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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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| | | | |
| − | == BLS ==
| + | ==ECG Analysis== |
| − | *Compressions
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| − | **Push hard (2cm) and fast (100pm)
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| − | **Do everything possible to minimize compression interruption
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| − | *Ventilation
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| − | **30:2 ratio when do not have advanced airway
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| − | ***Do not overventilate! (leads to decr venous return)
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| − | **8-10 breaths per min when intubated
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| − | | |
| − | == 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 == | + | ==Algorithms== |
| − | *Shock as quickly as possible and resume CPR immediately after shocking | + | *[[Adult Pulseless Arrest]] |
| − | **Biphasic - 200J
| + | *[[ACLS: Bradycardia]] (with pulse) |
| − | **Monophasic - 360 J
| + | **Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA |
| − | *Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
| + | *[[ACLS: Tachycardia]] |
| − | *Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
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| − | **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 ==
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| − | *Only intervene if pt is symptomatic | |
| − | **Hypotension, AMS, chest pain, pulm edema
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| − | *1st Line
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| − | **Transcutaneous pacing
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| − | **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 == | + | ==References== |
| − | *AHA 2010 Guidelines for ACLS
| + | <references/> |
| | | | |
| − | [[Category:Airway/Resus]] | + | ==External Links== |
| | + | *[http://www.blog.numose.com/emed-basics/pulseless Numose EMed: The Pulseless Patient] |
| | + | *[http://www.blog.numose.com/emed-cardiology/bradycardia Numose EMed: ACLS Bradycardia] |
| | + | *[http://www.blog.numose.com/emed-cardiology/svt Numose EMed: ACLS Narrow Complex Tachycardia] |
| | + | *[http://www.blog.numose.com/emed-cardiology/wct Numose EMed: ACLS Wide Complex Tachycardia] |
| | | | |
| − | [[Category:Cards]] | + | [[Category:Cardiology]] |
| | + | [[Category:EMS]] |
| | + | [[Category:Critical Care]] |
