2015 ACLS Review

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DISCLAIMER• The following information is provided by

the American Heart Association. • Monies collected do not represent income

for the American Heart Association.• Please review and study your American

Heart Association ACLS Manual before attempting to complete the AHA ACLS

Course.

QRS Complex

P wave indicates Atrial depolarization. QRS complex indicates Ventricular depolarization

T wave indicates re-polarization

Rhythm Recognition• Fastorslow?• Regularorirregular?• QRSnarroworwide?• IsthereaPwave?• IsthePwavecloseorfarfromQRS?• IsthePwaveinthesameplace?

Normal Sinus Rhythm

1st Degree Heart Block• Usuallybenign,verycommon• NottreatableinACLSunlesssymptomatic• Notactuallyablock- justadelayinconduction• PRI- >20(4smallboxes)• IftheRs arefarfromPs,thenyouhavea1stDegree

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

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

2nd Degree, Type 2 Heart Block• BlockedPwaves/droppedQRSComplexes• IfsomePsdon’thaveQs,thenyouhaveaMobitz 2

• Thisisgettingworse…

3rd Degree Heart Block(Complete Heart Block)

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

Supra Ventricular Tachycardia(SVT)

• Firingsomewhereabove theVentricles• Treatableover150BPMperACLS• RegularandFAST!

Ventricular Tachycardia(V- tach with or w/o Pulses)

• Extremelydangerousarrhythmia• Patientwontlastlong• WideandBizarrepattern,butregular• Shock-ablerhythm(ifnopulsepresent)

Torsades de Pointes• Translatesto:“TwistedoftheSpikes”• DescribedasPolymorphicTachycardia• MaydegeneratetoV-Fibifpersistent• CausedbyHYPOkalemia/HYPOmagnasemia

Ventricular Fibrillation(V-Fib)

• Won’thaveapulse• Fineorcoarse• Shock-ablerhythm• PatientisinCARDIACARRESTatthispoint

Pulseless Electrical Activity (PEA)

• ANY rhythmcanbePEA aslongasitdoesn’thaveaPULSE!

• YOUMUSTCHECKAPULSEWITHEVERYRHYTHM- InaCardiacArrest!

Asystole (Flat line)• HeartnotproducingANYelectricalactivity• NON-ShockableRhythm• PatientisDEAD

Acute M.I. (Where do you see STEMI?)

ACLS DRUGSAtropine

• DerivedfromtheNightshadePlant(deadly)• Dilatespupils,increasesheartrate• Usedtotreatsymptomaticbradycardia• NolongerusedforPEA

DOSE:0.5mgwithamaximumof3.0mg

ACLS DRUGS

Adenosine• Inhibitsneurotransmitters• “Resets”heart• Asystolefor3-5seconds• CausesatransientheartblockintheAVnode• UsedtotreatAsymptomaticSVTover150bpm• NOT forwidecomplexIRREGULARV-Tach

DOSE:6.0mgthen12.0mg

ACLS DRUGSAmiodaroneBolus

• Anti-arrhythmic• WorksontheAtriaandtheVentricles• Ifyoucanshock,useAmiodarone

DOSE:300mgthen150mg.MAX:450mg

ACLS DRUGSEpinephrine(Bolus)

• Hormonenaturallyoccurringinthebody• AffectstheSympatheticNervousSystem• Constrictsbloodvessels,increasesperipheralresistance

• IncreasesHeartRate(InotropiceffectsandChronotropiceffects)(contractilityandrate)

DOSE:1.0mgNOMAXDOSE!

ACLS DRUGSDopamine

• Second-linedrugforsymptomaticbradycardiawhenatropineisnoteffective

• Usedforcardiogenicshockintheabsenceofhypovolemia

Dose:2-20micrograms/kg/mininfusion

ACLS DRUGSEpinephrine(Infusion)

• Second-linedrugforsymptomaticbradycardiawhenatropineisnoteffective.ChooseEPIorDopamine

Dose:2-10micrograms/mininfusion

ACLS DRUGSMagnesiumSulfate

• ForthetreatmentofTorsades

Dose:1-2Grams(SlowPush)

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

• Hyper/Hypokalemia• Hypothermia

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

CircularAlgorithm

Treatment Modalities per ACLS• V-FIBor(V-TACHw/opulses)aretheonlyshock-ablerhythms.

• 360JMonophasicDefibrillator/200JBi-Phasic• HighQualityCPR100-120BPM• EPI1mg• Amiodarone- 300mg,then150mg(450mgMAX)

SVT• Treatableat150BPM• UseValsalva ManeuverFirst(ThinkBLS)• Stable=Drugs.Adenosine6mg,12mg,done• Unstable=Electricity.SynchronizedCardioversion.(sedatefirst)JouleSettingsdiscussedinclass

• MAKESUREYOUPUSHSYNCHBUTTON!

SVT Algorithm

V-TACH w/PULSES (Regular)• Dangerousarrhythmia- PT.wontlastlong• Stable= UseAdenosine• Unstable=Electricity(Cardioversion)• JouleSettingsdiscussedinclass• Trytosedatefirst.Don’tdelaytreatment.• PT.willusuallybeUNSTABLE!

V-TACH Algorithm

V-Tach (Irregular, Torsades)• Dangerousarrhythmia- PT.wontlastlong• Stable=Adenosine- notindicated.• MagnesiumSulfate• (DEFIBRILLATE-Won’tbeabletosync)

Bradycardias

• Lessthan50-60BPM

• Stable=DONOTAGGRESSIVELYTREAT-watchpatient

• Unstable=(1)Atropine(2)DopamineorEPIDrip(3)Pacing…

Bradycardia Algorithm

Pacing• ApplyD-FibPadsonPt• SetPacerat80BPM*• IncreasemAuntil1pacerspikeprecedesQRS• CheckFemoralArteryforpulsethatmatchesmonitor

• Ifisdoesn’t,increasemAuntilitdoes

PEA (Pulseless Electrical Activity)

• Arhythmthatappearsonamonitortohaveapulse,butdoesnotwhenthepulseischecked

• HighqualityCPR• Epinephrine,1.0mg• NON- SHOCKABLE!• PushEpiAlways

Complete Heart Block (3rd degree)

• TheuseofAtropineisnotindicated• Transcutaneouspacing• Fluids• Oxygen• Cardiologyconsult

Hypothermia Protocol (Targeted Temperature Management)

• PatientMUSTbeIntubatedandComatose• Coolto32-36Celsius• Atleast24hours• OptimizesNeurologicRecovery• MaintainHemodynamics

THE END!

THANKYOU!!!