ACLS Handbook [2013]

8/11/2019 ACLS Handbook [2013]

1/105

2013 ACLS Handbook

AIRWAY AND BREATHING

Waveform capnography

1. Measures eha!e" #$%

%. Recommen"e" for a!! &n'u(a'e" pa'&en's

). Mos' re!&a(!e *ay 'o mon&'or pa'&en's resp&ra'&ons

+. #on'&nue 'hroughou' 'he per&, arres' per&o"

Reasons 'o use *aveform capnography

1. #onf&rm p!acemen' of 'he ET 'u(e

%. De'ec' R$-# (ase" on #$% changes

). Mon&'or #R /ua!&'y

-upp!emen'a! oygen 0espec&a!!y h&gh f!o*

1. No' nee"e" for $-# pa'&en's

W&'hou' resp&ra'ory "&s'ress

W&'h an -$% 23+4

%. T&'ra'e 'o ma&n'a&n -$% 2 3+4 &n hypo&c pa'&en's

). Hyper,oygena'&on &n R$-# pa'&en's

May re"uce cere(ra! (!oo" f!o* "ur&ng resusc&'a'&on

5ong 'erm may crea'e oygen 'o&c&'y

App!y oygen 'o pa'&en's *&'h A#- 'ha'6

Have an oygen sa'ura'&on 7 3+4

Are &n car"&ac or resp&ra'ory fa&!ure

ACLS CHANGES 2010


2/105


3/105

2013 ACLS Handbook

DE9IBRI55ATI$N AND #ARDI$8ER-I$N

8en'r&cu!ar 'achycar"&a

1. -'a(!e monomorph&c 8Tach : car"&over'

%. -'ar' a' 1;;< an" &ncrease s'ep*&se

). A (&phas&c "ose has (een a""e"

+. Trea' po!ymorph&c 8Tach *&'h unsynchron&=e"

shoc>

A,f&( an" A :f!u''er

1. Recommen"e" (&phas&c "ose A,f&( 1%; : %;; &ng 'he a&r*ay

In"&ca'&ons nconsc&ous pa'&en'

A(sence of a gag ref!e

-&=&ng

#orner of 'he mou'h 'o 'he ang!e of 'he

man"&(!e Inser'&on

ps&"e "o*n 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'

-&"e*ays 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'

Mus' (e f!ush *&'h 'he mou'h



9/105

2013 ACLS Handbook

B5- AIRWAY MAINTENAN#E NA-$HARANGEA5

In"&ca'&ons

#onsc&ous or sem& consc&ous pa'&en'

a'&en' *&'h a gag ref!e

-&=&ng

Nose 'o 'ragus of 'he ear

Inser'&on

5u(r&ca'e *e!!

#hoose 'he !arges' nos'r&!

Gen'!y use a sp&ra! mo'&on 'o &nser'

#hec> pa'&en' ven'&!a'&on

If res&s'ance &s encoun'ere" remove an" 'ry 'he

o'her nos'r&!

#au'&on Do no' use on pa'&en's *&'h ser&ous hea" &n@ur&es

#on'ra&n"&ca'e" *&'h (as&!ar s>u!! frac'ures



10/105

2013 ACLS Handbook

B5- AIRWAY MAINTENAN#E

-#TI$NING

-of' ca'he'ers Asp&ra'es 'h&n secre'&ons oro an" naso pharyn

erform&ng en"o'rachea! suc'&on&ng

-uc'&on 'hrough an &n p!ace a&r*ay

R&g&" ca'he'ers -uc'&on&ng oropharyn 'h&c> par'&cu!a'e ma''er

En"o'rachea! suc'&on&ng

se s'er&!e 'echn&/ue Inser' ca'he'er &n'o 'he en"o'rachea! 'u(e

se 'he !arges' 'u(e poss&(!e

Do no' &nser' (e!o* 'he en" of 'he ET 'u(e

Be sure open&ng &s no' occ!u"e" "ur&ng &nser'&on

App!y suc'&on&ng (y occ!u"&ng 'he

ca'he'er open&ng "ur&ng *&'h"ra*a!Do no' suc'&on !onger 'han 1; secon"s



11/105

2013 ACLS Handbook

AD8AN#ED AIRWAY-

-RAG5$TI#

#om(&'u(e

&ng a&r*ay

5MA 0!aryngea! mas> a&r*ay

-A5T a&r*ay

NA-$TRA#HEA5 INTBATI$N

#onsc&ous or sem& consc&ous pa'&en's

Inser' &n !arges' nos'r&! 05u(r&ca'e *e!!

Do no' use a s'y!e''e

G!o''&c open&ng !oca'e" (y soun" an" vapor &n 'he

'u(e

Mos' usefu! &n pu!monary e"ema an" pa'&en's

una(!e 'o open 'he mou'h -'op &nser'&on &f res&s'ance &s encoun'ere"

#on'ra&n"&ca'e" &n hea" 'rauma



12/105

2013 ACLS Handbook

AD8AN#ED AIRWAY-

END$TRA#HEA5 INTBATI$N

Essen'&a! for unconsc&ous pa'&en's

May (e use" on consc&ous pa'&en's *&'h R-I

0Rap&" se/uence &n'u(a'&on

erforme" *&'h

5aryngoscope

M&!!er (!a"e , s'ra&gh'

Mac&n'osh (!a"e : curve"

#hec> scope pr&or 'o &nser'&on

En"o'rachea! 'u(e

Tr&a! &nf!a'e 'he 'u(e cuff pr&or 'o &nser'&on

-'y!e''e

1; cc syr&nge

5u(r&can'

#onf&rm p!acemen'

Auscu!'a'&on

#apnography

#hes' ray

-ecure 'he 'u(e



13/105

2013 ACLS Handbook

8ENTI5ATI$N 0B5-

Mou'h 'o mou'h an" mou'h 'o mas>

Does no' preven' "&sease 'ransm&ss&on

Mus' prov&"e a goo" sea!

De!&ver enough (rea'h 'o ma>e 'he ches' r&se

Your eha!e" (rea'h can on!y supp!y 1F4 oygen

Am(u (ag

-afes' me'ho" 'o preven' "&sease 'ransm&ss&on

#an supp!y 1;;4 oygen

$pen 'he a&r*ay

#omp!e'e!y sea! 'he mas>

De!&ver (rea'h vo!ume enough 'o ma>e 'he ches'

r&se

Each (rea'h shou!" (e 1 secon" "ura'&on

Re/u&res % rescuers 'o assure a goo" mas> sea!



14/105

2013 ACLS Handbook

8ENTI5ATI$N 0A#5- Au'oma'e" pneuma'&c ven'&!a'ors

rov&"es au'oma'&c ven'&!a'&on 'o &n'u(a'e"

pa'&en's

-e's ra'e '&"a! vo!ume EE pressure 9&$% an"

m&nu'e vo!ume

#A

rov&"es EE 0pos&'&ve en" ep&ra'ory pressure

Re/u&res a mas> an" a #A mach&ne

Mos' usefu! for consc&ous pu!monary e"ema

pa'&en's Epan"s 'erm&na! (ronch& an" a!veo!ar sacs

BIA

rov&"es (o'h pos&'&ve &nsp&ra'ory an" ep&ra'ory

pressure

Mos' usefu! on as'hma'&c an" #$D an"

pneumon&a pa'&en's 'ha' re/u&re a""&'&ona!&nsp&ra'ory pressure suppor' *&'h EE.



15/105

2013 ACLS Handbook

Why use *aveform capnography

#apnography measures #$% resu!'&ng from (rea'h&ng

I' &s 'he on!y accura'e *ay 'o assess (rea'h&ng

AHA re/u&res &' on a!! &n'u(a'e" pa'&en's

Ho* *aveform capnography *or>s

#$% &s a(sor(e" &n 'he IR a' +.) nm

Eha!e" (as passes 'hrough an IR a"ap'or a''ache" 'o

'he ET 'u(e

Th&s prov&"es an e!ec'r&ca! s&gna! 'o 'he car"&ac mon&'or

The mon&'or prov&"es eha!e" #$% resp&ra'&on ra'e an"

a capnograph&c *aveform ana!ys&s

Waveform capnography &s use" 'o

Measure #$% !eve!

De'erm&ne 'he resp&ra'&on ra'e

-ho* 'he capnography *aveform

In"&ca'e a m&sse" 'u(e

To &n"&ca'e a m&sse" &n'u(a'&on

WAVEFORM CANOGRAHY


16/105

2013 ACLS Handbook

MANA5 M$NIT$R DE9IBRI55$R-

Genera!

