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16. Secondary A,B,C,D
1. Primary confirmation
1. Visualizes ETT goes through the
vocal cords
2. Observes vapors in the tube
3. Chest rise
4. 5 point auscultation of the chest
19. Secondary A,B,C,D
– Circulation
1. Establish IV access
2. Identify rhythm monitor
3. Administer drugs
4. “appropriate for rhythm and
condition”
20. Simultaneous recording of aortic diastolic (red) and right atrial (yellow) pressures during CPR in
which 2 ventilations are delivered within 4-second time period
Ewy, G. A. Circulation 2005;111:2134-2142
43. How to give the medication
during CRP?
• I.V. • E.T.T
– Fast I.V. Bolus.
– 2-3 times the I.V. dose
– 10 cc N.S. flush.
– Raise the arm. – Diluted 10cc N.S.
– Use central venous – 3-4 ambo-bag “to
access if it available. diffuse the medication”
45. Which Meds can be given
through E.T.T?
NAVEL
Naloxon Atropine Vasopressin Epinephrine Lidocaine
46. Epinephrine
• Action : α & β – adrenergic agonist activity
• Indication: all Pulseless rhythms.
• Dose:
• initial dose 1mg ( 10mL of 1:10 000 solution )
• Additional doses of 1mg every 3- 5 min
• No maximum dose.
• Precautions:
• PVC with digitalis.
• Hypertension
• Myocardial ischemia
47. Vasopressin
• Survival higher in patients who had higher endogenous
vasopressin 1,2
• Action :
• Vasoconstriction by direct stimulation of the smooth
muscle V1 receptor.
• Combination with epinephrine resulted in decreased
cerebral perfusion 3
• increase coronary perfusion and cerebral oxygen
delivery during CPR 4
• Has no β – adrenergic activity.
• Indication: all Pulseless rhythms.
• Dose:
– Start with 40 units I.V. once.
– Don’t combine with epinephrine
48. Vasopressin & Epinephrine
no statistically significant differences between
vasopressin and epinephrine
for death within 24 hrs or death before hospital discharge after a
successful CPR.
• There is thus insufficient evidence to support or refute the
use of vasopressin as an alternative to or in combination
with epinephrine in any cardiac arrest rhythm.
49. Atropine
– Action : vagolytic action “SA and AV node”
– Indication: asystole & PEA with rhythm < 60/min .
– Dose:
– initial dose 1 mg
– Additional doses every 3-5 min
– max dose 3 mg/Kg
– Precautions:
– Myocardial ischemia
50. Amiodarone
– Action : Na+, K+, Ca++ channel blocker and α & β Blocker.
– Indication: shock refractory VF/ Pulseless VT.
– Dose:
– initial dose 300 mg bolus
– Additional doses of 150 mg/kg
– Infusion dose of
– 1 mg/min for 6 Hr ( 360 mg ) then
– 0.5 mg/min for 18 Hr ( 540 mg )
– Maximum dose of 2.2 Gram / 24 Hr
– Precautions:
– Prolonged QT.
– Hypotension
– Negative Inotrope
54. Medications
Medication 2005 changes
Epinephrine •No change
Vasopressin •All pulseless rhythms
•Can be used in E.T.T
Atropine •Maximum dose 3 mg
Amiodarone •No changes
Lidocaine •No changes
55. References
• Aung K, Htay T. Vasopressin for cardiac arrest: a systematic review and
meta-analysis. Arch Intern Med 2005:17-24
• 2005 International Consensus Conference.Circulation 2005;112:III-29
• Linder KH, Strohmenger HU, Ensinger H, Hetzel WD, Ahnefeld FW,
Georgieff M, Stress hormone response during and after cardiopulmonary
resuscitation. Anesthesiology 1992;77:662-668
• Linder KH, Haak T, Keller A, Bothner U, Lurie KG, Release of
endogenous vasopressors during and after cardiopulmonary
resuscitation. Heart 1996;75:145-150
• Wenzel V, Linder KH, Augenstein S, Prengel AW, Strohmenger HU,
Vasopressin combined with epinephrine decreases cerebral perfusion
compared with vasopressin alone during cardiopulmonary resuscitation in
pigs. Stroke. 1998;29:1462-1467: discussion 1467-1468.
• Babar SI, Berg RA, Hilwig RW, Kern KB, Ewy GA Vasopressin versus
epinephrine during CPR: a randomized swine outcome study.
Resuscitation 1999; 185-192
• Linder KH, Dricks B, Strohmenger HU, Prengel AW, Lindner IM, Lurie
KG, Randomized comparison of epinephrine and vasopressin in patients
with out of hospital VF. Lancet. 1997; 349: 535-537
56. References
• Kudenchuk PJet al. Amiodarone for resuscitation after out-of-hospital
cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999:871-878
• Dorian P et al. Amiodarone as compared with lidocaine for shock-resistant
ventricular fibrillation. N Engl J Med 2002:884-90
• 2005 International Consensus Conference.Circulation 2005;112:III-17
• Paul Dorian, et al. NEJM 2002 Amiodarone as Compared with Lidocaine for
Shock-Resistant Ventricular Fibrillation