1. BLS Primary Survey - Save A Heart CPR. BLS Primary Survey • Be proﬁcient with BLS: 2. AED:...

1. BLS Primary Survey

• Be proficient with BLS:

2. AED:

• Turn ON, Attach Pads, Analyzing (do not touch patient), Shock Advised, Clear and Shock

• TAKE NOTE: Resume chest compressions when AED is charging

ACLS 2010 Study Guide

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Monitor “RDR” (Rate/Depth/Recoil) during compressions

BLS primary survey continues during ALS secondary survey (ABCD)

If pulses are present with ineffective respirations, provide rescue breathing giving 1 breath every 5-6 seconds. Assess for bilateral chest rise and fall.

Check carotid pulses for less than 10 seconds.

At least 100 compressions per minute

2 breaths are given with 30 compressions for 2 minutes (5 cycles of 30:2)

• If no shock advised, resume compressions

• Know the contraindications with AED (i.e. hairy chest, wet victims, dermal patches, pacers, bra with wires, etc.)

3. Airway Management

• Always intervene with the least to the most invasive interventions

POSITION

PATENCY• Suction (<10 sec)• OPA, NPA

OXYGENATE• Nasal Cannula• Simple Masks

VENTILATE• Bag-Mask: Give 1 breath every 5-6 seconds

(10-12/min)• Advanced Airways: Give 1 breath every 6-8

· Waveform Capnography: PETCO₂ (Partial End-Tidal CO₂)

- Normal range: 35-45 mmHg

- Used for quantitative measurement of perfusion

- Reliable verification of ETT placement

- Monitor’s quality of compressions. Must have at least 10 mm Hg or greater to achieve perfusion.

- Identifies ROSC (return of spontaneous circulation) during compressions with abrupt increase of PETCO₂.


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- Post-Arrest Care: PETCO₂ goal is to achieve 35-40 mmHg or greater

· Advanced Airways

- Not needed if airway is patent during compressions

- ETT (endotracheal tube) – Verify by auscultating 5 placements, visualizing bilateral chest rise/fall, using PETCO₂ as continuous monitoring

- LMA and King Tube can be inserted without stopping chest compressions

- Give 1 breath every 6-8 seconds (8-10 breaths/minute) with or without compressions.

4. Ischemic Stroke


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· CPSS (Cincinnati Pre-hospital Stroke Scale): One-sided weakness, Slurred speech, Facial droop

· 8 D’s of Stroke: Detection, Dispatch, Delivery, Door, Data, Decision, Drug, Disposition

• Patient must be brought to closest stroke center. If none, then to closest hospital with CT scanner. If CT is unavailable, to closest hospital.

• 12-Lead is verified for possible STEMI

• If with negative CT scan, fibrinolytic can be administered if onset of symptoms is within 3 hours ( 4.5 hours on some patients).


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5. Acute Coronary Syndrome


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• Focus on STEMI (ST Elevation MI) pathway, verified on 2 contiguous leads on 12-Lead

• Memorize “MONA” doses and contraindications specially for Nitro and Morphine

• Know atypical signs of MI• Know contraindications of Right Ventricular Infarction (RVI) or Inferior

Infarct


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6. Invtravenous/Intraosseous

• Preferred route of medication administration is via peripheral IV

• After multiple attempts of IV insertion without success, IO is inserted.

• Know IO insertion sites and be familiar with various IOs

• All medications given through IV can be administered via IO.

• Goals of IO: Insertion, Administration and Discontinuation (<24 hours)


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7. Bradycardia


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Sinus Bradycardia

3rd Degree AV Block

8. Tachycardia


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NOTE:

Know appropriate dosing of Dopamine and Epinephrine

TCP is preferred for 3rd Degree AVB unless unavailable then Atropine is

Regular: Narrow Complex TachycardiaSupraventricular Tachycardia

Rate: 150 >


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Irregular: Narrow Complex TachycardiaAtrial Fibrillation

Regular: Monomorphic Wide Complex Tachycardia

Ventricular Tachycardia

Irregular: Polymorphic Wide Complex Tachycardia

Torsade de Pointes

Synchronize


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9. Pulseless Arrest


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Ventricular Fibrillation

Pulseless Ventricular Tachycardia

Asystole

Pulseless Electrical Activity

No Pulse

No Pulse


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NOTE: VF, Pulseless VT, Asystole and Agonal are not

10.Post-Resuscitation Care: ROSC

• ROSC (Return of Spontaneous Circulation)• Maintain O₂ Sat 94%>, titrate 10-12 breaths/min• Consider advanced airway and maintain PETCO₂ 35-40 mm Hg>• 1-2 L NS/LR bolus (at 4˚C to induce hypothermia if ALOC)• Titrate vasopressors to keep BP 90 mm Hg>• Identify and treat reversible causes • 12-Lead ECG for possible PCI if STEMI or high suspicion of AMI


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• Consider hypothermia for 12-24 hours in ALOC for cerebral oxygenation and ventilation

• Keep glucose slightly above normal to avoid hypoglycemia during hypothermia

11.Termination of Resuscitation Effort

• DNAR (Do Not Attempt Resuscitation)

• Decapitation

• Presence of Rigor Mortis

• Continued decompensation during resuscitative efforts

• Inherent danger to team during resuscitation

• Unwitnessed arrest

• No defibrillation during BLS or ALS

• MD ordered termination


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1. BLS Primary Survey - Save A Heart CPR. BLS Primary Survey • Be proﬁcient with BLS: 2. AED:...

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