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| == 2010 AHA Recommendation Changes==
| | ''See [[critical care quick reference]] for drug doses and equipment size by weight. |
| *Routine use of cricoid pressure is NOT recommended
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| *Airway adjunct is recommended while performing ventilation
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| *Pulse/rhythm checks should only occur q2min
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| *Most critical component is high-quality compressions
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| *Atropine and cardiac pacing are NOT recommended for asystole/PEA
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| == ECG Analysis == | | ==ECG Analysis== |
| #Is the rhythm fast or slow? | | #Is the rhythm fast or slow? |
| #Are the QRS complexes wide or narrow? | | #Are the QRS complexes wide or narrow? |
| #Is the rhythm regular or irregular? | | #Is the rhythm regular or irregular? |
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| == [[BLS]] == | | ==Algorithms== |
| | | *[[Adult Pulseless Arrest]] |
| ==Adult Cardiac Arrest==
| | *[[ACLS: Bradycardia]] (with pulse) |
| === V-Fib and Pulseless V-Tach ===
| | **Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA |
| *Shock as quickly as possible and resume CPR immediately after shocking
| | *[[ACLS: Tachycardia]] |
| **Biphasic - 200J
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| **Monophasic - 360 J
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| *Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
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| *Give antiarrhythmic if (2nd shock + 2min of CPR) again fails | |
| **1st line: Amiodarone 300mg IVP w/ repeat dose of 150mg as indicated
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| **2nd line: Lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
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| **Magnesium 2g IV, followed by maintenance infusion
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| ***Only for polymorphic V-tach
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| | |
| === Asystole and PEA ===
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| *Give [[epinephrine|Epi]] 1mg q3-5min
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| *Consider H's and T's
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| **Hypovolemia
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| **Hypoxia
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| **Hydrogen ion
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| **Hypo/hyperkalemia
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| **Hypothermia
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| **Tension pneumo
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| **Tamponade
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| **Toxins
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| **Thrombosis, pulmonary
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| **Thrombosis, coronary
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| == Bradycardia with Pulse==
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| *Only intervene if pt is symptomatic
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| **Hypotension, AMS, chest pain, pulm edema
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| *1st Line
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| **Transcutaneous pacing | |
| **Chronotropes
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| ***Dopamine 2-10mcg/kg/min
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| ***Epineprhine 2-10mcg/min
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| *2nd Line
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| **Atropine 0.5mg q3-5m can be given as temporizing measure
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| ***Do not give if Mobitz type II or 3rd degree block is present
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| *Transvenous pacing required if transQ pacing + chronotropes is ineffective
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| | |
| == Tachycardia ==
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| 3 questions:
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| #Is the pt in a sinus rhythm?
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| #Is the QRS wide or narrow?
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| #Is the rhythm regular or irregular?
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| ===Narrow Regular===
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| #'''See also [[Tachycardia (Narrow)]]'''
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| # Sinus Tachycardia
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| ##Treat underlying cause
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| # [[SVT]]
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| ##Vagal maneuvers (convert up to 25%)
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| ##Adenosine 6mg IVP (can follow with 12mg if initially fails)
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| ###If adenosine fails initiate rate control with CCB or BB
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| ####Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
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| ####Metoprolol 5mg IVP x 3 followed by 50mg PO
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| ##Synchronized cardioversion (50-100J)
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| ===Narrow Irregular ===
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| # MAT
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| ##Treat underlying cause (hypoK, hypomag)
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| # Sinus Tachycardia w/ frequent PACs
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| # [[A fib]] / A Flutter w/ variable conduction
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| ##Rate control with:
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| ###Dilt
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| ###MTP (good in setting of ACS)
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| ###Amiodarone (good in setting of hypotension, CHF)
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| ###Digoxin (good in setting of CHF)
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| ##Synchronized cardioversion (120-200 J)
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| ===Wide Regular===
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| *If unstable: shock (synchronized 100J)
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| **Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
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| *If stable:
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| **Meds
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| ***Procainamide
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| ****20-50mg/min; then maintenance infusion of 1mg/min x6hr
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| ****Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given
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| ****Avoid if prolonged QT or CHF
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| ***Amiodarone
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| ****150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
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| ***Adenosine
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| ****May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
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| **Synchronized cardioversion (100J)
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| ===Wide Irregular===
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| *DO NOT use AV nodal blockers
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| **Can precipitate V-Fib
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| # A fib w/ preexcitation
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| ##1st line - Electric cardioversion
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| ##2nd line - Procainamide, amiodarone, or sotalol
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| # A fib w/ aberrancy
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| # Polymorphic V-Tach / Torsades
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| ##Emergent defibrillation (NOT synchronized)
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| ##Correct electrolyte abnormalities
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| ###HypoK, hypoMag
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| ##Stop prolonged QT meds
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| ==See Also== | | ==See Also== |
| | *[[AHA ACLS Recommendation Changes by Year]] |
| *[[ACLS (Treatable Conditions)]] | | *[[ACLS (Treatable Conditions)]] |
| *[[Adult Quick Drug Card]] | | *[[BLS (Main)]] |
| *[[SVT]] | | *[[Critical care quick reference]] |
| *[[Antiarrhythmics]] | | *[[Post cardiac arrest]] |
| *[[Arrhythmias (DDX)]] | | *[[PALS (Main)]] |
| *[[Cardiac Arrest Management]]
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| *[[Synchronized Cardioversion]]
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| == Source ==
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| *AHA 2010 Guidelines for ACLS
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| [[Category:Airway/Resus]]
| | ==References== |
| | <references/> |
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| [[Category:Cards]] | | [[Category:Cardiology]] |
| | [[Category:EMS]] |
| | [[Category:Critical Care]] |
