...1/5/2020 Advanced cardiac life support (ACLS)...
.... ©2020 UpT oDate, Inc. All rights reserved. Advanced cardiac life support (ACLS) in adults A u t...
...American Heart Association (AHA) formally endorsed cardiopulmonary resuscitation (CPR) in 1963, and by 1966, they had adopted standardized CPR guidelines for instruction to lay­rescuers . Advanced cardiac life support (ACLS) guidelines have evolved over the past several decades based on a combination of scientific evidence of variable strength and expert consensus. The AHA and European Resuscitation Council developed the most recent ACLS Guidelines in 2010 using the comprehensive review of resuscitation literature performed by the International Liaison...
...Committee on Resuscitation (ILCOR), and these were updated in 2015 and 2018 . Guidelines are reviewed continually but are formally released every five years and published in the journals Circulation and Resuscitation. This topic will discuss the management of cardiac arrhythmias in adults as generally described in the most recent iteration of the ACLS Guidelines. Where our suggestions dif fer or expand upon the published guidelines, we state this explicitly...
...published guidelines, we state this explicitly . The evidence supporting the published guidelines is presented separately , as are issues related to controversial treatments for cardiac arrest patients, .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 1/28 1/5/2020...
.... The evidence supporting the published guidelines is presented separately , as are issues related to controversial treatments for cardiac arrest patients, .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 1/28 1/5/2020 Advanced...
...1/28 1/5/2020 Advanced cardiac life support (ACLS)...
...- UpT oDate basic life support (BLS), airway management, and post­cardiac arrest management. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest"  and "Therapies of uncertain benefit in basic and advanced cardiac life support"...
...UpT oDate basic life support (BLS), airway management, and post­cardiac arrest management. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest"  and "Therapies of uncertain benefit in basic and advanced cardiac life support"  and ...
...basic life support (BLS), airway management, and post­cardiac arrest management. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest"  and "Therapies of uncertain benefit in basic and advanced cardiac life support"  and  "Basic life support (BLS) in adults"...
..."Advanced emergency airway management in adults"  and  "Post­cardiac arrest management in adults" .) E V...
...S Because of the nature of resuscitation research, few randomized controlled trials have been completed in humans. Many of the recommendations in the American Heart Association (AHA) and the European Resuscitation Council's 2015 Guidelines for advanced cardiac life support and the 2018 update (hereafter referred to as the ACLS Guidelines) are made based upon retrospective studies, animal studies, and expert consensus . Guideline recommendations are classified according to the GRADE system . The evidence supporting the ACLS Guidelines...
...are classified according to the GRADE system . The evidence supporting the ACLS Guidelines is reviewed in detail separately . (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest" .) P...
...is reviewed in detail separately . (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest" .) P R...
...medications to treat arrhythmias) should be carried out either while CPR is performed or , if a required intervention cannot be performed while CPR is in progress, during the briefest possible .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 2/28 1/5/2020 Advanced...
...2/28 1/5/2020 Advanced cardiac life support (ACLS)...
...fectiveness of CPR' .) Patients are often over­ventilated during resuscitations, resulting in excessive intrathoracic pressure, which can compromise venous return resulting in reduced cardiac output and inadequate cerebral and cardiac perfusion. A 30:2 compression to ventilation ratio (one cycle) is recommended in patients without advanced airways. According to the ACLS Guidelines, asynchronous ventilations at 8 to 10 per minute are administered if an endotracheal tube or...
....) Patients are often over­ventilated during resuscitations, resulting in excessive intrathoracic pressure, which can compromise venous return resulting in reduced cardiac output and inadequate cerebral and cardiac perfusion. A 30:2 compression to ventilation ratio (one cycle) is recommended in patients without advanced airways. According to the ACLS Guidelines, asynchronous ventilations at 8 to 10 per minute are administered if an endotracheal tube or extraglottic airway is in place, while continuous chest compressions are performed simultaneously...
.... W e believe that 6 to 8 ventilations per minute by BMV with supplemental oxygen are suf ficient in the low­flow state of cardiac arrest and prevent excessive intrathoracic pressure. Resuscitation team management  —  The resuscitation of a sudden cardiac arrest (SCA), by its...
