WHAT TO REVIEW TONAYT:

CPR
 Call emergency response
 Heel of 1 hand in center of chest
 Other on top
 PUSH HARD AND FAST
 100-120 Chest Compressions
 5 cycles
 30:2 Compression to breaths ratio
o Do it when clear airway
 Max of 10 seconds interruptions
 Avoid excessive ventilation (1.2-1.2)
o Bagging when intubated is given over 5-6 seconds
o Bagging when not intubated is over 1-2 seconds
o EC technique (use to secure ambu bag)
 Stop CPR when
 CODE BLUE:
o Check if scene is safe
o Assess patient
 BP
 Any Clinical Deterioration
 SBAR Format
 Situation, Background, assessment, request
 Pinch shoulders to assess LoC
o Bring E-CART
 1 - medication
 2 - pedia supplies
 3 - syringe
 4 - Tubings
 5 – airway
 6 – IV Fluids
 Tell team assessment to the patient
 Priorities; Compression, Airway, Breathing (compression, ABC’s)
 Can’t halt CPR 10 seconds at any point during procedure
 ECG; White- Right Shoulder, Black – Left, Red – Lower Right, Green – Lower Left, Brown - Center
ECG Readings
 Cardiac arrest – no pulse, no breathing, no response
 Heart Attack - +pulse, +breathing, +response
 Normal: p-wave, QRS wave, t-wave
 SHOCKABLE
Madame or kaunti p
No p wave, ful QRS, ventricular
- Pulseless ventricular tachycardia cardiac arrhythmia in which coordinated ventricular
contractions are replaced by very rapid but ineffective contractions
- Ventricular fibrillation (V-fib) is a dangerous type of arrhythmia, or irregular heartbeat.
NONSHOCKABLE
- Pulseless electrical activity (PEA) cardiac arrest in which the electrocardiogram shows a heart
rhythm that should produce a pulse, but does not
- ASYSTOLE is Flatline
TLDR; SHOCK is when heart if functioning but irregular, NONSHOCK if heart has no activity

SHOCKABLE RHYTHM
 Defibrillation
 Call medical team
 Code
NON-SHOCKABLE RHYTHM
 Epinephrine every 3-5 mins
 Amiodarone for refractory Ventricular fibrillation/Primary ventricular fibrillation

Bradycardia - abnormally slow heart rate that is less than 60 beats per minute
Tachycardia - a heart rate of more than 100 beats per minute (BPM) is considered too fast.

MEDICATION
- Atropine – for symptomatic bradycardia; 1mg, 3-5 mins intervals, 3mg max allowed
- Dopamine and epinephrine – second line for symptomatic bradycardia; improve health status
overreaching a target heart rate
- Epinephrine – drug use in cardiac arrest; vasoconstrictive effect, increases cardiac output.
ADENOSINE – for supraventricular tachycardia
ATROPINE – 0.5 – 1mg
Amiodarone
- 1st dose 6mg =
- 2nd dose 12 mg =
- 3rd dose 12 mg 10 – 20ml NSS
BETA BLOCKERS – Used for supraventricular and ventricular arrhythmias
- ESMOLOL 0.5mg
- LABETALOL 10mg slow IV push 1-2 mins
DIGOXIN 0.5 – 1mg
- Slow SA node (electrical impulses to stimulate contraction) and shortens atrial refectories
Drugs for PULSELESS CARDIAC ARREST
- Epinephrine
- Amiodarone
- Lidocaine
norepinephrine dobutamine, dopamine, terlipressin – give to increase BP,
increase perfusion
 2mkm/hr for norepi
 20mkm/hr for dobu and dopa
 Atropine0.5-1mg, dopamine5-20mg, epinephrine 2-10mcg for symptomatic
bradycardia
BETA BLOCKERS
 ESMOLOL 0.5mg/ SIVP
 LABETOLOL 10mg SIVP
Stop cpr when:
 Changing roles
 Intubation
 Checking ng pulse, breathing and rhythm
 defibrillation
 putting cardiac board
4 chambers
P wave - atrium