ACLS (Main): Difference between revisions
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== | ''See [[critical care quick reference]] for drug doses and equipment size by weight.'' {{Adult top}} [[PALS (Main)]].'' | ||
* | ==Background== | ||
*A series of clinical algorithms created by the AHA/ASA used in the treatment of cardiovascular/neurological emergencies. | |||
*Involves airway management, IV access, and ECG interpretation. | |||
* | |||
== ECG Analysis == | ==[[ECG]] Analysis== | ||
*What is the atrial and ventricular rate? | |||
*Is the rhythm regular or irregular? | |||
**If irregular, does it follow any repeatable pattern? | |||
*What is the axis? | |||
**ERAD often seen in VT but not SVT | |||
*What is the P wave amplitude, duration, morphology, and synchrony with QRS complex? | |||
**Is the P wave positive in Lead II | |||
*What is the QRS complex amplitude, duration, morphology? | |||
*What is the T wave amplitude, duration, morphology? | |||
**Is the T wave positive in Lead II | |||
*What is the length of PR and QT intervals? | |||
*Is there ST Elevation/Depression or Hyperacute T waves? | |||
**If yes, does it follow any anatomical pattern or is it diffuse? | |||
*Is there anything else abnormal about this ECG? | |||
**Pacemaker Spikes | |||
**Hypertrophy of atrial/ventricles | |||
== [[ | ==Algorithms== | ||
*[[Adult Pulseless Arrest]] | |||
**Pulseless Ventricular Tachycardia/Ventricular Fibrillation | |||
== [[ | **Pulseless Electrical Activity/Asystole | ||
**Cardiac Arrest In Pregnancy | |||
*Adult [[Post-Cardiac Arrest Care]] | |||
*Termination of Resuscitation | |||
*[[ACLS: Bradycardia]] (with pulse) | |||
*[[ACLS: Tachycardia]] (with pulse) | |||
*[[Acute coronary syndrome]] | |||
*Suspected [[cerebrovascular event]] | |||
==Treatable Conditions== | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Condition''' | |||
| align="center" style="background:#f0f0f0;"|'''Common clinical settings''' | |||
| align="center" style="background:#f0f0f0;"|'''Corrective actions''' | |||
|- | |||
| [[Acidosis]]|| | |||
*Preexisting [[acidosis]], [[DM]], [[diarrhea]], [[drugs and toxins]], prolonged resuscitation, renal disease, [[shock]] | |||
|| | |||
*Reassess adequacy of [[oxygenation]], and [[ventilation]]; reconfirm [[endotracheal-tube placement]] | |||
*Hyperventilate | |||
*Consider intravenous [[bicarbonate]] if pH <7.20 after above actions have been taken | |||
|- | |||
| [[Cardiac tamponade]]|| | |||
*Hemorrhagic diathesis, cancer, [[pericarditis]], [[trauma]], after cardiac surgery or [[MI]] | |||
|| | |||
*Give [[fluids]]; obtain [[bedside echocardiogram]] | |||
*Perform [[pericardiocentesis]]. Immediate surgical intervention is appropriate if pericardiocentesis is unhelpful but cardiac tamponade is known or highly suspected. | |||
|- | |||
| [[Hypothermia]]|| | |||
*[[Alcohol abuse]], [[burns]], CNS disease, debilitated or elderly patient, [[drowning]], [[drugs and toxins]], endocrine disease, history of exposure, homelessness, extensive skin disease, spinal cord disease, [[trauma]] | |||
|| | |||
*If severe (temperature <30°C), limit initial shocks for [[V-Fib]] or [[pulseless V-Tach]] to three; initiate active internal rewarming and cardiopulmonary support. Hold further resuscitation medications or shocks until core temperature is >30°C. | |||
*If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas | |||
|- | |||
| [[Hypovolemia]], [[hemorrhage]], [[anemia]]|| | |||
*Major [[burns]], [[DM]], GI losses, hemorrhage, hemorrhagic diathesis, cancer, [[pregnancy]], [[shock]], [[trauma]] | |||
|| | |||
*Give [[fluids]] | |||
*Transfuse [[pRBCs]] if hemorrhage or profound anemia is present | |||
*[[Thoracotomy]] is appropriate when patient has [[cardiac arrest]] from [[penetrating trauma]] and a cardiac rhythm and the duration of cardiopulmonary resuscitation before thoracotomy is <10 min | |||
|- | |||
| [[Hypoxia]]|| | |||
*Consider in all patients with cardiac arrest | |||
|| | |||
*Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement | |||
|- | |||
| [[Hypomagnesemia]]|| | |||
*[[Alcohol abuse]], [[burns]], [[DKA]], severe [[diarrhea]], diuretics, drugs (eg, cisplatin, cyclosporine, pentamidine) | |||
|| | |||
*Give 1-2 g [[magnesium sulfate]] intravenously over 2 min | |||
|- | |||
| [[Myocardial infarction]]|| | |||
*Consider in all patients with [[cardiac arrest]], especially those with a history of [[coronary artery disease]] or prearrest [[acute coronary syndrome]] | |||
|| | |||
*Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass) | |||
|- | |||
| [[Poisoning]]|| | |||
*[[Alcohol abuse]], bizarre or puzzling behavioral or metabolic presentation, classic [[toxicologic syndrome]], occupational or industrial exposure, and psychiatric disease | |||
|| | |||
*Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote | |||
*Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available | |||
