ICU Advantage: Cardiac Arrest Algorithm

Introduction

• Presenter: Eddie Watson
• Objective: Simplify complex critical care topics for better understanding
• Goal: Build confidence in handling ICU cases

Overview of ACLS Algorithms

• Developed by the American Heart Association (AHA)
• Designed to manage cardiovascular emergencies
• Focus on arrhythmias
• Proper ECG interpretation is critical

Cardiac Arrest Algorithm

• Purpose: Manage pulseless patients in cardiac arrest
• Possible Arrhythmias:
  • Ventricular Tachycardia (VT or V-tac)
  • Ventricular Fibrillation (V-fib)
  • Pulseless Electrical Activity (PEA)
  • Asystole
• ECG rhythm assessment is essential

Initial Response

• Call for help: Activate emergency response
• Begin CPR
• Provide Oxygen and Ventilatory Support
• Attach ECG Monitor and Defibrillator

Shockable vs Non-Shockable Rhythms

• Shockable Rhythms: V-fib and pulseless V-tac
• Non-Shockable Rhythms: PEA and Asystole

Left Branch: Shockable Rhythms

1. Deliver Shock
   • Joules: 120-200 (biphasic)
2. Immediate CPR
   • Duration: 5 cycles or 2 minutes
3. IV/IO Access
4. Rhythm Check: Determine if shockable
5. Repeat Process
   • Increase joules for subsequent shocks
6. Administer Epinephrine
   • Dose: 1 mg IV push, flush with 10-20 mL
   • Repeat every 3-5 minutes
7. Consider Advanced Airway & Capnography
8. Administer Amiodarone
   • First dose: 300 mg IV push
   • Second dose: 150 mg IV push

Right Branch: Non-Shockable Rhythms

1. Immediate CPR
2. IV/IO Access
3. Administer Epinephrine
   • Continue every 3-5 minutes
4. Rhythm Check: Assess for ROSC or shockable rhythm
5. Treat Reversible Causes

Progression Between Branches

• Transition possible between shockable and non-shockable rhythms
• Continue process until ROSC, a non-shockable rhythm appears, or the code is called

Practical Scenario Walkthrough

1. Initial Assessment: No breathing/pulse, start CPR
2. Shockable Rhythm Detected: Deliver shock, resume CPR
3. Administer Medications: Epinephrine and Amiodarone as needed
4. Monitor Changes: Constant rhythm checks
5. ROSC Detected: Transition to post-cardiac arrest care

Conclusion

• Practice and Mastery: Regular review of AHA guidelines post-certification is crucial
• Confidence in Emergencies: Quick decision-making is essential
• Community Support: Engage with other learners and professionals for enhanced learning

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