A!! manua! mon&'or "ef&(r&!!a'ors prov&"e

'he same func'&ons

You mus' (ecome fam&!&ar *&'h 'he one

'ha' you use

Mo"es

Bas&c )+ !ea"s for rhy'hm &n'erpre'a'&on

A 1% !ea" capa(&!&'y

A "ef&(r&!!a'or mo"e

#ar"&overs&on : synchron&=e"

Def&(r&!!a'&on , unsynchron&=e"

A pac&ng mo"e

-e's 'he ra'e

Increases curren' 'o o('a&n cap'ure

ELECTRICAL THERAY


17/105

2013 ACLS Handbook

MANA5 M$NIT$R DE9IBRI55AT$R-

) + an" ? !ea" p!acemen'

) !ea" RA 0*h&'e 5A 0(!ac> 55 0re"

+ !ea" RA 0*h&'e 5A 0(!ac> 550re" R5 0green

? !ea" RA 0*h&'e 5A 0*h&'e 550re" R5 0green 81

0(ro*n

ELECTRICAL THERAY


18/105

2013 ACLS Handbook

1% 5EAD 5A#EMENT 5E9T -IDE

1% 5EAD 5A#EMENT RIGHT -IDE

ELECTRICAL THERAY


19/105

2013 ACLS Handbook

#ARDI$8ER-I$N #ar"&overs&on &s use" 'o 'rea' rap&" hear'(ea's 'ha'

are no' re!a'e" 'o a 'rea'a(!e cause an" comprom&se

hemos'as&s

To car"&over' 'he un&' mus' (e &n 'he DE9IB mo"e Be sure 'o push 'he -YN# (u''on (efore your &n&'&a!

"ose an" aga&n (efore each su(se/uen' "ose.

9a&!ure 'o push 'he -YN# (u''on *&!! resu!' &n

"ef&(r&!!a'&on

When 'he un&' &s &n 'he sync mo"e a !&gh' *&!! appear

over each R *ave as sho*n.

ELECTRICAL THERAY


20/105

2013 ACLS Handbook

#ARDI$8ER-I$N

If 'he pa'&en' &s consc&ous cons&"er se"a'&on

8a!&um or verse"

#harge 'he un&' 'o 'he appropr&a'e @ou!e !eve!

Be sure 'ha' 'he un&' &s &n 'he synchron&=e"

mo"e

Be sure 'ha' everyone &s c!ear or 'he pa'&en'

IM #5EAR Y$R #5EAR WERE A55 #5EAR

De!&ver 'he charge Ho!" 'he charge (u''on un'&! 'he R *ave cap'ures

If you &ncrease 'o 'he ne' @ou!e !eve! (e sure

'o re synchron&=e.

ELECTRICAL THERAY


21/105

2013 ACLS Handbook

ETERNA5 A#ING E'erna! pac&ng &s "one us&ng mu!'&func'&on pa"s

The an'er&or pos'er&or pos&'&on for pa" !oca'&on &s

mos' effec'&ve

-e"a'e 'he pa'&en' &f consc&ous

-e' a hear' ra'e of a' !eas' F; (ea's per m&nu'e

A"@us' 'he curren' un'&! (o'h e!ec'r&ca! an"

mechan&ca! cap'ure &s a''a&ne"

Mechan&ca! cap occurs *hen a caro'&" pu!se &s fe!'

'ha' ma'ches 'he se' ra'e

-*&'ch 'o 'rans ,venous pac&ng A-A

#on'ra&n"&ca'&ons

Asys'o!e

u!se!ess 8Tach

-&"e effec's

->&n (urns

#hes' musc!e con'rac'&on

#hes' "&scomfor'

ELECTRICAL THERAY


22/105

2013 ACLS Handbook

DE9IBRI55ATI$N

Ho* "ef&(r&!!a'&on *or>s

An e!ec'r&ca! charge &s p!ace" across 'he hear'

Th&s crea'es asys'o!e

E&'her 'he hear' *&!! rema&n &n asys'o!e or a ne*

rhy'hm *&!! occur

Rhy'hms 'ha' re/u&re ear!y "ef&(r&!!a'&on

8en'r&cu!ar f&(r&!!a'&on

u!se!ess ven'r&cu!ar 'achycar"&a

Mu!'& form ven'r&cu!ar 'achycar"&a 0Torsa"es

ELECTRICAL THERAY


23/105

2013 ACLS Handbook

DE9IBRI55ATI$N

a" con'ac'

Goo" pa" con'ac' &s essen'&a! for successfu!

"ef&(r&!!a'&on. Be sure 'o "ry 'he pa'&en' (efore app!y&ng 'he pa"s

-have ches' ha&rs &n pa" app!&ca'&on areas

Remove any n&'ro pas'e or o&n'men's

Avo&" pacema>er !oca'&ons

a" p!acemen'

a"s may (e p!ace" &n e&'her 'he an'er&or an'er&or or

'he an'er&or pos'er&or pos&'&on

The an'er&or pos'er&or pos&'&on &s preferen'&a! &f pac&ng &s

an'&c&pa'e"

ELECTRICAL THERAY


24/105

2013 ACLS Handbook

DE9IBRI55ATI$N

Def&(r&!!a'or opera'&on

-e' 'he un&' &n 'he "ef&(r&!!a'or mo"e

#harge 'he "ef&(r&!!a'or

#!ear 'he pa'&en' (efore a"m&n&s'er&ng 'he

shoc>

Th&s &nc!u"es any'h&ng 'ouch&ng 'he pa'&en'

IM #5EAR Y$R #5EAR WERE A55 #5EAR

De!&ver 'he shoc>

Remem(er

Do #R *h&!e 'he "ef&(r&!!a'or &s charg&ng

-'ar' #R &mme"&a'e!y af'er 'he shoc> &s

"e!&vere"

ELECTRICAL THERAY


25/105

2013 ACLS Handbook

GENERA5

The pharmaco!og&ca! approach

Wor>s *e!! for non, arres' pa'&en's

Is s!o*er ac'&ng &n arres'e" pa'&en's

9ac'ors con'r&(u'&ng 'o pharmaco!og&ca!

success

The /ua!&'y of #R

The "o*n '&me (efore me"&ca'&on

a"m&n&s'ra'&on

The con"&'&on of 'he pa'&en's ar'er&es

MEDI#ATI$N A##E-- R$TE-

In'ravenous

G&ve me"&ca'&ons 'hrough !arge (ore I8-

The preferre" s&'es are

An'ecu(&'a!

E'erna! @ugu!ar

Try 'o s'ar' I8- (efore arres' occurs

HARMACOLOGY


26/105

2013 ACLS Handbook

MEDI#ATI$N A##E-- R$TE-

In'ra,osseous 0I$ access

D&rec' &n@ec'&on 'hrough 'he (one *a!! &n'o 'he

(one marro* venous p!e&s

-afe an" re!&a(!e

You can a"m&n&s'er f!u&"s co!!o&"s an" a!!

me"&ca'&ons

In"&ca'&ons for I$ access

Ina(&!&'y 'o ach&eve I8 access

rev&ous!y re/u&re" cen'ra! !&nes

Emergen' nee" for "rugs or f!u&"s

#ar"&ac arres' *&'hou' I8 access

#on'ra&n"&ca'&ons 'o I$

9rac'ure &n 'he e'rem&'y

rev&ous &nser'&on a''emp' &n 'he same (one Infec'&on a' 'he &n@ec'&on s&'e

Ina(&!&'y 'o !oca'e !an"mar>s or ecess&ve '&ssue

HARMACOLOGY


27/105

2013 ACLS Handbook

In'ra,osseous "ev&ces


28/105

2013 ACLS Handbook

INTRA,$--E$-

#onf&rma'&on of ca'he'er p!acemen'

#a'he'er &s f&rm!y sea'e" &n 'he (one

9!ash of (!oo" or (one marro*

ressur&=e" f!u&"s f!o* *&'hou' "&ff&cu!'y

harmaco!og&ca! effec's are no'e"

Af'er I$ &nser'&on

-'a(&!&=e I$

Remove 'rocar

Asp&ra'e 'he I$

A''ach a shor' connec'&ng 'u(&ng *&'h a ) *ay

s'opcoc>

9!ush I$ 'o &nsure pa'ency

ressur&=e" f!u&"s shou!" f!o* free!y

There shou!" (e no ev&"ence of e'ravas&on

9or consc&ous pa'&en's cons&"er !&"oca&ne for pa&n

9!ush *&'h 1;,%; cc N.-. af'er each me"&ca'&on

HARMACOLOGT


29/105

2013 ACLS Handbook

END$TRA#HEA5 R$TE

5eas' effec'&ve rou'e of a"m&n&s'ra'&on

Me"s 'ha' can (e g&ven ET 0NA8E5

Narcan A'rop&ne

8asopress&n

Ep&nephr&ne

5&"oca&ne

Ru!es for ET a"m&n&s'ra'&on

se %,%.? '&mes 'he I8 "ose 0ecep'

vasopress&n

-'op compress&ons

se 1; m! 'o'a! vo!ume 0"&!u'e *&'h N.-. or

s'er&!e *a'er

8en'&!a'e severa! '&mes

Resume compress&ons

HARMACOLOGY


30/105

2013 ACLS Handbook

MEDI#ATI$N- T$ -TIM5ATE THE HEART

EINEHERINE

In"&ca'&ons

#ar"&ac arres'

Bra"ycar"&a refrac'ory 'o a'rop&ne an" T#

Ac'&ons

Increases hear' ra'e con'rac'&!&'y au'oma'&c&'y an"

vasocons'r&c'&on

Dose

1,) mg every ),? m&nu'es

Infus&on

M& J mg ?;;m! &n D?W or N.-. Infuse a' %,1; mcgm&n for (ra"ycar"&a

Infuse a' J,+; mcg m&n for hypo'ens&on

Rou'e

I8 or I$

-&"e effec's

Tachycar"&a

Hyper'ens&on 8--

Increase" oygen "eman"

