Difference between revisions of "ACLS (Main)"

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== Recommendations ==
''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 ==
**Push hard (2cm) and fast (100pm)
**Do everything possible to minimize compression interruption
**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 ==
*[[Adult Pulseless Arrest]]
*Shock as quickly as possible and resume CPR immediately after shocking
*[[ACLS: Bradycardia]] (with pulse)
**Biphasic - 200J
**Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA
**Monophasic - 360 J
*[[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 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 [[epinephrine|Epi]] 1mg q3-5min
*Consider H's and T's
**Hydrogen ion
**Tension pneumo
**Thrombosis, pulmonary
**Thrombosis, coronary
== Bradycardia ==
*Only intervene if pt is symptomatic
**Hypotension, AMS, chest pain, pulm edema
*1st Line
**Transcutaneous pacing
***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 ===
##Treat underlying cause (hypoK, hypomag)
# Sinus Tachycardia w/ frequent PACs
# [[A fib]] / A Flutter w/ variable conduction
##Rate control with:
###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: (hypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
**Shock (synchronized 100J)
*If stable:
***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
***150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
**Elective synchronized cardioversion (100J)
***May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
===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==
*[[AHA ACLS Recommendation Changes by Year]]
*[[ACLS (Treatable Conditions)]]
*[[ACLS (Treatable Conditions)]]
*[[Adult Quick Drug Card]]
*[[BLS (Main)]]
*[[Critical care quick reference]]
*[[Post cardiac arrest]]
*[[Arrhythmias (DDX)]]
*[[PALS (Main)]]
*[[Cardiac Arrest Management]]
== Source ==
*AHA 2010 Guidelines for ACLS
==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:Critical Care]]

Latest revision as of 23:51, 8 August 2018