rANESTHESIA 1

ANESTHESIA
IMAGES ANG GRAPHS
PREDICTORS OF DIFFICULT BAG AND MA S K
VENTILATION
0 Obese (BMI > 30)
B Beard ·; nr;,: ': :\ .· i[
E Edentulous (no teeth)
's Snoring (H/o OSA) .
E Elderly (age> 55yrs) '
Oas.s o [Link] I ClassJJ Classllf

MALLAMPATTI - airway assessment modality (PUSH - MNEUMONIC)

Structures seen J I
Pillars " Partial view of
pillars
Uvula .. Tip is missing Only base is
visible
Soft J>alate + +

_Hard palate + + +
Eas Difficult Difficult
Class O - epiglottis is visible- rare, no relation to difficulty

3: CORMACK & LEHANE CLASSIFICAnON ON DIRECT

[Link]:
Grade I Grade II Grade m Grade IV

For prognostic

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 ANESTHESIA I

Structures seen : epiglottis, vocal cord, posterior commissure - grade 1

Grade 2 : predominant view of posterior commissure
Grade III - hanging epiglottis
Grade IV - no glottis stuctures seen
I, II easy, III/IV - difficulty

BARKING DOG/ SNIFFING POSITION

Ideal posit ion for intubation RAMP / HELP (HE AD ELEVATED
Not rose position LARYNGO S CO PY POS I TION)
Head on ring pillow/ donut Obese and patient with large breast
Extension at atlanto-occipital joint
Flexion at lower cervical ·oint

FACE MASK

Bag and mask ventilation,, increases risk of

as iration
Increases dead space

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 1ANESTHESIA I

AIRWAY MANUPILATI ON
A) OPENING OF AIRWAY: HEAD TILT/ CHIN LIFT/ JAW "[Link]
1 jr1 v1 ll umt
1 liin l ift

I
I
I
hP ,HI t ilt ;

Manipulate position of head

B) MANULA LINE STABILIZATION (MILS)

'
\

'
'
1
'
Suspected cervical spine injury use hard cervical collar
If need to intubate - then MILS
Stabilize the head wh ile intubation (Q)

C) TRIPLE MANEUVER (AIIMS)

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 rANESTHESIA 1

OXYGEN DELIVERY DEVICES :

A. Oxygen delivery systems are classified as
1. Low-flow systems: nasal prongs (max : 6L/min)
2. Reservoir systems : face masks and face masks with reservoir bags
3. High flow systems: air-entrainment masks or heated, humidified 02 delivered through
nasal prongs

Table 1. The flow rate and approximate for different Fi02 oxygen delivery devices:

Nasal cannula 1-6 0.24-0.44

5-8 .40-0.60
6-10 0.60-0.80
Non breathing mask 10-15 0.90-1 .00
Venture mask 2-15 0.24-0.60
Venture mask is a fixed flow device others are variable flow (Fi02 changes with patient
mechanics)
Therefore venture mask is used in COPD

'I

Simple face mask/ Hudson mask : max Fi02

Nasal canunula : max Fi02 - 44%
~,,-,--,-.,.,.._,,,...,----\-
: 60%

Venturimask/ air entrainment mask: fixed

Non breathing tnask : max Fi02 100% when flow device
a reservoir bag is attached Presenc,e of a valve

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High flow nasal cannula (HFNC)
High flow , fixed performance, heated and humidified
oxygen delivery device
FiO2 range : 21-100%

Naso pharyngeal and naso pharyngeal airwcrt

Nasal trumpet
Guedal's airway Appropriate size Tragus to tip of nose
Appropriate size I
Angle of mandible and central incisor ,
EAC to an le of Ii

Laaryngeal mask airway/ supraglottic airway device/ extra glottic airway device (LMA}
Ti is face in in front of esophagus

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 IANESTHESIA I

LMA CLASSIC
A> ONLY 1 TUBE
B> 1st generation
C> Sizes available - 8 :
1,1.5,2 ,2.5,3,4,5,6
[)> Most common size used : male =
4, female = 4, child (30-50kg) =
3
E> Max intracuff pressure = 60cms of
water