HARMACOLOGY


31/105

2013 ACLS Handbook

MEDI#ATI$N- T$ -TIM5ATE THE HEART

8A-$RE--IN

#!ass&f&ca'&on

An'&"&ure'&c hormone

Non, a"renerg&c vasocons'r&c'or In"&ca'&ons

#ar"&ac arres' as an a!'erna'&ve 'o ep&nephr&ne

Ac'&ons

8asocons'r&c'&on, s'&mu!a'es smoo'h musc!e

recep'ors

Increases coronary perfus&on "ur&ng #R

Increases v&'a! organ (!oo" f!o* an" cere(ra!

oygen

Dosage : +; un&'s

Rou'e : I8 I$ ET

-&"e effec's :o'en'&a! vasocons'r&c'&on

HARMACOLOGY


32/105

2013 ACLS Handbook

ANTI,ARRHYTHMIA MEDI#ATI$N-

AMI$DAR$NE 0#$RDAR$NE

#!ass&f&ca'&on : an'&,"ysrhy'hm&c

In"&ca'&ons

8T89 Rap&" a'r&a! arrhy'hm&as

Ac'&ons

ro!ongs recovery per&o" of car"&ac ce!!s

Affec's so"&um po'ass&um an" ca!c&um channe!s

Affec's a!pha an" (e'a

Dosage 0I8I$

#ar"&ac arres', );; mg &n 1; m! Repea' 1?; mg ),? m&n

erfus&ng pa'&en's 1?; mg over 1; m&n. Repea' &n 1; m&n.

Infus&on 03;; mg ?;; m!

1 mg m&n for F hours 'hen ;.? mg m&n for 1J hours

-&"e effec's

HTN (ra"ycar"&a A8 (!oc>s #H9 arrhy'hm&as

#on'ra&n"&ca'&ons

#ar"&ogen&c shoc>

-econ" or 'h&r" "egree hear' (!oc>s

HARMACOLOGY


33/105

2013 ACLS Handbook

ANTI,ARRHYTHMIA MEDI#ATI$N-

5ID$#AINE

#!ass&f&ca'&on

An'&,"ysrhy'hm&c

In"&ca'&ons

8T 89 8#-

Ac'&ons

-o"&um channe! (!oc>er

Depresses ven'r&cu!ar &rr&'a(&!&'y an" au'oma'&c&'y

Dosage

#ar"&ac arres', 1,1.? mg>g repea' ha!f "ose 'o )mg>g

8T 8#- ;.?,;.K? mg>g L ?,1; m&n as nee"e"

Infus&on

Ma&n'enance : M& % gm ?;;m! 0+mgm!

Infuse a' 1,+ mgm&n 01?,F; m!hr

Rou'e

I8I$ET

-&"e effec's

Musc!e 'remors

se&=ures

HARMACOLOGY


34/105

2013 ACLS Handbook

MEDI#ATI$N- T$ #$NTR$5 HEART RATE

ATR$INE

#!ass&f&ca'&on arasympa'he'&c (!oc>er

In"&ca'&ons -ymp'oma'&c (ra"ycar"&a

Ac'&on Increases hear' ra'e an" con"uc'&on

'hrough 'he A8 no"e

Dosage

;.? mg Repea' every ),? m&nu'es Ma&mum "ose ) mg

Rou'e I8I$ET

-&"e effec's Tachycar"&a "&!a'e" pup&!s ang&na

-ma!! "oses may cause (ra"ycar"&a

HARMACOLOGY


35/105


36/105

2013 ACLS Handbook

MEDI#ATI$N- THAT #$NTR$5 HEART RATE

#ARDIEM 0DI5TIAEM

#!ass&f&ca'&on

An'&,"ysrhy'hm&c

In"&ca'&ons

-8T 0Espec&a!!y A,f&( an" A, f!u''er

Ac'&on

#a!c&um channe! an'agon&s'

-!o*s con"uc'&on

-moo'h musc!e "&!a'&on

Dosage G&ve ;.%? mg>g over % m&nu'es 01?,%; mg

May repea' ;.)? mg>g &n 1? m&nu'es

Infuse 1%? mg1;;m! a' ?,1? mghr

Rou'e

-!o* push fo!!o*e" (y an &nfus&on

-&"e effec's Bra"ycar"&a

Hypo'ens&on

HARMACOLOGY


37/105

2013 ACLS Handbook

E5E#TR$5YTE- -$DIM BI#ARB$NATE

#!ass&f&ca'&on A!>a!&=er (uffer

In"&ca'&ons Me'a(o!&c ac&"os&s

Tr&cyc!&c an'&"epressan' over"ose

Hyper>a!em&a

Ac'&on Increases pH revers&ng ac&"os&s

Dosage 1 mE/>g &v push 'hen ;.? mE/>g every 1;

m&nu'es

May g&ve as an &nfus&on for cer'a&n over"oses

Rou'e I8 push or &nfus&on

-&"e effec's

Hyperna'rem&a hyperosmo!a!&'y Me'a(o!&c a!>a!os&s

HARMACOLOGY


38/105

2013 ACLS Handbook

E5E#TR$5YTE- #A5#IM #H5$RIDE

#!ass&f&ca'&on E!ec'ro!y'e

In"&ca'&ons

Hypoca!cem&a Hyper>a!em&a

Hypermagnesem&a

#a!c&um channe! (!oc>er over"ose

Ac'&on Increase" &no'rop&c force an" con'rac'&!&'y

Dosage %,+ mg>g of a 1;4 so!u'&on. Repea' &n 1; m&n. &f

re/u&re"

sua! "ose &s ?;;mg 'o 1 gm

Rou'e I8I$

-&"e effec's Hyperca!cem&a

8en'r&cu!ar f&(r&!!a'&on

Eacer(a'es "&g&'a!&s 'o&c&'y

HARMACOLOGY


39/105

2013 ACLS Handbook

E5E#TR$5YTE- MAGNE-IM -59ATE

#!ass&f&ca'&on An'&,"ysrhy'hm&c e!ec'ro!y'e

In"&ca'&ons Refrac'ory "ysrhy'hm&as

Torsa"es

Hypomagnesem&a

Ac'&on -'a(&!&=es '&ssue mem(ranes

Ra&ses magnes&um !eve!s

-moo'h musc!e re!aan'

Dosage 89 pu!se!ess 8T : 1,% gm over 1,% m&nu'es

8T *&'h pu!se : 1,% gm &n 1; m! over 1,% m&nu'es

Hypomagnesem&a *o ec'opy ;.?,1 mghr &nfus&on

Rou'e I8 or &nfus&on

-&"e effec's Bra"ycar"&a

Hypo'ens&on

#au'&on a'&en's *&'h !&''!e or no ur&ne ou'pu'

HARMACOLOGY


40/105


41/105

2013 ACLS Handbook

8A-$RE--$R-

N$REINEHERINE 05E8$HED #!ass&f&ca'&on

8asopressor

In"&ca'&ons

Hypo'ens&on refrac'ory 'o "opam&ne

-B 7K; mmHg an" !o* per&phera! res&s'ance

Ac'&on

r&mar&!y a!pha

Dosage M& + mg%?;m! D?W or N.-.

Infuse a' ;.1,;.? mcg>gm&n

Rou'e

I8 &nfus&on on!y

-&"e effec's

Increase" myocar"&a! *or> !oa" an" $% "eman" -evere '&ssue necros&s &f &nf&!'ra'e"

HARMACOLOGY


42/105

2013 ACLS Handbook

8A-$RE--$R-

D$BTAMINE 0D$BTERE #!ass&f&ca'&on

A"renerg&c s'&mu!a'or

In"&ca'&ons #H9 *&'h hypo'ens&on

Hypo'ens&on -B 7 K;,1;; mmHg *&'h no s&gns ofshoc>

Ac'&on r&mar&!y (e'a

Increase &n s'ro>e vo!ume *o &ncrease &n hear' ra'e

Dosage M& ?;; mg %?;m! D?W %;;; mcgm!

Infuse a' %,%; mcgm! 0average + m!hr

Rou'e I8 &nfus&on on!y

-&"e effec's Tachycar"&a

#hes' pa&ns

a!p&'a'&ons

HARMACOLOGY


43/105

2013 ACLS Handbook

8A-$DI5AT$R- NITR$G5Y#ERINE 0N&'ros'a' Tr&"&!

#!ass&f&ca'&on An'&hyper'ens&ve

In"&ca'&ons Ang&na MI #H9

Ac'&on -moo'h musc!e "&!a'or

Re"uces pre!oa" an" af'er!oa"

Re"uces ar'ery spasm

Dosage Ta(!e' spray 1 -5 every ? m&nu'es

1 &nch of n&'ro pas'e

Infus&on : M& ?; mg &n %?; m!.

