JP2009515593A - Apparatus and method for secondary cardiac life support - Google Patents

Abstract

  A device (300, 400) and method operable to guide responders via audible prompts and visual cues through appropriate procedures to be applied to a patient during cardiac arrest. Embodiments of the present invention make it easier to recognize and follow, for example, the type and dose of drug to be administered and the order in which actions (eg, cardiopulmonary resuscitation (CPR)) are performed on a patient. The embodiment (300) of the present invention can be placed in a conventional hospital emergency cart storing emergency equipment and medicine, or it can be loaded into hardware or computer hardware (200). It can be application software loaded or loaded.

Description

(Cross-reference of related patent applications)
This patent application claims the benefit of US Provisional Application No. 60 / 35,371, filed Nov. 12, 2005, entitled “THE CODE BLUE CLOCK”.

  The present invention relates to a system based on computer hardware and software used during the execution of a cardio life support procedure.

  Thousands of patients suffer sudden cardiac deaths each year. Since 1919, cardiovascular disease (CVD) has been the leading cause of death in our country (USA). Nearly 40 percent of deaths in our country are somehow related to CVD. In addition, as the population ages, more and more people are accepted in hospitals. When it is discovered that a sudden heart attack has occurred in a patient in a hospital, a series of actions are taken to resuscitate the patient. Optionally, a response team (conventionally, Code Blue) consisting of nurses, supervisors, life-saving technicians, technicians and preferably physicians who are familiar with the advanced cardio life support (ACLS) procedure A response team (referred to as a code blue response team) is called to perform the resuscitation procedure. However, physicians often do not have immediate access to make ACLS adjustments or have no experience with specific protocols.

  Most nursing personnel working in a typical ward are not required to learn or qualify for ACLS. In addition, most physicians working outside of the intensive care unit (ICU) or emergency room (ER) have accurate knowledge of the various drug treatments in the code blue situation and the specific time series associated with them. Does not use the ACLS protocol often enough.

  Unfortunately, a very typical situation is as follows. During the 3 am tour, the nurse goes to see the patient. The nurse notices that the patient's breathing is very shallow and that the patient's heart rate is simply 10 times per minute. The patient does not wake up even if the nurse calls or shakes her body. The nurse is located, for example, on the wall of the patient's room, traditionally known as the Code Blue button, which sends an emergency notification to all responders required in the hospital except the doctor ) Activate the switch. During that time, the doctor is often alone in the entire hospital building, and if the doctor is treating an emergency patient in the ER, the doctor cannot leave the place. At that time, the ward manager will inform the patient's home doctor via the answering service. The answering machine service typically promises the ward manager to notify the doctor again if there is no response within 20 minutes from the home doctor. On the one hand, the patient may stop breathing. A responder who remembers the ACLS procedure is urgently needed in the patient's room. However, no one in the patient's room may be working at the ER, or may not be able to follow the latest changes in the ACLS protocol. As a result, the patient may unfortunately die despite the respondents' hard work of lacking ACLS knowledge and experience.

  Guide responders via audible prompts and visual cues through required medications, doses and proper timing procedures during cardiac arrest events according to the ACLS protocol What is desired is a method and apparatus that can operate as such.

  The preferred embodiment of the present invention comprises an ACLS method and apparatus operable to guide responders via audible prompts or visual cues through the appropriate procedure to be applied to the patient during cardiac arrest. The preferred embodiment of the present invention can be located in a conventional hospital emergency cart containing emergency devices and medicines, or it can be hardware and application software. The application software includes a central processing unit (CPU), memory, input / output means such as a keyboard, mouse, touchpad, trackball, speaker, buzzer, illuminated indicator, video display, data bus, etc. Can be loaded into and loaded into computer hardware having computing software and drivers. The computer hardware may be a mainframe, personal computer (PC), terminal, tablet PC, laptop PC, personal digital assistant (PDA), or the like. Input to computer hardware / software can be facilitated via keystrokes, screen taps, button or switch actuation, voice recognition, mouse clicks, biological recognition methods, and the like. The preferred embodiment of the present invention advantageously recognizes ACLS procedures such as the type and dose of drug to be administered and the order in which actions are performed on the patient (eg, cardiopulmonary resuscitation (CPR)), and Make tracking easier.

  It will be apparent to those skilled in the art to which the present invention pertains that various modifications of the structure of the present invention and a wide variety of embodiments and applications of the present invention do not depart from the scope of the invention as set forth in the claims. Suggested naturally. The disclosures and the descriptions herein are merely illustrative and are not intended to be limiting in any sense.

  For a better understanding of the preferred embodiments of the present invention, including the features, advantages and specific embodiments of the present invention, reference is made to the following detailed description taken in conjunction with the accompanying drawings.

  Unless otherwise specified, in the following detailed description, the same reference numerals as those in the drawings correspond. The same reference numerals refer to the same parts throughout the various figures.

  While the construction and use of the preferred embodiment of the present invention will be described in detail below, it should be recognized that the preferred embodiment of the present invention provides a variety of applicable inventive concepts that can be implemented in a wide range of specific situations. It is. Certain features of the preferred embodiment shown and described may be simplified or emphasized in illustrating the principles of the invention.

  The preferred embodiment of the present invention comprises an ACLS method and apparatus operable to guide responders via audible prompts and visual cues through appropriate procedures to be applied to the patient during cardiac arrest. As can be seen from FIG. 2, the preferred embodiment of the present invention preferably includes application software running on computer hardware, which includes a central processing unit (CPU), memory, eg, keyboard, mouse. Input / output means such as touchpad, touch screen, trackball, speaker, buzzer, illuminated indicator, printer, video display, ports (such as serial, parallel, USB, infrared (IR), and wireless) Can be loaded into and loaded into computer hardware having a data bus, power supply and regulation circuitry, computing software and drivers. The computer hardware may be a mainframe, a personal computer (PC), a mobile terminal, a thin client terminal, a tablet PC, a laptop PC, a personal digital assistant (PDA) (as seen from FIG. 4), and the like. Input to computer hardware / software can be facilitated via keystrokes, screen taps, button or switch activation, voice recognition, mouse clicks, biological recognition, and the like.

  Embodiments of the invention are in the form of at least one computer readable medium and processor instructions embedded in at least one computer readable medium. The processor directive contains an algorithm used during the ACLS procedure, such as an algorithm that is generally in the form of a decision tree. A decision tree is a set of decisions and possible outcomes of the decisions used to form a plan to reach a goal, in this case patient resuscitation. A decision tree is a predictive model that is a mapping of the observations about the patient to the conclusions about the patient's final outcome. The processor instructions are configured to be readable by at least one processor from at least one computer readable medium, thereby prompting, accepting input, starting a timer, Have at least one computer decide what to show. The embodiment 300 of the present invention may be located in a conventional hospital emergency cart containing emergency devices and therapeutic agents as seen in FIGS. 3A-3C. FIG. 3A is a front view of an apparatus 300 having an audio output 301, a touch sensitive digital display 302 and a digital clock display 303. FIG. FIG. 3B is a top view showing the digital clock display 303 from above and the input buttons 304 responding to prompts and commands of the apparatus 300. FIG. 3C is a side view of the apparatus 300.

  Generally speaking, the preferred embodiment of the present invention comprises at least one prompting means for obtaining information from a user and at least one for obtaining a user response to an information prompt. Input means, at least one timing means for obtaining timing information based on an elapsed time or a temporary occurrence of a situation, and a decision route selection based on an information prompt and a user response to the timing information Operable logic means and at least one output providing a communication queue to guide the responder through the appropriate procedure to be applied to the patient during cardiac arrest based on the output from the logic means From the equipment used to perform the ACLS procedure. The The operation of the computer hardware commanded through the software can be changed by upgrading or modifying the software. Such changes can also be made to the software via the hardware port, for example when the ACLS procedure is improved or modified, or new drug treatments or doses are introduced. The scope of the present invention encompasses at least the possibility of making such changes. Preferred embodiments of the present invention are recognized to advantageously perform ACLS procedures such as, for example, the type and dose of drug treatment to be administered, and the sequence of performing actions (eg, cardiopulmonary resuscitation (CPR)) on the patient. And make tracking easier.

  The following is a description of the operation of the preferred embodiment of the present invention. Details of the method of the invention and the apparatus for carrying out the method follow the general description. Assume that a patient at the hospital experiences cardiac arrest and a physician who is familiar with the ACLS procedure cannot respond immediately. The nurse moves the emergency cart containing the preferred embodiment of the present invention into the patient's room. The device is activated by an on-off switch. In one embodiment of the invention, the touch screen prompts the nurse to initiate a specific algorithm by selecting whether the patient is an adult or a child, and within a few seconds, the first audible command responds. Comes out of the device at a volume suitable for the listener. Once the first command is followed, the nurse then touches the screen to inform the device of that fact and the first timer of the timers is activated. The first timer counts down to a certain level (eg, zero), after which another command is given. Another timer, eg, a second timer, a third timer, a fourth timer in a plurality of timers, operate simultaneously and / or sequentially, each timer generating another occurrence in the ACLS procedure Or determine exactly what action should be taken. Such behaviors and events may include, among other things, therapeutic drug dosage and administration, CPR performance, and monitoring of patient vital signs. If the patient's condition changes during the resuscitation process, the method and apparatus according to the present invention are adapted to prompt the nurse to change the condition, and the method thus changes the selection on the screen. Alternatively, the scenario involves a physician who is not well versed in the ACLS procedure using a PDA loaded with application software adapted to perform the method according to the preferred embodiment of the present invention. Can be made. In any case, the audible and visual prompts can be English or any other language that is optimal for the respondent's whereabouts and language.

