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  • image High-quality cardiopulmonary resuscitation (CPR) with minimal interruptions in chest compressions should be emphasized in all patients following cardiac arrest.
  • image The AHAalgorithm for basic life support following cardiac arrest now emphasizes circulation, airway, and breathing forming the pneumonic “CAB” versus the historic pneumonic “ABC.”
  • image The purpose of using vasopressor therapy following cardiac arrest is to augment low coronary and cerebral perfusion pressures encountered during CPR.
  • image Despite several theoretical advantages with vasopressin, clinical trials have not consistently demonstrated superior results over that achieved with epinephrine.
  • imageAmiodarone remains the preferred antiarrhythmic during cardiac arrest with lidocaine considered as an alternative.
  • image Successful treatment of both pulseless electrical activity (PEA) and asystole depends almost entirely on diagnosis of the underlying cause.
  • image Intraosseous administration is the preferred alternative route for administration if IV access cannot be achieved.

On completion of the chapter, the reader will be able to:

  1. Discuss the most common causes of cardiac arrest in both adult and pediatric patients.

  2. Define each component of the “chain of survival,” and apply this concept to a victim of cardiac arrest.

  3. Discuss the importance of electrical defibrillation and its effect on survival for a patient with VF or PVT.

  4. Compare and contrast the principles of cardiocerebral resuscitation with cardiopulmonary resuscitation.

  5. Formulate a pharmacologic treatment plan for a patient with ventricular fibrillation or pulseless ventricular tachycardia.

  6. Compare and contrast the different sympathomimetic agents used to treat ventricular fibrillation or pulseless ventricular tachycardia.

  7. Discuss the role of vasopressin for a patient with cardiac arrest.

  8. Describe the role of antiarrhythmic agents in a patient with ventricular fibrillation or pulseless ventricular tachycardia.

  9. Discuss the role of therapeutic hypothermia for a comatose patient following cardiac arrest.

  10. List the common correctable causes of PEA and asystole.

  11. Formulate a pharmacologic treatment plan for a patient with pulseless electrical activity or asystole.

  12. Discuss the role of sodium bicarbonate for a patient with cardiac arrest.

  13. Cite the doses of the drugs used to treat a cardiac arrest.

  14. Discuss strategies for drug administration if IV access cannot be obtained.

  15. Describe the treatment of cardiac arrest as it applies to special situations such as drowning, hypothermia, pregnancy, trauma, and electrical shock.

  16. Discuss treatment strategies that pertain to postresuscitative care following a cardiac arrest.

  17. Formulate a monitoring plan for the postresuscitation phase of cardiac arrest.

Cardiac arrest is defined as the cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation (e.g., a detectable pulse, unresponsiveness, and apnea).1 While there is wide variation in the reported incidence of cardiac arrest, it is estimated that there are 350,000 people in North America each year who suffer a cardiac arrest and receive attempted resuscitation.2 Approximately half of those are in an outpatient setting. Unfortunately, survival rates have not significantly improved over 30 years, ranging between 6.7% and 8.4%, despite enormous efforts in research and development.3 Survival following in-hospital cardiac arrest is somewhat higher (approximately 18%), with higher rates being observed in ...

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