Post on 25-May-2020
transcript
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)
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
Supra Ventricular Tachycardia(SVT)
• Unstable=Electricity.SynchronizedCardioversion.(sedatefirst)100J,200J,300J360J*(discussedinclass)
• MAKESUREYOUPUSHSYNCHBUTTON!
Ventricular TachycardiaWith Pulses
• Extremelydangerousarrhythmia• Patientwontlastlong• 12-leadifstable• WideandBizarrepatternandregular• Monomorphicvs.Polymorphic?– Useextremecaution!
VentricularTachycardiaWithPulses
Ventricular TachycardiaWith Pulses
Treatment:-Valsalvamaneuverfirst(ThinkBLS)
Stable- UseAmiodorone
- Anti-arrythmic- WorksontheAtriaandtheVentricles- 150mgbolusover10min,repeatX1.- 1mg/minmaintenancedripifyoubreakrhythm
Ventricular TachycardiaWith Pulses
*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)
Ventricular Fibrillation(V-Fib)
• Won’thaveapulse
• Fineorcoarse
• Shock-ablerhythm
• Startat360J,andcontinueat360J*(WithaMONO-phasicDefibrillator)
• HighQualityCPR
Ventricular Fibrillation(V-Fib)
• 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!!!