-'ar' a' 1; mcgm&n 0)m!hr

Rou'e -5 I8 &nfus&on pas'e

-&"e effec's Hypo'ens&on hea"ache 'achycar"&a

#au'&on Erec'&!e "ysfunc'&on "rugs

R&gh' s&"e" &nfarc'

HARMACOLOGY


44/105

2013 ACLS Handbook

8A-$DI5AT$R- NITR$R--IDE 0NIRIDE

#!ass&f&ca'&on An'&,hyper'ens&ve

In"&ca'&ons Hyper'ens&on #H9 *&'h pu!monary e"ema

Ac'&on -moo'h musc!e "&!a'or

Decreases pre!oa" an" af'er!oa"

Wor>s more &n 'he ar'er&es 'han 'he ve&ns

Dosage Infus&on : M& ?; mg %?;m! D?W %;;mcgm!

-'ar' a' ;.? : ;.J mcg>gm&n

Rou'e

I8 &nfus&on on!y

-&"e effec's Hypo'ens&on

Hea"ache

#yan&"e 'o&c&'y

HARMACOLOGY


45/105

2013 ACLS Handbook

8A-$DI5AT$R-

A#E INHIBIT$R- 0Ena!apr&! #ap'opr&! 5&s&nopr&! #!ass&f&ca'&on

An'&,hyper'ens&ve

In"&ca'&on

Hyper'ens&on#H9 os' MI

Ac'&on reven's convers&on of ang&o'ens&on I 'o ang&o'ens&on II

-uppresses ren&n, ang&o'ens&on a!"os'erone sys'em

Dosage Ena!apr&!, ?,+; mg $

;.F%?,1.%?mg I8 over ? m&n. every F hours #ap'opr&! : 1%.?,?; mg $ BIDTIB

5&s&nopr&!, 1;,+; mg $ O"ay

Rou'e I8 $

-&"e effec's Hypo'ens&on

#hes' pa&n Tachycar"&a an" "ysrhy'hm&as

HARMACOLOGY


46/105

2013 ACLS Handbook

DIERETI#- 9R$-EMIDE 05A-I

#!ass&f&ca'&on

5oop "&ure'&c

In"&ca'&ons u!monary e"ema

Ac'&on

8aso"&!a'&on : re"uce" venous pressure

Inh&(&'s rea(sorp'&on of so"&um &n 'he >&"neys

Dosage +; : J; mg0&ncrease &n %; mg &ncremen's

Rou'e

I8 s!o* push

-&"e effec's

Dehy"ra'&on

T&nn&'us

Hypo>a!em&a

HARMACOLOGY


47/105

2013 ACLS Handbook

ANA5GE-I#- M$RHINE

#!ass&f&ca'&on Narco'&c ana!ges&c

In"&ca'&ons #hes' pa&n "ur&ng a -TEMI unre!&eve" (y

n&'rog!ycer&ne

u!monary e"ema

Ac'&on o'en' ana!ges&c

romo'es venous poo!&ng : re"uces pre!oa"

Re"uces an&e'y

Dosage %,+ mg &n % mg &ncremen's

Rou'e -!o* I8 push

-&"e effec's Resp&ra'ory "epress&on nausea an" hypo'ens&on

#au'&on : uns'a(!e ang&na non -T e!eva'e"pa'&en's 0mor'a!&'y

HARMACOLOGY


48/105

2013 ACLS Handbook

ANA5GE-I#-

DI5ADID

#!ass&f&ca'&on

$p&o&" ana!ges&c In"&ca'&ons

#hes' pa&n "ur&ng a -TEMI unre!&eve" (yn&'rog!ycer&ne

u!monary e"ema

Ac'&on o'en' ana!ges&c much s'ronger 'ha' morph&ne

) mg D&!au"&" %; mg morph&ne

Re"uces an&e'y

Does no' a!'er (!oo" pressure

Dosage ;.? : 1 mg s!o* I8 push

Rou'e -!o* I8 push

-&"e effec's Resp&ra'ory "epress&on #au'&on *&'h e!"er!y pa'&en's

Rap&" push &n "oses a(ove 1 mg may (e a pro(!em

HARMACOLOGY


49/105

2013 ACLS Handbook

BETA B5$#ER- #ommon (e'a (!oc>ers

Me'opro!o! 05opressor

-o'a!o! 0Be'apace

Esmo!o! 0(rev& (!oc>

In"&ca'&ons Dur&ng MI 'o "ecrease oygen consump'&on

-8T refrac'ory 'o o'her 'herap&es

Ac'&on Decreases

Hear' ra'e

-'ro>e vo!ume

Au'oma'&c&'y an" con"uc'&v&'y

Dosage Me'opro!o!, ? mg "ose L ? m&nu'es 0 1? mg ma

-o'a!o! : 1;; mg over ? m&nu'es for 8Tach

Esmo!o! : ?;; mg>g over 1 m&n. Then ?; mcg>gfor + m&nu'es

Rou'e $ra! I8

#on'ra&n"&ca'&ons #H9 hypo'ens&on (ra"ycar"&a hear' (!oc>s

HARMACOLOGY


50/105

2013 ACLS Handbook

ANTI5ATE5ET-

A-IRIN

#!ass&f&ca'&on

An'&,p!a'e!e'

In"&ca'&ons

#ar"&ac ches' pa&n

ns'a(!e ang&na

Ac'&on

B!oc>s 'hrom(oane

reven's p!a'e!e' aggrega'&on

eeps p!a'e!e's from occ!u"&ng ar'er&es

Rou'e

$ra!

Dosage 1F%,)%? mg 0che*a(!e

HARMACOLOGY


51/105

2013 ACLS Handbook

ANTI5ATE5ET-

#5$ID$GRE5 05A8I

In"&ca'&ons

-TEMI

H&gh r&s> -T "epress&on or T *ave &nvers&on

a'&en's *&'h p!anne" #I

a'&en's 'ha' canno' 'a>e asp&r&n

Ac'&on

Inh&(&'s g!ycopro'e&n

Dosage

);; mg $ fo!!o*e" (y K? mg $

#ons&"era'&ons

H&s'ory of (!ee"&ng

a'&en's *&'h &mpa&re" !&ver func'&on

!anne" surgery &n 'he near fu'ure

HARMACOLOGY


52/105

2013 ACLS Handbook

ANTI5ATE5ET- INTEGRI55IN

#!ass&f&ca'&on G!ycopro'e&n II( IIIa &nh&(&'or

In"&ca'&ons #hes' pa&n -T "epress&on or e!eva'&on

ns'a(!e ang&na

Non,O *ave MI

Ac'&on B!oc>s en=yme essen'&a! 'o p!a'e!e' aggrega'&on

Dosage 1J; mg >g over 1,% m&nu'es

Infuse L % mcg>gm&n.

Decrease 'o ;.? mcg>gm&n pre ca'he'er&=a'&on

-&"e effec's B!ee"&ng 0&ncrease" *&'h hepar&n runn&ng

Nausea vom&'&ng

Hypo'ens&on an" (ra"ycar"&a

#on'ra&n"&ca'&ons Ac'&ve &n'erna! (!ee"&ng

!a'e!e's 7 1;;;;;

-ys'o!&c B 21J;

HARMACOLOGY


53/105

2013 ACLS Handbook

ANTI#$AG5ANT- HEARIN

#!ass&f&ca'&on

An'&coagu!an'

In"&ca'&ons a'&en's un"ergo&ng ang&op!as'y

-e!ec'e" pa'&en's rece&v&ng f&(r&no!y'&c 'herapy

MI pu!monary em(o!&sm D8T

Ac'&on

reven's convers&on of pro'hrom(&n 'o 'hrom(&n

Dosage Bo!us "ose of F;; un&'s>g

Infus&on of 1% un&'s>ghr

-&"e effec's

Hemorrhage

Throm(ocy'open&a

#on'ra&n"&ca'&ons Ac'&ve (!ee"&ng pep'&c u!cers hepa'&c "&sease

Hemoph&!&a

HARMACOLOGY


54/105

2013 ACLS Handbook

9IBRIN$5YTI#-

In"&ca'&ons Ac'&ve MI !ess 'han 1% hours

1% !ea" *&'h -T e!eva'&on &n % con'&guous !ea"s

Ne* (ranch (un"!e (!oc> Acu'e &schem&c s'ro>e 7 ) hours

Ac'&on 5ys&s of f&(r&n ho!"&ng 'oge'her 'hrom(& (!oc>&ng 'he ar'ery

A!!o*s (!oo" f!o* 'o "&s'a! ar'er&es (!oc>e" (y 'he c!o'

Dosage TN : -&ng!e (o!us );,?; mg I8 push over ? m&n.