...in the low­flow state of cardiac arrest and prevent excessive intrathoracic pressure. Resuscitation team management  —  The resuscitation of a sudden cardiac arrest (SCA), by its nature a low frequency , high acuity event, is often chaotic. A growing body of literature demonstrates that by employing the principles of Crisis Resource Management (CRM), adapted...
...ficult to establish. In CRM, it is imperative that one person assumes the role of team leader . This person is responsible for the global management of the resuscitation, including: ensuring that all required tasks are carried out competently? incorporating .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 3/28 1/5/2020 Advanced...
...3/28 1/5/2020 Advanced cardiac life support (ACLS)...
...Initial management and ECG interpretation  —  In the 2010 ACLS Guidelines, circulation assumed a more prominent role in the initial management of cardiac arrest and this approach continues in the 2015 and 2018 updates. The "mantra" is: circulation, airway , breathing (C­A­B). Once unresponsiveness is recognized, resuscitation begins by addressing circulation (excellent...
...'Excellent basic life support and its importance'  above and  "Basic life support (BLS) in adults", section on 'Recognition of cardiac arrest' .) .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print...
..."Basic life support (BLS) in adults", section on 'Recognition of cardiac arrest' .) .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 4/28 1/5/2020 Advanced...
...4/28 1/5/2020 Advanced cardiac life support (ACLS)...
...- UpT oDate In the non­cardiac arrest situation, the other initial interventions for ACLS include administering oxygen (if the patient’ s oxygen saturation is below 94 percent), establishing vascular access, placing the patient on a cardiac and oxygen saturation monitor...
...In the non­cardiac arrest situation, the other initial interventions for ACLS include administering oxygen (if the patient’ s oxygen saturation is below 94 percent), establishing vascular access, placing the patient on a cardiac and oxygen saturation monitor , and obtaining an electrocardiogram (ECG) . Unstable patients must receive immediate care, even when data are incomplete or presumptive (...
...E N T Over the years, airway management during cardiac arrest has gone through many iterations. The development of new techniques and the changing science supporting or refuting specific approaches has contributed to confusion. When ACLS was first developed, the suggested management strategy was to provide a protected airway with endotracheal intubation as early in...
...2  and airway protection being subsidiary until a return of spontaneous circulation (ROSC) is achieved. In fact, during the first few minutes following sudden cardiac arrest (SCA) in adults, oxygen delivery to the brain is limited primarily by reduced blood flow , leading to the recommendation that the performance of excellent chest compressions takes priority over ventilation during the initial period of basic life support...
.... Overzealous ventilation (excess volume and/or frequency) has, in fact, been found to be detrimental to maintaining circulation due to the generation of elevated intrathoracic pressures .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 5/28 1/5/2020 Advanced...
...5/28 1/5/2020 Advanced cardiac life support (ACLS)...
...in place, over­ventilation is more likely to occur merely due to the ease of ventilation through an endotracheal tube. Delivery of lower tidal volumes due to the mechanical impediments of BMV as well as the mandated 30:2 compression to ventilation ratio limiting minute ventilation are the most likely reason for the data showing improved neurologic survival in unintubated cardiac arrest. Suggested approach to airway management while performing ACLS  —  The ventilation rate is...
..."Direct laryngoscopy and endotracheal intubation in adults" .) .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 6/28 1/5/2020 Advanced...
...6/28 1/5/2020 Advanced cardiac life support (ACLS)...
...- UpT oDate If advanced airway management is to be performed in cardiac arrest patients, it must be done by competent providers, require less than 10 seconds to complete without interruption of excellent chest compressions, and be used only after all other more essential resuscitative maneuvers have been initiated. Once performed, rescuers must avoid hyperventilation. In addition, unless adequate...
...Although evidence is lacking, it is reasonable to provide 100 percent oxygen during CPR. In patients who are successfully resuscitated (ie, spontaneous circulation returns), it is important to maintain oxygen saturation above 94 percent. Hyperoxia may be harmful to patients with cardiac ischemia and should be avoided. (See  "Post­cardiac arrest management in adults", section on 'Mechanical ventilation'  and ...
