Wear PPE, limit the number of people and consider proper resuscitation
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- Attention to the proper use of PPE during care provision; |
- Limit the number of people who will perform the service; |
- Assess patients who are eligible for reanimation. |
Start CPR, provide oxygen, install monitor/ defibrillator and prepare for intubation
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- Start CPR if there is no pulse and ventilation. Perform cycles of 30 chest compressions for every two ventilation periods of one second each, using an AMBU mask with a HEPA filter. |
- Or perform continuous chest compressions at a rate of 100/minute using a facial mask with passive oxygenation. |
- Check the CRA rhythm as soon as possible. |
- Prepare the material for invasive airway passage as soon as possible. |
Check the heart rate
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- If a shockable heart rate is detected (ventricular fibrillation - VF and pulseless ventricular tachycardia - VT), deliver a shock using a two-phase defibrillator of 120-200J energy level or a single-phase defibrillator of 360J energy level. |
- Non-shockable rhythm (asystole and pulseless electrical activity). |
Prioritize orotracheal intubation
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- Stop chest compressions during intubation, minimize interruptions considering ten-second intervals. |
- Prioritize professionals with more experience to perform the procedure and consider using videolaryngoscopy, if possible. |
- If the procedure fails, consider using a supraglottic device or an AMBU mask with a HEPA filter. |
- Minimize disconnection of devices to limit aerosolization, connect to a ventilator with a HEPA filter as soon as possible. |
- Consider using waveform capnography to confirm the procedure. |
- Provide a ventilation period every six seconds (ten ventilation periods/minute) with continuous compressions. |
VF/pulseless VT
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- After the first shock, resume chest compressions immediately. |
- Provide venous or intraosseous access. |
- After two minutes of CPR, check the heart rate and, if VF or pulseless TV is observed, perform new defibrillation. |
- Resume CPR for two minutes, consider chest compressions with a mechanical device. |
- Use 1 mg epinephrine IV or IO during the second cycle of CPR and consider it every 3-5 minutes. |
- After two minutes of CPR, check the heart rate and, if VF or pulseless TV is observed, perform new defibrillation. |
- Use 300 mg amiodarone (1st dose) IV or IO in the third cycle of CPR and after 3-5 minutes consider the second dose of 150 mg, or lidocaine, first dose 1-1.5 mg/kg and second dose 0.5-0.75 mg/kg. |
- Continue the service while VF/pulseless VT is observed then, check the rhythm, deliver a shock, perform CPR and give medications, considering the medication interval and maximum antiarrhythmic dose. |
- Treat the reversible causes of CRA: hypovolemia, hypoxia, acidosis (H+), hypo or hyperkalemia, hypothermia, pulmonary tension, cardiac tamponade, toxics, pulmonary thrombosis, and coronary thrombosis. |
Asystole and PEA
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- After the first shock, resume chest compressions immediately. |
- Provide a venous or intraosseous access. |
- Use 1 mg epinephrine IV or IO during the second cycle of CPR and consider it every 3-5 minutes. |
- Treat the reversible causes of CRA. |
Return of spontaneous circulation (ROSC)
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- If the patient shows return of spontaneous circulation, perform post-CRA care: consider a proper airway and fixation, check the position using waveform capnography, check vital signs, consider fluid replacement and use of vasoactive drugs, provide laboratory tests, perform chest radiography and electrocardiogram, consider temperature control (32-36ºC for at least 24h) if the patient is unconscious. |