ACLS Algorithms

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Author:
readyreg29
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270288
Filename:
ACLS Algorithms
Updated:
2014-04-20 19:21:40
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ACLS Algorithms
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ACLS Algorithms
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MEDIC 2014
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  1. Cardiac arrest 
    (VF/VT)
    • SHOCK
    • CPR (2mins)
    • IV/IO 
    • Check rhythm (VF/VT)
    • SHOCK
    • CPR (2mins)
    • Epinephrine: 1mg-1:10,000 (3-5)
    • Advanced airway
    • Check Rhythm
    • SHOCK
    • CPR (2mins)
    • Amiodarone: 300mg
    • H & T's
  2. Cardiac arrest 
    (asystole/PEA)
    • NO SHOCK
    • CPR (2mins)
    • Epinephrine: 1mg-1:10,000 (3-5mins)
    • Advanced airway
    • Determine rhythm
    • **REPEAT
    • Consider H & T's
  3. Return of Spontaneous Circulation (ROSC)
    Steps/Considerations
    • Maintain O2 >94%
    • Consider advanced airway
    • Treat hypotension 
    • IV/IO
    • Vasopressor infusion
    • Consider treatable causes
    • 12-lead ECG
  4. Treatment for bradycardia with a Pulse
    Stable
    Unstable
    • Stable: Supportive care; O2
    • Unstable:
    • Atropine: .5mg (every 5mins) 3mg max.
    • TCP
    • Dopamine: 400mg:250mL 2-10 mcg/kg/min
    • or
    • Epinephrine: 1mg:500mL / 2-10mcg/min
  5. Tachycardia with a Pulse
    Treatment - Stable / Unstable
    • 12 Lead ECG
    • Stable
    • Adenosine: 6mg; 20ml NS
    •                  12mg (x2)
    • Amiodarone: 150mg (over 10mins)
    • Unstable
    • Synchronized cardioversion
  6. Critical EMS assessments and actions of Stroke:
    • Support ABC's (O2)
    • Stroke assessment
    • Time of symptom onset (last normal)
    • Triage stroke center
    • Alert hospital
    • Check glucose
  7. The first five steps in ACLS care:
    • Maintain patent airway
    • Oxygen (<94%)
    • Vitals
    • Cardiac monitor
    • IV access
    • **12-Lead
  8. Transcutaneous Pacing Steps:
    • Apply Limb leads
    • Apply Pads
    • Pacer mode
    • Rate: 70
    • Current: increase until spike is followed by a QRS "Capture"
    • Check pulse
  9. H's
    • Hypovolemia
    • Hypoxia
    • Hypo/Hyperkalemia
    • Hypothermia
  10. T's
    • Tension Pneumothorax
    • Tamponade Cardiac
    • Toxins
    • Thrombosis Pulmonary
    • Thrombosis Coronary
  11. Electrical treatment for tachycardia, unstable, with pulse:
    • Synchronized cardio version
    • Biphasic 50-100J
  12. Electrical treatment for tachycardia without a pulse:
    • Defibrillate (shock) 
    • Biphasic 120-200J
  13. The BLS survey is a systematic approach to basic life support that stresses:
    • Early CPR
    • Early defibrillation
  14. BLS does not include
    • Advanced airways
    • or
    • Drug administration
  15. The BLS survey helps achieve the goal of supporting or restoring effective:
    • Oxygenation
    • Ventilation
    • Circulation 
    • until ROSC or ALCS
  16. The BLS survey assessment steps:
    • Check responsiveness (5-10 sec)
    • Activate ERS / get AED
    • Circulation (5-10 sec)
    • Defibrillation (no pulse; shock)
  17. Circulation steps
    If no pulse -
    • CPR (30:2)
    • Compressions at least 100 per min
    • Complete chest recoil
    • Switch compressors every 2 minutes
  18. Circulation (during BLS survey)
    If pulse is present
    • Rescue breathing 10-12 breaths/min
    • Check pulse every 2 min
  19. For unconscious patients in cardiac or respiratory arrest HCP's should conduct what survey
    ACLS after completing the BLS survey
  20. For conscious patients who may need more advanced assessment and management techniques the HCP should conduct what survey
    ACLS first
  21. How do you confirm proper placement of advanced airway devices
    • Physical examination
    • Quantitative waveform capnography
  22. In quantitative waveform capnography the PETCO2 should beat least:
    • 10mmHg
    • **if not attempt to improve CPR quality
  23. In intra-arterial pressure the diastolic pressure should be at least:
    • 20mmHg
    • ** if not attempt to improve CPR quality
  24. Treatment of medications vs. electricity:
    • When patient is:
    • Stable - MEDICATIONS
    • Unstable - ELECTRICITY
  25. MAGNESIUM SULFATE 
    Indications
    • VF
    • Pulseless VT
    • Torsades de pointes
    • 1-2 Gm; 50-100 mL NS or D5W, over 1-2
    • minutes.
  26. Rules for discontinuing CPR
    • 2 or more rounds of drugs
    • Advanced airway
    • Asystole in 2 or more leads
  27. Rules for synchronized cardioversion
    • Every fast rhythm with a pulse
    • ** except wide and irregular (torsades)