2 [Link]
2~
GaS'lric drain tube
I
' supreme
No - Proseal
No cuff - I GEL

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 ANESTHESIA

MACINTOSH BLADE MILLER BLADE

Curved blades straight blade - pediatric
Direct laryngoscopes
Hold in non dominant hand
B&ide of
[Link]

Tongue

~ ~ led~e

Held : left handed

Insert in right angle of mouth
Most common complication : Breakage of central incisor
Movement at shoulder
Appl ied force - fo rwards and upwards

12: ENDOTRACHEAL TUBE:

14-lSmm -
Bevel

\
' Murphy Eye
Spring loaded
one way Valve

Cuff

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 l'ANESTHESIA I

Bevel improves visualization

Murphy's eye - secondary ventilation pore
Cuff - prevents aspiration

;;
H1Pf~Cl#ll'Jfl)

ll1~V&.ITl~T" [Link]!RifA L
[!JPDITN510N jNfUMT/ON

Capnography
Measures ventilation and circulation
st
1 look at value of CO2, hypo < 30mm Hg, hyper > 45m Hg
Sudden / gradual

Problem in expiratory part

Difficult in expiration : Shark f in appearance
Partially obstructed ETT or obstructive lung diseases (COPD/ BRONCHOSPASM/
UPPER AIRWAY OBSTRUCTION)

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 !ANESTHESIA I

Neuromuscular monitoring
Ulnar nerve is being monitored

NERVE AND MUSCLE METHOD OF RECORDING OF PATTERNS OF

COMBINATION USED RESPONSE STIMULATION
MOST COMMON: I :MECHANOMYOGRAPHY(MMG): Single twitch
: ulnar NERVE gold standard
MUSCLE : adducor p0llicis
2ND MOST COMMON 2: ACCELEROMYOGRAPHY TOF : train of four
NERVE : facial (AMG): me used
MUSCLEoricuaris oculi
3: ELECTROMYOGRAPHY (EMG) Tetani

IDENTIFICATION OF BLOCK:
, Nondepolarlzlng .,____ _D_e__
po _l_a_
rtz_ln--g__B
_ l____k...._--"'___..
No Drug Block Phase ~ ~hase II
Train-of-tour

Competitive antagonist at Nm Ach receptors : fade on TOF

Scoline is a partial agonist : constant but diminished - phase I
Phase II block, complication of scoline - TOF behaves like NDMR

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 ' ANESTHESIA I

NEURO MUSCULAR MONITORING :

ACTION No of twitches on TOF Intensity of 4 th response to
COUNT j 1st = T4/T1 TOF RATIO
1: INTUBATION •
2: MA INT AINENCE
3: WAIT & WATCH 0.3-0.7
4: ADMINISTER REVERSAL 0.7
__ _______
DRUGS
"

5: EXTUBATION 0.9
In NMDR - fade , TOF RATION increases

(i -1S I COLOR I'/\ I \ 'l>E.\

l:AIR Black body with black and white J,~

I
shoulder
2: OXYGEN Black body with white shoulder 2.5

3: NITROUS OXIDE Blue 3,5

4:CO2 Grey 7.5 % ( 1A)

7.5 % ( 2,6)
5: CYCLOPROPANE Orange 3,6 I

6: ENTONOX Blue body wilh blue and white 7

shoulder

N2o Entonox
0 en

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 ~ANESTHESIA I

SAFETY FEATURE : ANTI HYPOXIA

I~ ! .,

PIN INDEX SAFETY SYSTEM = PISS

PREVENTS WRONG ATTACHMENT OF DISS - DIAMETER INDEX SAFETY
CYLINDER TO MACHINE SYSTEM
PREVENTS WRONG ATTACHMENT OF
PIPLINE TO MACHINE
02 FLUSH
Valve in front anesthesia machine
When pressed this valve, high flow 02
- 100% oxygen from common gas outlet
at high flows of 35-75L/min
Part of [Link] pressure system
Aadvantages - emergency 02 supply
Diadv : barotrauma

Isoflurane Purele
Desflurane Blue
(special
vapourier :
TEC6
Halothale Red colour

Vapourizers - volatile
anesthetic agents, colour coded

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 ANESTHESIA \

MAPLESON CIRCUIT
\1111£0FCllml'f --
IDIIIIR:ATIDII =~ 1.=.
1I--:U
PUftWT
, IID1tUlM
I -
:d_ / ([Link]..