|- | |||
| [[Hyperkalemia]]|| | |||
*[[Metabolic acidosis]], excessive administration of potassium, [[drugs and toxins]], vigorous exercise, hemolysis, renal disease, [[rhabdomyolysis]], [[tumor lysis syndrome]], and clinically significant tissue injury | |||
|| | |||
*If hyperkalemia is identified or strongly suspected, treat with all of the following: 10% [[calcium chloride]] (5-10 mL by slow intravenous push; do not use if hyperkalemia is secondary to [[digitalis poisoning]]), [[glucose]] and [[insulin]] (50 mL of 50% dextrose in water and 10 units of regular insulin intravenously), [[sodium bicarbonate]] (50 mmoL intravenously; most effective if concomitant [[metabolic acidosis]] is present), and [[albuterol]] (15-20mg nebulized or 0.5mg by intravenous infusion) | |||
|- | |||
| [[Hypokalemia]]|| | |||
*[[Alcohol abuse]], [[diabetes]], use of [[diuretics]], [[drugs and toxins]], profound gastrointestinal losses, [[hypomagnesemia]] | |||
|| | |||
*If profound hypokalemia (<2-2.5 mmoL of potassium per liter) is accompanied by cardiac arrest, initiate urgent intravenous replacement (2 mmoL/min intravenously for 10-15 mmoL), then reassess | |||
|- | |||
| [[Pulmonary embolism]]|| | |||
*Hospitalized patient, recent surgical procedure, peripartum, known risk factors for [[venous thromboembolism]], history of venous thromboembolism, or prearrest presentation consistent with diagnosis of acute [[pulmonary embolism]] | |||
|| | |||
*Administer [[fluids]]; augment with [[vasopressors]] as necessary | |||
*Confirm diagnosis, if possible; consider immediate cardiopulmonary bypass to maintain patient's viability | |||
*Consider definitive care (eg, thrombolytic therapy, embolectomy by interventional radiology or surgery) | |||
|- | |||
| [[Tension pneumothorax]]|| | |||
*Placement of [[central catheter]], [[mechanical ventilation]], pulmonary disease (including [[asthma]], [[chronic obstructive pulmonary disease]], and necrotizing [[pneumonia]]), [[thoracentesis]], and [[trauma]] | |||
|| | |||
*[[Needle decompression]], followed by [[chest-tube insertion]] | |||
|} | |||
==See Also== | ==See Also== | ||
*[[AHA ACLS Recommendation Changes by Year]] | |||
*[[ACLS (Treatable Conditions)]] | *[[ACLS (Treatable Conditions)]] | ||
*[[ | *[[BLS (Main)]] | ||
*[[ | *[[Critical care quick reference]] | ||
*[[ | *[[Post cardiac arrest]] | ||
*[[ | *[[PALS (Main)]] | ||
== | ==External Links== | ||
*AHA | *[https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf 2020 AHA Guidelines] | ||
*[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] | |||
==References== | |||
<references/> | |||
[[Category: | [[Category:Cardiology]] | ||
[[Category:EMS]] | |||
[[Category:Critical Care]] |
Latest revision as of 20:58, 14 June 2023
See critical care quick reference for drug doses and equipment size by weight. This page is for adult patients. For pediatric patients, see: PALS (Main).
Background
- A series of clinical algorithms created by the AHA/ASA used in the treatment of cardiovascular/neurological emergencies.
- Involves airway management, IV access, and ECG interpretation.
ECG Analysis
- What is the atrial and ventricular rate?
- Is the rhythm regular or irregular?
- If irregular, does it follow any repeatable pattern?
- What is the axis?
- ERAD often seen in VT but not SVT
- What is the P wave amplitude, duration, morphology, and synchrony with QRS complex?
- Is the P wave positive in Lead II
- What is the QRS complex amplitude, duration, morphology?
- What is the T wave amplitude, duration, morphology?
- Is the T wave positive in Lead II
- What is the length of PR and QT intervals?
- Is there ST Elevation/Depression or Hyperacute T waves?
- If yes, does it follow any anatomical pattern or is it diffuse?
- Is there anything else abnormal about this ECG?
- Pacemaker Spikes
- Hypertrophy of atrial/ventricles
Algorithms
- Adult Pulseless Arrest
- Pulseless Ventricular Tachycardia/Ventricular Fibrillation
- Pulseless Electrical Activity/Asystole
- Cardiac Arrest In Pregnancy
- Adult Post-Cardiac Arrest Care
- Termination of Resuscitation
- ACLS: Bradycardia (with pulse)
- ACLS: Tachycardia (with pulse)
- Acute coronary syndrome
- Suspected cerebrovascular event
Treatable Conditions
Condition | Common clinical settings | Corrective actions |
Acidosis |
|
|
Cardiac tamponade |
|
|
Hypothermia |
|
|
Hypovolemia, hemorrhage, anemia |
| |
Hypoxia |
|
|
Hypomagnesemia |
|
|
Myocardial infarction |
|
|
Poisoning |
|
|
Hyperkalemia |
|
|
Hypokalemia |
|
|
Pulmonary embolism |
|
|
Tension pneumothorax |
|
|
See Also
- AHA ACLS Recommendation Changes by Year
- ACLS (Treatable Conditions)
- BLS (Main)
- Critical care quick reference
- Post cardiac arrest
- PALS (Main)
External Links
- 2020 AHA Guidelines
- Numose EMed: The Pulseless Patient
- Numose EMed: ACLS Bradycardia
- Numose EMed: ACLS Narrow Complex Tachycardia
- Numose EMed: ACLS Wide Complex Tachycardia