critical care medicine
Cardiopulmonary Resuscitation (CPR) in Adults
Monitor and IV
Electrocardiographic (ECG) monitoring is established to identify the underlying cardiac rhythm. An IV line may be started; 2 lines minimize the risk of losing IV access during CPR. Large-bore peripheral lines in the antecubital veins are preferred. In adults and children, if a peripheral line cannot be established quickly, a subclavian or femoral central line (see Central Venous Catheterization ) can be placed provided it can be done without stopping chest compression (often difficult). Intraosseous lines (see The type and volume of fluids or drugs given depend on the clinical circumstances. Usually, IV 0.9% saline is given slowly (sufficient only to keep an IV line open); vigorous volume replacement (crystalloid and colloid solutions, blood) is required only when arrest results from hypovolemia (see Intravenous Fluid Resuscitation ), or as part of the management of cardiogenic shock after return of spontaneous circulation. 