[Link],
\MAGIIL'S \.'Ulli."w-r;
LAtrS
U0Dl:f1CADD,
s

I
1:-S
~
IAft. \'.'Al.\'E A-,.:.ur CO!'CnOUI]) j 1-l • MV
·--!i~
• UCIISID
MAPLESON
~flnff
[Link]

!
I ~::::::::~
m . -· --
-
aom l,.f • .WV • FOi;
ft'.Dla:nc
A'JIG> flJ!lDE."fl'!(<3
"'t. SPCJt('[A..q ocs XGS}·
1£ ~\ • , m·a nm.
I" ~"" 6 i,. .
nL\.~ £
1: k:AID i I -
Apl VALVE NEAR TO PATIENT- Mapelson circuit A (spontaneous respiration)
Away from patient - D circuit (controlled respiration
E = ayre's T piece

Cricoid pressure/ sellick's maneuver

Poster,i or pressure on cricoid cartilate

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Prevent aspiration in RSI (raid sequence induction)

Blocks upper end of esophagus
Prevents regurgitated material in oral cavity

SPINAL NEEDLE
Sprone Whitacre Ouincke

e.~

C. Sipcae

SPOROTTE AND WHITACRE - Dura splitting needle, less risk PDPH, high failure
rate
Quince - dura cutting needle, increase PDPH ( post dural puncture headache), better
feel of structure

Caudal block done in pediatric patient <8yrs, type of epidural

Site : 2 PSIS joint by an equilatral triangle, apex is SH (sacral hiatus) , membrane
surrounding - saccrococcygeous membrane
Membrane ossifies by 8yrs, therefore not done< 8yrs

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 IANESTHESIA I

CLASSIFICATION
1. DIFFICULT AIRWAY ALGORITHM: in unanticipated difficult airway

PLAN A Face mask ventilation and intubation

PLAN B 1 0 genated using,_S
_A_G
__,_(s_u..,__,,,_,_ _ __,__d_e_ ~~-----------'I
vi_ce...,)_ _ _
PLAN C Final attempt at face mask
PLAN D Emergency cricoth)'roidotomy
J

;( j
I ll
2. ASA PHYSICAL STATUS CLASSIFICATION
• risk assessment
• 6 classes

I NORMAL HEAL THY ADULT

II Mild systemic disease controlled
III Severe systemic disease, limiting but no inca acitating
IV Severe stemic disease, life thrathenin
V Moribound atient
VI Brain dead rgan donor

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 1ANESTHESIA I

3. FACTORS AFFECTING PULSE OXIMETER

FALSELOW READING FALSEHIGH READING NO CHANGE IN READING

I METHMOGLOBINEMIA( 85%) CARBOXY HB DARK SKIN

METHYLENE BLUE ( 65%) I BI LIRU BIN

I

INDOCYANINE GREEN
J_ ACRYLIC FINGER NAILS

PERIPHERAL VASOCONSTRICTION: HEENA

SHOCK \HYPOTENSION
SHIVERING I
-------r------------,,-----------1 I
NAIL PAINTS I
I
• Black, blue, purple have maximum effect
4. FACTORS AFFECTING MAC
• Mac =POTENCY

.FACTOR
,. I DECREASE MAC/,!'''\,.· l 11 INCREASED- MAC/ -
INCREASED POTENCY 'DECREASED
--
POTENCY
Age Elderly Young (max at 6 months)
Alcohol Acute Chronic
Amphetamine Chronic acute
All anesthetic agent/ +
pregnancy

