2015 ACLS Review -...

2015 ACLS Review

(941)363-1392www.CMRCPR.com|FL

DISCLAIMER• The following information is provided by

the American Heart Association. • This is a study guide to give providers a

sense of what to focus their studies on.• Please review and study your American

Heart Association ACLS Manual before attempting to complete the AHA ACLS

Course.

Assessment

• Responsive:(ABC’s)Airway,Breathing,Circulation

• Unresponsive:(CAB)Circulation,Airway,Breathing.

• *Rememberthebasics:BLSbeforeACLS

BasicLifeSupport

• Responsiveness• Pulse/Breathingwithin10seconds• ChestCompressions– Ratio– Rate– Depth– Recoil?

BasicLifeSupport

• UsetheAEDassoonasitarrives• WhatifAEDdoesnotgivecommands?• BasicsequenceofusinganAED• ROSCwithcontinuouscompressionswhiletheAEDischarging.

• Reassessmentevery2minutesor5cycles.

BasicLifeSupport

• Ventilation– MaintainSAO2of94%or>– Howtoopentheairway(unresponsivevstrauma)– OPAvsNPA– BVM(2rescueronly)– BVMrate(1breathevery5-6s=10-12bpm)– Howtosuction?– CricoidPressure?

AdvancedLifeSupport

PleaseremembertothinkBLSbeforeALS!– Unresponsive,pulseless,apneic?– Unresponsive,pulses,apneic?– Unresponsive,pulses,breathing?– AMS,pulses,breathing?– ETC……………..– Knowcauses(HandT’s)

AdvancedLifeSupport

• StablevsUnstable– Stable:• A/Ox4• NoCP/SOB• NormalPMS• SystolicBPof90or>• Skinwarm/dry/normalcolor

AdvancedLifeSupport

• StablevsUnstable– Unstable:• LethargicorAMS• SignificantCPandSOB(<94%SAO2)• WeakandThready Pulses• SystolicBPof<90• Skincool/diaphoretic/palecolor

AdvancedLifeSupport

• Ventilation– MaintainSAO2of94%or>– AdvancedAirways• Types(IE:ETtube)• Ventilations-1breathevery6seconds=10bpmduringarrestandnormalBLSrateduringRSI.• Continuouscompressionsduringarrest• ReassessmentofETtubeandcomplications?

AdvancedLifeSupport

• Ventilation– NormalETCO2of35-40• Typicallylower(10-20)duringcardiacarrest.• ETCO2lessthan10isasignofpoorperfusionanddecreasedCPP.• ETCO2of“0”isafailedintubation• ExhaledCO2

AdvancedLifeSupport

AdvancedLifeSupport

• AcuteCoronarySyndrome– 12-leadpriority– MONA:• Morphine- 2-4mg• Oxygen-asneeded• Nitro- 0.4mg• Aspirin- 160-324mg

*ContraindicationsofgivingNitro?*IdentificationofPosteriorMI?

AdvancedLifeSupport

• AcuteCoronarySyndrome– AnteriorSTEMI(V1-V6)

AdvancedLifeSupport

• AcuteCoronarySyndrome– InferiorSTEMI(II,III,AVF)

AdvancedLifeSupport

• AcuteCoronarySyndrome– PosteriorMI(ReciprocalchangesinV1-V3withST-ElevationinII,III,AVF)

AdvancedLifeSupport

• AcuteStroke– Timeisoftheessence(3-5hours)– HemorrhagicorIschemic?– Tpa vsSurgery?– CTScan– ComponentsofCincinnatiSTROKEassessment– AlwaysthinkBLSandgetabloodGlucosefirst!

AdvancedLifeSupport

• Pefusing Rhythms:– NormalSinusRhythm– SinusBrady– HeartBlocks– SinusTach– SVT– V-Tach– A-Fib

NormalSinusRhythm

SinusBradycardia

SinusBradycardia-Heartratetypically<50/min-Onlytreatableifshowingsignsofpoorperfusion-Treatment:

-Perfusing:OxygenandFluids-PoorPerfusion:

1.Atropine- 0.5mgevery3-5min(Maxof3mg)DerivedfromtheNightshadePlant(deadly)Dilatespupils,increasesheartrateUsedtotreatsymptomaticbradycardiaonly

SinusBradycardia2.Dopamine- 2-20mcg/kg/min-Second-linedrugforsymptomaticbradycardiawhenatropineisnoteffective-Usedforcardiogenicshockintheabsenceofhypovolemia

3.Epinepherine- 2-10mcg/mininfusion.

1st Degree Heart Block• Usuallybenign,verycommon• NottreatableinACLSunlesssymptomatic• Notactuallyablock- justadelayinconduction• PRI- >0.20(4smallboxes)• IftheRs arefarfromPs,thenyouhavea1st Degree• Ifsymptomatic,treatwithsamemedicationsasbradycardia.

2nd Degree Heart Block, type 1aka “Wenckebach”

• UsuallyIrregular• NottreatableinACLSunlesssymptomatic• PRI- Long,long,longer,DROP- mustbeaWenckebach!• Ifsymptomatic,treatwithsamemedicationsas

bradycardia.