  28. Identify rhythm
    Why?
    Treatment (stable/unstable)
    • Sinus Brady
    • Slow rate
    • Treatment
    • Stable: O2 & monitor
    • Unstable: Atropine .5mg, TCP, Dopamine, Epinephrine

  29. Identify rhythm
    Why?
    Treatment
    • 2nd degree heart block type II
    • P-wave follows every QRS; some p-waves w/out QRS
    • Treatment
    • Stable: supportive care
    • Unstable: Treat underline cause (H's & T's)
  30. Drugs that can be administered by endotracheal route
    NAVEL

    • Narcan
    • Atropine
    • Vasspressin
    • Epinephrine
    • Lidocaine
  31. The difference between V-tach & SVT:
    SVT: you can't see the P-waves

  32. Identify rhythm
    Why?
    Treatment
    • Supraventricular Tachycardia
    • Can't see P-waves
    • Treatment
    • Stable: Adenosine 6mg; 12mg
    • Unstable: Synchronized Cardioversion

  33. Identify rhythm
    Why?
    Treatment
    • Ventricular tachycardia
    • Fast, wide, no P-wave
    • Treatment
    • Stable: Adenosine 6mg,12mg, Amiodarone 150mg (10 mins), or Lidocaine 1 - 1.5 mg/kg
    • Unstable: Synchronized Cardioversion
  34. Medical Emergency Teams and Rapid Response Teams are responsible for performing:
    • Rapid assessment
    • Initiating appropriate treatment to reverse physiologic deterioration
    • Prevent poor outcome
  35. When interpreting cardiac rhythms; what do you want to know about the rhythm and the patient:
    • Rhythm: Fast or Slow
    • Patient: Stable or Unstable
  36. Factors of an unstable patient
    • Hypotension
    • ALOC
    • Shock
    • Ischemic chest discomfort
    • Acute heart failure
  37. Synchronized Cardioversion
    Initial recommended doses
    • Narrow regular: 50-100J
    • Narrow irregular: 120-200J 
    • Wide regular: 100J
  38. In Post-Cardiac Arrest Care the recommended cooling comatose adult patient with ROSC after out-of-hospital VF cardiac arrest:
    32 C to 34 C for 12 to 24 hours
  39. HCP's should ventilate to achieve PETCO2 of
    35 - 45 mmHg
  40. Ventilations during cardiac arrest
    Bag-Mask
    Advanced airway
    • BVM: 30:2
    • Advanced airway: 1 ventilation every 6 to 8 seconds (8 to 10 bpm)
  41. Ventilations during Respiratory arrrest
    • 1 ventilation every 5 to 6 seconds
    • (10 to 12 bpm)
  42. High - Quality CPR consists of:
    • Rate at least 100/min
    • Compression depth at least 2 inches (5 cm)
    • Allow complete recoil
    • Minimize interruptions in compressions
    • Avoid excessive ventilations
  43. When VF is present, CPR can provide a small amount of blood flow to the heart and brain; but cannot:
    Directly restore an organized rhythm
  44. Reasons to stop or withhold resuscitative efforts:
    • Rigor mortis
    • Indicators of DNAR status
    • Threat to safety of providers
  45. Self-adhesive pads provide
    • Reduced risk of arching
    • Allow monitoring of patients underlying rhythm
    • Permit the rapid delivery of a shock

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