...patients who are successfully resuscitated (ie, spontaneous circulation returns), it is important to maintain oxygen saturation above 94 percent. Hyperoxia may be harmful to patients with cardiac ischemia and should be avoided. (See  "Post­cardiac arrest management in adults", section on 'Mechanical ventilation'  and  "Overview of the acute management of ST...
....) Randomized trials  —  The optimal approach to airway management for victims of sudden cardiac arrest in the pre­hospital setting remains uncertain, but is likely BMV or a supraglottic airway rather than endotracheal intubation. .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print...
...The optimal approach to airway management for victims of sudden cardiac arrest in the pre­hospital setting remains uncertain, but is likely BMV or a supraglottic airway rather than endotracheal intubation. .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 7/28 1/5/2020 Advanced...
...7/28 1/5/2020 Advanced cardiac life support (ACLS)...
...oDate ? In a randomized trial of BMV (1020 patients) versus endotracheal intubation (1023 patients) for pre­hospital management of out­of­hospital cardiac arrest in France or Belgium between 2015 and 2017, the primary outcome (survival with favorable neurologic outcome at 28 days) was similar in the two groups (4.3 percent with BMV compared with 4.2 percent) . However...
...? In a multicenter cluster randomized trial of a supraglottic airway device (4886 patients) versus endotracheal intubation (4410 patients) for pre­hospital airway management of out­of­hospital cardiac arrest in England between 2015 and 2017, the primary outcome (favorable neurologic outcome at earliest of hospital discharge or 30 days) was similar between the two groups . Similarly , there were no dif...
...supraglottic airway group (87 versus 79 percent). ? In a multicenter cluster­crossover trial of a laryngeal tube (1505 patients) versus endotracheal intubation (1499 patients) for pre­hospital airway management of out­of­hospital cardiac arrest in the United States between 2015 and 2017, the primary outcome (72­hour survival) occurred significantly more often in patients randomized to receive the laryngeal tube (18.3 versus 15.4 percent) . Pre­specified secondary outcomes of survival to discharge and survival with...
...favorable neurologic function were also greater in the laryngeal tube group. Until additional data are available suggesting a clear improvement in outcomes from a particular ventilatory technique, BMV (or placement of a supraglottic device with the avoidance of over­ ventilation) remains the preferred pre­hospital approach to airway management for cardiac arrest patients. Observational studies  — ...
...airway management is not the best approach for managing patients with SCA: ? In a prospective nationwide Japanese study involving 649,359 patients with sudden out­of­ hospital cardiac arrest, the rate of survival with a favorable neurologic outcome was significantly lower among those managed with advanced airway techniques compared with BMV (1.1 versus 2.9 percent? odds ratio  0.38, 95% CI 0.36­0.39) . Higher rates of survival with a favorable neurologic outcome when using BMV persisted across all analyzed...
...in the United States used a propensity­matched cohort to compare outcomes among intubated and non­intubated patients who sustained SCA while in­patients . In this study , each of .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 8/28 1/5/2020 Advanced...
...8/28 1/5/2020 Advanced cardiac life support (ACLS)...
...generalizable to all settings, their size and consistent findings across all subgroup analyses support their conclusions. Other evidence supporting a more basic approach to airway management during resuscitation of cardiac arrest includes a retrospective review of registry data involving 10,691 cardiac arrest patients, which reported that patients managed in the prehospital setting with BMV had significantly higher rates of neurologically intact survival to hospital discharge than patients managed with either a supraglottic airway or intubation (18.6 versus 5.2 percent and 5.4 percent,...
...significantly higher rates of neurologically intact survival to hospital discharge than patients managed with either a supraglottic airway or intubation (18.6 versus 5.2 percent and 5.4 percent, respectively) . However , randomized trials of airway management in the setting of cardiac arrest are lacking and some observational studies have reached dif ferent conclusions from the larger studies described above ....
...I A S Sudden cardiac arrest V entricular fibrillation and pulseless ventricular tachycardia  — ...
...entricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) are non­perfusing rhythms emanating from the ventricles, for which early rhythm identification and defibrillation, are the mainstays of treatment. The most recent version of the AHA algorithm for the management of cardiac arrest can be accessed here ( AHA cardiac arrest algorithm ) (...
