Update Management of ACLSAmerican Heart Association 2005 Training Program for Nachuak Hospital Staff 13 14 May 2009 By Dr.Sathaporn Kunnathum

Adult > 12 year Air way Breathing- Initial - Subsequent Head tilt-chin lift (trauma : jaw thrust) 2 effective breaths at 2 sec/breath 10 breaths/min

Infant & child < 12tilt-chin Head yearlift (trauma : jaw thrust) 2 effective breaths at 1- 1 sec/breath 20 breaths/min

Neonate (0-1 month) Head tilt-chinlift (trauma : jaw thrust) 2 effective breaths at 1- 1 sec/breath 40-60 breaths/min the depth of the chest 120/min

Circulation- Compression depth - Compression rate - Compression : ventilation ratio ( 2 rescuers)

1 - 2 inches

100 /min

the depth of the chest 100/min

30 : 2

15 : 2

3:1

BLS algorithm

ACLS Advance Cardiac Life SupportUse

of adjunctive equipment in supporting ventilation Establishment of IV access Administration of drugs Cardiac monitoring Defibrillation control arrhythmias Care after resuscitation

ACLS algorithmPrimary

A B C D

BLS : open airway : positive pressure ventilations : chest compressions : defibrillation

Secondary ABCD surveySecondary

ACLS

A : Intubate as soon as possible B : Confirm tube placement primary physical examination secondary confirmation device (measures of end tidal CO2) : Secure tracheal tube : Confirm initial oxygenation and ventilation C : Establish IV access - Identify rhythm # monitor ECG - Administer fluid and drug # appropriate for rhythm and condition D : Differential diagnosis

ACLS Rhythms

Agonal Rhythm/Asystole

Pulseless Electrical Activity (PEA)

Note that PEA can look like any rhythm (any organized electrical activity), but if no pulse it is PEA

Course Ventricular Fibrillation

Fine Ventricular Fibrillation

Sinus Tachycardia

Note the rate is > 100 bpm

Reentry Supraventricular Tachycardia

This is a regular, narrow complex tachycardia without P waves with a sudden onset and cessation

Monomorphic Ventricular Tachycardia

Polymorphic Ventricular Tachycardia

Torsades de Pointes

Sinus Bradycardia

Note the rate