5. BRACHIAL PLEXUS BLOCK

INTERSCALENE SUPRACLAVICULAR AXILLARY

ANATOMY
APPROACH
Between scalene
muscles
. . . . ..
APPROACH
.
ar tery
APPROACH
Around axillary
artery
STRUCTURE Trunks Cords/ division Rad ial , median, ulnar
BLOCKED
INDICATION Shoulder and upper Below elbow Below elbow
arm sx
SPARING Inferior trunk C8 ,T2 Mucocutaneous nerve
(ulnar)
COMPUCATIONS Phrenic nerve palsy Mc : phr enic nerve Arterial puncture
(100%) palsy
Most specific:
pneumothorax

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 "ANESTHESIA j

6. AGENTS OF CHOICE

SURGERY/CONDITION CONCEPT INDUCTION MUSCLE INHALED REMARKS

AGENT BELAXANT AGENTS
NEUROSURGERY • •• •

RAISED ICT SURGERY • - -• - Thiopentone Any Sevo

CARDIAC DISEASE • • Etomidate Cisatro/ Iso - min IV

• (only
cardiostable)
vec depression

PEDIATRIC PATIENT • , Ketamine Atracurium Sevo -

sweet in
smell
DAY CARE SURGERY Propofol Mivacurium Sevo
recovery I I
Epidural
always
HEART DISEASE IN Epidural
PREGNANCY
• Except severe MS/ AS, aortic dissection, uncorrected TOF, Eissenmenger syndrome -
general anesthesia over epidural in pregnecy with heart disease

MECHANISM OF ACTIONS
DRUG MOA
1: BARBITURATES GABA A AGONIST (INCREASED DURATION OF OPENING)
2. BENZODIAZEPINES GABAAAGONIST (INCREASED FREQUENCY OF OPENING)
3: KETAMINE NMDA ANTAGONIST
4: PROPOFOL & GABA AGONIST
ETOMIDATE
5: NDMR (Q) COMPETITIVE ANTAGONIST AT NICOTINE
ACETYLCHOLINE RECEPTOR
6: DMR PARTIAL AGONISTAT ACETYLCHOLINE RECEPTOR
7: LOCAL ANESTHffiC SODIUM CHANNEL BLOCKER
8: INTRAUPID EARLY RECOVERY OF BLOCKED SODIUM CHANNELS

IV : PRINCIPLE OF WORKING :
TECHNIQUE PRINCIPLE OF WORKING
1: BIS (BI SPECTRAL INDEX) FRONTAL PROCESSED EEG
2: PULSE OXIMETER BEER LAMBERT LAW
3: CAPNOGRAPHY INFRARED SPECTROSCOPY
4: NEUROMUSCULAR MONITORING PERIPHERAL NERVE STIMULATION
5: FLOW METER VARIABLE ORIFICE & CONSTANT PRESSURE

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 l'ANESTHESl'A I

V: COMPLICATIONS :
1: EXCESSIVE DOSE LONG TERM ADMINSTRATION:

A. PROPOFOL INFUSION SYNDROME: when given >4mg/kg/hr for >48hrs

- Acute refractory bradycardia
- Ass,ociated multisystem disorder
- Fatal condition - no T/t
B. ETOMIDATE: inhibition of 11 beta hydroxylase used in steroid sysntesis
- Adreno cortical insufficiencies
C. SCOLINE : ultra fast onset of action = < 10 mins
- Dose 7-10mg/kg
- Phase II block of scoline = NDMR30-60secs
- Ultra short duration of action
D. ATRACURIUM: metab by hoffman's elimination
- metabolite - laudonosine - excreted renally, induces seizures
- agent of choice for renal and hepatic failure= atracurium
E. N20:
- Occupational hazards
- Inhibition-of vit B12 deficient enxzymes
- Peripheral neuropathy
- Megaloblastic qnemia
- Tetratogenecity
- SACD of cord
F. LOCAL ANESTHETIC
- CNS - early and mild, seizures, t/t
- CVS :late and grave, cardiac areest, t/t - intra lipid

2: COMPLICATIONS
a. Most common: post operative nausea & vomiting
-
Aoc for treatment: ondensetron
b. Hypothermia: CBT < 36c
- Mc route of loss of heat: radiation >convection> conduction >evaporation
-
Gold standard for core temperature monitoring: pulmonary artery catheter/ swan
gany catheter
c. MALIGNANT HYPERTHERMIA
- Genetic defect (chromosome 19)
- Abnormal rynodine receptor
- Triggors a_re scoline and volatile anesthetic agents
- Earliest and most sensitive : sudden and abrupt rise of ETCO2

