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Cardiac Arrest and Hs and Ts

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Foreign i will be reviewing cardiac arrest algorithm and hsnts once the patient is identified unresponsive not breathing and without a pulse immediate cpr is initiated with addition of supplemental oxygen in connection to the monitor defibrillator as soon as possible after connecting the fibrillator we can analyze the rhythm that will take us down one of the

Two pathways one of them is ventricular tachycardia ventricular fibrillation where the heart rhythm cannot produce a pulse immediate defibrillation is required with 120 to 200 joules on biphasic defibrillator and from 200 to 360 joules on on a basic defibrillator after the fibrillation immediate cpr is required even if defibrillation is successful the heart

At this point is likely to need the support of the cpr after the first shock if not already established iv or i o axis is recommended to be placed recommendations for cpr are 30 compressions to two ventilation if not intubated for two minutes then rhythm check and pulse check once patient is intubated it is continued cpr for two minutes with one breath every 6

Seconds then rhythm and pulse check this can be done simultaneously and it will not interfere with the reading if ventricular fibrillation or ventricular tachycardia is still present shock is advised with 200 to 360 joules after second shock cpr recommended to be resumed immediately and one milligram of epinephrine can be given one milligram of epi can be given

Every three to five minutes considerations for advanced airway and connection to capnography can be made at this time capnography is a very useful tool during the code where capnography can provide information on effectiveness of compression and return of spontaneous circulation after two minutes of cpr poles and rhythm check is done if ventricular fibrillation

Or ventricular tachycardia is still present shock is advised after delivery of the shock and resuming of the cpr two medications are considered amiodarone and lidocaine both come the myocardium and stabilize electrical membrane can be given first dose 300 milligrams and second dose 150 milligrams lidocaine is weight based it is first dose one milligram to 1.5

Milligram per kilogram of body weight subsequent doses are 0.5 to 0.75 milligrams per kilogram of body with a maximum dose of 3 milligrams per kilogram that is the first dose if it’s one milligram and the four additional doses of 0.5 milligrams per kilogram of body are possible while alternating with epinephrine if at any pulse check and rhythm check there is a

Systole or pulseless electrical activity on the monitor then pathway of the algorithm is changed to second pathway assistively both the electrical activity where there is no shocks a murderone or light a key only delivery of compressions and epinephrine every three to five minutes so following the second pathway from the beginning if after initiating the cpr and

Determining the initial rhythm on defibrillator as acystole or pulses electrical activity which is a rhythm that should produce a pulse but it doesn’t one milligram of epi is given and cpr is continued at this point ivio access is placed if not already established and consideration for advanced airway is made with connection to capnography after two minutes second

Pulse and rhythm check is made if assistedly or postless electrical activity persists just cpr is continued it is important to determine the reversible causes at this point and treated reversible causes can be classified in several ways one of them is h’s and t’s under h’s category of possible causes that led to pulseless electrical activity or assistally the

First on the list is hypoxia diagnosis can be supported by frequent airway issues desaturations bradycardia cyanosis treatment is effective airway such as endotracheal 2 supplemental oxygen and bag mass ventilation it is hypovolemia diagnosis can be supported by trending low blood pressures narrow qrs rapid heart rate black neck veins it is treated by stopping

The loss of fluids administration of supplemental fluids and consideration of possible vasopressors next is high hydrogens ions which is the acidosis diagnosis can be supported by abgs low amplitude qrs complexes and treatment will be with bicarbonate and ventilations this is hyperkalemia diagnosis can be supported by labs hit t wave white qrs’s cramps renal

Failure and diabetes it is treated with calcium chloride calcium chloride stabilizes the cell membrane it does not have any effect on serum potassium level insulin with ample for d50 will push the potassium into the cells as well as albuterol and sodium bicarb they promote temporary potassium shift from extracellular to intracellular space however later treatment

To lower potassium may be dialysis loop diuretics and k axillate next is hypokalemia diagnosis is supported by labs low t wave u wave white qrs complex cramps and history of diuretic use and is treated with magnesium magnesium helps retain potassium in the body it prevents loss of potassium in urine and gi tract next is hypothermia diagnosis is supported by

Low temperatures below 35 celsius osborne wave which is depicted over here this little bump next to the qrs is the osborne way other signs and symptoms are slow or absent heart rate during hypothermia electrical activity of the heart slows down pacemaker cells fire less and less eventually heart stops treatment is rewarming in a controlled way with such tools

Such as bear hugger warm iv fluids increasing room temperature is helpful and warm blankets now on the teas tension pneumothorax is diagnosed by difficulty ventilating with a bag valve mask or through the endotracheal tube absent lung sounds on one side and tracheal deviation also by chest x-ray treatment is with needle decompression second intercostal space

Midclavicular line and placement of the chest tubes next is pulmonary and coronary thrombosis diagnosed with electrocardiogram x-ray ultrasound uh ct treated with a surgical embolectomy or strong thrombolytics such as tpa cardiac tamponade diagnosed with muffled heart sounds narrow complex qrs’s rapid heart rate ultrasound such as echo or pericardial sac and

Is treated with needle decompression pericardiocentesis uh 20 cc’s of clear fluid is a good result and if it’s bloody it’s bad toxins can be the cause of pulseless electrical activity such as cat overdose of calcium channel blockers and digoxin tricyclic antidepressants uh treat it with antidotes per taxidrome that could be supplemental calcium for calcium channel

Blockers fluids with glucagon for beta blockers digoxin immunophob for digoxin and sodium bicarb for trans cyclic antidepressants two emerging trends focused on using measurements of qrs and ultrasound at the bedside during the code to locate the cause of the also’s electrical activity or system such as hypovolemia obstruction or hard and electrolyte problem

If the qrs is narrow then it is more likely a problem outside the heart such as hypovolemia or obstruction and the heart itself is functioning appropriately absorptions such as pulmonary embolism tension pneumothorax cardiac tamponade or hypovolemia if the qrs is wide or the electrocardiogram itself is abnormal then it is more likely hypoxia abnormal potassium

Levels acidosis drugs myocardial infarction hypothermia that is effective if the qrs was not wide from the past medical history ultrasound is used to determine to differentiate between pulmonary embolism from hypovolemia and cardiac tamponade foreign is also important the likelihood that what brought them to the hospital could be the cause of postless electrical

Activity is high here are some examples end-stage renal disease possible cause is acidosis high potassium levels pericardial effusion nausea and vomiting possible causes hypovolemia electrolyte imbalance low potassium alkalosis gi bleeding possible causes hypovolemia status asthmaticus possible cause is hypoxia patients with copd on a ventilator possible causes

Tension pneumothorax from ruptured lung trauma patient hypovolemia tension pneumothorax cardiac tamponade fat embolism psych history tricyclic antidepressants overdose history of atrial fibrillation possible cause could be digoxin overdose calcium channel blocker overdose after all this said all of this information is for consideration and educational purposes

Only and different facilities policies should be followed so you just made it to the end of the video if you found the video useful please click that like button i hope you enjoyed it thank you thank you for watching and i wish you great success

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Cardiac Arrest and Hs and Ts By Seva Sobol