Rhythms can quickly degenerate into unstable rhythms
Be careful when inserting guidewires, persistent shocks can degenerate fib into asystole
Standard ACLS guidelines may not apply:
Any organized rhythm should be assumed to be perfusing the patient adequately
Starting CPR may precipitate fatal ventricular rhythms
Modified vs. Standard ACLS:
ERC recommends up to 3 defibrillations with epi held until temperature >30°C, then epinephrine interval of 6 min until temperature >35°C<unk> A recommends 3 defibrillations and 3 rounds of epinephrine with further dosing guided by clinical response
Recent consensus suggest only one defibrillation and round of ACLS meds → rewarm 5°C → one defib/meds → Repeat
Any organized rhythm should be assumed to be perfusing the patient adequately
Starting CPR may precipitate fatal ventricular rhythms
ERC recommends up to 3 defibrillations with epi held until temperature >30°C, then epinephrine interval of 6 min until temperature >35°C<unk> A recommends 3 defibrillations and 3 rounds of epinephrine with further dosing guided by clinical response
Recent consensus suggest only one defibrillation and round of ACLS meds → rewarm 5°C → one defib/meds → Repeat
Should be considered if:
K > 12 mmol
Asystole persists beyond >32°C
Lactate and pH have less consistent prognostic significance in hypothermia
K > 12 mmol
Asystole persists beyond >32°C
Accidental hypothermia
Generalized
Malignant hyperthermia
Hypothermia
Traumatic asphyxia
Freezing
Lightning injuries
Frostbite