{ilrufilfifinT :lniviorirafiru'lcuntLinlrr:orruhldd.:trnuro.rnr:ninr:tjrunru'lo
druto?omirulrrutl (mechanical ventilator) rrovninr: iurniafiirunru'lcTourirnr:rliurada,,r

0.J{u

. rJiddrniattirufirflle*:.l:l control respiraiion Tnsarlrdanifi votume controt yio

pressure control ntln?1lnu*nlatlrnndfl gIn

. If.rnir tioat votume (TV) 'lfiru rcdr.JqrrJrurndrlo,tfi:-hs 6o !::lrru 6 fi.J n,/nn,

rfianfin rdu,rnr:rfiorloao"n rouqrnnr:'lfifr:-lilro:yrfltq rflr rnrfiu'bl ns.Jdnr:nrua :ysi!nrrrJ
n'utir{nr u'le rnrhilri lnu ss rr.rir drrfinrrvrulqlfiutd vorume contror un;1 rfiu go rr.,.fr
drrit r rcrto,:ri? EJyrt'lo uul pressure control

. iran:rnr:mrutotlild minute Ventilation ltvtg firnlr: otuis.,:vlofie :erunr:yol

nrilou'looanlrd"(urdaobiaqj1urirr paco, 40-45 finfirror: ram 1quau.lo'n:rnr: ru'lorirrdu
:h:x'rru to f,.r tz efidourfi

. tfir:n'rnrrrr{l{uaanirquluolrrrr'hrdrornrnia.{liruyru'hhiadlu:lnror'riicnfi

rilour:oinur::ollaon6nulu6aouorlilrnn.j.rioan: 9+ lnuo.n6lduo.rn:vd'l riq t oo%

riouriflaon.,r1nuorrlunr:n:ro6ooru::a'u oxygen saturation drurnda.: putse oxymetry ttio
ordflnrror:re:;Fri! pao,/Fio, a1nn1:rar! eec fi,Jd::0"! no, iifro.ir:Jnani'trlunr:riruyru'h

::flyur: 6o r{rhirfluioua; oo

92 r?udldrrinqnfru51rl

. lufl01'riulriuu;rir}6riruvrltlflr-trua!tfiffn11r hvperventitation d{q:dltfi:!o'! Fbco,

oqnlua;ril'lfirfionr:root-'lto,ttdutfioonru'lun:I onfi:uv ritelnlfi:lirrrutfiootdatd o"noa.:
ua:nr:ufintdnnr:'ld positive end expiratory pressure (PEEP) lurtulofl': dlo:d.rrunlfirJilrru
rdoolrandr r{rqiri'riqnonr drtri cardiac output nnat 6rnr:td peep tun:nifiificdu nRos
un:"tfflururordrvl'r:n rfiu{r,rofiq; tfir::nir.r o,sat trlrrnn'ir g+"2" lotrlf Fio, tioun'lrioln;

60

2. :$J:iilalisu1qfin (cardiovascular system)
fi{ u:{c:ri.ililfi'fior oloan:tt otnr::*nr+T 1o ui6:Jfl nr:ril,tru1o.::c:J:iY a ll uulnfim

(hemodynamic management) tu{drudroofiiorrrdrornrJfrri6nr:druiin rrrdrdo':lrnnrufld,l
cardiac arrest o:tfioarr:nr:rnnoonfireutottdo ldodr,,r"1 ri'rirrnru rilunr:rildun:;{unaln
nr:onrdlgo.tdrtnru tfiofi retum of spontaneous circulation (ROSC) al tf,nn'l:va"lta.Jfltl
inflammatory cytokine tflonr:n:;fiun::lrunr:o-ntcutguri'rdr.:nranfirflfi'lunrr:6ancrnnr:6oLda
uonorndu-,:fina-n3runrtt dau* o'tla.r:vultntiulTnfinlu{ilrtr posfcardiac anest finfiru

nfi'rrYrfivirtu{rh16onernnrrfio tdo'n n-ttiui{oreo'rdu{orynnr:inurnn:6onqrnn't:6ntda r
tdtunr:inur:cuulnnliuulafi ntatfi til post-cardiac anest d',td

. 'hiar:rirou::nir-rtt:tou'luvoan 6asr't'r6i?unor.,t (central venous pressure, cvP) q',1

rl:;mru 8 fi.: tz fin6uortJ:or firlrfluri:ruorcdo.l'lfinr:rirrfirr6r rul cvp cvfiriro{lurixii
do.rnr:rrdr lna rarrvrdoor rvnso{n11v cardiac arrest ororfiocrnl:ndfidr cve g.:Ioilri
drr{uf,riril?rrruortir'luvnoardaa nju cardiac lamponade, pulmonary embolism, tension
pneumothorax drnf:l fllhrdfinrrvfrviru onnr::rr.r-a:;tttunrrblar:rh rfil 16r afjtnr:lfi
n1:rirarotiqrrEurlfior:rirdqrun4ficl"1rdotirulunT rdl therapeutic hypothermia

. :cn-!nrl n'ulofisrrafiu os-90 fioFr n: :oyr niodrnmrri'ufioTnfin > 90 finfitln:

:or lqunn',Jernnr:tfisr:rirru cve oqj'lurjr'r 8-12 finfiL cnd:orrrdr urnnrun"u1nfinrl.,:1ri

16er:r rflrlaurune:rior:rurl#EJr vasoactive agent cYo:rlo: tduo'tunr:r.rfi t

. nr'le::d'!nxl rdrldura.roanSreulu16onrirprri6uiurnt'it (superior vena cava O2sat.