...ventricles, for which early rhythm identification and defibrillation, are the mainstays of treatment. The most recent version of the AHA algorithm for the management of cardiac arrest can be accessed here ( AHA cardiac arrest algorithm ) ( algorithm 2 ). Excellent cardiopulmonary...
...be identified and managed as quickly as possible ( table 3 ) . Begin performing excellent chest compressions as soon as sudden cardiac arrest (SCA) is recognized and continue while the defibrillator is being attached. If a defibrillator is not immediately available, continue CPR until one is obtained. As soon as a defibrillator is available, attach it to the patient (...
...) and charge it while continuing CPR, then stop compressions to assess the rhythm and defibrillate if appropriate (eg, VF or pVT is present). If asystole or pulseless electrical activity (PEA) is present, continue CPR. Resume CPR immediately after any shock is given. (See "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest", section on 'VF and pulseless VT' .) .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print...
..."Supportive data for advanced cardiac life support in adults with sudden cardiac arrest", section on 'VF and pulseless VT' .) .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 9/28 1/5/2020 Advanced...
...9/28 1/5/2020 Advanced cardiac life support (ACLS)...
...been associated with decreased survival . In the 2015 ACLS update,  vasopressin  was removed from the treatment algorithm for cardiac arrest, as trial data suggest it is inferior to epinephrine . Some study results have raised doubts about the benefit of  epinephrine...
..., pending more conclusive data or a formal change in ACLS protocols, we suggest giving epinephrine in accordance with existing guidelines. (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest", section on 'VF or VT arrest and vasopressors' .) Evidence suggests that antiarrhythmic drugs provide little survival benefit in refractory VF or pVT...
...more conclusive data or a formal change in ACLS protocols, we suggest giving epinephrine in accordance with existing guidelines. (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest", section on 'VF or VT arrest and vasopressors' .) Evidence suggests that antiarrhythmic drugs provide little survival benefit in refractory VF or pVT . Nevertheless, the current ACLS Guidelines state that they may be used in certain...
...e suggest that antiarrhythmic drugs be considered after a second unsuccessful defibrillation attempt in anticipation of a third shock. (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest", section on 'Antiarrhythmic drugs' .) ?...
...lidocaine  (1 to 1.5 mg/kg IV/IO bolus, then 0.5 to 0.75 mg/kg every 5 to 10 minutes) may be administered .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 10/28 1/5/2020 Advanced...
...10/28 1/5/2020 Advanced cardiac life support (ACLS)...
...Magnesium sulfate  (2 g IV/IO bolus, followed by a maintenance infusion) may be used to treat polymorphic ventricular tachycardia consistent with torsade de pointes, but is not recommended for routine use in adult cardiac arrest patients. (See  'Irregular wide complex' below .)...
....) Refractory VF or pVT may be caused by an acute coronary syndrome (ACS), in which case percutaneous coronary intervention can be performed if the patient is successfully resuscitated and the procedure is feasible. Note that following cardiac arrest, the electrocardiogram (ECG) may be insensitive for ACS? cardiology consultation is needed for patients with return of spontaneous circulation (ROSC) . Causes other than ACS can lead to SCA ( table 3...
...Asystole and pulseless electrical activity  —  Asystole is defined as a complete absence of demonstrable electrical and mechanical cardiac activity . Pulseless electrical activity (PEA) is defined as any one of a heterogeneous group of organized electrocardiographic rhythms without suf...
...ficient mechanical contraction of the heart to produce a palpable pulse or measurable blood pressure. By definition, asystole and PEA are non­perfusing rhythms requiring the initiation of excellent CPR immediately when either is present. The most recent version of the AHA algorithm for the management of cardiac arrest can be accessed here ( AHA cardiac arrest algorithm ) (...
...pressure. By definition, asystole and PEA are non­perfusing rhythms requiring the initiation of excellent CPR immediately when either is present. The most recent version of the AHA algorithm for the management of cardiac arrest can be accessed here ( AHA cardiac arrest algorithm ) ( algorithm 2...