  It can be seen that the preferred embodiment of the present invention is adapted to guide responders through difficult situations by commanding what to do in what order and timing the situation accurately. In this way, proper drug treatment at the correct dose is performed and actions are taken at the proper time, thus increasing the probability of patient survival. Throughout the entire resuscitation process, the preferred embodiment of the present invention provides an audible prompt to the responder regarding the timeliness of drug administration and at what intervals.

  Another aspect of the preferred embodiment of the present invention is the use of pharmaceutical drug treatment with a color coded package in combination with the apparatus and method according to the present invention. In this way, the audible command can be simplified to guide the nurse to administer a particular package of medication regardless of the medical name of the medication. Thus, any responder who can initiate an intravenous fluid (IV) fluid can administer a suitable medication that is appropriate for the situation.

  Another aspect of the preferred embodiment of the present invention is in combination with an automatic external defibrillator (AED). Such a combination can be performed, for example, by using the software and hardware elements of the preferred embodiment of the present invention and the power supply of the AED. By using the preferred embodiment of the present invention with an AED, the result is that the AED recognizes the individual rhythms rather than the responder before proceeding with the protocol, so that the method according to the preferred embodiment of the present invention is modified. Become. In other words, the protocol remains as it is except for the steps that require rhythm recognition. It is noted that pharmaceutical protocols, intravenous (IV) and airway prompts and CPR cycles are not part of the AED. Another aspect of the preferred embodiment of the present invention relates to safety issues. When respondents are prompted to select one of the medication choices, the closest distance should be used to prevent accidental selection of the wrong choice while that choice appears on the same screen. It is located apart. In another safety aspect regarding particularly important decisions, a confirmation prompt may be provided to confirm the responder's selection. Such verification can also be done by using a bar code or similar reader to read the bar code from the pharmaceutical package to confirm the steps already taken. In another aspect of the preferred embodiment of the present invention, a list of actions taken is recorded in the memory portion of the hardware and further displayed on a video display for quick reference during the ACLS procedure. In addition, options can be provided to the user via a video display or via individual switches or keystrokes to return to the previous display to review the actions taken or the choices that were available. it can. The actions stored in the memory can be printed on the printer at the same time as the event occurs or at a later time. Such behavior is correlated to the actual time of occurrence of such an event, such time being universal world time (UTC) or local time. For example, venous line acquisition at 2:34, first epinephrine administration at 4:10, second shock at 7:42, and so on. If a mistake is made during the ACLS process, the device allows the responder to be aware of such a mistake, and in response, some action is taken via the keyboard.

  If it becomes necessary to declare the patient's death, the device according to the preferred embodiment of the present invention receives input from the respondent of the sentence, at which point the device indicates that this is the desired behavior. Provide a confirmation prompt.

  When implemented, the preferred embodiment of the present invention is adapted to receive input from responders regarding the age, weight and / or height of the patient. In response to the input, the device is adapted to adjust the exact dose for drug treatment and the level of voltage shock to be applied. For example, the video display and audible prompt may provide the text “if the newborn goes to step x, the infant goes to step y and the child goes to step z”. Thus, the lookup table loaded into the memory computer hardware has values representing doses for newborns, infants, young children, and children. The same concept extends to, for example, venous and endotracheal tube sizes. This advantageously overcomes the need to perform such calculations during the ACLS procedure.

  1A-1TTT provide a detailed flow chart of a method that may be performed in a first embodiment of a device according to the present invention used to promote adult resuscitation. The method can be modified as described herein to promote child resuscitation. As will be explained below, all text in the quote is audibly and visually audible to the responder via a voice converter, touch screen, video display, etc. by the device according to the first embodiment of the invention. Or a command or prompt transmitted in both ways. Furthermore, as described above, a plurality of timers used to detect when an action should be taken is used in the first embodiment of the present invention. The first embodiment of the present invention preferably uses the following six timers (hereinafter referred to as clocks).

  External clock A. This clock holds the elapsed time from the start of the ACLS procedure to the end of the ACLS procedure until the user stops the entire event (such an elapsed time is its code blue event as a code blue event). Because of their nature, they are sometimes called “codes”). This clock is displayed on the video display and is also visible to the responder and is therefore referred to as the external clock.

  CPR clock B. This clock is not visible to the responder (hence referred to as the “internal” clock) and is of a two-minute cycle that indicates the length of the individual CPR activity (CPR session). The ACLS guidelines are very specific about the importance of chest compressions for drug treatment.

  Boost clock C. This clock is also an internal clock that tracks the timing of this type of medication (epinephrine or Vasopressin). This is one cycle every 3 minutes.

  Anti-venous clock D. This internal clock cycles once every 3 minutes to track the timing of epinephrine or amiodarone.

  Atropine clock E. This internal clock cycles once every three minutes to track the atropine timing.

  Venous / airway prompt. This “internal” or “external” clock cycles once every five minutes until confirmed by a touch screen or other input recognition.

  It is noted that various clocks can be provided in a computer using a signal clock source. Furthermore, a first embodiment of the device according to the invention includes an audible metronome cadence. The current ACLS protocol emphasizes the need for better, faster and uninterrupted CPR. The new chest compression rate is 100 times / minute. An audible metronome rhythm sets the pace for this number audibly.

  Referring now to FIG. 1A, an initial selection between an adult and a child is prompted. If an adult is selected, the apparatus starts at step 1. If a child is selected, the device performs a step for resuscitation of the child, a step modified from the adult version as described below. The steps are taken automatically by the device (based on an algorithm) following a response (and / or) input from a user (or sensor) in response to a prompt and transmission from the device.

  As can be seen from FIG. 1B, in step 1, the external clock A is started. The device communicates: “wear monitor and defibrillator” and “check pulse”. If there is a pulse, go to step 55. If there is no pulse, the following ventricular tachycardia / ventricular fibrillation algorithm (referred to as “V Tach or V Fib” or VT / VF) (proceed to step 2), asystole algorithm (proceed to step 18) Or select from the Pulseless Electrical Activity (PEA) algorithm (proceed to step 36).

  As can be seen from FIG. 1C, in Step 2 (VT / VF), the device starts CPR with “defibrillation at 200 joules” and “clear all” (3 times) and “compression of 100 times per minute” Communicate. The metronome rhythm then starts at 100 times / minute. Clock B is set at 2 minutes and then started. The device then communicates: "Is the IV line established?" If the user answers “yes”, step 3 begins. If you answer “No”, you will be asked every 3 minutes until you answer “Yes”. The device then communicates: "Is the airway device in place and confirmed?" If no, a question can be asked every 5 minutes until a positive response is obtained. Further, the prompt may remain on the touch screen until the vein (IV) and / or airway is established.

  As can be seen from FIG. 1D, in step 3 (VT / VF), when clock B reaches 2 minutes, the apparatus communicates: “Stop CPR and check rhythm”. In that case, there are four options: VT / VF (continue below), asystole (proceed to step 18 (b)), pulseless electrical activity (PEA) (proceed to step 36 (b)) and pulse recovery ( Proceed to step 55). If the first option is selected, the device “defibrillates at 300 joules”, “clears all” (3 times), and “continue CPR with 100 compressions per minute” Communicate. Metrome-like rhythm starts with 100 beats per minute. Clock B is set at 2 minutes and restarted. At this point, if a venous line is established, the apparatus continues to step 4. If the venous line is not established, the device will continue to prompt until it is established. On the other hand, if the responder indicates that the venous line has not been established but the oral airway is in place, the apparatus proceeds to step 5 (a). If the oral airway is not in place, the device will continue to prompt until the oral airway is in place. The device may indicate that no medication can be given if neither the venous line nor the oral airway is established.

  As can be seen from FIG. 1E, in step 4 (venous line acquisition), the device communicates the medication, dosage and method of drug treatment. That is, intravenous injection of 1 mg of epinephrine or intravenous injection of 40 units of vasopressin. Clock C is set for 3 minutes. The device may indicate that vasopressin can be administered only once. Thus, if it is administered in this case, it will not be optional in the next step. However, if not given at this step, it may be offered as an option once more. The same applies to step 4 (a) as well. Alternatively, in step 4 (a) where the venous line has not been secured but the airway device has been confirmed, does this device ET 2.5 mg of epinephrine in 5 ml of water or NS (saline)? Or, tell the ET to get 40 units of vasopressin to 5 ml of water or NS. The apparatus then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1F, in step 5 (VT / VF), the device communicates: “Continue CPR at 100 compressions per minute” and the device is metronomous with 100 beats per minute. Provide rhythm. Once clock B reaches 2 minutes, the device communicates: “Stop CPR and check rhythm”. Based on the rhythm, there are four options for user acceptance: VT / VF (following below), asystole (proceed to step 19 (b)), pulsatile electrical activity (to step 38 (b) Forward), and pulse recovery (go to step 55). If the first option is selected, the device communicates: “Defibrillate at 360 joules” and “Clear all” (3 times) and “Continue CPR at 100 compressions per minute” To do. The metronome rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1G, in Step 6 (Securing the intravenous line) (VT / VF), the apparatus administers amiodarone 300 mg intravenously or lidocaine 1-1.5 mg / kg intravenously. And communicate methods of drug treatment. Clock D is set for 3 minutes. Alternatively, the venous line is not secured, but the airway device is confirmed in step 6 (a), the device communicates with 5 ml of water or NS with lidocaine 2-3 mgET. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock D is set at 3 minutes. It can be noted that the device cannot administer amiodarone via the airway device and therefore this is not offered as an option. Once it is indicated that the venous line has been established, the device conveys no further need to perform step 10 (a) for the remainder of the protocol.

