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If bradycardia is accompanied by life-threatening adverse signs, give atropine 500 mcg IV (IO) and, if necessary, repeat every 3–5 minutes to a total of 3 mg. Consider mechanical chest compressions only if high-quality manual chest compression is not practical or compromises provider safety. An increase in ETCO 2 during CPR may indicate that ROSC has occurred. However, chest compression should not be interrupted based on this sign alone. During manual chest compressions, ‘hands-on’ defibrillation, even when wearing clinical gloves, is a risk to the rescuer. the involvement of stakeholders from around the world including members of the public and cardiac arrest survivors.

If cardioversion fails to restore sinus rhythm and the patient remains unstable, give amiodarone 300 mg intravenously over 10–20 minutes (or procainamide 10–15 mg kg -1 over 20 minutes) and re-attempt electrical cardioversion. The loading dose of amiodarone can be followed by an infusion of 900 mg over 24 hours. After dealing 50,000 damage, create an explosion centered [ sic] on your current target, dealing up to 40% per rank weapon damage [ sic] to nearby enemies.Hospitals should have a resuscitation team that immediately responds to in hospital cardiac arrest (IHCA). For refractory VF, consider using an alternative defibrillation pad position (e.g. anterior- posterior).

Electrical cardioversion is the preferred treatment for tachyarrhythmia in the unstable patient displaying potentially life-threatening adverse signs. High-quality chest compressions with minimal interruption and early defibrillation remain priorities. Symptoms such as syncope (especially during exercise, while sitting or supine), palpitations, dizziness and sudden shortness of breath that are consistent with an arrhythmia should be investigated. Systems should define criteria for the withholding and termination of CPR, and ensure criteria are validated locally ( see the Ethics Guidelines). Hospitals should review cardiac arrest events to identify opportunities for system improvement and share key learning points with hospital staff.The guidelines reflect the increasing evidence for extracorporeal CPR (eCPR) as a rescue therapy for selected patients with cardiac arrest when conventional ALS measures are failing and to facilitate specific interventions (e.g. coronary angiography and percutaneous coronary intervention (PCI), pulmonary thrombectomy for massive pulmonary embolism, rewarming after hypothermic cardiac arrest) in settings in which it can be implemented. Use data-driven, performance-focused debriefing of rescuers to improve CPR quality and patient outcomes. Antero-lateral pad position is the position of choice for initial pad placement. Ensure that the apical (lateral) pad is positioned correctly (mid-axillary line, level with the V6 ECG electrode position) i.e. below the armpit. Consider pacing in patients who are unstable, with symptomatic bradycardia refractory to drug therapies.

Apparently healthy young adults who suffer sudden cardiac death (SCD) can also have signs and symptoms (e.g. syncope/pre-syncope, chest pain and palpitations) that should alert healthcare professionals to seek expert help to prevent cardiac arrest. severe heart failure – manifested by pulmonary oedema (failure of the left ventricle) and/or raised jugular venous pressure (failure of the right ventricle) If treatment with atropine is ineffective, consider second line drugs. These include isoprenaline (5 mcg min −1 starting dose), and adrenaline (2–10 mcg min −1).Lidocaine 100 mg IV (IO) may be used as an alternative if amiodarone is not available or a local decision has been made to use lidocaine instead of amiodarone. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts. This is achieved by continuing chest compressions during defibrillator charging, delivering defibrillation with an interruption in chest compressions of less than 5 seconds and then immediately resuming chest compressions.

Hospitals should train staff in the recognition, monitoring and immediate care of the acutely ill patient. The hospital resuscitation team should include team members who have completed an accredited RCUK adult ALS course. The guidelines recognise the increasing role of point-of-care ultrasound (POCUS) in peri-arrest care for diagnosis, but emphasises that it requires a skilled operator, and the need to minimise interruptions during chest compression. Minimise the risk of fire by taking off any oxygen mask or nasal cannulae and place them at least 1 m away from the patient’s chest. Ventilator circuits should remain attached.Emergency medical systems (EMS) should consider implementing criteria for the withholding and termination of resuscitation (TOR) taking into consideration specific local legal, organisational and cultural context ( see the Ethics Guidelines). where k and c are constants, which vary between earthquake sequences. A modified version of Omori's law, now commonly used, was proposed by Utsu in 1961. [2] [3] n ( t ) = k ( c + t ) p {\displaystyle n(t)={\frac {k}{(c+t)