Re'ep!ase, 1; un&'s fo!!o*e" (y 1; un&' (o!us ); m&n apar'

A!'ep!ase,1? mg (o!us 'hen ;.K? mg>g over ); m&nu'es

-&"e effec's B!ee"&ng

A!!erg&c reac'&ons

Reperfus&on arrhy'hm&as

HARMACOLOGY


55/105

2013 ACLS Handbook

9IBRIN$5YTI#-

#on'ra&n"&ca'&ons Ac'&ve (!ee"&ng

Hemorrhag&c s'ro>e In'racran&a! neop!asm

Aor'&c "&ssec'&on

Hea" 'rauma or pr&or s'ro>e ) mon'hs

-u(arachno&" hemorrhage

ncon'ro!!e" B 21J? sys'o!&c or 11; "&as'o!&c

!a'e!e' coun' 7 1;;;;;mm or INR 21.K

#T "emons'ra'es mu!'&p!e &nfarc'&ons

HARMACOLOGY


56/105

2013 ACLS Handbook

TYE- $9 -TR$E- Ischem&c

#ause" (y an occ!us&on of an ar'ery &n 'he (ra&n

Accoun's for JK4 of a!! s'ro>es

5&>e!y can"&"a'es

D&a(e'&cs

H&s'ory of a'herosc!ero'&c "&sease

H&s'ory of c!o''&ng a(norma!&'&es

H&s'ory of ph!e(&'&s

H&s'ory of a'r&a! f&(r&!!a'&on

Hemorrhag&c

#ause" (y a rup'ure of a (!oo" vesse! &n 'he (ra&n

Accoun's for 1)4 of a!! s'ro>es

TA &s con'ra&n"&ca'e"

A non con'ras' #T &s re/u&re"

5&>e!y can"&"a'es

H&s'ory of hyper'ens&on

Afr&can Amer&cans

H&s'ory of A8 ma!forma'&ons H&s'ory of aneurysms

H&s'ory of # or coca&ne use

STRO!E "CVA


57/105

2013 ACLS Handbook

-TR$E 9$#-

RE,H$-ITA5

Rap&" s'ro>e &"en'&f&ca'&on

Rap&" 'ranspor'

IN H$-ITA5

Rap&" "e'erm&na'&on of f&(r&no!y'&c e!&g&(&!&'y

Non con'ras' #T scan

Ec!us&on cr&'er&a

T&ne from s'ro>e onse'

A"m&n&s'ra'&on of a f&(r&no!y'&c agen'

In&'&a'&on of 'he s'ro>e pa'h*ay

A"m&ss&on 'o a s'ro>e un&'

STRO!E "CVA


58/105

2013 ACLS Handbook

-TR$E -IGN- AND -YMT$M- In&'&a! assessmen' 0#&nc&nna'& sca!e

A!*ays chec> (!oo" g!ucose

9ac&a! "roop non symme'r&ca! sm&!e

Arm "r&f' : affec'e" arm "r&f's "o*n*ar"

A(norma! speech

-!urre" *or"s

Wrong *or"s

Ina(&!&'y 'o spea>

-econ"ary neuro!og&ca! assessmen' Num(ness &n 'he e'rem&'&es

up&!!ary response s&=e an" eye movemen'

8&s&on 'rou(!e 0one or (o'h eyes B&!a'era!!y e/ua! gr&p s'reng'h

E/ua! e'ens&on an" prona'&on of (o'h fee'

5eve! of consc&ousness

-u""en confus&on

er&o"s of aphas&a

Trou(!e *a!>&ng ga&' "&s'ur(ances

D&==&ness !oss of (a!ance -evere hea" ache 0*ors' hea"ache I ever ha"

STRO!E " CVA


59/105

2013 ACLS Handbook

I-#HEMI# -TR$E

a'ho!ogy

$ccurs *hen a cere(ra! ar'ery (ecomes occ!u"e"

Th&s causes an area of 'he (ra&n 'o &nfarc'

The &nfarc'e" area &s surroun"e" (y a !arger

&schem&c area ca!!e" 'he penum(ra

The goa! of s'ro>e managemen' &s 'o preven' 'he

penum(ra from &nfarc'&ng *orsen&ng the stroke.

ro'ec'&on of 'he penum(ra

The (es' *ay 'o save 'he penum(ra &s 'o open 'heocc!u"e" vesse! *&'h TA.

TA mus' (e g&ven *&'h&n ) hours of 'he onse' of

s'ro>e symp'oms

Beyon" ) hours 'he r&s> of g&v&ng TA "oes no'

ou'*e&gh 'he (enef&'s

Before g&v&ng TA a!! pa'&en's mus' (e g&ven a noncon'ras' #T scan.

STRO!E " CVA


60/105

2013 ACLS Handbook

I-#HEMI# -TR$E

Inc!us&on cr&'er&a

An &schem&c s'ro>e caus&ng measura(!e

neuro!og&c "amage

$nse' of symp'oms 7 ) hours (efore (eg&nn&ng'rea'men'

Age 2 1J years

Ec!us&on cr&'er&a

Hea" 'rauma or s'ro>e &n 'he prev&ous ) mon'hs

-ymp'oms of a su(arachno&" hemorrhage

H&s'ory of a prev&ous &n'ra,cran&a! hemorrhage

ncon'ro!!e" B 21J? sys'o!&c or 11; "&as'o!&c

!a'e!e' coun' 7 1;;;;; mm or INR 21.K

#T "emons'ra'es mu!'&,!o(a! &nfarc'&on

STRO!E " CVA


61/105

2013 ACLS Handbook

I-#HEMI# -TR$E

os' TA managemen'

Mon&'or pa'&en' for (!ee"&ng

Mon&'or EG

#on'ro! B 'o ma&m&=e perfus&on.

Avo&" ecess&ve (!oo" pressures

#on"uc' fre/uen' neuro!og&ca! chec>s

Every 1? m&nu'es for 'he f&rs' hour

Every ); m&nu'es for 'he ne' hour

Then every % hours

Mon&'or coagu!a'&on fac'ors

A"m&' pa'&en' 'o a s'ro>e cen'er

STRO!E "CVA


62/105

2013 ACLS Handbook

HEM$RRHAGI# -TR$E a'ho!ogy

$ccurs *hen a (!oo" vesse! &n 'he (ra&n rup'ures

The rup'ure" vesse!

5ea>&ng (!oo" &s &nf!amma'ory Th&s crea'es an &ncrease &n cere(ra! sp&na! f!u&"

Th&s &ncreases &n'racran&a! pressure

Managemen'

A rap&" non con'ras' hea" #T &s essen'&a!

In'u(a'e 'he pa'&en' as soon as poss&(!e

A''ach 'he pa'&en' 'o a ven'&!a'or

eep 'he #$% !eve! 'o %?,); 'o hyper oygena'e

Hyper oygena'&on cons'r&c's 'he cere(ra! ar'er&es

Th&s he!ps con'ro! (!ee"&ng

#on'ro! (!oo" pressure 'o !o*es' !eve! 'ha' *&!!

ma&n'a&n a"e/ua'e organ perfus&on

#ons&"er mann&'o! as an osmo'&c "&ure'&c

Transpor' rap&"!y 'o a neurosurg&ca! opera'&ng

fac&!&'y

STRO!E "CVA


63/105

2013 ACLS Handbook

STRO!E " CVA ALGORITHM


64/105

2013 ACLS Handbook

STRO!E ALGORITHM

#UIC! VIEW

BP EKG- SPO2

HISTORY PHYSICAL EXAM

IV BGL - LABS

NON CONTRAST CTISCHEMIC HEMORRHAGIC

NEUROSURGERYFIBRINOLYTICS

IF LESS THAN3 HOURS

FROM ONSET

FREQUENT NEURO

EVALUATIONS

SYMPTOMS

IMPROVING

(TIA)

FREQUENT NEURO

EVALUATIONS

ONSET TIME O2 IFREQUIRED


65/105

2013 ACLS Handbook

a'hophys&o!ogy

An acu'e coronary syn"rome occurs *hen a

coronary ar'ery (ecomes par'&a!!y or 'o'a!!y

(!oc>e".

The syn"romes &nc!u"e

ns'a(!e ang&na

-TEMI an" non -TEMI a''ac>s

-u""en car"&ac "ea'h

ACUTE CORONARY

SYNDRONES


66/105

2013 ACLS Handbook

In&'&a! eva!ua'&on

-ymp'oms sugges'&ve of &schem&a or an MI

5$# 1% !ea" EG v&'a! s&gns -$% oygen

hys&ca! eam h&s'ory 0'hrom(o!y'&c can"&"a'e

I8 access e!ec'ro!y'es car"&ac mar>ers

coagu!a'&on #hes' ,ray

In&'&a! 'rea'men'

$ygen 0&f -$% 7 3+4

Asp&r&n 1F;,)%? mg

N&'rog!ycer&ne : -5 or spray

Morph&ne I8 &f pa&n &s no' re!&eve" (y )

n&'rog!ycer&ne

1% !ea" &n'erpre'a'&on

-T e!eva'&on or ne* !ef' (ranch (un"!e (!oc>

-TEMI : h&gh r&s>

-T "epress&on or T *ave &nvers&on

In"&ca'es &schem&a h&gh r&s> uns'a(!e ang&na

Norma! or non "&agnos'&c changes 0-T or T *ave

5o*er r&s> re/u&res mon&'or&ng

ACUTE CORONARY

SYNDROMES


67/105

2013 ACLS Handbook

-TEMI 7 1% H$R-

H&gh r&s>

-T e!eva'&on &n % or more re!a'e" !ea"s

Ne* !ef' (ranch (un"!e (!oc>

Trea'men'