2nd Degree, Type 2 Heart Block• BlockedPwaves/droppedQRSComplexes• IfsomePsdon’thaveQs,thenyouhaveaMobitz 2• Thisisgettingworse…• Alwaysgeta12-lead?• Treatment:

– Dopamine- 2-20mcg/kg/min– Pacing

3rd Degree Heart Block(Complete Heart Block)

• Malignant• UsuallyBradycardic,Irregular• Won’ttakelong…NEEDTOTREAT!• IfthePsandQsdonotagree,thenyouhavea3rd degree!• Treatment:

– Dopamine- 2-20mcg/kg/min– Pacing

Sinus TachycardiaHR:101-149

Supra Ventricular Tachycardia(SVT)


• Firingsomewhereabove theVentricles• TreatablewhensustainedHRof150or>BPMperACLS• RegularandFAST!• Ifstableperform12-lead!UseValsalvaManeuverFirst(ThinkBLS)

• Stable=Drugs.Adenosine6mg,12mg,done.– Inhibitsneurotransmitters– “Resets”heart– Asystolefor3-5seconds– CausesatransientheartblockintheAVnode– NOTforwidecomplexIRREGULARV-Tach


• Unstable=Electricity.SynchronizedCardioversion.(sedatefirst)100J,200J,300J360J*(discussedinclass)

• MAKESUREYOUPUSHSYNCHBUTTON!

Ventricular TachycardiaWith Pulses

• Extremelydangerousarrhythmia• Patientwontlastlong• 12-leadifstable• WideandBizarrepatternandregular• Monomorphicvs.Polymorphic?– Useextremecaution!

VentricularTachycardiaWithPulses


Treatment:-Valsalvamaneuverfirst(ThinkBLS)

Stable- UseAmiodorone

- Anti-arrythmic- WorksontheAtriaandtheVentricles- 150mgbolusover10min,repeatX1.- 1mg/minmaintenancedripifyoubreakrhythm


*ConsiderusingAdenosinetotreatmonomorphicWideComplexTachycardia.

UnstableElectricity(Monophasic)akasynchronizedcardioversion.100J,200J,300J360JTrytosedatefirst.Don’tdelaytreatment.

Atrial Fibrillation

Atrial Fibrillation-Irregularlyirregular

-Typicallybenignandpatient’scanliveoutanormallifewithratecontrollingmedicationsandanticoagulants.

-Typicallypresentsaspalpitations

-OnlytreatifsustainedHRof120or>

Atrial FibrillationValsalvamaneuverfirst(ThinkBLS)Treatment:Stable

-Diltiazem (0.25mg/kgslowIVpushover2min)-Mayrepeatx1at0.35mg/k

Unstable-SynchronizedCardioversion-Useextremecaution?

Cardiac Arrest *ThinkBLSbeforeACLS-EarlyCPRandDefibrillation-UseasystematicApproachtointegrateALSSkillsandmedications.-Canbecategorizedintotwogroups:ShockableandNon-Shockable.-Shockable:V-FibandV-Tachw/opulses-Non-Shockable:PEAandAsystole

Ventricular Fibrillation(V-Fib)


• Won’thaveapulse

• Fineorcoarse

• Shock-ablerhythm

• Startat360J,andcontinueat360J*(WithaMONO-phasicDefibrillator)

• HighQualityCPR


• Epinephrine- 1mgevery3-5minutes(noMAX)– Hormonenaturallyoccurringinthebody– AffectstheSympatheticNervousSystem– Constrictsbloodvessels,increasesperipheralresistance– IncreasesHeartRate(InotropiceffectsandChronotropiceffects)(contractilityandrate)

• Amiodarone- 300mg,then150mg(450mgMAX)

Ventricular Tachycardiaw/o pulses

Ventricular Tachycardiaw/o Pulses

• Won’thaveapulse

• Fineorcoarse

• Shock-ablerhythm

• Startat360J,andcontinueat360J*(WithaMONO-phasicDefibrillator)

• HighQualityCPR

• Epinephrine- 1mgevery3-5minutes(noMAX)

• Amiodarone- 300mg,then150mg(450mgMAX)

Pulseless Electrical Activity

Pulseless Electrical Activity• Organizedrhythmwithoutapulse.

• TypicallyresemblesNormalSinusinorigin.

• NON- SHOCKABLE!

• RememberHandT’s

• HighqualityCPR

• Epinephrine,1.0mg

• PushEpiAlways

Asystole (Flat line)

Asystole (Flat line)• HeartnotproducingANYelectricalactivity• NON-ShockableRhythm• PatientisDEAD• Treatment:– HighqualityCPR– Epinephrine- 1.0mg(nomax)

H’s and T’s• Hypovolemia• Hypoxia• HydrogenIons(acidosis)

• Hyper/Hypokalemia• Hypothermia

• Toxins• Tamponade(cardiac)• TensionPneumothorax• Thrombosis(coronary)• Thrombosis(Pulmonary)

ROSC: Post Cardiac Arrest• Optimizeventilationand

oxygenation• TreatHypotension• 12-lead• Labs• Initiatehypothermia

management– 1-2Lofcoldnormalsaline– Tempof32-36C over12-24hours

THE END!

THANKYOU!!!

2015 ACLS Review -...

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