  As can be seen from FIG. 1H, in step 7 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (following), asystole (proceed to step 18 (b)), pulsatile electrical activity (proceed to step 36 (b)) and pulse recovery (proceed to step 55) ) Is provided. If the first option is selected, the device communicates: “Defibrillate at 360 joules” and “Clear all” (3 times) and “Continue CPR at 100 compressions per minute” To do. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1I, in Step 8 (Securing Venous Lines) (VT / VF), the device is used for drug, dosage and drug treatment, such as intravenous injection of 1 mg of epinephrine or intravenous injection of 40 units of vasopressin. Communicate about the method. Clock C is set for 3 minutes. The device may indicate that vasopressin can only be administered once. However, if it is not administered at this step, it cannot be offered as a postponement option. The above also applies to step 8 (a). Alternatively, the venous line is not secured, but the airway device has been confirmed In step 8 (a), the device ETs 2.5 ml of epinephrine in 5 ml of water or NS, or 5 ml of water or NS If you get 40 units of vasopressin, it will be transmitted. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1J, in step 9 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (following), asystole (proceed to step 19 (b)), pulseless electrical activity (proceed to step 38 (b)) and pulse recovery (proceed to step 55) ) Is provided. If the first option is selected, the device will “defibrillate at 360 joules”, “clear all” (3 times), and “continue CPR with 100 compressions per minute”. Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1K, in Step 10 (Securing the intravenous line) (VT / VF), this device is used for pharmaceutical, dosage, such as intravenous injection of 150 mg of amiodarone or intravenous injection of 1-1.5 mg / kg of lidocaine. And communicate drug treatment methods. Clock D is set at 3 minutes. Alternatively, the venous line is not secured, but in step 10 (a) when the airway device has been confirmed, the device communicates when 5 mg of water or NS ET lidocaine 2-3 mg / kg. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock D is then set for 3 minutes. The device may note that amiodarone cannot be administered via the airway device, and therefore it is not offered as an option. Once it is indicated that the venous line has been established, the device does not communicate any further need to perform step 10 (a) in the rest of the protocol.

  As can be seen from FIG. 1L, in step 11 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue below), asystole (proceed to step 18 (b)), pulseless electrical activity (proceed to step 36 (b)), and pulse recovery (proceed to step 55). Forward) is provided. If the first option is selected, the device communicates: “Defibrillate at 360 Joules”, “Clear All” (3 times) and “Continue CPR with 100 compressions per minute” To do. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1M, in step 12 (venous line reservation) (VT / VF), the device communicates medication, dosage, and method of drug treatment, such as intravenous injection of 1 mg of epinephrine. Clock C is set for 3 minutes. Alternatively, the venous line is not secured, but the airway device is confirmed in step 12 (a), the device communicates with 5 ml of water or NS when ET epinephrine is 2.5 mg. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1N, in step 13 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue below), asystole (proceed to step 19 (b)), pulseless electrical activity (proceed to step 38 (b)), and pulse recovery (up to step 55) Forward) is provided. If the first option is selected, the device communicates: “Defibrillate at 360 joules” and “Clear all” (3 times) and “Continue CPR at 100 compressions per minute” To do. A metronome-like rhythm starts at 100 beats per minute. Clock B is set in 2 minutes and restarted.

  As can be seen from FIG. 1O, in step 14 (VT / VF), the device communicates: “Does the patient have received a maximum dose of 3 mg / kg lidocaine?”. If the response is “no”, the device then communicates with an intravenous injection of 1-1.5 mg / kg lidocaine and the clock is not set for this medication. Alternatively, the apparatus continues to step 14 (a). If the response is “yes”, the apparatus continues to step 15. In step 14 (a) where the venous line has not been secured, but the airway device has been confirmed, the device communicates when it receives 2-3 mg / kg lidocaine in 5 ml of water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”.

  As can be seen from FIG. 1P, in step 15 (reversible causes), the device communicates: “Have you considered the following reversible causes?” The following prompt is then communicated: Blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis, hypothermia, It is. The user is then given the option of saving this list for later reference or keeping the list secret. The device includes a prompt button or, if it becomes necessary to refer again, this list may be included on the screen at this point for easy access by the user.

  As can be seen from FIG. 1Q, in step 16 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (following), asystole (proceed to step 18 (b)), pulseless electrical activity (proceed to step 36 (b)), and pulse recovery (proceed to step 55) ) Is provided. If the first option is selected, the device will “defibrillate at 360 joules”, “clear all” (3 times), and “continue CPR with 100 compressions per minute”. Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1R, in step 17 (secure vein line) (VT / VF), the device communicates medication, dosage and method of drug treatment, such as intravenous injection of epinephrine 1m. Clock C is set for 3 minutes. Alternatively, in step 17 (a), where the venous line has not been secured but the airway device has been identified, the device communicates when epinephrine 2.5 mg is ET in 5 ml of water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes. At this point in the method, the apparatus performs a nested loop of steps 16 and 17. There is no new medication until the medical team is ready to "call the code" and declare the patient dead. At that point, the end procedure remains on the screen until step 54.

  As can be seen from FIG. 1S, in step 18 (Asystole), the device communicates: “Confirm asystole from two precedents” and “Start CPR with 100 compressions per minute”. . Clock B is then set at 2 minutes and started. The device then prompts according to step 3 “Is the vein line established?” If so, the apparatus continues to step 19. If not, the prompt is continued and the question is re-inquired every 5 minutes until a positive response is made. On the other hand, the device communicates: "Is the airway device in place and confirmed?" This prompt continues and the question is re-inquired every 5 minutes until a positive response is made. Further, the prompt may remain on the screen until a venous line and / or airway is established. Alternatively, in step 18 (a) (Asystole), the device communicates: “Confirm atrial arrest from two precedents” and “Start CPR at 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. Information about the venous line and airway from this step is stored in the memory of the computer.

  As can be seen from FIG. 1T, in step 19 (secure vein line) (asystole), the device communicates: “Consider transcutaneous pacing”. The device communicates medication, dosage and drug treatment method, such as intravenous injection of 1 mg of epinephrine or intravenous injection of 40 units of vasopressin. Clock C is set for 3 minutes. The device may indicate that vasopressin can be administered only once. Therefore, if it is administered at this point at this point, it is not an option at the next step. However, if not given at this step, it may be offered as an option once more. Alternatively, the venous line is not secured, but the airway device has been confirmed In step 19 (a), the device ETs 5 ml water or NS with epinephrine 2.5 mg, or 5 ml water or NS. ET when 40 units of Bassopressin are ET. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes. The apparatus then continues to step 20. As can be seen from FIG. 1U, in step 19 (b) (Asystole), the device communicates: “Confirm asystole from two precedents” and “Start CPR at 100 compressions per minute”. Clock B is then set at 2 minutes and started.

  As can be seen from FIG. 1U, in step 20 (Asystole), the device communicates: “Consider transcutaneous pacing”. Clock B reaches 2 minutes and the device communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (go to step 20 (b)), asystole (follow), pulseless electrical activity (go to step 38 (b)), and pulse recovery (go to step 55). Proceed) is presented. The device communicates: “Continue CPR with 100 compressions per minute”. The metronome rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In step 20 (b) (VT / VF), the device “defibrillates at 200 joules”, “clears all” (3 times), and “continues CPR with 100 compressions per minute”. introduce. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. The apparatus then proceeds to step 4.

  As can be seen from FIG. 1V, in step 21 (securing the venous line) (asystole), the device communicates the medication, dosage and method of drug treatment, such as intravenous injection of 1 mg of atropine. Alternatively, in step 21 (a) where the venous line has not been secured but the airway device has been confirmed, the device communicates when ET 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. At this point in the method, the device reminds the responder that atropine can only be administered up to four times, and this fact is encoded in the application software.

  As can be seen from FIG. 1W, in step 22 (reversible cause), the apparatus communicates: "Did you consider the following reversible causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis , Hypothermia is transmitted. The user is then given the option to save the list for later reference or to hide the list. The device may include a prompt button, or this list may be included on the screen at this point for easy access by the user if it needs to be referenced again.

