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  • Guidelines 2000 CPR and Emergency Cardiovascular Care

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Guidelines 2000 CPR and Emergency Cardiovascular Care

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  1. Background
    1. New guidelines for Emergency Resuscitation
    2. Broad evidence based changes
    3. Guidelines applied Internationally
    4. Applied across all Resuscitation courses
      1. Basic Life Support: Cardiopulmonary Resuscitation
      2. Advanced Cardiac Life Support
      3. Pediatric Advanced Life Support
  2. Basic Life Support Changes
    1. No pulse check before starting CPR
      1. Laypersons inaccurately identify pulseless patient
    2. Automatic Electrical Defibrillator (AED)
      1. Public access Defibrillator emphasized
      2. Early Defibrillation critical for survival in arrest
    3. Bag Valve Mask ventilation emphasized
      1. Pre-hospital providers should be skilled with BVM
      2. Endotracheal Intubation de-emphasized
      3. Tidal Volumes decreased to 50% (6-7 ml/kg)
    4. Adult Resuscitation Chest Compressions
      1. All patients (child and adult) are compressed 100/min
      2. Ratio of Chest Compressions to ventilations
        1. One and two rescuer ratio are now both 15:2
  3. Advanced Cardiac Resuscitation Changes
    1. Antiarrhythmic Drugs
      1. Bretylium no longer included in recommendations
      2. Amiodarone may be preferable to Lidocaine usage
      3. Vasopressin is alternative to Epinephrine in V-Fib
        1. No Epinephrine used within 20 minutes of dose
      4. Sotalol is a new option for Ventricular Tachycardia
      5. High dose Epinephrine de-emphasized (may be harmful)
      6. New emphasis on use of one Antiarrhythmic
        1. Contrast to prior Antiarrhythmic soups
        2. Pro-arrhythmic effects increase with poly-drugs
    2. Acute Coronary Syndrome
      1. Pre-hospital 12 lead Electrocardiogram
      2. Pre-hospital triaging to fibrinolytic candidate
      3. Early Fibrinolysis in Acute Myocardial Infarction
      4. Anti-platelet drugs (GP IIB IIIA Inhibitors)
        1. Indicated for patients likely to go to angiogram
        2. Indicated for Unstable Angina, Non-ST elevation MI
    3. Acute Ischemic Stroke
      1. Intravenous tPA within 3 hours of symptom onset
      2. Do not use intravenous tPA beyond 3 hours of symptoms
    4. Endotracheal Intubation must be performed correctly
      1. Providers must be skilled (>6 intubations per year)
      2. Consider alternative airway management if not skilled
        1. Esophageal-tracheal Combitube (ETC)
        2. Laryngeal mask airway (LMA)
      3. Confirm endotracheal placement with end-tidal CO2
      4. Use commercial tube holder
    5. Cocaine induced emergencies
      1. Ventricular dysrhythmias
        1. Sodium Bicarbonate
        2. Alpha adrenergic blockers
      2. Acute Coronary Syndrome
        1. Benzodiazepines
        2. Nitrates
        3. Alpha adrenergic blockers
      3. Inappropriate Medications
        1. Non-selective Beta-Blockers (selective also)
  4. References
    1. (2000) Circulation 102(suppl I):86
      1. http://www.circulationaha.org

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