Acls 2011

ACLS
djorgenmorris

1. ACLS FOR DUMMIES (PARAMEDICS)

2. Algorhythms are your best friend

3. Main Algorhythms CPR Algorhythm Pulseless Arrest Tachycardia with pulse Bradycardia ROSC

4. CPR Algorhythm (BLS Code) “Hey, hey, are you okay?” You are 911 Jaw thrust or head tilt chin lift Use an Ambu bag and at least one basic airway adjunct ONLY 10 seconds Hard and fast 30:2 Turn on your AED / Monitor Rhythm check Shock Start CPR again

5. Algorhythm

6. Pulseless Arrest

7. Pulseless Arrest Call for assistance if not already there Use Ambu bag Attach cardiac monitor Check rhythm Confirm V-fib or V-tach

8. Pulseless Arrest Shock at 200 J Resume CPR If you did not secure an airway yet, do it now. Attach Auto Pulse Establish IV or IO access Get ready with the EPI

9. Pulseless Arrest Check rhythm Shock at 200 J Restart CPR Give either one: EPINEPHRINE 1mg VASOPRESSSIN 40 units

10. Pick One

11. Pulseless Arrest Rhythm Check Shock Give an antiarrhythmic: LIDOCAINE 1 – 1.5 mg/kg AMIODARONE 300 mg Mag Sulfate if Torsades

12. Pulseless Arrest Package patient Initiate transport Reconfirm airway Continue to give EPINEPHRINE q 3 -5 minutes Repeat antiarrhythmics: LIDOCAINE (0.5- 0.75 mg / kg ) half first dose AMIODARONE (150 mg) half first dose If you get a pulse back with one of these drugs, set up a drip.

13. Pulseless Arrest Not shockable PEA Asystole

14. Pulseless Arrest Assure adequate CPR Secure Airway Establish IV or IO Administer medications: EPINEPHRINE 1 mg q 3-5 min Vasopressin 40 Units (one time) Atropine (Asystole or slow PEA)

15. Pulseless Arrest Recheck rhythm after 5 cycles of cpr If shockable, then shock If there is a pulse, treat as indicated

16. Pulseless Arrest

17. Pulseless Arrest If patient is intubated, do continuous compressions Recheck tube placement often Document tube placement confirmations

18. Tachycardia with Pulse

19. Is there a pulse?

20. Is he stable or unstable?

21. Tachycardia OXYGEN ECG GOOD SET OF VITALS ANY CAUSES? Hyperventilation Overdose TREAT THE PATIENT NOT THE MONITOR

22. TACHYCARDIA STABLE OR UNSTABLE GO BACK TO GENERAL IMPRESSION HOW LONG WILL PATIENT TOLERATE THE RHYTHM ? HOW LONG HAS THE PATIENT BEEN IN THIS RHYTHM ?

23. TACHYCARDIA: Unstable Establish IV Sedate patient if possible Cardioversion: Press Sync button Press Shock (hold down until it discharges)

24. TACHYCARDIA: Stable Establish IV 12 lead ECG Identify the rhythm

25. Tachycardia: Narrow SVT Vagal Maneuvers Adenosine 6 mg (Rapidly) 12 mg 12 mg A-Fib Think about cardizem A- Flutter

26. Tachycardia: Narrow Transport patient Transmit 12 lead Call for additional orders

27. TACHYCARDIA: Wide complex Ventricular Tachycardia Amiodarone Cardioversion Atrial fib with aberrancy Think about cardizem SVT with aberrancy Adenosine

28. TACHYCARDIA H’s and T’s Look for possible causes

29. ELECTRICAL CARDIOVERSION Not usually needed for HR < 150 bpm Check O2 Sats ; IV; Intubation equipment Premedicate if possible: valium or versed

30. CARDIOVERSION V- Tach: start at 100 J PSVT: start at 50 J

31. BRADYCARDIA Less than 60 bpm Is patient symptomatic ? Some causes of bradycardia Healthy, athletic person Patient on beta blockers Patient on digoxin Overdose of narcotics

32. BRADYCARDIA

33. BRADYCARDIA (SYMPTOMATIC) Use atropine while you are setting up the pacemaker Does not last very long Pace 3 rd degree

34. BRADYCARDIA Transmit ECG if available Sedate patient if necessary Don’t delay pacing Atropine may not work for transplanted hearts

35. Causes of Arrest / Arrhythmia

36. Treatments of these causes Cause Treatment Hypoxia Hypvolemia Hypothermia Hypokalemia Hypoglycemia Toxins Thrombosis Trauma Cardiac Tamponade Tension Pneumothorax Hyperkalemia Metabolic Acidosis Respiratory Acidosis Ventilation IV Fluids Warm Patient Restore electolyte imbalance Sugar Detoxify Thrombolysis Surgery / bleeding control Pericardialcentesis Thoracic decompression Bicarb Bicarb Ventilation

37. HOW TO WORK MEGACODES IN CLASS Use all help available If you are working with a partner and you have a helper Person 1 - Airway Person 2- Monitor then IV / drugs Person 3 (1 st responder or bystander)- Chest compressions Be serious Use the ‘event’ button on LP 12

38. Amiodarone 3 Ways: For VF/Pulseless V- Tach V- Tach or wide complex regular Maintenance Drip

39. Amiodarone #1: VF or Pulseless VT 300 mg 2 vials of 150 mg

40. Amiodarone #2: V- tach with pulse 150 mg over 10 minutes 150 mg in 100 mL spiked with macro is 100 gtt /min

41. Amiodarone #3: Maintenance 1 mg / min 100 mg in 100 mL bag spiked with micro drip = 60 gtt /min