  As can be seen from FIG. 1X, in step 23 (Asystole), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (following step 20 (b)), asystole (following below), pulseless electrical activity (going to step 36 (b)) and pulse recovery (going to step 55). ) Is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1Y, in step 24 (Venous line acquisition) (Asystole), the device uses a drug, dosage and drug treatment, such as intravenous injection of 1 mg of epinephrine or intravenous injection of 40 units of vasopressin. Communicate the way. Clock C is set for 3 minutes. The device may indicate that vasopressin can only be administered once. Therefore, if it is administered at this point, it is not an option for the next step. However, if it is not administered at this step, it can be offered as an option once more. Alternatively, the venous line is not secured, but the airway device has been confirmed In step 24 (a), the device ETs 2.5 mg of epinephrine in 5 ml of water or NS, or 5 ml of water or NS If you get 40 units of vasopressin, it will be transmitted. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1Z, in step 25 (Asystole), the device communicates: “Stop CPR and check rhythm”. The four options are then: VT / VF (following step 20 (b)), asystole (following), pulseless electrical activity (going to step 38 (b)), and pulse recovery (going to step 55). Proceed) is presented. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1AA, in step 26 (venous line acquisition) (asystole), the device communicates medication, dosage and method of drug treatment, such as 1 mg intravenous atropine injection. Alternatively, the venous line is not secured, but the airway device communicates in step 26 (a) when the device ETs 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. It is flagged internally by the device that this is the second of a total of four possible doses of atropine. Such facts can also be communicated to the responder as a reminder.

  As can be seen from FIG. 1BB, in step 27 (cause of reversibility), the apparatus communicates: "Did you consider the following reversibility causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponase, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis Communicates hypothermia. The user is then given the option to save the list for later reference or to hide the list. The device may include a prompt button or may include this list on the screen at this point so that the user can easily access it when there is a need to reference it again.

  As can be seen from FIG. 1CC, in step 28 (Asystole), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (following step 20 (b)), asystole (following below), pulseless electrical activity (going to step 36 (b)) and pulse recovery (going to step 55). ) Is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1DD, in step 29 (securing the venous line) (asystole), the device communicates the medication, dosage and drug treatment method, such as intravenous injection of 1 mg of epinephrine. Clock C is set for 3 minutes. Alternatively, although the venous line is not secured, in step 29 (a) when the airway device has been confirmed, the device communicates when epinephrine 2.5 mg is ET in 5 ml of water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes. At this point, the termination procedure remains on the video display until step 54.

  As can be seen from FIG. 1EE, in step 30 (Asystole), the device communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue to step 20 (b)), asystole (continue below), pulseless electrical activity (proceed to step 38 (b)) and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1FF, in step 31 (securing the venous line) (asystole), the device communicates medication, dosage and drug therapy, such as intravenous injection of 1 mg of atropine. Alternatively, the venous line is not secured, but the airway device communicates in step 31 (a) when the device ETs 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. This is internally flagged by the device to be the third of four total doses of atropine that can be administered. Such facts can also be communicated to responders as reminders.

  As can be seen from FIG. 1GG, in step 32 (Asystole), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR, check rhythm”. The four options are then: VT / VF (continue to step 20 (b)), asystole (continue below), pulseless electrical activity (proceed to step 36 (b)), and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1HH, in step 33 (securing the venous line) (asystole), the device communicates the medication, dosage and drug treatment method, such as intravenous injection of 1 mg of epinephrine. Clock C is set for 3 minutes. Alternatively, the venous line is not secured, but the airway device communicates in step 33 (a) when the device ETs 2.5 mg epinephrine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1II, in step 34 (Asystole), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR, check rhythm”. The four options are then: VT / VF (following step 20 (b)), asystole (following), pulseless electrical activity (going to step 38 (b)), and pulse recovery (going to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1JJ, in step 35 (securing the venous line) (asystole), the device communicates the medication, dosage and method of drug treatment, such as intravenous injection of 1 mg of atropine. Alternatively, although the venous line is not secured, in step 35 (a) where the airway device has been confirmed, the device communicates when ET 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and call for assistance 5 times”. Clock E is then set at 3 minutes. The device internally flags that this is the fourth of four total doses of atropine that can be administered. Such facts can also be communicated to responders as reminders. At this point, the termination procedure remains on the video display from step 54. Steps 32 and 33 are looped until the responder calls the code or the end part of the method is called. At this point, no further medication is given in the action to be taken.

  As can be seen from FIG. 1KK, in step 36 (pulseless electrical activity), the apparatus communicates: “Start CPR at 100 compressions per minute”. The metronome rhythm then starts at 100 beats per minute. Clock B is set at 2 minutes and then started. The device then communicates: "Is the venous line established?" If the user answers “yes”, then the method returns to step 3. If “no”, the question is re- asked every 5 minutes until “yes” is answered. The device then communicates: "Is the airway device in place and confirmed?" If “no”, the question is retried every 5 minutes until a “yes” response is obtained. In addition, prompts may remain on the touch screen until a venous line and / or airway is established. If yes, the method continues to step 37. As can be seen from FIG. 1NN, in step 36 (b) (pulseless electrical activity), the apparatus communicates: “Start CPR at 100 compressions per minute”. The metronome rhythm then starts at 100 beats per minute. Clock B is set at 2 minutes and then started.

  As can be seen from FIG. 1LL, in step 37 (venous line acquisition) (pulseless electrical activity), the device is a pharmaceutical, dosage and drug treatment method, such as intravenous injection of 1 mg of epinephrine or 40 units of vasopressin. To communicate. Clock C is set for 3 minutes. The device may indicate that vasopressin can only be administered once. Therefore, if it is administered at this point, it is not offered as an option in the next step. However, if it is not administered at this step, it may be offered as an option once more. Alternatively, at step 37 (a) where the venous line is not secured but the airway device has been confirmed, the device ETs 2.5 ml of epinephrine in 5 ml of water or NS, or 5 ml of water or NS ET VOSOPRESSIN 40 credits. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1MM, in step 38 (pulseless electrical activity), once clock B reaches 2 minutes, the device communicates: “Stop CPR and check rhythm”. Based on the rhythm, there are four options: VT / VF (proceed to step 20 (b)), asystole (proceed to step 19 (b)), pulseless electrical activity (continue below), and pulse recovery ( Proceed to step 55). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. The device communicates: "Is the pulse 60 or less?" If the user selects “Yes”, the method proceeds to step 39. . If the user selects “No”, the method proceeds to step 40.

  As can be seen from FIG. 1NN, in step 39 (securing the venous line) (pulseless electrical activity), the device communicates the medication, dosage and method of drug treatment, such as intravenous injection of 1 mg of atropine. Alternatively, the venous line has not been secured, but the airway device has been confirmed in step 39 (a), the device communicates when ET 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. It is flagged internally by the device that this is the first of a total of four doses that can be administered. Such facts can also be communicated to responders as reminders.

  As can be seen from FIG. 1OO, in step 40 (reversible cause), the apparatus communicates: "Have you considered the following reversible causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis, Hypothermia is transmitted. The user is then offered the option of saving the list for later reference or hiding the list. The device may include a prompt button, or this list may be included on the screen at this point for easy access if the user needs to refer again.

  As can be seen from FIG. 1PP, in step 41 (pulseless electrical activity), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (go to step 20 (b)), asystole (go to step 18 (b)), pulseless electrical activity (following below), and pulse recovery (go to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1QQ, in step 42 (securing the venous line) (pulseless electrical activity), the device is used for pharmaceuticals, dosages such as intravenous injection of 1 mg of epinephrine, or intravenous injection of 40 units of vasopressin. And communicate methods of drug treatment. Clock C is set for 3 minutes. The device may indicate that vasopressin may be administered only once. Thus, if it is administered at this point, it is not an option in the next step. However, if it is not administered at this step, it may be offered as an option once more. Alternatively, in step 42 (a), where the venous line has not been secured but the airway device has been identified, the device ET 5 ml of epinephrine in NS or 5 ml of water or NS Communicate when NS is given 40 units of Vasopressin. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1RR, in step 43 (pulseless electrical activity), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue to step 20 (b)), asystole (proceed to step 19 (b)), pulseless electrical activity (continue below), and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. The device communicates: "Is the pulse 60 or less?" If the user selects “Yes”, the method continues to step 44. If the user selects “No”, the method continues to step 45.

  As can be seen from FIG. 1SS, in step 44 (securing the venous line) (pulseless electrical activity), the device communicates medication, dosage and drug treatment method, such as intravenous injection of 1 mg of atropine. Alternatively, in step 44 (a) where the venous line has not been secured but the airway device has been identified, the device communicates when ET 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. It is flagged internally by the device that this is the second of a total of four doses of atropine that can be administered. Such facts can also be communicated to responders as reminders.

  As can be seen from FIG. 1TT, in step 45 (cause of reversibility), the apparatus communicates: "Have you considered the following reversibility causes?" Next, the following prompts were observed: blood volume reduction, drug overdose, cardiac tamponade, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis, hypothermia Provided. The user is then given the option to save the list for later reference or keep the list secret. The device includes a prompt button, or if a reference is required again, this list can be included on the screen at this point so that the user can easily access it.

  As can be seen from FIG. 1UU, in step 46 (pulseless electrical activity), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue to step 20 (b)), asystole (proceed to step 18 (b)), pulseless electrical activity (following below), and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1VV, in step 47 (securing the venous line) (pulseless electrical activity), the device communicates medication, dosage and drug treatment method, such as intravenous injection of 1 mg of epinephrine. Clock C is set for 3 minutes. Alternatively, the venous line is not secured, but the airway device is confirmed in step 47 (a), the device communicates with ET of 2.5 ml epinephrine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes. At this point, the termination procedure remains on the video display until step 54.