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 IANESTHESIA I

- Late sign: hyperthermia

- Aoc: dantrolene (dil in sterile water) 2 .5 mg\kg 5 mins (max 10 mg\kg)
- Infusion: lmg\kg over 6 hours (24-48 hours)
d. AIR EMBOLISM:
- Most common: venous air embolism
- Most ~ensitive invasive modal ity: TEE
"Oi1t'aail fk"l)pn arc abo Mam\'t Ill local
- Most sensitive invasive modality: precordial _ . . . Wocbk. i. m apu·
. . . - IRIINIPG,__ llo'll'I
N\'t
Doppler ....»arioo widl .... ad cq,crillcm
lltiidl I ckllf
· W.. idetinnd pac w ..,._.....,_ 10
e. INTRA OP ANAPHYLAXIS: d i m ! ~ DCn'C Wld:, . . . ....
-(A.- - ..
..U -,cliaalc,;I [Link]&
- Most common etiology for intraop an~phylaxis _.,&en)----·
13-
~ IOimpllM

- Antib iotics > muscle relaxants (roe > scolin > atra) > Sat iallldcrnl'hltd - '-,c nt,rliulal (A._,...
...C
Abela) llbcn. _. die ltMI - ni...a.
chlorhexidine ,__, ........ C etn. la 6d, ia dti 11,c l!fOllp,
CGldilclmf ,opubeian ,~ ,'dod!y ol
o.J 1110., al•) •e d i e - ~ 10 loc:al
SUSCEPTIBILITY OF INDIVIDUAL NERVE UP....,.,_....._.._. '-al • ~ lllad:lle
FIBERS TO LOCAL ANESTHETIA ..en, .... ... If - - . . . . . ctnrty wnaa-·

Table 3-1

Classification of Peripheral Nerve Fibers

Sensitivity to
Local Anesthetic
Fiber Diameter Conduction (Subarachnoid,
Myelinated (mm) Velocity (mis) Function Procaine, %)
A-o. Yes 12-20 70-120 Innervation of skeletal
muscles
Proprioception
A-13 Yes 5-12 30-70 Touch
Pressure
A"'Y Yes 3-6 1&-30 Skeletal muscle tone 1
A-6 Yes 2-5 12-30 Fast pain 0.5
Touch
Temperature
B Yes 3 3-15 Preganglionic 0.25
autonomic fibers
C No 0.4-1.2 0.5-2:0 Slow pain 0.5
Touch
Temperature
Postganglionic sym-
pathetic fibers

DECREASING ORDER OF SUSCEPTIBILITY IS :

• A gamma > A delta > A alpha= A beta > 8 >C

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 ANESTHESIA I

CARDIOPULMONARY RESUSICATION
BASIC LIFE S UPPORT
t C}Nltl
--=
GOALS

1. Maintain oxygen and blood supply to vital organs

during cardiac arrest
2. Restore spontaneous circulation (Cardiac output
during CPR with effective, uninterrupted chest
compression is at best 25% to 30% of the
normal spontaneous circulation.
3. Minimize post resuscitation organ injury
4. Improve the patient's survival and neurologic
outcome.

CHAIN OF SURVIVAL

I dent if ies a sequence of SIX critical actions that increase survival rates from sudden cardiac
arrest (SCA)

OUTSIDE HOSPITAL CARDIAC ARREST

OHCA

INSIDE HOSPITAL CARDIAC ARREST (IHCA)

b%1¥t 1tiE'itt?tfeM·ffl1Mlw·a err b:nf~ ..:iiiai

• Recovery (including additional treatment, observation, rehabi litation and psychological
support)

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 ' ANESTHESIA I

·,.
.......
I
..............
Compressions
...........
•--·--
. I
...,._
,. Amy
'!""].... ...,
I
.............
.........
Breathing

