Emergency and Critical Care Pocket Guide
CPR: Adult, Child, or Infant
?Unresponsive? (Not breathing, or only gasping
Call for assistance—have someone get defibrillator/AED
Check pulse within 10 seconds (If present, give breath every 5–6 seconds; check pulse every 2 minutes)
IF NO PULSE
Position patient supine on hard, flat surface
Begin chest compressions, 30:2, push hard and fast ≥100/ minutes, allow full chest recoil—minimize interruptions
Open airway: head-tilt/chin-lift, ventilate × 2(avoid excessive ventilations)
Attach AED to adult (and child >1 year old).
■ Resume CPR immedi
■ Ately for 2 minutes
■ Initiate ALS interventions
■Check rhythm every 2 minute
ACLS Algorithm
NOTE: Not all patients require the treatment indicated by these algorithms. These algorithms assume that you have assessed the patient, started CPR where indicated, and performed reassessment after each treatment. These algorithms also do not exclude other appropriate interventions that may be warranted by the patient’s condition
Treat the patient, not the ECG
ACLS
■ Cardiac Arrest During PCI
■Consider mechanical CPR
■Consider emergency cardiopulmonary bypass
■ Consider cough CPR
■Consider intracoronary verapamil for reperfusioninduced VT
■ Cardiac Tamponade Cardiac Arrest
■ Consider emergency pericardiocentesis
■Consider emergency department thoracotomy
■Drowning Cardiac Arrest
■ Begin rescue breathing ASAP
■ Start CPR with A-B-C (airway and breathing first)
■Anticipate vomiting (have suction ready)
■Attach AED (dry chest off with towel)
■Check for hypothermia
■Use standard BLS and ACLS
■Electrocution Cardiac Arrest (Respiratory arrest is common)
Is the scene safe ?
■ Triage patients and treat those with respiratory arrest or cardiac arrest first
■Start CPR
Stabilize the cervical spine
■ Attach AED
■ Remove smoldering clothing
■Check for trauma
■Use large bore IV catheter for rapid fluid administration
■ Consider early intubation for airway burns
■ Use standard BLS and ACL
■ Pulmonary Embolism Cardiac Arrest (PEA is common)
■ Use standard BLS and ACLS
■ Perform emergency echocardiography
■Consider fibrinolytic for presumed PE
■ Consult expert
■ Consider percutaneous mechanical thrombectomy or surgical embolectomy
■Trauma Cardiac Arrest Consider reversible causes
■ Stabilize cervical spine
■Jaw thrust to open airway
■Direct pressure for hemorrhage
■ Perform standard CPR and defibrillation
■Use advanced airway if BVM inadequate (consider cricothyrotomy if ventilatio impossible)
■ Administer IV fluids for hypovolemia
■Consider resuscitative thoraco tomy
Reversible Causes
■ Hypoxia
■ Acidosis
■ Hypovolemia
■Toxins
■ Coronary thrombosis
■Cardiac tamponade
■Hyper-hypokalemia
■Hypothermia
■ Pulmonary thrombosis
■ Tension pneumothorax
Commotio Cordis”: a blow to the anterior chest causing VF
■ Prompt CPR and defibrillation
■ Use standard BLS and ACLS
Hypothermia
■ Remove wet clothing and stop heat loss (cover with blankets and insulatingequipment)
■Keep patient horizontal
■Move patient gently, if possible; do not jostle
■ Monitor core temperature and cardiac rhythm
■ Treat underlying causes (drug overdose, alcohol, trauma, etc.) simultaneously with resuscitation
■ Check responsiveness, breathing, and pulse If Pulse and Breathing No Pulse
STEMI Fibrinolytic Protocol
“Time is muscle”
“Door-to-drug” time should be <30 minutes
■ S/S: Cx pain >15 minutes but <12 hours
■ Get immediate 12-lead ECG (must show ST elevation or new LBBB)
■ ECG and other findings consistent with AMI
■ Give: O2, NTG, morphine, ASA (If no contraindications)
■ Start 2 IV catheters (but do not delay transport)
Systolic/diastolic BP: right arm ___/___ left arm___/___
Complete Fibrinolytic Checklist (all should be “No”)
■ Systolic BP greater than 180 to 200 mm Hg
■ Diastolic BP >100–110 mm Hg
■ Right arm versus left arm BP difference >15 mm Hg
■ Stroke >3 hours or <3 months
■ Hx of structural CNS disease
■Head/facial trauma within 3 weeks
Major trauma, GI or GU bleeding, or surgery within 4 weeks
■ Taking blood thinners; bleeding/clotting problems
■ Pregnancy
■ Hx of intracranial hemorrhage
■ Advanced cancer, severe liver/renal disease
: High-Risk Profile/Indications for Transfer
(If any are checked, consider transport to a hospital capable of angiography and revascularization)
❑ Heart rate ≥100 bpm and SBP ≤100 mm Hg
❑ Pulmonary edema (rales)
❑ Signs of shock
❑ Received CPR
❑ Contraindications to