  As can be seen from FIG. 1WW, in step 48 (pulseless electrical activity), the device communicates: “Stop CPR and check rhythm”, then four options: VT / VF (step 20 (b ), Asystole (proceed to step 19 (b)), pulseless electrical activity (continue below) and pulse recovery (proceed to step 55). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. The device communicates: "Is the pulse 60 or less?" If the user selects “Yes”, the method proceeds to step 49. If the user selects “No”, the method proceeds to step 50.

  As can be seen from FIG. 1XX, in step 49 (venous line reservation) (pulseless electrical activity), the device communicates medication, dosage and drug treatment method, such as intravenous injection of 1 mg of atropine. Alternatively, the venous line is not secured, but the airway device is confirmed in step 49 (a), the device communicates when ET 2 mg atropine in 5 ml water or NS. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock E is then set at 3 minutes. It is flagged internally by the device that this is the third of a total of four doses of atropine that can be administered. Such facts can also be communicated to responders as reminders.

  As can be seen from FIG. 1YY, in step 50 (pulseless electrical activity), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue to step 20 (b)), asystole (proceed to step 18 (b)), pulseless electrical activity (following below), and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  As can be seen from FIG. 1ZZ, in step 51 (securing the venous line) (pulseless electrical activity), the apparatus communicates the medicine, the dose, and the drug treatment method, such as intravenous injection of 1 mg of epinephrine. Clock C is set for 3 minutes. Alternatively, the venous line is not secured, but the airway device is confirmed in step 51 (a), the device communicates with 5 ml of water or NS when ET epinephrine is 2.5 mg. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  As can be seen from FIG. 1AAA, in step 52 (pulseless electrical activity), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. There are then four options: VT / VF (continue to step 20 (b)), asystole (proceed to step 19 (b)), pulseless electrical activity (following below), and pulse recovery (to step 55). Forward) is provided. The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. The device communicates “whether the pulse is 60 or less”. If the user selects “Yes”, the method continues to step 53. If the user selects “No”, the method continues to step 54.

  As can be seen from FIG. 1BBB, in step 53 (venous line acquisition) (pulseless electrical activity), the device communicates medication, dosage and method of drug treatment, such as intravenous injection of 1 mg of atropine. Alternatively, the venous line is not secured, but the airway device is confirmed in step 53 (a), the device communicates when ET 2 mg atropine into 5 ml water or NS. The device then communicates: “Stop CPR and give 5 assisted ventilations”. Clock E is then set at 3 minutes. It is internally flagged by the device that this is the fourth of a total of four doses of atropine that can be administered. Such facts can also be communicated to responders as reminders. At this point, the end procedure from step 54 remains on the video display. Steps 50 and 51 are looped until the responder calls the code or until the end of the method is called. At this point, there is no further medication or action to be taken.

  As can be seen from FIG. 1CCC, the termination procedure is invoked. The device communicates: "Do you really want to end the ACLS activity?" If yes, the device then communicates: “Confirm that you want to end ACLS activity”. If no, continue the loop. At this point, the user is given the option to print a summary of the occurrence along with the timing of the medication administered relative to the external clock and the internal elapsed time clock. In one aspect of the present invention, it is printed on a piece of paper having an adhesive back that can be inserted into the apparatus and ejected from the apparatus.

  As can be seen from FIG. 1 DDD, in step 55 (there is a pulse), the apparatus communicates: “Check blood pressure and heart rate”. Then three options are: heart rate is 60 or less (proceed to step 56), heart rate is 60 to 120 (proceed to step 68), or heart rate is 120 or more (step 61) Go to) is provided.

  As can be seen from FIG. 1EEE, in step 56 (bradycardia), the device communicates: “Is the patient symptom or unstable?”. Two options are provided for selection. If no, then continue to: If yes, then (proceed to step 58). This device will acquire 12 lead EKGs ”. Then type II or III AV block? Two options are provided for selection. If no, then continue to: If yes, go to step 57. The apparatus communicates: “Attach, monitor and observe percutaneous pacer pad on patient” and “provide oxygen”. Options are then provided. Press here if the patient becomes unstable or has symptoms. If an option is selected, the method proceeds to step 58.

  As can be seen from FIG. 1FFF, in step 57 (bradycardia), the device “installs, monitors and observes the percutaneous pacer pad to the patient” and “provides oxygen” and “transvenous pacemaker. Prepare. ” The responder is then aroused and prompted. If symptoms are noticeable, use a percutaneous pacer until a transvenous pacemaker is installed and immediately communicate with a specialist.

  As can be seen from FIG. 1GGG, in step 58 (bradycardia), the device communicates medication, dosage and drug treatment method, such as intravenous injection of 0.5 mg of atropine. Clock E is set for 3 minutes. The device communicates: “Attach the patient with a percutaneous pacer pad” and “Provide oxygen” and “If the heart rate remains low, consider the following” and do the following: Atropine 0 Administer 5 mg every 3-5 minutes up to 6 doses, infuse epinephrine 2 to 10 mcg / min, dopamine 2 to 10 mcg / kg / min, and search for root cause Appears on the video display.

  As can be seen from FIG. 1HHH, in step 59 (bradycardia), the apparatus communicates: “Is the heart rate less than 60” or “Is the patient symptom or unstable?” To do. If the two options are “No”, continue to the following, and if “Yes” is selected, (Proceed to Step 60) is provided for selection. The device then prompts to monitor and observe if the patient is currently stable without any serious signs or symptoms.

  As can be seen from FIG. 1III, in step 60 (bradycardia), the apparatus communicates “use transcutaneous pacer”. The device communicates medications, dosages and drug treatment methods, such as intravenous injection of 0.5 mg atropine. Clock E is set at 3 minutes. The device communicates: “If heart rate remains low, consider the following” and receive the following: 6 times atropine 0.5 mg every 3-5 minutes for immediate diagnosis The video display will show that the dose is up to 2 mcg / min, 2-10 mcg / min infusion of epinephrine, 2-10 mcg / kg / min infusion of dopamine, and searching for the root cause.

  As can be seen from FIG. 1JJ, in step 61 (bradycardia / unstable), the device communicates: "Is the patient stable?" Two options are provided for selection. That is, unstable (continues below) and stable (proceeds to step 63). The device communicates: “Perform synchronized cardioversion immediately at 100 joules”. The device communicates: "Is the patient stable?" If it is unstable, continue to If stable is selected, the process proceeds to step 63. The device communicates: “Perform synchronous defibrillation immediately at 200 joules”.

  As can be seen from FIG. 1 KKK, in step 62 (bradycardia / unstable), the device communicates: "Is the patient stable?" Two options are provided for selection. That is, unstable (continue to the following) and stable (proceed to step 63). The device communicates: “Perform synchronous defibrillation immediately at 300 joules”. The device communicates: "Is the patient stable?" If unstable, continue to If stable is selected, the process proceeds to step 63. The device communicates: “Perform synchronous defibrillation immediately at 360 joules”. The method then proceeds to step 55.

  As can be seen from FIG. 1 LLL, in step 63 (tachycardia / stable), the device “provides oxygen”, “establishes a venous line”, “immediately receives a diagnosis by a specialist”, and “12 lead EKGs”. To get. " There are then four options: QRS narrow (<12 seconds) (following below), QRS wide (> 12 seconds) (going to step 66), regular rhythm (going to step 64) and irregular rhythm (Proceed to step 65) is provided for selection.

  As can be seen from FIG. 1 MMM, in step 64 (Tachycardia / Stable / Narrow / Regular), the device will consider treating SVT (Supraventricular Tachycardia) ”, providing the following precautions: Is done. That is, expert diagnosis, vagus nerve manipulation, adenosine rapid IV push, monitor, oxygen. The apparatus then continues to step 70.

  As can be seen from FIG. 1 NNN, in step 65 (tachycardia / stable / narrow / irregular), the device communicates “Consider treatment for coarse-fibrillation (A-fib / filter)” and the following precautions: That is, diagnosis, examination of pulse control by diltiazem IV (diltiazem IV), examination, oxygen are provided. The apparatus then continues to step 70.

  As can be seen from FIG. 1OOO, in step 66 (tachycardia / stable / narrow / regular), the device has two options: regular rhythm (following below), irregular rhythm (proceeding to step 67). I will provide a. The device then communicates: “Consider stable ventricular tachycardia” and the following four precautions: amiodarone 150 mg intravenously over 10 minutes. If the patient becomes unstable, synchronous exclusion Fibrillation preparation, specialist diagnosis, monitoring, oxygen are provided. The apparatus then proceeds to step 70.

  As can be seen from FIG. 1 PPP, in step 67 (tachycardia / stable / broad / regular), the device may inject amiodarone 150 mg intravenously over the following precautions: diagnosis, 10 minutes; Provide 2gm of magnesium for 10 minutes for polymorphic ventricular tachycardia, prepare synchronous defibrillation if patient becomes unstable, monitor, and oxygen To do. The apparatus then continues to step 70.