I8 n&'rog!ycer&ne

An'&p!a'e!e' an'&coagu!an's

Hepar&n

In'egr&!&n

5oveno

!av&

repare for #I-TENT #ABG

7 3; m&nu'es "oor 'o 'a(!e

9&(r&no!y'&cs &f #I &s "e!aye"

7 ); m&nu'es EM- 'o "rug '&me

A#E &nh&(&'ors af'er F hours

Be'a (!oc>ers *hen s'a(!e

ACUTE CORONARY

SYNDROMES


68/105

2013 ACLS Handbook

N$N -TEMI HIGH RI- A#- -T "epress&on

T *ave &nvers&on

ns'a(!e ang&na

Trea'men' I8 n&'rog!ycer&ne &f (!oo" pressure uncon'ro!!e"

#on'ro! c!o''&ng

An'& p!a'e!e's

!av&

In'egr&!&n

An'& coagu!an's

Hepar&n

5oveno

A#E &nh&(&'ors 0af'er F hours

Be'a (!oc>ers *hen s'a(&!&=e"

#ar"&ac ca'he'er&=a'&on

#I or #ABG &f &n"&ca'e"

ACUTE CORONARY

SYNDROMES


69/105

2013 ACLS Handbook

A#- A5G$RITHM

ACUTE CORONARY

SYNDRONES


70/105

2013 ACLS Handbook

ACS ALGORITHM

#UIC! VIEW

VITALS BP EKG SPO2 HXEXAM

IV 12 LEAD O2 IF REQUIRED

OXYGENNITROGLYCERINE

ASA MORPHINE IF

REQUIRED

STEMINON STEMHIGH RISK

CATH PCI STENTCABG

ST ELEVATION 2LEADS

NE!LEFT BBB

IV NITROGLYCERINEHEPARIN

INTEGRILINBETA BLOCKERS

(STABLE)

ST DEPRESSION

T!AVE INVERSION

UNSTABLE ANGINA

IV NITRO HEPARIN

INTEGRILIN BETA

BLOCKERS ACE

INHIBITORS

CATH PCI STENTCABG


71/105

2013 ACLS Handbook

ULMONARY EDEMA

#UIC! VIEW

FO!LERS POSITION"O2

BP EKG SPO2

PHYSICAL EXAM "

HOSTORY " LABS

BIPAP " CPAP IF CONSCIOUSINTUBATE IF UNCONSCIOUS

NITROGLYCERINE IF BP#1$$

MORPHINE 2-% &' SLO! IVPUSH

LASIX $-1 &'"*' +, .#1$$

CHF !ITH

HYPOTENSION

DOPAMINE -2-2$

&/'"*'"&+0

DOBUTAMINE

2-2$MCG"KG"MIN

CHF SYSTOLIC

BP #1$$

NITROGLYCERIN1$-

2$ &/'"&+0

NITROPRUSSIDE $- &/'"*'"&+0


72/105

2013 ACLS Handbook

HYOTENSION ALGORITHM

#UIC! VIEW

-ymp'oma'&c *&'h sys'o!&c B 7 3; mmHg

ADMINISTER OXYGEN

EKG SPO2 MONITOR

IV LABS

PHYSICAL EXAM "HISTORY

FLUID BOLUS 1-2 L

IF LUNGS CLEAR

REASSESS BP

DOPAMINE DRIP-2$ &/'"*'"&+0

SBP $SIGNS OF

SHOCK

NOREPINEPHRINE

SBP #$

EPINEPHERINE

2-1$ &/'"&+0


73/105

2013 ACLS Handbook

-YMT$MATI# BRADY#ARDIA-

-&nus

ers

-ymp'oma'&c (ra"ycar"&as &nvo!ve perfus&on

&na"e/uac&es.

-ome s&gns &nc!u"e

Decrease" !eve! of consc&ousness

Hypo'ens&on

Dyspnea

a!e co!or

D&aphores&s

Genera!&=e" *ea>ness

BRADYCARDIAS


74/105

2013 ACLS Handbook

BRADY#ARDIA A5G$RITHM

BRADYCARDIAS


75/105

2013 ACLS Handbook

SYMTOMATIC BRADYCARDIA

#UIC! VIEW

EVALUATERHYTHM

NO

ATROPINE $ &'3&' &45

TCP 6 7$-$ BPM

D8.4&+09 "9.+09.:;+09

I0,9 /8&.?95

20> 8; 3;> >9';99 HB

MAY TRY ATROPINE

TCP 6 7$-$

BPM

D8.4&+09 "9.+09.:;+09

I0,


76/105

2013 ACLS Handbook

Tachycar"&as &nc!u"e

-&nus 'achycar"&a

-upraven'r&cu!ar 'achycar"&a

A'r&a! f&(r&!!a'&on f!u''er

8en'r&cu!ar 'achycar"&a *&'h a pu!se

Asymp'oma'&c 'achycar"&as

B HR -$% s'a(!e *&'h goo" perfus&on

a'&en' consc&ous an" fu!!y a!er'

-ymp'oma'&c 'achycar"&as

A!'ere" !eve! of consc&ousness

Ina"e/ua'e perfus&on

#hes' pa&n

Dyspnea

-&nus 'achycar"&as

$ccur from a revers&(!e cause

9ever an&e'y shoc> s'ress s'&mu!an's eer'&on

Are 7 1?; (ea's per m&nu'e

Trea' 'he cause 'rea' 'he 'achycar"&a

TACHYCARDIAS


77/105

2013 ACLS Handbook

-8T A5G$RITHM

TACHYCARDIAS


78/105

2013 ACLS Handbook

TREATMENT ALGORITHM

STABLE SVT

#UIC! VIEW

Hemo"ynam&ca!!y s'a(!e a(sence of ches' pa&n

5$# EG 8--$% $% &f nee"e"

hys&ca! eam an" h&s'ory R$ non car"&ac causes

I8 access !a(s car"&ac mar>ers #R

@

8aga! maneuvers

@A"enos&ne Fmg rap&" push f!ush

A"enos&ne 1% mg rap&" push f!ush

@#ar"&=em ;.%?mg>g 'hen ;.)?mg>g &n 1? m&n

$R8erapam&! %.?,?mg repea' ?,1;mg 1?,); m&n

@Me'opro!o! ?mg over ? m&n repea' ?m&n %

$R

A'eno!o! ?mg over ? m&n may repea' &n 1; m&nu'es

@#ar"&over', ?;,1;; < (&phas&c &n&'&a! "ose &ncrease &n&ncremen's


79/105

2013 ACLS Handbook

TREATMENT ALGORITHM

UNSTABLE SVT

#UIC! VIEW

Hemo"ynam&ca!!y uns'a(!e A5$# orunconsc&ous

@

5$#. EG 8- -$% $% &f re/u&re"

Br&ef h&s'ory eam R$ non car"&accauses

@

I8 I$ access "o no' "e!ay car"&overs&on

-e"a'&on &f consc&ous an" B a!!o*s

@-ynchron&=e" car"&overs&on

?;,1;;< &n&'&a! "ose (&phas&c &ncrease &n&ncremen's

@

If unsuccessfu! com(&ne *&'hpharmaco!og&ca! 'rea'men' use" for

s'a(!e -8T


80/105

2013 ACLS Handbook

ATRIA5 9IBRI55ATI$N 95TTER

-'a(!e *&'h R8R 7 +J hours

Hemo"ynam&ca!!y s'a(!e no ches' pa&n INITIA5

5$# EG 8- -$% oygen &f re/u&re"

hys&ca! eam an" h&s'ory R$ non car"&ac causes I8 !a(s car"&ac mar>ers ches' ,ray

TREATMENT

#on'ro! ra'e : #a!c&um channe! (!oc>er 0choose 1 #ar"&=em ;.%? mg>g 'hen ;.)? mg>g &n1? m&n. &f re/u&re"

8erapam&!, %.?,? mg repea' ?,1; mg 1?,); m&n &f re/u&re"

Be'a (!oc>er 0choose one

Me'opro!o! ? m" over ? m&n. repea' ? mg %

$'her (e'a (!oc>ers :!a(e'a!o! a'eno!o! so'a!o! esmo!o!

#ar"&over' &f "rug 'herapy &s unsuccessfu! ?;,1;; @ou!es (&phas&c &n&'&a! "ose. Increase &n &ncremen's

#ons&"er an'&coagu!an' 'herapy

N$TE A,f&( A f!u''er shou!" (e 7 11; (ea's m&n'o (e cons&"ere" con'ro!!e".

TACHYCARDIAS


81/105

2013 ACLS Handbook

A,9IB A 95TTER 2 +J H$R-

-'a(!e *&'h R8R no ches' pa&n

INITIA5

5$#EG-$% oygen &f re/u&re"

hys&ca! eam an" h&s'ory R$ non car"&accauses

I8 !a(s car"&ac mar>ers ches' ,ray

TREATMENT

De!ay car"&overs&on un!ess uns'a(!e ns'a(!e : oor perfus&on # A5$#

#on'ro! ra'e *&'h

#a!c&um channe! (!oc>ers

Be'a (!oc>ers

a'&en' nee"s 'o (e curren' *&'h an'&coagu!an'

'herapy

R$ em(o!& for + *ee>s (efore car"&overs&on

TACHYCARDIAS


82/105

2013 ACLS Handbook

A,9IB A, 95TTER N-TAB5E WITH R8R

Hemo"ynam&c &ns'a(&!&'y ches' pa&n a!'ere" !eve!

of consc&ousness unrespons&ve

In&'&a!