Scvor) uia serum lactate rfro:Jr: rfiun'rr: lda tdotrnaonEteu vrnrwlt Scvo, < 70olo Y€a

serum lactate > 2 mmoyL ar:vtinr:inurmru#uslou

i; m:rrr-o cvp 6nn*'rfirrir < 12 fiff6 urnrtiovrrirnrrtricrlirour:d'u cvP > 8 -12

io6trn::ovr
e) dr:rd'rnlloi-rTnfin tadu > 90 findrln: :ovr fior:rurnolurqul norepinephrine

uia dopamine a.r

31 or:mr:d'lnrrrr{lfiur:o.r rfin rfiaqustutnt't 'jt HCT < 30% rirnr:"lfi pacreo reo

cell

Irost-Cardiac Aresr Care aiafi na,saei 93

4) vlnnlrinuirflul orrl do 1) fi,i g) ud',rf,nil!.i1 scvo, < 70% ria::o-r tactate

flfin{ (lactate clearance) riounirSoua: 10 lfialrrultfi dobutamine rdorfjlr cardiac

oulDut

nr:r,rd 1 rrao,rrurorray{anr:fier:fur16onldur vasoactive aqentsl

Epinephrine 0.1-0.5 mcg/kg/min . firj::lamilu symptomatic bradycardia
In 70 kg adult. T-35 mcg/min
fi1*lnor*uotrio atropine

. rilusrfi fi'n'luffrhu severe hypotension

I (systolic BP < 70 mmHg)

. 'ld'tufi:Jrs anapnylaxis frfi hypotension

t-"-"t^ar" 0.1-0.5 mcg/kg/min fi54 respiratory distress
In 70 kg adult, 7-35
mcg/mrn . t1iuU1fiflnlUhJ 1U severe hypotension

(systolic BP < 70 mmHg) fifi to*
"y"-

temic vascular resistance

. nr:rdon'tdludrlru severe sepsivsep-

tic shock

. n't 114 4 ; u \t n']t nL1t 4tltg'm., 'tuvar.r.r'rofl'l:u'Yl

dn [o

L 0.5 2.0 ug/kg/min (hypovolemia)
In 70 kg adult,35-'140 ug/min
[] . l4rai.ltlti1lulell,,U severe hypolension
5-10 ug/kg/min
Dopamine (systolic BP < 70 mmHg; fifi low
5- 10 ug/kg/min
Dobutamine systemic vascular resistance

. tdlufi r-hu nrr r qr-llofi ndfi nrr v

bradycardia dlrdla

. ldrdo nir cardiac output

. lt olY':{nll Lt IUDJ!1Ul4U severe

hypotension

Load 50 ug/kg over 10 min ldrfiorfi r cardiac output

then infuse 0.375 ug/kg/min 014vi{fi fi tachycardia {oun'j1

1"""* dobutamine

ofi':nr:nmrfrnnril?;!ilflnriuilnfimo.0f,,rhr.i post-oardiac arre$t n?fli'tn1?fifJfittifl

a?')rJd'ulflfisre.iruflluflxuynoa 16fla uo{ (arterial tinet vrs.ldrdotfi'ldrirnrrroulnfinfiufiqir 10fl
rorrytun:rfififirJru1d'ilur vasopressor 'lulurng,l ritnr:r-onrrrniuynon r6ootrirdrunartnjru

fl'ru central venous catheter rr ltri nlrn:red1 Scvo, lln;flttn:rorr,rfiotrlfrff n,n6u.i ntr

'lni arterial line u",tdra'lunt:nr'tq arterial blood gas LLflg serum lactate lfid'xu

94 r'rltirfninqmdug'tu

uonelndftJxunr:ldf:-rnr:snrenfiulv{flrrirh lelectrocardiogram, EcG) l4'ufifid'le1n dfi
nosc rftdriorirulunr:ifiodt nrr:nfirlrdofirlolrnrfianrduwrdu (acute coronary syndrome,

ACS) Tounlrrlr?clru ST-segment elevation vion?r lrjfruurr n\t ttllu left bundle branch block

rflu{orj,:dlunTrd.r{rhurflri:-rnrrn:roleunr:fiofierrrcvnoq16oolnl:uri (coronary angiogram,
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rnrc urnndoufirfi oirrununrr v hypotherm ia

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blocking agent