  As can be seen from FIG. 1QQQ, in step 68 (normal heart rate), the apparatus communicates “provide oxygen” and “establish a venous line”. The device provides the following precautions: immediate specialist diagnosis, 12-lead EKG acquisition, vital signs and symptom monitoring. The apparatus then proceeds to step 70.

  In step 70 (after resuscitation), the device will perform the following precautions: specialist diagnosis, oxygen, vital signs and symptom monitoring, D-stick investigation, 12-lead EKG acquisition, appropriate research Delivery to the clinic and review of vasoactive drug infusions.

  If the patient's choice is a child, the steps taken by the device must be corrected for physical differences between the adult and the child, but are taken if the patient's choice is an adult. Is similar to Such modifications are as follows. In a pediatric step 1, an external clock A is started. The device communicates: “Check pulse” and “Install monitor and defibrillator”. If there is a pulse, go to pediatric step 31. If there is no pulse, it is then communicated: “Start CPR at 100 compressions per minute”. The metronome rhythm then starts at 100 beats per minute. The device communicates “Check rhythm”. Two choices are provided. VT / VF (proceed to pediatric step 2) and asystole / pulseless electrical activity algorithm (proceed to pediatric step 18).

  In pediatric step 2 (VT / VF), the device “defibrillates at 2 joules per kilogram”, “clear all” (3 times) and “continue CPR with 100 compressions per minute” Communicate. The metronome rhythm then starts at 100 beats per minute. Clock B is set at 2 minutes and then started. The device then communicates: "Is a vein line or IO access established?" If the user answers “yes”, then pediatric step 3 begins. If the answer is “no”, the question is re-answered every 3 minutes until “yes” is answered. The device then communicates: "Is the airway device in place and confirmed?" If no, the question is re-read every 5 minutes until a positive response is obtained. In addition, prompts may remain on the touch screen until a venous line and / or airway is established.

  In pediatric step 3 (VT / VF), clock B reaches 2 minutes and the device communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (continue below), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). If the first option is selected, the device will “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and “continue CPR with 100 compressions per minute” Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted. At this point, if the venous line / IO (IV / IO) has been established, the device continues to pediatric step 4. If the venous line / IO is not established, the device will continue to prompt until it is established. On the other hand, if the responder indicates that the venous line / IO has not been established, but the oral airway is in place, the device begins to proceed to pediatric step 5 (a). If the oral airway is not in place, the device will continue to prompt until the oral airway is in place. If neither device is established, the device may indicate that no drug treatment can be administered.

  In pediatric step 4 (ensure venous line or IO access) (VT / VF), the device is a pharmaceutical, dose such as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 ml / kg) And communicate drug treatment methods. Alternatively, in step 4 (a) where the venous line / IO access has not been secured, but the airway device has been confirmed, the device ET (1: 1) epinephrine 0.1 mg / kg into 5 ml NS. , 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 5 (VT / VF), the device communicates "Continue CPR at 100 compressions per minute" and the device provides a metronome rhythm with 100 beats per minute. Once clock B reaches 2 minutes, the device communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (following), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). If the first option is selected, the device will “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and “continue CPR with 100 compressions per minute” Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 6 (ensure venous line / IO access) (VT / VF), the device can be used for drugs, doses and drug treatments, such as amiodarone 5 mg / kg IV / IO or lidocaine 1 mg / kg IV / IO. Communicate the method. Clock D is set at 3 minutes. Alternatively, the venous line / IO access is not secured but the airway device is confirmed in pediatric step 6 (a), the device communicates to 5 ml water or NS with lidocaine 2-3 mg / kgET . The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock D is then set for 3 minutes. The device can note that amiodarone cannot be administered via the airway device, so it is not offered as an option. Once it is shown that the venous line has been established, the device does not further communicate the need to perform pediatric step 4 (a) or pediatric step 6 (a) for the remainder of the protocol.

  In pediatric step 7 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then offered: VT / VF (continue below), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). If the first option is selected, the device will “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and “continue CPR with 100 compressions per minute” Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 8 (ensure venous line / IO access) (VT / VF), the device is administered as a drug, administered as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 ml / kg). Communicate the amount and method of drug treatment. Clock C is set for 3 minutes. Alternatively, in pediatric step 8 (a) where venous line / IO access has not been ensured but the airway device has been confirmed, the device will add 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 9 (VRT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (following), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). If the first option is selected, the device will continue CPR with “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and “squeeze 100 times per minute” Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 10 (ensure venous line / IO access) (VT / VF), the device communicates medication, dosage and drug treatment method as lidocaine 1 mg / kg IV /. Clock D is set for 3 minutes. Alternatively, in pediatric step 10 (a) where venous line / IO access has not been secured, but the airway device has been confirmed, the device can be treated with lidocaine 2-3 mg / kg ET in 5 ml water or NS. introduce. The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock D is then set at 3 minutes. The device then communicates: “Check D-stick”.

  In pediatric step 11 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (following), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). If the first option is selected, the device will continue CPR with “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and 100 compressions per minute ". A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 12 (ensure venous line / IO access) (VT / VF), the device is administered as a drug, administered as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 mg / kg). Communicate the amount and method of drug treatment. Clock C is set for 3 minutes. Alternatively, in pediatric step 12 (a) where venous line / IO access has not been ensured but the airway device has been identified, the device will receive 5 ml NS in epinephrine 0.1 mg / kg ET (1: 1 , 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 13 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (continue below), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (c)). If the first option is selected, the device "defibrillates at 4 joules per kilogram", "clears all" (3 times) and "continues CPR with 100 compressions per minute" Communicate. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 14 (VT / VF), the device communicates: "Is the patient received a maximum dose of lidocaine of 100 mg?" If the response is “no”, then the device communicates lidocaine 1 mg / kg IV / IO in pediatric step 14 (a) and the clock is no longer set. Alternatively, the device continues to pediatric step 14 (b). If the response is “yes”, the device continues to pediatric step 15. In the pediatric step 14 (b) where the venous line has not been secured but the airway device has been confirmed, the device communicates with 5 ml of water or NS when lidocaine 2-3 mg / kgET. The device then communicates: “Stop CPR and do 5 assisted ventilations”. The clock is not set any further.

  In pediatric step 15, the device communicates: "Have you considered the following reversible causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalosis, pulmonary embolism, hypokalosis, coronary thrombosis, hypothermia Is transmitted. The user is then given the option to save or keep the list for later reference. The apparatus may include a prompt button or include this list on the screen at this point to make it easier for the user to access it if it needs to be referenced again.

  In pediatric step 16 (VT / VF), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then offered: VT / VF (following), asystole (proceeding to pediatric step 18), and orderly rhythm (proceeding to pediatric 28 (c)). If the first option is selected, the device will “defibrillate at 4 joules per kilogram”, “clear all” (3 times), and “continue CPR with 100 compressions per minute” ". A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 17 (ensure venous line / IO access) (VT / VF), the device can be used for pharmaceutical, Communicate quantity and drug treatment methods. Clock C is set for 3 minutes. Alternatively, in pediatric step 17 (a) where venous line / IO access has not been ensured, but the airway device has been confirmed, the device uses 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000: 0.1 ml / kg). The device then communicates: “Stop CPR and give 5 assisted ventilations”. Clock C is then set for 3 minutes. At this point in the method, the device performs a nested loop of pediatric steps 16 and 17. No new medication will be given until the team is ready to "call the code" and declare the patient's death. At this point, the termination procedure remains on the screen until pediatric step 54.

  In pediatric step 18 (asystole / pulseless electrical activity), the device communicates: “Start CPR at 100 compressions per minute”. Clock B is then set at 2 minutes and started. The device then prompts according to pediatric step 3 "has vein line / IO access established?" If not, you will be continuously prompted and asked again every 5 minutes until a positive response is provided. On the other hand, the device communicates: "Is the airway device in place and confirmed?" Continued prompts and re-questions every 5 minutes until a positive response is provided. The prompt may remain on the touch screen until the venous line / IO and / or airway is established.

  In pediatric step 19 (ensure venous line / IO access) (asystole / pulseless electrical activity), the device is as follows: epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 ml / kg) Communicate medicines, dosages and methods of drug treatment. Clock C is set for 3 minutes. Alternatively, in pediatric step 19 (a) where venous line / IO access has not been ensured, but the airway device has been confirmed, the device will add 0.1 ml / kgET (1: 1, epinephrine) to 5 ml NS. 000; 0.1 ml / kg). The device then communicates: “Stop CPR and give 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 20 (asystole / pulseless electrical activity), clock B reaches 2 minutes and the device communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (go to pediatric step 2), asystole (following below), and orderly rhythm (go to pediatric step 28 (b)). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 21 (ensure venous line / IO access) (asystole / pulseless electrical activity), the device is as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 mg / kg) Communicate medicines, dosages and methods of drug treatment. Clock C is set for 3 minutes. Alternatively, in pediatric step 21 (a) where venous line / IO access has not been secured, but the airway device has been confirmed, the device will add 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is set for 3 minutes.

