ACLS

ADVANCED CARDIAC LIFE SUPPORT For a conscious patient: ADVANCED CARDIAC LIFE SUPPORT (ACLS) Survey (VOMIT) V – Visualize, Verbalize, Vital Signs O – Oxygenate if patient’s SpO2 at room air is <94%. Avoid supplementary oxygen for SpO2 > 94% to avoid oxygen toxicity. M – Attach to a cardiac Monitor I – Intravenous (IV) / Intraosseous (IO) Access T – Treat STABLE BRADYCARDIA: Observe UNSTABLE BRADYCARDIA: Treat (All Trained Dogs Eat) A – Atropine 0.5mg q3 – 5 mins max: 3mg T – Transcuatneous Pacer (TCP) D – Dopamine infusion 2 – 10mcg/kg/min E – Epinephrine infusion 2 – 10mcg/kg/min (0.1-0.5mcg/kg/min) TACHYCARDIAS SUPRAVENTICULAR TACHYCARDIA (SVT) 21336001206517677 0017677 VENTRICULAR TACHYCARDIA (VT) with Pulse 2085976172085180 00180 STABLE TACHYCARDIAS (SBP > 90mmHg) Stable SVT Physiologic Vagal Maneuver Carotid massage for < 60y/o), no CAD) Cough/strain for >60 y/o, with CAD) Pharmacologic – DOC: Adenosine 6 – 12 – 12mg fast IV/IO Stable VT Pharmacologic – DOC: Amiodarone 150mg IV/IO slow in 10mins UNSTABLE TACHYCARDIAS (SBP <90mmHg) Unstable SVT Synchronized Cardioversion, 50J initial Unstable VT Synchronized Cardioversion, 100J initial Unstable, New – onset Atrial Fibrillation Synchronized Cardioversion at 120 – 200J For an unconscious patient: Basic Life Support (BLS) Survey 1. Check for Responsiveness 2. Check for Breathing. (Scan the Chest) 3. Get Help and ask for an AED. 4. Check for Pulse (5 – 10 seconds) If the patient is unresponsive, not breathing and pulseless, start High Quality CardioPulmonary Resuscitation (HQ CPR) 61912591440Characteristics of HQ CPR Push hard (2 inches / 5cm deep) Push fast (at least 100 compressions / min) Allow complete chest recoil Minimize interruptions ( <10sec) Avoid excessive ventilation Compression – ventilation ration 30:2 00Characteristics of HQ CPR Push hard (2 inches / 5cm deep) Push fast (at least 100 compressions / min) Allow complete chest recoil Minimize interruptions ( <10sec) Avoid excessive ventilation Compression – ventilation ration 30:2 SHOCKABLE ARREST RHYTHMS Ventricular Fibrillation (VF) 2962275152400 000 Pulseless Ventricular Tachycardia (VT) 297180021590180 00180 Class I: HQ CPR Class IIA: Shock at 360J Class IIB: No drug 11525258826500 2mins, SAS Class I: HQ CPR Class IIA: Shock at 360J Class IIB: Epinephrine 1mg IV/IO 1: 10,000 dilution + 20mL PNSS & elevate arms 108585010795000 2mins, SAS Class I: HQ CPR Class IIA: Shock at 360J Class IIB: Amiodarone 300mg IV/IO + 20mL PNSS & elevate arms * SAS = Stop, analyse rhythm, switch roles NON-SHOCKBALE ARREST RHYTHMS Asystole Pulseless Electrical Activity (PEA): any organized rhythm without a pulse Class I: HQ CPR Class IIA: NO SHOCK Class IIB: Epinephrine 1mg IV/IO 1:10,000 dilution (q3-5mins) + 20mL PNSS & elevate arms Reversible Causes of Cardiac Arrest (H’s & T’s) 5 H’s 5 T’s Hypovolemia Hypoxia Hydrogen Ion Acidosis Hypo/Hyperkalemia Hypothermia Tension Pneumothorax Tamponade, Cardiac Toxins Thrombosis, Pulmonary Thrombosis, Coronary WITH RETURN OF SPONTANEOUS CIRCULATION (ROSC) A Advanced airway: confirm with 5 point aauscultation (primary) and waveform B capnography (secondary); Ventilate at 1 breath every 5-6 seconds or 10-12 breaths/min C Volume: Run 1-2L PNSS/PLRS IB bolus Presssors: Dopamine 2-10mcg/kg/min Epinephrine 2-10mcg/min D Therapeutic Hypothermia: Run 30mL/kg of 4OC of PLRS/PNSS for 30mins and maintain a core body temperature of 32-34OC for 12-24hrs Post-Cardiac Arrest Care (sign of the cross) 201930065722500254317518097500 NGT 39338258953500 Portable CXR CVP 12- L ECG ICU Urinary Catheter RESCUE BREATHING Airway Devices Ventilations during cardiac arrest Ventilations during respiratory arrest Bag - mask 2 ventilations after every 30 compressions 1 ventilation every 5-6 sec (10-12 breaths per min) Any advanced airway 1 ventilations every 6-8 sec (8-10 breaths per min) Dangers of Hyperventilation: 26670015684500 4457700100965001. Intragastric Pressure: prone to regurgitation of gastric contents pulmonary aspiration 34290001416780020097751841500026670016827500 3095625112395002. Intrathoracic Pressure: venous return cardiac output 51911251416050026670015113000 48482251047750028194009525000159067585725003. Carbon Dioxide Hypocarbia Cerebral Vasoconstriction blood flow to the brain Uses of Waveform Capnography: 1. Confirms correct placement of ET tube 2. Reflects effectiveness of chest compressions (should be =/> 10mmHg) 3. Predicts ROSC CRICOID PRESSURE is not recommended ACUTE CORONARY SYNDROME (ACS): M – O – N – A OXYGEN supplementation if SpO2 <94% at room air ASPIRIN: 160-325mg non-enteric coated tablet Contraindications: 1. gastric ulcer 2. allergy to aspirin NITROGLYCERIN: up to 3x sublingual (SL) spray Contraindications: 1. Bradycardia / Tachycardia / Hypotension 2. Right ventricular (RV) infarct or dysfunction 3. Intake of a phosphodiesterase inhibitor within 72hrs MORPHINE: 2-5mg IV Watch out for: 1. Bradycardia / Hypotension / Bradypnea 2. Difficulty of breathing (histamine release) Request for a 12-L ECG Repurfusion therapy: 197167511684000 30mins after ED arrival Fibrinolysis 19716751085850090mins after ED arrival PCI (Percutaneous Coronary Intervention) STROKE Cincinnati Pre-hospital Assessment Scale (FAST): 1. Facial Droop 2. Arm Drift 3. Slurring of Speech (Abnormal Speech) Time Zero: the time patient was last seen normal. 29718002032000Rule out hypoglycaemia in a patient w/ sensorium. Request for a CRANIAL CT SCAN! Or divert to a hospital with CT – capabilities. Fibrinolysis: within 3hrs of symptom-onset