Shock, Shock, Shock Everybody Shock AHA 2015 Scien8fic Update. Kelly Counts, ACNP-BC, FNP-C Washington University of St. Louis Emergency Services
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1 Shock, Shock, Shock Everybody Shock AHA 2015 Scien8fic Update Kelly Counts, ACNP-BC, FNP-C Washington University of St. Louis Emergency Services
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3 Objec8ves Review scien8fic updates that will impact cardiopulmonary resuscita8on and emergency cardiovascular care. Discuss how the changes will impact our daily prac8ce. Iden8fica8on of the new 2015 AHA guidelines for opioid overdose
4 Back in the day. The ACLS guidelines were first published in 1974 squad , 1986, Chain of Survival and AED :2 & Stroke Guidelines 2010 CAB 2015
5 Dispatcher Recogni8on Out of Hospital Cardiac Arrest (OHCA) CHAIN OF SURVIVAL Ac8va8on Recognize unconscious with abnormal or agonal respira8ons Chest compression only CPR to callers
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7 Compressions 2010 Early CPR 100 compressions/minute compressions/minute 2010 Depth of compression of at least Depth of compression of at least 2, while avoiding excessive depths > 2.4
8 Ancillary Devices for CPR Impedence Threshold Devices-àOUT Thumpers.Bands.Not Recommended
9 V
10 Opioid Overdose CAB before Narcan If vic8m responds to Narcan s8ll transport Empiric administra8on of Narcan IM or IN
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12 Opioid-Associated Life-Threatening Emergency (Adult) Algorithm New 2015 Assess and activate. Check for unresponsiveness and call for nearby help. Send someone to call and get AED and naloxone. Observe for breathing vs no breathing or only gasping. Begin CPR. If victim is unresponsive with no breathing or only gasping, begin CPR.* If alone, perform CPR for about 2 minutes before leaving to phone and get naloxone and AED. Administer naloxone. Give naloxone as soon as it is available. 2 mg intranasal or 0.4 mg intramuscular. May repeat after 4 minutes. Does the person respond? At any time, does the person move purposefully, breathe regularly, moan, or otherwise respond? Yes Stimulate and reassess. Continue to check responsiveness and breathing until advanced help arrives. If the person stops responding, begin CPR and repeat naloxone. No Continue CPR and use AED as soon as it is available. Continue until the person responds or until advanced help arrives. *CPR technique based on rescuer s level of training American Heart Association
13 Acute Coronary Syndrome Pre-hospital 12 lead ECG should be acquired early for pa8ents with possible ACS Computer generated interpreta8on..good or bad? MONA. O Reperfusion <120 minutes
14 Pediatrics RATE same as adults Too much fluid may be bad Premedica8ng with atropine prior to intuba8on Amiodarone OR lidocaine acceptable for VF/ VT
15 Cardiac Arrest in Pregnancy: Provision of CPR 2015 (Updated): Priori8es for the pregnant woman in cardiac arrest are provision of highquality CPR and relief of aortocaval compression. If the fundus height is at or above the level of the umbilicus, manual lem uterine displacement can be beneficial in relieving aortocaval compression during chest compressions (Old): To relieve aortocaval compression during chest compressions and op8mize the quality of CPR, it is reasonable to perform manual lem uterine displacement in the supine posi8on first. If this technique is unsuccessful, and an appropriate wedge is readily available, then providers may consider placing the pa8ent in a lem lateral 8lt of 27 to 30, using a firm wedge to support the pelvis and thorax. Why: Recogni8on of the cri8cal importance of high-quality CPR and the incompa8bility of the lateral 8lt with high-quality CPR has prompted the elimina8on of the recommenda8on for using the lateral 8lt and the strengthening of the recommenda8on for lateral uterine displacement.
16 Summary hops://eccguidelines.heart.org/index.php/ circula8on/cpr-ecc-guidelines-2/ NEW Web-Based Integrated Guidelines Con8nuously updated instead of every 5 years Renewal maybe more frequent than every 2 years Faster Deeper SAVES LIVES
17 References hop:// PMC / hop://circ.ahajournals.org/content/102/ suppl_1/i-1.full hop:// p1644.html hops://eccguidelines.heart.org/index.php/ circula8on/cpr-ecc-guidelines-2/
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