Difference between revisions of "ACLS (Main)"

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(Tachycardia (with Pulse))
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== [[Bradycardia (with Pulse)]]==
 
== [[Bradycardia (with Pulse)]]==
  
== Tachycardia (with Pulse) ==
+
== [[Tachycardia (with Pulse)]] ==
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===
 
*If unstable: shock (synchronized 100J)
 
**Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
 
*If stable:
 
**Meds
 
***Procainamide
 
****20-50mg/min; then maintenance infusion of 1mg/min x6hr
 
****Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given
 
****Avoid if prolonged QT or CHF
 
***Amiodarone
 
****150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
 
***Adenosine
 
****May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
 
**Synchronized cardioversion (100J)
 
 
 
===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==

Revision as of 04:40, 12 January 2012

2010 AHA Recommendation Changes

  • 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

ECG Analysis

  1. Is the rhythm fast or slow?
  2. Are the QRS complexes wide or narrow?
  3. Is the rhythm regular or irregular?

BLS

Adult Cardiac Arrest

V-Fib and Pulseless V-Tach

  • Shock as quickly as possible and resume CPR immediately after shocking
    • Biphasic - 200J
    • Monophasic - 360 J
  • 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 IVP 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 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 (with Pulse)

Tachycardia (with Pulse)

See Also

Source

  • AHA 2010 Guidelines for ACLS