5$#EG -$% oygen &f re/u&re"

Br&ef h&s'ory

I8 I$ access. D$ no' "e!ay car"&overs&on

Trea'men'

#ar"&over'

A'r&a! f!u''er ?;,1;; @ (&phas&c &n&'&a! "ose

Increase &n &ncremen's

A'r&a! f&(r&!!a'&on : 1%;,%;; @ (&phas&c &n&'&a! "ose

Increase &n &ncremen's

harmaco!ogy 0&f car"&overs&on &s unsuccessfu!

Am&o"arone : 1?; mg over 1; m&nu'es

D&go&n : 1;,1? mg>g 0;.?,1.; mg

Rap&" an'&coagu!a'&on

TACHYCARDIAS


83/105

2013 ACLS Handbook

-TAB5E 8 TA#H WITH A 5-E

W&"e comp!e 2 1?; (m&n

no *aves no a'r&a! f&(r&!!a'&on

INITIA5

5$# EG -$% $% &f re/u&re"

a'&en' eam an" h&s'ory

I8 !a(s car"&ac mar>ers ches' ,ray

#ons&"er a"enos&ne

TREATMENT

An'&,"ysrhy'hm&c

Am&o"arone : 1?; mg over 1; m&nu'es May repea'

5&"oca&ne ,;.?,1;? mg>g repea' a' ha!f "ose 'o ) mg

roca&nam&"e : %;,?; mgm&n &nfus&on

Magnes&um 1,% gm

-o'a!o! : 1;; mg over ? m&nu'es

#ar"&over' 0If pharmaco!ogy &s unsuccessfu! 1;;%;;);;)F; @ou!es monophas&c

1%;,%;;


84/105

2013 ACLS Handbook

N-TAB5E 8TA#H WITH A 5-E

Ra'e 21?;

Decrease" 5$#

Hypo'ens&on *&'h ches' pa&n

oss&(!e pu!monary e"ema

INITIA5

5$#EG8--$% $% &f re/u&re"

I8I$ access

Br&ef h&s'ory &f poss&(!e

Do no' "e!ay car"&overs&on

TREATMENT

#ar"&overs&on

-e"a'&on &f respons&ve

1%;,%;; @ou!es (&phas&c

1;;,)F; @ou!es monophas&c

harmaco!ogy

se 'he same as for s'a(!e 8Tach &f car"&overs&on &s

unsuccessfu!

TACHYCARDIAS


85/105

2013 ACLS Handbook

CARDIAC ARREST

ASYSTOLE " EA


86/105

2013 ACLS Handbook

ULSELESS ELECTRICAL

ACTIVITY AND ASYSTOLE

#UIC! VIEW

Beg&n #R

A''ach mon&'or "ef&(r&!!a'or

#on'&nue #R &n % m&nu'ecyc!es

In'u(a'eI8 I$ access

@

A"m&n&s'er vasopressor

Ep&nephr&ne 1 mg

8asopress&n +; un&'s

@

#on'&nue #R

@

5oo> for revers&(!e causes 0?Hs an" Ts

HYPOXIA

HYPOVOLEMIA

HYDROGEN ION

(ACIDOSIS)

HYPERKALEMIA

HYOPKALEMIA

HYPOTHERMIA

TOXINS

THROMBUS

PULMONARY

THROMBUS

CORONARY

THROMBUS

CARDIAC

TENSION

PNEUMOTHORAX

TAMPONADE

H

T


87/105

2013 ACLS Handbook

CARDIAC ARREST VFIB

ULSELESS V TACH


88/105

2013 ACLS Handbook

VENTRICULAR FIBRILLATION

ULSELESS VTACH

#UIC! VIEW

Beg&n #R

-H$# 0 %;;< (&phas&c )F;< monophas&c

#on'&nue #R 'hroughou' en'&re co"e

-ecure a&r*ay an" s'ar' I8I$ *&'h N- or 5R

@Drug 8asopressor +;

Ep&nephr&ne 1mg every ),? m&nu'es "ur&ng co"e@

-H$# 0ma. "ose P%;; @ (&phas&c )F; @monophas&cQ

@Drug An'&,arrhy'hm&c

Am&o"arone );;mg

5&"oca&ne 1.? mg>g

@-H$# 0ma "ose P%;; @ (&phas&c )F; @ monophas&cQ

@Repea' "rug shoc> se/uence

Am&o"arone 1?;mg

5&"oca&ne : 1.?mg>g 'o )mg ma

@5oo> for revers&(!e causes ? Hs an" ? Ts


89/105

2013 ACLS Handbook

#$N-IDERATI$N- BE9$RE ARRE-T

The non arres'e" pa'&en'

Recogn&=e a cr&'&ca! pa'&en'

I' &s eas&er 'o preven' an arres' 'han 'o resusc&'a'e

$('a&n 'he fo!!o*&ng as ear!y as poss&(!e 1% !ea" EG

8&'a! s&gns &nc!u"&ng -$% an" 'empera'ure

$('a&n a comp!e'e h&s'ory (efore an arres' occurs

Dra* !a(s #T scans ,rays (!oo" 'ype &f nee"e"

Ma&n'a&n hemo"ynam&c an" resp&ra'ory s'a(&!&'y

#ons&"er ? Hs an" Ts (efore arres'

Hypo&a To&ns

Hypovo!em&a Throm(os&s 0pu!monary

Hy"rogen &on 0ac&"os&s Throm(os&s 0coronary

Hyperhypo>a!em&a Tampona"e

Hypo'herm&a Tens&on pneumo'hora

ARREST CONSIDERATIONS


90/105

2013 ACLS Handbook

Wha' causes EA u!monary em(o!&

Ac&"os&s

Acu'e myocar"&a! &nfarc'&on

Hyper>a!em&a

Drug over"ose

Trauma neumo'hora

Tampona"e

Hypovo!em&a

Hypo&a

Wha' causes asys'o!e Hypo&a

Hypo'herm&a Hypohyper>a!em&a

Ac&"os&s

Hypog!ycem&a

Drug over"ose

Trauma neumo'hora

Tampona"e

Hypovo!em&a

Hypo&a



91/105

2013 ACLS Handbook

Bas&c arres' managemen' 'rauma

-'ar' an" con'&nue #R

Ma&n'a&n h&gh /ua!&'y #R 'hroughou'

A''ach mon&'or an" "ef&(r&!!a'e A-A &f &n"&ca'e"

#on'ro! 'he a&r*ay 0a"vance" a&r*ay

5arge (ore I8 or I$ G&ve "rugs per 'he appropr&a'e a!gor&'hm

Trea' hypo&a

In'u(a'e 0cr&co'hyro'omy or 'racheo'omy

neumo'hora

#hes' "ecompress&on

#hes' 'u(e

Tampona"e

er&car"&a! cen'es&s

Trea' hypovo!em&a

#on'ro! (!ee"&ng

% 5arge (ore I8s or I$s *&'h a crys'a!!o&"

Rap&" (!oo" 'ype an" 'ransfus&on

In an emergency 'ype $ nega'&ve (!oo" can (e use"

A!*ays cons&"er 'he ?Hs an" Ts



92/105

2013 ACLS Handbook

E!ec'ro!y'e un(a!ance

Rena! "&a!ys&s Ac&"os&s

Hyper>a!em&a

Hypog!ycem&a

D&a(e'&cs

Ac&"os&s Hypog!ycem&a

Hyper>a!em&a

Hypo>a!em&a

A!coho!&cs Hypo>a!em&a

Hypog!ycem&a

Hypomagnesem&a #ons&"er a (ra&n (!ee" from a fa!!

ro!onge" vom&'&ng Dehy"ra'&on

Ac&"os&s

Hypo>a!em&a

ro!onge" "&arrhea Dehy"ra'&on

Ac&"os&s

Hypo>a!em&a

Hypomagnesem&a



93/105

2013 ACLS Handbook

Trea'men' of e!ec'ro!y'e un(a!ances Hyper>a!em&a

erform s'an"ar" A5- an" B5-

#a!c&um ch!or&"e : ?;;mg,1 gm 'o s'a(&!&=e ce!!s

-o"&um (&car(ona'e : ?; mE/ 'o sh&f' po'ass&um&n'o ce!!s

M& %? gm g!ucose an" 1; un&'s &nsu!&n &nfuse over1? m&nu'es

Hypomagnesem&a erform s'an"ar" B5- an" A5-

Mos'!y foun" &n a!coho!&cs "ehy"ra'&on an"ma!nour&she" pa'&en's

sua!!y presen's as po!ymorph&c 8Tach 0Torsa"es

G&ve 1,% gm magnes&um I8 (o!us

Me'a(o!&c ac&"os&s E'en"e" per&o" of arres' an" over"oses

Trea' per appropr&a'e B5- an" A5- pro'oco!s

9&rs' a''emp' 'o correc' *&'h #R an" &n'u(a'&on

se 1 mE/ >g "ose of so"&um (&car(ona'e Repea' a' ha!f "ose &f re/u&re"

