Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ 4 rhythms produce pulseless cardiac arrest: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electrical activity (PEA), & asystoleKey elements to survival (chain of survival) in patient with cardiac arrest (JAMA 1984;251:1723) Early access; early cardiopulmonary resuscitation (CPR): compressions, airway, breathing (CAB) (Circulation 2010; 122:S250); early defibrillation (10% ↓ in successful intervention for every 1min delay); early advanced cardiac life support (ACLS)Other elements associated with survival Location of cardiac arrest: in-hospital > community (3–4-fold delay in initiation of pharmacotherapy for community cardiac arrest); witnessed > unwitnessedInitial cardiac rhythmPreexisting medical conditionsAdult cardiopulmonary arrest usually results from an arrhythmia secondary to thrombosis or pulmonary embolismGoals of ACLS: sustained return of spontaneous circulation (ROSC), limiting end-organ damage, survival to hospital dischargeRole of drug therapy: enhance chance of ROSC, facilitate defibrillationPrompt delivery of CPR followed by defibrillation ↑ survival in patients with pulseless VT/VF ++Table Graphic Jump LocationTable 5-1 Hemodynamic ParametersView Table|Favorite Table|Download (.pdf)Table 5-1 Hemodynamic ParametersParameterAbbreviationNormal ValuesMeasured ParametersSystolic blood pressureSBP120mmHgDiastolic blood pressureDBP80mmHgCardiac outputCO4–6L/minHeart rateHR60–100bpmPulmonary capillary wedge pressurePCWP6–12mmHgCentral venous pressureCVP1–6mmHgBody surface areaBSA1.73m2ParameterAbbreviationFormulaNormal ValuesCalculated ParametersMean arterial pressureMAPMAP = 1/3 (SBP – DBP) + DBPMAP = CI × SVRI90mmHgCardiac outputCOCO = HR × SV4–6L/minCardiac indexCICI = CO/BSA2.5–4L/min/m2Systemic vascular resistanceSVRSVR = [(MAP – CVP) × 79.9]/CO770–1500dyne × s/cm5Systemic vascular resistance indexSVRISVR = [(MAP – CVP) × 79.9]/CI1200–2500dyne × s/cm5 × m2 ++Table Graphic Jump LocationTable 5-2 Evidence-Based Treatment Recommendations (Circulation 2005;112:IV1–203)*View Table|Favorite Table|Download (.pdf)Table 5-2 Evidence-Based Treatment Recommendations (Circulation 2005;112:IV1–203)*RecommendationImmediate bystander CPR(Class I)Perform high-quality CPR with minimal interruption in chest compressions & defibrillationEpinephrine(Class IIb)Administer 1mg IV/IO Q3–5min in patients with VF, PVT, PEA, or asystoleVasopressin(Class indeterminate)40 units IV/IO can replace 1st or 2nd dose of epinephrine in patients with VF, PVT, or asystole; insufficient evidence for use in PEAAmiodarone(Class IIb)300mg IV/IO can be followed by 150mg IV/IO in patients with VF/PVT unresponsive to CPR, shock & a vasopressorLidocaine(Class indeterminate)Alternative if amiodarone unavailable in patients with VF/PVTInitial dose is 1–1.5mg/kg IV; additional doses of 0.5–0.75mg/kg can be administered at 5- to 10-min intervals to a maximum dose of 3mg/kg if VF/PVT persistsMagnesium(Class IIa)Recommended for VF/PVT caused by torsades de pointes; give 1–2g diluted in 10mL D5W IV/IO push over 5–20min; clinical studies have not demonstrated a benefit when Mg2+ routinely administered during CPR without TdPThrombolysis(Class IIa)Consider on case-by-case basis when pulmonary embolism is suspectedTherapeutic hypothermia(Class IIa)(Class IIb)Implement in unconscious adult patients with ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options