CHEST COMPRESSIONS
Rescuers Should j Rescuers Should Not
Pw1am dell conpessioa • arw d 100-120'11111 Coffllres,ataraltslc,-IWl l~or lasllrlhln 12n-'mn
0aqnss -, a-,, d II leasl 2 ims (5C11t IO adlptb d less than 2 ims(S cm!
or Ital 2.4 ims an)
Niotf U rlCIII aftlr lK!I [Link] on 1w chlSI be'-' C0111)1essioa
• I
llliniztpa-,~,co,41essio1S ~W1¥essio6 lort,'lllllrlhln 1011C011ds
j
.,...__,,(2brllllaqlJC0111)[Link] Pl'IMdteitmMwnlalion
dehnd OIS 1 secand, ml cuilg chest risel (le. too~ trdlsor ~•ll'lfCmift lortej

POl '\ l'C IFllll-TEIU: \ C'E I \IH ' LI S I ( 111 [Link]'\11'\ l- \'\ l

1 I : Activation of
response system
cmcrgcncy I2"":I": Activate
S1a11 CPR
ERS &. gel AED Witnessed collapse: Sllll1C as adult
I

Unwitnessed collapse:
I": 2 mins of CPR
2"": leave the ,ictim to [Link] ERS

2: Compression to ventilation Always 30:2 l rescuer: 30-.2

ratio without advanced airway 2 rescuer. 15:2

13: Compression to ventilation I breath every 6 scc.s ( 10 breaths\ Children: about 2 inches
ratio with 11d,•1U1ccd airway min) Infants: about 1.5 inches

S: H4Ddi plamncoi Lower halfofsternum Infants: I rescuer: I finger

technique
thumb encircling

• Pediatric ventilatory arrest more common than respiratory arrest

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 ' ANESTHESIA I

AIRWAY
• Bag and mask ventilation with a head tilt, chin lift or head tilt-jaw trusht
maneuverer is recommended for initial airway control in most circumstances
• Triple manoeuvre : head tilt -chin lift, mouth open, jaw thrust

( j~w t h ru \f
~ - r hin li ft

hP,Hlli lt

- ,

_ , MANUALOEFIBRIUATOR

f ADVANCED CAROIAC LIFE

SUPPORT)
V
O Stemum

\~ -i<J
\ Apn ~

PLACEMENT OF ELECTRODES

• ADULT : upper left sternal border, just below the clavicle

- Lateral to the left of nipple
• CHILD/ INFANT: anterior and posterior

CordJoc: o rr• st h•art rhythms summary

~ f v JWf
ventricular
ftbrlJlo11on
/Y'1f1/'1/V'1fV
ventricula r
toc:bycordla
.~ --r--

pulseless
etec:trlc:al
activity
asystole

i t l
Shoc:kablo rhythms; [Link]
1o d_affbrllfate

VF~ VT.,. w,y oommon

for tMl'dMO .,,_, In the home
or In publlo p,__.
Non-shockablo rhythma-;
do not d'e flbrlllate

PEA and ..ystol• .,. more

fwt/Mdlao
,,,_,,,,_,._pau.,,,-
'
efflOltfl

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 JANESTHESIA I

• Mc cardiac arrest rhytms in adults and peads - asystole

Adult Basic Life Support Algorithm for Healthcare Providers

Verify scene safety.

• Cheek for responsiveness.

• Shoutfornearbyhelp.
• Activate emergency response
system via mobile device
1
(If appropriate). ,

• GetAEoandemergencyequlpment
(orseod someone to do so).
J
Normal • Provide rescue breathing,
brHthlng, Look torno breathing brHthlng, 1 breath every 6 seconds o<
Monitor untll pul,afalt or only gasping and check ,p ulMfalt 1obfeaths/mlo.
emergency pulse(slmultaneously).
• Check pulse every 2 mWltes;
responders arr!Ye. If no pulse, start CPR.
Is pulse definitely felt
• If possible opioid overdose,
within 10seoonds? administer naloxone If
avallabl~ p811protOCOL
No brHthlng
or only
pulse notfelt

By this time in all scenarios. emergency

response system or backup is activated.
- - - - - - - - - - - andAEDandemergencyequlpment are
retrieved or someone Is retrieving them.
Start CPR
• Perform cycles of 30 compressions
and 2 breaths.
• UseAEDassoonasilisavallable.