...In the ACLS Guidelines, asystole and PEA are addressed together because successful management for both depends on excellent CPR and rapid reversal of underlying causes, such as hypoxia, hyperkalemia, poisoning, and hemorrhage . Asystole may be the result of a primary or secondary cardiac conduction abnormality , possibly from end­stage tissue hypoxia and metabolic acidosis, or , rarely...
..., rarely , the result of excessive vagal stimulation. It is crucial to identify and treat all potential secondary causes of asystole or PEA as rapidly as possible. As tension pneumothorax and cardiac tamponade make CPR inef fective and are often rapidly reversible, the clinician should not hesitate to perform immediate needle thoracostomy or pericardiocentesis if thought necessary...
...thoracostomy or pericardiocentesis if thought necessary . Hesitation to perform either procedure can worsen outcomes, but there is little chance either intervention will make the situation worse. The accompanying tables describe important secondary causes of cardiac arrest ( table 3 ). After initiating CPR, immediately consider and treat reversible causes as appropriate and...
...V asopressin  was removed from the .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 11/28 1/5/2020 Advanced...
...11/28 1/5/2020 Advanced cardiac life support (ACLS)...
...asystole nor PEA responds to defibrillation.  Atropine  is no longer recommended for the treatment of asystole or PEA. Cardiac pacing is inef fective for cardiac arrest and not recommended. Evidence around the management of asystole and PEA, and cardiac arrest generally , is reviewed...
...Atropine  is no longer recommended for the treatment of asystole or PEA. Cardiac pacing is inef fective for cardiac arrest and not recommended. Evidence around the management of asystole and PEA, and cardiac arrest generally , is reviewed in detail separately...
... is no longer recommended for the treatment of asystole or PEA. Cardiac pacing is inef fective for cardiac arrest and not recommended. Evidence around the management of asystole and PEA, and cardiac arrest generally , is reviewed in detail separately . (See ...
..., is reviewed in detail separately . (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest" .) In summary...
...in detail separately . (See  "Supportive data for advanced cardiac life support in adults with sudden cardiac arrest" .) In summary , treatment for asystole and PEA consists of immediate consideration and treatment of...
...2 ) measurements from continuous waveform capnography (using tracheal tube sampling in intubated patients) may reflect cardiac output and cerebral perfusion pressure, and therefore the quality of CPR, although studies remain preliminary . Sudden, sustained increases in EtCO 2...
...CPR, a reasonable goal is to maintain diastolic pressure above 20 mmHg. Central venous oxygen saturation (SCVO 2 ) provides information about oxygen delivery and cardiac output. During CPR, a reasonable goal is to maintain SCVO 2  above 30 percent....
...reasonable goal is to maintain SCVO 2  above 30 percent. In the hands of skilled operators, point­of­care ultrasound (POCUS) may be useful during cardiac arrest for identifying underlying pathology , monitoring resuscitation, and determining the presence of spontaneous cardiac activity and likelihood of recovery . However...
...In the hands of skilled operators, point­of­care ultrasound (POCUS) may be useful during cardiac arrest for identifying underlying pathology , monitoring resuscitation, and determining the presence of spontaneous cardiac activity and likelihood of recovery . However , studies of POCUS in the setting of cardiac arrest are preliminary , and high­quality trials are needed. While such...
..., monitoring resuscitation, and determining the presence of spontaneous cardiac activity and likelihood of recovery . However , studies of POCUS in the setting of cardiac arrest are preliminary , and high­quality trials are needed. While such research is ongoing, it is crucial that ultrasound­related interventions not cause interruptions or otherwise interfere with the performance of excellent CPR....
..., and high­quality trials are needed. While such research is ongoing, it is crucial that ultrasound­related interventions not cause interruptions or otherwise interfere with the performance of excellent CPR. .uptodate.com/contents/advanced-cardiac-life-support-acls-in-adults/print 12/28 1/5/2020 Advanced...
...12/28 1/5/2020 Advanced cardiac life support (ACLS)...
...inadequate tissue perfusion thought to result from the slow heart rate . The most recent version of the AHA algorithm for the management of bradycardia can be accessed here ( AHA cardiac arrest algorithm ) ( algorithm 3 )....