  In pediatric step 22 (Asystole / Pulsatile electrical activity), the device communicates: "Have you considered the following reversible causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalosis, pulmonary embolism, hypokalosis, coronary thrombosis, hypothermia Symptoms are provided. The user is then given the option to save the list for later reference or to hide the list. The device includes a prompt button or, if it needs to be referenced again, this list can be included on the screen at this point for easy access by the user.

  In pediatric step 23 (Asystole / pulseless electrical activity), clock B reaches 2 minutes and the device communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (go to pediatric step 2), asystole (following below), and orderly rhythm (go to pediatric step 28 (b)). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 24 (ensure venous line / IO access) (asystole / pulseless electrical activity), the device is as epinephrine 0.01 mg IV / IO (1: 10,000: 0.1 ml / kg) Communicate medicines, dosages and methods of drug treatment. Clock C is set for 3 minutes. Alternatively, in pediatric step 24 (a) where the venous line / IO access has not been secured, but the airway device has been confirmed, the device adds 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 25 (asystole / pulseless electrical activity), the device communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (proceed to pediatric step 2), asystole (continue below), and orderly rhythm (proceed to pediatric step 28 (c)). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 26 (Asystole / Pulsatile electrical activity), the device communicates: "Have you considered the following reversible causes?" Then the following prompts: blood volume reduction, drug overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax, hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis, Hypothermia is provided. The user is then given the option to save this list for later reference or to hide the list.

  In pediatric step 27 (Asystole / pulseless electrical actuation), the device can be used for pharmaceuticals, doses and drugs, such as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 ml / kg). Communicate treatment methods. Clock C is set for 3 minutes. Alternatively, in pediatric step 26 (a) where the venous line / IO access has not been secured but the airway device has been confirmed, the device will add 5 ml NS to epinephrine 0.1 mg / kg ET (1: 1 , 000; 0.1 ml / kg). The device then communicates: “Stop CPR and give 5 conditioned ventilations”. Clock C is then set for 3 minutes. At this point in the method, the device performs a nested loop from pediatric steps 25-27. Pediatric step 28 (c) forms a loop. No new medication will be given until the team “calls the code” and declares the patient dead. At this point, the end procedure remains on the screen until the pediatric step 54.

  Pediatric step 28 (a) to pediatric step 28 (c) constitute pediatric step 28 (ordered rhythm). In pediatric step 28 (a), the apparatus communicates: "Check for pulse". If there is a pulse, the apparatus proceeds to pediatric step 29. If there is no pulse, the apparatus proceeds to pediatric step 21. In pediatric step 28 (b), the apparatus communicates: “Check for pulse”. If there is a pulse, the apparatus proceeds to pediatric step 29. If there is no pulse, the apparatus proceeds to pediatric step 24. In pediatric step 28 (c), the apparatus communicates: “Check for pulse”. If there is a pulse, the apparatus then proceeds to pediatric step 29. If there is no pulse, the apparatus proceeds to pediatric step 27.

  In pediatric step 29 (post-resuscitation care / decompensation), the device “examines vital signs” and “examines fluid bolus” (10-20 mL / kg NS or RL) introduce. A hypotension or Decompensated (continued below) or normal pressure or compensated (proceed to pediatric step 30) is then provided. The device will then further examine fluid concentrate mass, oxygen, labs, CXR, pain control, NG-tube, venous line acquisition, pulse oximeter and monitor, 0.1 to 1 mcg / Encourage to study epinephrine infusion at kg / min or dopamine infusion at 2-20 mcg / kg / min and / or norepinephrine infusion at 0.1-2 mcg / kg / min.

  In pediatric step 30 (post-resuscitation care / compensation), the device further examines the fluid concentrate mass, oxygen, laboratory, CXR, pain control, NG-tube, vein line reservation, pulse oximeter, and Consider monitoring a dopamine infusion at 2 to 20 mcg / kg / min, and / or an epinephrine infusion at 0.05 to 0.3 mcg / kg / min, and / or a milrinone infusion at 50 to 75 mcg / min. We encourage you to consider a kg load and an injection of 0.5 to 0.75 mcg / kg / min.

  In pediatric step 31 (with pulse), the device communicates: “Check for vital signs”, “provide oxygen”, “has venous line or IO access established?” (See pediatric step 3). If the response is “no”, the question is re-inquired every 3 minutes or left on the display screen until a positive response is made.

  In pediatric step 32 (with pulse), three options are provided: bradycardia (go to pediatric step 33), normal pulse (follow below), and tachycardia (go to pediatric step_). The device communicates: "Does heart rate provide a cardiopulmonary compromise?" If so, go to Pediatric Step 33. If not, the device communicates: “Monitor and observe”.

  In pediatric step 33 (with pulse / bradycardia), the device communicates: "Is the heart rate less than 60 or is the patient unstable?" If yes, the apparatus proceeds to pediatric step 34. If not, the device communicates: “Monitor, ventilate and observe”.

  In pediatric step 34, the apparatus communicates: "Is perfusion poor despite proper ventilation?" If so, the apparatus proceeds to pediatric step 34 (a), and if not, communicates "monitor, ventilate and observe". In pediatric step 34 (a) (unstable bradycardia), the apparatus communicates: “Continue CPR at 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set at 2 minutes and restarted.

  In pediatric step 35 (ensure venous line / IO access) (unstable bradycardia), the device can be used as a pharmaceutical, as epinephrine 0.01 mg IV / IO (1: 10,000; 0.1 ml / kg). Communicate dosages and drug treatment methods. Clock C is set for 3 minutes. Alternatively, in pediatric step 35 (a) where venous line / IO access has not been ensured but the airway device has been identified, the device will add 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes. The apparatus communicates: “Check D-Disk”.

  In pediatric step 36 (unstable bradycardia), the device communicates: "Have you considered the following reversible causes?" Then the following prompts: blood volume reduction, medication overdose, hypoxia, cardiac tamponade, acidemia, tension pneumothorax ", hyperkalemia, pulmonary embolism, hypokalemia, coronary thrombosis, Hypothermia is provided. The user is then given the option to save or keep this list for later reference. The device may include a prompt button, or the list can be included on the screen at this point so that the user can easily access it if it needs to be referenced again.

  In pediatric step 37 (unstable bradycardia), clock B reaches 2 minutes and the apparatus communicates: “Stop CPR and check rhythm”. Three options are then provided: VT / VF (proceed to pediatric step 2), asystole (proceed to pediatric step 18), and orderly rhythm (proceed to pediatric step 28 (b)). The device communicates: “Continue CPR with 100 compressions per minute”. A metronome-like rhythm starts at 100 beats per minute. Clock B is set in 2 minutes and restarted.

  In pediatric step 38 (unstable bradycardia), the device can be used for drug, dosage and drug treatment methods such as epinephrine 0.01 mg IV / IO (1: 10,000: 0.1 ml / kg) introduce. Clock C is set for 3 minutes. Alternatively, in pediatric step 38 (a) where venous line / IO access has not been ensured but the airway device has been identified, the device will add 5 ml NS to epinephrine 0.1 mg / kgET (1: 1, 000; 0.1 ml / kg). The device then communicates: “Stop CPR and do 5 assisted ventilations”. Clock C is then set for 3 minutes.

  In pediatric step 39 (tachycardia), the device communicates: "Does the heart rate result in cardiopulmonary compromise or poor perfusion?" If yes, the apparatus proceeds to pediatric step 43. If not, is the QRS duration longer than 0.08 seconds? To ask. If so, the apparatus proceeds to pediatric step 40. If not, the device communicates: "Do you have a history common to sinus tachycardia or do P waves exist?" If so, the apparatus proceeds to pediatric step 42. If not, go to pediatric step 41.

  In pediatric step 40 (extensive complex tachycardia / stable), the device communicates “possibility of ventricular tachycardia” and supports ABC's with the following prompts: pediatric cardiologist consultation, oxygen, vein Line, pulse oximeter, monitor, and defibrillator, amiodarone 5 mg / kg IV over 20 to 60 minutes, or procainamide 15 mg / kg IV or lidocaine 1 mg / kg IV concentrated mass over 30 to 60 minutes To consider. If the patient becomes unstable, shock at 0.5 to 1 joule / kg. If the first shock is ineffective, it tells you that it can be increased to 2 joules / kg.

  In pediatric step 41 (narrow compound tachycardia / stable), the device communicates “possibility of SVT (supraventricular tachycardia)”. This device can be repeated once, diagnosing a pediatric cardiologist, examining vagus nerve manipulation, adenosine 0.1 mg / kg IV rapid concentrated mass (maximum first dose is 6 mg), dose doubled (second time Administration of up to 12 mg) provides support for ABC's with oxygen, venous line, pulse oximeter, monitor and defibrillation pad.

  In pediatric step 42 (narrow compound tachycardia / stable), the device communicates “a sinus tachycardia is expected”. This device can be used for diagnosis of pediatric cardiologist, examination of ABC's support with oxygen, venous line, pulse oximeter, monitor and defibrillation pad, possibility to try fluid concentrate, pursuit of cause, etc. Provide a prompt.