L AEO arriVes.

Check rhythm.
Shockable rhythm?
Yu, No,
ahock1bl1

• Give t shock. Resume CPR • Resume CPR lmme<llatelyfo,

Immediately for 2 minutes 2 minutes (unlll prompted by AEO
(unti prompted by AEOto alow to allow rhytlvn check).
rhythm check). • Continue un)il ALS provldffl toke
• ConUnueoo1RALS P(ovlders take oyei: or•Ylctlm~rts t9move.
OV8f orvlcUm starts to move.

• 2020 Am«leln Hein Associluon

ADVANCED CARDIAC LIFE SUPPORT

• TEAM OF TRAINED PROFESSIONALS
• COMPRISES OF DOCTORS, ~AINED PARAMEDICAL STAFF, NURSES· MEMBERS:
MINIMUM 6 AND MAXIMUM 10

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 I ANESTHESIA I

1) 1 TEAM LEADER
2) 1 COMPRESSOR & 1 VENTILATOR (CHANGE ROLES EVERY 2 MINS)
3) 1 DEFIBRILLATOR
4) 1 INTRAVENOUS DRUG DELIVERY
5) 1 TIME KEEPER

Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA)

Start CPR
• GIYa~n
• Altldl 111onltol'/defoblilat0f

Vos Rhythm
lhocllable?

®
'
VF/pVT )
Eplnephrlna
Shock
10 _ _ ___,___ _ _ ___
ASAP

CPR 2mln CPR2 mln

• IV/IO KCMS • IV/1O ocalSS
• Epinephrine every 3-6 min
• Consider advanc:ed /lllwa'f,
I Cll~phy

Rhythm No
ahockable?

©f Vos Rhythm
lllockallle?
Shock

• CPR2mln
No

• Epinepl\rlne every 3·5 min

• Considorodvancedairwny,
captl()gtephy

No

Vn

0~ Shock

CPR2 mln
• AmJoclarone Of Hdocalne CPR2mln
• Treatrever$1blecauses • Treatrewrsibloc:oosos,

Rhythm Yts
lllockalllt?

12 i - - ~- ~ --

1
• If no signs ofroturn of
spontaneous clrcu&aU0t1
(ROSC).90 10100, 11
• lf,[Link] to
fost-car~ Arrest care
• Coosldef • PPf0P,14tonoss
0( r0$usclllltlon
0 2020Amc,l<on-A-1otlon

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 "ANESTHESIA I

Reversible Causes
Hypovolemia Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, ulmona Thrombosis, corona
Return of Spontaneous Circulation (ROSC)
Pulse and blood pressure
Abrupt sustained increase in PETCO, (typically 240 mm Hg)
Spontaneous arterial pressure waves with intra- arterial monitoring

......
DRUG THERAPY IN CPR

1
DRUG
ADRENALINE
-EPINEPHRINE
--
ADULT

mins
__J I
. ..
~;D~ATRIC

concentration)
,

Endotracheal: 2-2.5 times dose Max dose:1 mg

(1:1000) diluted in 10 ml normal Repeat every 3-5mins.
Endotracheal: 0.1 mg kg (0.1 ml kg of
' I
- -~ ·- --
1:1000 concentration)
AMIODARONE 1" dose: 300mg 5 mg kg bolus during cardiac arrest. May
2 dose; 150 mg repeat 3 doses for refractory VF
pulseless VT
LIGNOCAINE
I
1" dose: 1-1.5mg kg 1mg kg bolus dose
2nd dose: 0.5-0.75 mg kg
1
I
?!)
···"'•
l ,:-
•1rouble brvathlng
•can'! CfY
',-{ •can't make sounds

FOREIGN BODY OBSTRUCTION/ Alternate back blows and chest

CHOKING compressiob - 5 x 5
Heimlich maneuver > lyr If patient loses consciousness, CPR
Partial FBO - sound present cou9h..qut

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