ACLS (Main): Difference between revisions
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*Most critical component is high-quality compressions | *Most critical component is high-quality compressions | ||
*Atropine and cardiac pacing are NOT recommended for asystole/PEA | *Atropine and cardiac pacing are NOT recommended for asystole/PEA | ||
== ECG Analysis == | == ECG Analysis == | ||
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#Is the rhythm regular or irregular? | #Is the rhythm regular or irregular? | ||
== V-Fib and Pulseless V-Tach == | == [[BLS]] == | ||
==Adult Cardiac Arrest== | |||
=== V-Fib and Pulseless V-Tach === | |||
*Shock as quickly as possible and resume CPR immediately after shocking | *Shock as quickly as possible and resume CPR immediately after shocking | ||
**Biphasic - 200J | **Biphasic - 200J | ||
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***Only for polymorphic V-tach | ***Only for polymorphic V-tach | ||
== Asystole and PEA == | === Asystole and PEA === | ||
*Give [[epinephrine|Epi]] 1mg q3-5min | *Give [[epinephrine|Epi]] 1mg q3-5min | ||
*Consider H's and T's | *Consider H's and T's | ||
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**Thrombosis, coronary | **Thrombosis, coronary | ||
== Bradycardia == | == Bradycardia with Pulse== | ||
*Only intervene if pt is symptomatic | *Only intervene if pt is symptomatic | ||
**Hypotension, AMS, chest pain, pulm edema | **Hypotension, AMS, chest pain, pulm edema | ||
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*DO NOT use AV nodal blockers | *DO NOT use AV nodal blockers | ||
**Can precipitate V-Fib | **Can precipitate V-Fib | ||
# A fib w/ preexcitation | # A fib w/ preexcitation |
Revision as of 04:35, 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
- Is the rhythm fast or slow?
- Are the QRS complexes wide or narrow?
- 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
- 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
- Atropine 0.5mg q3-5m can be given as temporizing measure
- Transvenous pacing required if transQ pacing + chronotropes is ineffective
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
- If adenosine fails initiate rate control with CCB or BB
- 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)
- Rate control with:
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
- Procainamide
- Synchronized cardioversion (100J)
- Meds
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
- ACLS (Treatable Conditions)
- Adult Quick Drug Card
- SVT
- Antiarrhythmics
- Arrhythmias (DDX)
- Cardiac Arrest Management
- Synchronized Cardioversion
Source
- AHA 2010 Guidelines for ACLS