...in blood volume, cardiac output, breathing rate,...

...The Heart Cardiac muscle that contracts...
...beat Called a cardiac cycle Volume in...
...per minute = cardiac output General diastole...

...periods of high cardiac output, blood flow...
...not impaired with high–cardiac output states. 6....
...three factors: (a) Cardiac output (CO) (b)...
...vascular resistance (PVR) Cardiac Output 1. A...
...HR. 2. Normal cardiac output is between...
...the percentage of cardiac output that flows...
...total percentage of cardiac output involved in...
...of >15% of cardiac output can result...
...of >20% of cardiac output. e) A...
...response to increased cardiac output or increased...
...is measured as cardiac output. Cor Pulmonale...
...Gas Exchange—Perfusion Perfusion Cardiac output Slide 2...
...bicarbonate during a cardiac arrest emergency. b)...
...differentiate pulmonary from cardiac problems. Sleep–Rest History...
...dyspnea associated with cardiac problems or severe...
...pain caused by cardiac disease. Subjective Data...
...arterial pressure, and cardiac output. 5. Hemodynamic...
...is initiated when cardiac involvement is suspected...
...central location. d) Cardiac dysrhythmias. Capnography 1....
...embolism, or decreased cardiac output. b) Increased...
...fever or increased cardiac output) or hypoventilation...

... Basic Cardiac Rhythm Interpretation Objectives:...
...permeability changes in cardiac cells and the...
...2. Describe the cardiac conduction system, the...
...patient who requires cardiac monitoring. 3. Interpret...
...Permeability A. Resting cardiac cell 1. Cardiac...
...cardiac cell 1. Cardiac function is dependent...
...state. B. Active cardiac cell—action potential 1....
...charge, stimulating the cardiac cells extending across...
...b) As the cardiac cell receives an...
...shift, resulting in cardiac depolarization and repolarization...
...repolarization of the cardiac muscle. 2. Action...
...PowerPoint Slides 1. Cardiac Function Dependent on...
...anion. 2. Resting Cardiac Cell Negatively charged...
...Potential of a Cardiac Cell Produces changes...
...Depolarization Repolarization II. Cardiac Conduction and the...
...Electrocardiogram 1. The cardiac cycle is maintained...
...c) Along a cardiac conduction pathway 2....
...(3) Along a cardiac conduction pathway b)...
...QT interval. C. Cardiac monitoring systems 1....
...essential for accurate cardiac monitoring, and lead...
...patient who requires cardiac monitoring 1. Electrode...
...node (SA) 3. Cardiac Conduction Pathway 4....
...Patient Who Requires Cardiac Monitoring Components of...
...Premature beats 7. Cardiac conduction blocks 8....
...Normal and abnormal cardiac events 2. Major...
...angina if the cardiac output decreases to...
...in atria Decrease cardiac output Nursing assessment...
...a decrease in cardiac output from loss...
...the patient’s underlying cardiac rhythm and the...
...cause of sudden cardiac arrest. 2. Defibrillation...
...cause of sudden cardiac arrest. Defibrillation is...
...Conduction abnormalities 1. Cardiac impulse conduction can...
...slow conduction include cardiac ischemia, digitalis, antiarrhythmic...
...enough to maintain cardiac output; however, complete...
...Abnormalities Inhibition of cardiac impulses along conduction...
...are contracting independently. Cardiac output greatly diminished....
...used in treating cardiac conduction disturbances. Antiarrhythmics...
...agents, and decrease cardiac stimulation, and can...
...because of decreased cardiac stimulation. They are...
...classified as a cardiac glycoside and inotropic...
...assessment of the cardiac, respiratory, and neurologic...
...Used in treating cardiac conduction disturbances Classifications...
...rate that maintains cardiac output. a) The...
...order to maintain cardiac output. In this...
...the patient’s own cardiac electrical activity and...
...the patient’s own cardiac electrical activity and...
...prior aborted sudden cardiac death or proven...
...heart attack and cardiac arrest. e) The...
...it does prevent cardiac arrest. 2. Patient...
...cannot maintain adequate cardiac output Pulse generator...
