ALS (Recover) Module 2: Treating Non- Shockable Rhythms Latest Version 100% Correct

Treating Non-Shockable Rhythms The non-shockable rhythms (asystole and pulseless electrical activity) are the most common primary arrest rhythms in dogs and cats. In Module 2, we will discuss diagnosing the arrest rhythm using ECG analysis, and how that rhythm diagnosis guides ALS therapy. We will also discuss vasopressor therapy as a mainstay of treatment, as well as parasympatholytic drugs and additional therapies for prolonged asystole and prolonged PEA. ECG Interpretation: ECG analysis during CPR is focused on differentiating three major types of arrest rhythms: Perfusing rhythms associated with pulses Non-shockable arrest rhythms that do not require electrical defibrillation Shockable arrest rhythms that require electrical defibrillation Remember that non-shockable rhythms are the most common arrest rhythms in dogs and cats. Timing: During the brief pause in compressions between cycles of BLS, the team leader should interpret the ECG and announce the rhythm diagnosis. Agreement should be reached among all team members as to the ECG rhythm diagnosis; if consensus is not reached immediately, chest compressions should be re-started and the discussion about rhythm diagnosis can continue during the next cycle of compressions. Ultimately, if consensus cannot be reached, the team leader should make the diagnosis after considering input from all team members. Chest compressions should never be stopped during a cycle of BLS strictly to evaluate the ECG. However, if there is a sudden rise in EtCO2, and a strong, palpable pulse is noted during a cycle of BLS, it is reasonable to briefly pause chest compressions to review the ECG and palpate the pulse to determine if ROSC has truly been achieved. Avoiding Pitfalls Evaluating the ECG rhythm during CPR will guide decision-making for specific ALS interventions, such as drugs or defibrillation. Because of motion artifact, it is not possible to interpret the ECG during chest compressions. In addition, lead dislodgement is common during CPR, especially if alligator clips are used and are placed proximally on the limbs where movement is more pronounced. The use of pregelled adhesive electrodes on the foot pads, or alligator clips placed more distally on the limbs may reduce the risk of lead dislodgement.Some ECG monitors also appear to create spontaneous rhythms that may be mistaken for the patient's ECG when not connected to the patient, or following dislodgement. Artifact: Note that in this example, although the alligator clips are not attached to a patient, there is an ECG signal on the monitor. This is likely due to electrical noise in the environment. A secure lead attachment is critical for obtaining an accurate ECG signal. ECG Rhythm Diagnosis Algorithm Recall that evaluating the ECG during