A-Textbook-of-Clinical-Pharmacology-and-Therapeutics-5th-edition

220 CARDIAC DYSRHYTHMIAS
Unresponsive
Open airway
look for signs of life
CPR 30:2
Until defibrillator/monitor attached
Call
resuscitation
team
Assess
rhythm
Shockable
(VF/pulseless VT)
Non-shockable
(pulseless electrical
activity/asystole)
1 Shock
150–360 J biphasic or
360 J monophasic
During CPR:
• Correct reversible causes*
• Check electrode position and
contact
• Attempt/verify:
i.v. access
airway and oxygen
• Give uninterrupted
compressions when airway secure
• Give adrenaline every 3–5 mins
• Consider: amiodarone, atropine,
magnesium
Immediately resume:
CPR 30:2
for 2 min
Immediately resume:
CPR 30:2
for 2 min
*Reversible causes
Hypoxia
Tension pneumothorax
Hypovolaemia
Cardiac tamponade
Hypo/hyperkalaemia/other metabolic disturbance Toxins
Hypothermia
Thrombosis (coronary or pulmonary)
Figure 32.2: Adult advanced life support.
(Redrawn with permission from the
European Resuscitation Council
Guidelines, 2005.)
and check that the chest falls between respirations. If available,
100% oxygen should be used.
Check for a pulse by feeling carefully for the carotid or
femoral artery before diagnosing cardiac arrest. If the arrest
has been witnessed, administer a single thump to the precordium.
If no pulse is palpable, start cardiac compression
over the middle of the lower half of the sternum at a rate of
100 per minute and an excursion of 4–5 cm. Allow two breaths
per 30 chest compressions. Drugs can cause fixed dilated
pupils, so do not give up on this account if drug overdose is a
possibility. Hypothermia is protective of tissue function, so do
not abandon your efforts too readily if the patient is severely
hypothermic (e.g. after being pulled out of a freezing lake).
Mobilize facilities for active warming.
ADVANCED LIFE SUPPORT
Basic cardiopulmonary resuscitation is continued throughout as
described above, and it should not be interrupted for more than
10 seconds (except for palpation of a pulse or for administration
of DC shock, when personnel apart from the operator must
stand well back). ‘Advanced’ life support refers to the treatment
of cardiac dysrhythmias in the setting of cardiopulmonary