...who aborted sudden cardiac death Aborted proven...
...Prophylactically in high cardiac risk groups Designed...
...bradycardia pacing. Storing cardiac events Implantation of...
...for patients experiencing cardiac dysrhythmias. Suggestions for...

...Objectives: 1. Describe cardiac output as the...
...easily acquired. B. Cardiac output and cardiac...
...Cardiac output and cardiac index 1. Cardiac...
...cardiac index 1. Cardiac output is the...
...8 L/min. 2. Cardiac index a) Individualizes...
...first determinant of cardiac output and is...
...urine output 2. Cardiac Output and Cardiac...
...Cardiac Output and Cardiac Index Individualizes patients’...
...First determinant of cardiac output; fluid temperature...
...catheter. 2. Ideal cardiac output monitor would...
...measures stroke volume, cardiac output, and contractility...
...to determine: (1) Cardiac output (2) Preload...
...of factors, including cardiac output, systemic venous...
...related to the cardiac cycle (Fig. 7-4)....
...circulation throughout the cardiac cycle. (2) MAP...
...circulation throughout the cardiac cycle. (3) Normal...
...Impedance Cardiography Assesses cardiac function by measuring...
...measures stroke volume, cardiac output, and contractility...
...Helps to determine: Cardiac output Preload Afterload...
...pressures c) Determining cardiac output d) Sampling...
...used to determine cardiac output placed in...
...used to obtain cardiac output if the...
...connects to the cardiac output–monitoring device 5....
...port 2. Continuous cardiac output (CCO) 3....
...port Oximetry Continuous cardiac output (CCO) Volumetric...
...critical care uits, cardiac catheterization laboratories and...
...measurements 1. Measuring cardiac output a) Intermittent...
...measurements 2. Measuring Cardiac Output Intermittent Fluid...
...pulmonary hypertension. (5) Cardiac contractility—improved by use...
...pulmonary vascular vasodilation. Cardiac contractility. Intra-aortic balloon...
...hypothermia, hypovolemia or cardiac failure. a) Collaborative...
...hypothermia, hypovolemia, or cardiac failure. Low SVR...

...Vena Cava?? Hearts Cardiac cycle – pumping...
...Figure 8.16 Arthropod Cardiac Cycle Cardiomyocytes contract...
...sucked into heart Cardiac ganglion neurons spontaneously...
...Aortic and Pulmonary Cardiac Cycle – highly...
...Figure 8.18a Mammalian Cardiac Cycle Atria and...
...action potentials in cardiac muscle P wave...
...Events in the Cardiac Cycle Heart functions...
...Heart and Lungs Cardiac Output Cardiac output...
...Lungs Cardiac Output Cardiac output (CO) Volume...
...position of the cardiac muscle length-tension relationship...
...TPR Body varies cardiac output (CO) and...
...How will the cardiac output and systemic...

...and Toxicology (BIOL3020) Cardiac Muscle Contraction At...
...keeping inside negative Cardiac Muscle Contraction ....
...Muscle Contraction . Cardiac Muscle Contraction 9...

...disturbances Client with cardiac arrest develops mixed...
...in clients with cardiac disease Use judiciously...
...consciousness Stupor Coma Cardiac manifestations Dysrhythmias Cardiac...
...Cardiac manifestations Dysrhythmias Cardiac arrest Integumentary manifestations...
...of acidosis on cardiac function Ensuring adequate...
...underlying problem (shock, cardiac arrest) Improve tissue...
...of acidosis Decreased Cardiac Output Risk for...
...will maintain baseline cardiac rhythm Client will...
...levels Implementation Monitor cardiac status Monitor vital...
...in pulmonary edema, cardiac failure Monitor serum...
...increases to maintain cardiac output Chronic respiratory...
...function Respiratory status Cardiac status Changes in...

...appearance) Skeletal and cardiac muscle Actin and...
...Skeletal muscle and cardiac muscle differ in...
...Less developed in cardiac muscle Sarcoplasmic reticulum...
...Can change both cardiac and skeletal muscle...
... Property  Skeletal Muscle  Cardiac Muscle  Smooth Muscle...