Difference between revisions of "ACLS (Main)"

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== Recommendations ==
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''See [[critical care quick reference]] for drug doses and equipment size by weight.
 
 
*Routine use of cricoid pressure is NOT recommended
 
*Airway adjunct is recommended while performing ventilation
 
*Pulse/rhythm checks should only occur q2min
 
*Most critical component is high-quality compressions
 
*Atropine and cardiac pacing are NOT recommended for asystole/PEA
 
 
 
== BLS ==
 
 
 
*Compressions
 
**Push hard (2cm) and fast (100pm)
 
**Do everything possible to minimize compression interruption
 
*Ventilation
 
**30:2 ratio when do not have advanced airway
 
***Do not overventilate! (leads to decr venous return)
 
**8-10 breaths per min when intubated
 
 
 
== 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?
  
== V-Fib and Pulseless V-Tach ==
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==Algorithms==
 
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*[[Adult Pulseless Arrest]]
*Shock as quickly as possible and resume CPR immediately after shocking
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*[[ACLS: Bradycardia]] (with pulse)
**Biphasic - 200J
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**Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA
**Monophasic - 360 J
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*[[ACLS: Tachycardia]]
*Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
 
*Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
 
**1st line: Amiodarone 300mg w/ repeat dose of 150mg as indicated
 
**2nd line: Lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
 
**Magnesium 2g IV, followed by maintenance infusion
 
***Only for polymorphic V-tach
 
 
 
== Asystole and PEA ==
 
 
 
*Give [[epinephrine|Epi]] 1mg q3-5min
 
*Consider H's and T's
 
**Hypovolemia
 
**Hypoxia
 
**Hydrogen ion
 
**Hypo/hyperkalemia
 
**Hypothermia
 
**Tension pneumo
 
**Tamponade
 
**Toxins
 
**Thrombosis, pulmonary
 
**Thrombosis, coronary
 
 
 
== Bradycardia ==
 
 
 
*Only intervene if pt is symptomatic
 
**Hypotension, AMS, chest pain, pulm edema
 
*1st Line
 
**Transcutaneous pacing
 
**Chronotropes
 
***Dopamine 2-10mcg/kg/min
 
***Epineprhine 2-10mcg/min
 
*2nd Line
 
**Atropine 0.5mg q3-5m can be given as temporizing measure
 
***Do not give if Mobitz type II or 3rd degree block is present
 
*TransQ pacing and chronotropes ineffective = need for transvenous pacing
 
 
 
== Tachycardia ==
 
3 questions:
 
#Is the pt in a sinus rhythm?
 
#Is the QRS wide or narrow?
 
#Is the rhythm regular or irregular?
 
 
 
===Narrow Regular===
 
#'''See also [[Tachycardia (Narrow)]]'''
 
# Sinus Tachycardia
 
##Treat underlying cause
 
# [[SVT]]
 
##Vagal maneuvers (convert up to 25%)
 
##Adenosine 6mg IVP (can follow with 12mg if initially fails)
 
###If adenosine fails initiate rate control with CCB or BB
 
####Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
 
####Metoprolol 5mg IVP x 3 followed by 50mg PO
 
##Synchronized cardioversion (50-100J)
 
 
 
===Narrow Irregular ===
 
# MAT
 
##Treat underlying cause (hypoK, hypomag)
 
# Sinus Tachycardia w/ frequent PACs
 
# [[A fib]] / A Flutter w/ variable conduction
 
##Rate control with:
 
###Dilt
 
###MTP (good in setting of ACS)
 
###Amiodarone (good in setting of hypotension, CHF)
 
###Digoxin (good in setting of CHF)
 
##Synchronized cardioversion (120-200 J)
 
 
 
===Wide Regular===
 
 
 
*1. V-Tach (until proven otherwise!)
 
*If stable:
 
**Antiarrhytmics
 
***Procainamide 20-50mg/min
 
****Cont until rhythm suppressed, hypotensive, or max dose (17mg/kg)
 
****Avoid if [[Prolonged QT]]
 
***Amiodarone 150mg over 10min, repeated as needed
 
***Sotalol 100mg IV over 5min
 
****Avoid if prolonged QT
 
**Elective synchronized cardioversion (100J)
 
**Adenosine may be considered for diagnosis and treatment only if:
 
***Rhythm is regular and monomorphic
 
*2. SVT w/ aberrancy
 
 
 
===Wide Irregular===
 
*DO NOT use AV nodal blockers
 
**Can precipitate V-Fib
 
 
 
 
 
# A fib w/ preexcitation
 
##1st line - Electric cardioversion
 
##2nd line - Procainamide, amiodarone, or sotalol
 
# A fib w/ aberrancy
 
# Polymorphic V-Tach / Torsades
 
##Emergent defibrillation (NOT synchronized)
 
##Correct electrolyte abnormalities
 
###HypoK, hypoMag
 
##Stop prolonged QT meds
 
  
 
==See Also==
 
==See Also==
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*[[AHA ACLS Recommendation Changes by Year]]
 
*[[ACLS (Treatable Conditions)]]
 
*[[ACLS (Treatable Conditions)]]
*[[Adult Quick Drug Card]]
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*[[BLS (Main)]]
*[[SVT]]
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*[[Critical care quick reference]]
*[[Antiarrhythmics]]
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*[[Post cardiac arrest]]
*[[Arrhythmias (DDX)]]
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*[[PALS (Main)]]
*[[Cardiac Arrest Management]]
 
  
== Source ==
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==References==
*AHA 2010 Guidelines for ACLS
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<references/>
  
[[Category:Airway/Resus]]
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==External Links==
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*[http://www.blog.numose.com/emed-basics/pulseless Numose EMed: The Pulseless Patient]
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*[http://www.blog.numose.com/emed-cardiology/bradycardia Numose EMed: ACLS Bradycardia]
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*[http://www.blog.numose.com/emed-cardiology/svt Numose EMed: ACLS Narrow Complex Tachycardia]
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*[http://www.blog.numose.com/emed-cardiology/wct Numose EMed: ACLS Wide Complex Tachycardia]
  
[[Category:Cards]]
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[[Category:Cardiology]]
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[[Category:EMS]]
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[[Category:Critical Care]]

Latest revision as of 23:51, 8 August 2018