  In pediatric step 43 (narrow compound tachycardia / unstable), the device interrogates “QRS duration is longer than 0.08 seconds?”. If so, go to Pediatric Step 45. If not, the device then communicates: “Do you have a history common to sinus tachycardia or do you have P waves?”. If not, go to Pediatric Step 44. If so, the device communicates: “Venous sinus tachycardia is expected”. This device is used to diagnose pediatric cardiologists, consider ABC's support with oxygen, wear venous lines, pulse oximeters, monitors and defibrillation pads, test fluid concentrates, pursue causes Prompt like

  In pediatric step 44 (narrow compound tachycardia / unstable), the device communicates "possible supraventricular tachycardia (SVT)". The device provides prompts such as a pediatric cardiologist's diagnosis, sedation review with sedation. In that case, the device communicates: “Electrically fibrillate at 0.5 to 1 joule / kg”. The device may increase to 2 Joules / kg if the first shock is not effective, vagus nerve manipulation, adenosine 0.1 mg / kg IV rapid concentrated mass (maximum first dose is 6 mg), dose Can be doubled and repeated once (maximum second dose is 12 mg), supports ABC's with oxygen, provides prompts like venous line, pulse oximeter, monitor and defibrillation pad .

  In pediatric step 45 (wide compound tachycardia / unstable), the device communicates “possible ventricular tachycardia”. The device prompts to consider sedation with a sedative. In that case, the device communicates: “Defibrillate at 0.5 to 1 Joule / kg”. The device prompts you to increase to 2 Joules / kg if it is not effective at the first shock. Prompt to study amiodrone 5 mg / kg IV over 20 to 60 minutes, or procainamide 15 mg / kg IV, or lidocaine 1 mg / kg IV over 30 to 60 minutes. Encourage pediatric cardiologists to diagnose, support ABC's with oxygen, consider venous lines, pulse oximeters, and monitors.

  In pediatric step 54, the termination procedure is invoked. The device communicates: “Do you really want to end ACLS activity?”. If so, then the device communicates: “Confirm that you want to end ACLS activity”. If not, the loop continues. At this point, the user is given the option to print a summary of the situation along with the timing of the medication administered in relation to the external clock and the clock indicating the internal elapsed time. In one aspect of the invention, a sheet of paper having an adhesive back that can be inserted into the apparatus is printed and then ejected from the apparatus.

  The present invention can be adapted to provide voice and video commands, prompts, and reminders in various languages. Embodiments of the present invention include a touch-sensitive display that provides navigation and on-screen selection, graphical input elements, input buttons that provide program path / option selection, user prompts, and an internal timer that provides program path selection. In addition, embodiments of the apparatus of the present invention may use a speaker or other voice converter to output voice commands. The clock provided to the responder is an illuminated, segmented display that provides a numeric time display (digital clock) adapted to count down, count up and the timing of user actions within the program. May be included. The processing of various commands within the CPU of the computer hardware includes conventional computer operations. Subsequent actions within the program perform timing, prompting, and / or subsequent input operations. Subsequent prompts are displayed on the image display and announced via audio output. Timing operations (countdown, countup, elapsed time, and absolute time) are performed by the program and output via a segmented display. Subsequent user input for route selection and approval of user prompts in the program is accomplished via input buttons and I or touch display.

  Application software in which the method according to the invention is implemented is a standard drive such as a hard drive, RAM memory, or other commonly used storage media such as memory cards, flash memory devices, magnetic disks, optical disks or the like. It is stored in the medium. Program updates, including updates to the ACLS algorithm, can be performed by overwriting old code with new program files and / or program data on a memory medium.

  Form factors that accommodate embodiments of the present invention include front perforations with speakers mounted in the housing behind the perforations, touch-sensitive image displays, buttons projecting from the top near the front, projecting from the top, and in front near the back A rectangular cubic housing having an opening to receive the facing segmented display may be included.

  The embodiments shown and described so far are merely exemplary. While numerous features and advantages of the preferred embodiments of the present invention have been set forth in the foregoing description, along with details of the invention, the disclosure is illustrative only and terminology used in the claims Variations are possible within the principles of the invention to the full extent indicated by the general meaning of

A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. 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A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. 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A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flow chart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. A flowchart of an exemplary method of the present invention performed on an adult patient is presented. FIG. 2 is a block diagram of an exemplary computer-based apparatus suitable for performing the method of the present invention. FIG. 2 is a diagram of an exemplary apparatus adapted to carry out the method according to the invention adapted to be installed in a hospital emergency cart. FIG. 2 is a diagram of an exemplary apparatus adapted to carry out the method according to the invention adapted to be installed in a hospital emergency cart. FIG. 2 is a diagram of an exemplary apparatus adapted to carry out the method according to the invention adapted to be installed in a hospital emergency cart. 1 shows an exemplary apparatus adapted to carry out the method according to the invention in the form of a PDA.

Claims (20)

In a device for use in performing a secondary cardiac life support (ACLS) procedure,
At least one prompting means to obtain information from the user;
At least one input means for obtaining a user response to the information prompt;
At least one timing means for obtaining timing information based on an elapsed time of ACLS or a situation occurring during an ACLS process;
Logic means operable to accept user information and timing information and to determine and output a decision path selection based thereon;
A secondary heart comprising at least one output means for transmitting a command to guide the user through a proper procedure to be applied to the patient during cardiac arrest based on the output from the logic means A device used when performing lifesaving procedures.   The at least one timing means and logic means are executed using computer hardware having an operating system and application software, and the computer hardware further includes a power source, input means, data bus, and central processing unit. The apparatus of claim 1 including a memory unit and output means.   The apparatus of claim 2, wherein the computer hardware is located in a stand-alone unit configured to be installed in an emergency cart.   3. The hardware according to claim 2, wherein the hardware is selected from the group consisting of a main frame, a personal computer (PC), a terminal, a tablet PC, a laptop PC, and a personal digital assistant (PDA). The device described. The input means is composed of one selected from the group consisting of a keyboard, mouse, touch pad, trackball and touch screen display,
3. The apparatus of claim 2, wherein the output means comprises a member selected from the group consisting of a speaker, a buzzer, an illuminated indicator, a video display and a printer. Logic means including a computerized decision tree program adapted to execute on computer hardware;
A lookup table in computerized memory means adapted to store information to be conveyed to the output means and timing information based on input to the input means;
Memory means adapted to store digital representations of video and voice commands and prompt data;
A digital-to-analog converter and a speech synthesizer adapted to convert digital speech data into an analog signal;
The apparatus of claim 1, wherein the output means includes an audio transducer that outputs an analog audio signal that guides the responder through the proper procedure to be applied to the patient during cardiac arrest.   The analog audio signal is selected from languages consisting of English, Spanish, German, French, Chinese, Japanese, Russian, Portuguese, Korean, Vietnamese, Swedish, Norwegian, and Finnish 7. The apparatus of claim 6, wherein the apparatus is one from a group of groups.   The apparatus of claim 6, wherein the software is adapted to accept software updates.   7. The responder is instructed to indicate the type and dose of drug to be administered to the patient and the order in which actions are to be performed (such as CPR) on the patient. The device described. An external clock adapted to hold the elapsed time from the start of the ACLS procedure to the end of the ACLS procedure;
CPR clock B adapted to track individual CPR activity;
Vasopressor clock C adapted to track the timing of this type of medication (epinephrine or vasopressin);
An antiarrhythmic clock D adapted to track the timing of epinephrine or amiodarone;
An atropine clock E adapted to track the timing of the atropine;
The apparatus of claim 9, further comprising a venous line / airway clock.   The device of claim 1 in combination with an automatic external defibrillator (AED).   2. The apparatus of claim 1, wherein the apparatus is configured to communicate a first set of commands if the patient is an adult and a second set of commands if the patient is a child.   2. A device according to claim 1, wherein the device is adapted to provide the type and dosage of the drug with reference to the drug contained in the encoded packaging maintained with the device.   The list of actions taken in the ACLS process is correlated with the actual time when such a situation occurs and output via a video display or a printer. apparatus. In a system that provides real-time instructions for device usage and procedures to be followed in patient resuscitation,
Input means and output means for providing an array of inputs related to program path and option selection;
At least one timer providing a prompt to the user and program routing;
Voice prompts and tuning about user behavior, a graphical display of information to the user, and an array of outputs including a digital time display, and a user while reviving a patient experiencing heart disease pain And a logic unit adapted to manipulate information from said timer and input to instruct and arouse.   The apparatus of claim 14, wherein the input / output means comprises a touch-sensitive display screen. Computer hardware selected from the group consisting of a mainframe, a personal computer (PC), a terminal, a table PC, a laptop PC and a personal digital assistant (PDA);
An operating system,
The apparatus of claim 14 including application software adapted to execute the processes of the system.   15. The device according to claim 14, in combination with an automatic external defibrillator (AED).   If the patient is an adult, the first set of instructions is configured, and if the patient is a child, the second set of instructions is configured to be transmitted. The apparatus of claim 14. In a method for providing real-time instructions regarding the use and procedure of a device to be followed during patient resuscitation, the system comprises:
Providing an input means and an output means for providing an array of inputs relating to program paths and option selection;
Information about whether the patient is an adult or a child,
Based on the information, the logic unit selects the first set of instructions or the second set of instructions,
Providing at least one timer providing time for providing user prompts and selection of program paths;
Provides an output of an array,
A method comprising manipulating and alerting a user during resuscitation of a patient experiencing heart disease pain by manipulating information from the timer and input by a logic unit.

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