AREST CONSIDERATIONS


94/105

2013 ACLS Handbook

REGNAN#Y ARRE-T-

Bas&c B5- an" A5- per a!gor&'hms

9or suspec'e" em(o!us : f&(r&no!y'&cs

9or magnes&um over"ose 1 gm ca!c&um

ch!or&"e

May a!so use ca!c&um g!ucona'e

INTBATED ATIENT-

D$E A5G$RITHM D&s!o"ge" 'u(e

$(s'ruc'e" ET 'u(e

neumo'hora

E/u&pmen' fa&!ure



95/105

2013 ACLS Handbook

TREATMENT- D$NE T$ RE8ENT ARRE-T- I' &s a!*ays (e''er 'o 'rea' 'o preven' an arres' 'han 'o "ea! *&'h an

arres' s&'ua'&on

Anaphy!a&s per&,arres's 5arge (ore I8 EG 8- -$% oygen &f re/u&re"

Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm

A"m&n&s'er ?; mg "&phenhy"ram&ne I8

A"m&n&s'er 1 mg ep&nephr&ne or +; un&'s vasopress&n A"m&n&s'er up 'o +,J ! crys'a!!o&" 1 !&'er a' a '&me

#ons&"er 1%? mg -o!u,Me"ro! I8

As'hma per&,arres's 5arge (ore I8 EG 8- -$% h&gh f!o* oygen


M& %.?mg a!(u'ero! an" ;.?mg A'roven' ne(u!&=e"

May con'&nue a!(u'ero! ne(u!&=e" 'rea'men'

A"m&n&s'er 1 mg ep&nephr&ne -O

In'u(a'e &f severe an" pu' pa'&en' on a ven'&!a'or

#ons&"er -o!u,Me"ro! 1%? mg

u!monary e"ema per&,arres's 5arge (ore I8EG8--$% oygen &f re/u&re"


If pa'&en' &s consc&ous use #A or BIA A-A

If pa'&en' &s unconsc&ous &n'u(a'e an" suc'&on

#on'ro! (!oo" pressure *&'h NTG or n&'ropruss&"e

Ins'a! a 9o!ey ca'he'er

A"m&n&s'er +;,J; mg 5as& I8

ERI$ARREST SITUATIONS


96/105

2013 ACLS Handbook

$ver"oses

#oca&ne 5arge (ore I8EG8--$% 'empera'ure oygen


A"m&n&s'er a (en=o "&a=epam

ressure ven'&!a'e" oygen for pu!monary e"ema

#on'ro! (!oo" pressure N&'rog!ycer&ne N&pr&"e

hen'o!am&ne 0a!pha (!oc>er

An'&,"ysrhy'hm&c as re/u&re"

Tr&,cyc!&c an'&"epressan's -ymp'oms

#onvu!s&ons

#oma

#ar"&ac arrhy'hm&as Ac&"os&s

Hypo'ens&on

Trea'men' 5arge (ore I8EG8- -$% $YGEN I9 REOIRED


Non,arres',ac'&va'e" charcoa! 07 1 hour

Ben=o "&a=epam for se&=ures

-o"&um (&car(ona'e for ac&"os&s 9!u&" (o!us NA#5 for hypo'ens&on

Arres',a"m&n&s'er 1 mE/ >g so"&um (&car(ona'e



97/105

2013 ACLS Handbook

$8ERD$-E-

#a!c&um channe! (!oc>ers I8 EG 8- -$% chec> BG5 oygen &f re/u&re"

9!u&"s for hypo'ens&on N- ?;;,1;;; m!

Ac'&va'e" charcoa! 7 hour of &nges'&on

Insu!&n for &mprove" energy

Ep&nephr&ne &nfus&on %,1; mg m&n

#a!c&um ch!or&"e ;.% mE/>g or ca!c&um g!ucona'e ;.) mE/ >g

ac&ng for (ra"ycar"&as

Be'a (!oc>ers -ame 'rea'men' as ca!c&um channe! (!oc>ers ecep' g&ve ),1; mg

g!ucagon IM or I8

Narco'&cs I8 EG 8- -$% oygen &f re/u&re"

A"m&n&s'er %,+ mg Narcan may have 'o repea'

Ben=o "&a=epams

I8EG 8- -$%. oygen &f re/u&re" Roma=&con, on!y &f a >no*n (en=o "&a=epam over"ose

If uncer'a&n a!!o* pa'&en' 'o na'ura!!y process

HY$THERMIA #R

Ho!" "ef&(r&!!a'&on un'&! core 'empera'ure &s 2)) "egrees #

Warm *&'h (!an>e's *arm I8s or per&'onea! !avage

When *arm 'rea' per appropr&a'e a!gor&'hm

They are no' "ea" un'&! 'hey are *arm an" "ea"



98/105

2013 ACLS Handbook

Reasons 'o 'erm&na'e resusc&'a'&on

Re'urn of effec'&ve spon'aneous

c&rcu!a'&on

#r&'er&a for &rrevers&(!e "ea'h

Ehaus'&on of 'he hea!'h care prov&"er

A va!&" DNR

Au'hor&=a'&on (y a phys&c&an

Transfer 'o a h&gher !eve! of care

If pa'&en' rema&ns &n arres' af'er repea'e"

a''emp's *&'h h&gh /ua!&'y #R an" A#5-

TERMINATE

RESUSCITATION


99/105

2013 ACLS Handbook

Hemo"ynam&c s'a(&!&'y

Bas&c

1% !ea" car"&ac mon&'or

An'&,arrhy'hm&c "r&p as re/u&re"

$ygen 'o >eep -$% 23+4

Ra'e con'ro!

#on'ro! ra'e per A#5- pro'oco!s

B!oo" pressure con'ro! 9!u&"s are 'he f&rs' !&ne

8asopressors are 'he secon" cho&ce

un!ess f!u&"s are con'ra&n"&ca'e" (y

'he pa'&en's con"&'&on.

OST ARREST

MANAGEMENT


100/105

2013 ACLS Handbook

Hemo"ynam&c an" ven'&!a'&on op'&m&=a'&on

se 1;;4 oygen &n 'he &n&'&a! resusc&'a'&on

T&'ra'e &nsp&re" oygen 'o ma&n'a&n -$% 2 3+4

Avo&" ecess&ve ven'&!a'&on 'o re"uce &n'ra'horac&cpressure

Recommen"e" ven'&!a'&on ra'es 1;,1% BM ET#$ : )?,+;

a#$% ,+;,+?

A"m&n&s'er f!u&"s an" vasoac'&ve "rugs 'o

$p'&m&=e (!oo" pressure

Improve car"&ac ou'pu'

$p'&m&=e sys'em&c perfus&on

M&!" hypo'herm&a se" on a!! pa'&en's unrespons&ve af'er R$-#.

reven's (ra&n "e'er&ora'&on "ue 'o g!o(a! &schem&a

Tempera'ure goa! &s )%,)+ "egrees #

T&me a' hypo'herm&a 1%,%+ hours

Trea' hypo'ens&on *&'h f!u&"s 01,% !&'ers

8asopressors may (e use" &f f!u&"s "o no' *or> Targe' g!ycem&c con'ro! 'o 1++,1J; mgm!

Imme"&a'e coronary reperfus&on *&'h a #I

OST ARREST

MANAGEMENT


101/105

2013 ACLS Handbook

OST ARREST

MANAGEMENT


102/105

2013 ACLS Handbook

OST ARREST ALGORITHM

#UIC! VIEW

OPTIMIE

VENTILATION

AND

OXYGENATION

OPTIMIE

CARDIAC

FUNCTION

ADVANCED

CRITICAL CARE

12 LEAD

PCI

INAPROPRIATE

NEUROLOGICA

L

MILDHYPOTHERMI

A

INTUBATE

RATE 1$ BPM

OXYGEN SAT

%-

CO2 3-%$

&&H'

RATE # 7$

RHYTHM

INFUSION

BLOOD

PRESSURE

FLUIDS

VASOPRESSORS


103/105

2013 ACLS Handbook

Ro!e of 'he 'eam !ea"er

$rgan&=es 'he group

Mon&'ors performance of 'eam mem(ers

Bac>s up 'eam mem(ers

Mo"e!s ece!!en' 'eam (ehav&or

Tra&ns an" coaches

9ac&!&'a'es un"ers'an"&ng

9ocuses on comprehens&ve pa'&en' care

Ro!e of 'eam mem(ers

#!ear a(ou' ro!e ass&gnmen's

repare" 'o f&!! 'he&r ro!e ass&gnmen's We!! prac'&ce" &n resusc&'a'&on s>&!!s

no*!e"gea(!e a(ou' 'he a!gor&'hms

#omm&''e" 'o success

Team mem(er ass&gnmen's

#ompressor #R

A&r*ay managemen'

I8 I$ me"&ca'&ons

Mon&'or "ef&(r&!!a'or

$(server recor"er '&me >eeper

TEAM CONCET


104/105

2013 ACLS Handbook

TEAM CONCET

TYI#A5 #$DE 5AY$T


105/105

ACLS Handbook [2013]

Documents

Transcript of ACLS Handbook [2013]