267.4 📌 章末速蚘

267.4.0.0.1 Cardiac Arrest
  • Shockable: VF, pulseless VT
  • Non-shockable: PEA, asystole
267.4.0.0.2 Chain of Survival
  1. Early recognition + call 911
  2. Early CPR
  3. Early defibrillation
  4. Early ACLS
  5. Post-arrest integrated care
267.4.0.0.3 High-Quality CPR
  • Rate 100-120/min, depth ≥ 5 cm, full recoil, minimize interruptions, 30:2 ratio
267.4.0.0.4 ACLS Shockable
  1. Defibrillation 200 J biphasic
  2. CPR + epinephrine 1 mg IV/IO q3-5 min
  3. Amiodarone 300 mg after 3rd shock for refractory
  4. Treat reversible causes
267.4.0.0.5 ACLS Non-Shockable
  • CPR + epinephrine + treat Hs and Ts
267.4.0.0.6 Reversible Causes (4 H + 4 T)
  • Hs: hypoxia, hypovolemia, H+ (acidosis), hyper/hypokalemia, hypothermia
  • Ts: tension pneumothorax, tamponade, toxins, thrombosis (PE/MI), trauma
267.4.0.0.7 Post-Cardiac Arrest Care
  • TTM 32-36°C × 24 hr for comatose (TTM2 trial: equivalent; fever avoidance key)
  • Hemodynamic management (MAP > 65)
  • Coronary angiography for suspected ischemic
  • Neurologic prognostication delayed ≥ 72 hr + multimodal
267.4.0.0.8 ECPR
  • VA-ECMO for refractory cardiac arrest
  • Selected patients (shockable rhythm, witnessed, younger)
  • ARREST trial 2020 supports
267.4.0.0.9 Special Situations
  • Pregnancy: left uterine displacement + perimortem cesarean within 4-5 min
  • Hypothermia: not dead until warm and dead
  • Drug overdose: antidotes
  • Massive PE: thrombolysis
  • Trauma: address bleeding + pneumothorax + tamponade
267.4.0.0.10 Drugs
  • Epinephrine essential
  • Amiodarone for refractory shockable
  • Magnesium for torsades
  • Vasopressin + atropine no longer in algorithms
267.4.0.0.11 AED + Bystander CPR
  • AED widely deployed; layperson use
  • Hands-only CPR acceptable + encouraged
  • Dispatcher-assisted CPR
  • Major impact on OHCA outcomes
267.4.0.0.12 盧醫垫 hint
  • Cardiac arrest = TEAM activity — clear roles + communication
  • Shockable rhythm: defibrillate first + early
  • Non-shockable rhythm: CPR + epinephrine + investigate causes
  • Pregnant pt cardiac arrest: don’t forget perimortem cesarean
  • Refractory cardiac arrest + young: consider ECPR
  • Post-arrest: TTM + delayed prognostication + don’t withdraw too early
  • Continuous CPR + ETCO2 monitoring = quality measure