2015 acls review - cprclassespa.com · acls drugs epinephrine (bolus) • hormone naturally...
TRANSCRIPT
DISCLAIMER• The following information is provided by
the American Heart Association. • Monies collected do not represent income
for the American Heart Association.• Please review and study your American
Heart Association ACLS Manual before attempting to complete the AHA ACLS
Course.
QRS Complex
P wave indicates Atrial depolarization. QRS complex indicates Ventricular depolarization
T wave indicates re-polarization
Rhythm Recognition• Fastorslow?• Regularorirregular?• QRSnarroworwide?• IsthereaPwave?• IsthePwavecloseorfarfromQRS?• IsthePwaveinthesameplace?
1st Degree Heart Block• Usuallybenign,verycommon• NottreatableinACLSunlesssymptomatic• Notactuallyablock- justadelayinconduction• PRI- >20(4smallboxes)• IftheRs arefarfromPs,thenyouhavea1stDegree
2nd Degree Heart Block, type 1aka “Wenckebach”
• UsuallyIrregular• NottreatableinACLSunlesssymptomatic• PRI- Long,long,longer,DROP- mustbeaWenckebach!
2nd Degree, Type 2 Heart Block• BlockedPwaves/droppedQRSComplexes• IfsomePsdon’thaveQs,thenyouhaveaMobitz 2
• Thisisgettingworse…
3rd Degree Heart Block(Complete Heart Block)
• Malignant• UsuallyBradycardic,Irregular• Won’ttakelong…NEEDTOTREAT!• IfthePsandQsdonotagree,thenyouhavea3rd degree!
Supra Ventricular Tachycardia(SVT)
• Firingsomewhereabove theVentricles• Treatableover150BPMperACLS• RegularandFAST!
Ventricular Tachycardia(V- tach with or w/o Pulses)
• Extremelydangerousarrhythmia• Patientwontlastlong• WideandBizarrepattern,butregular• Shock-ablerhythm(ifnopulsepresent)
Torsades de Pointes• Translatesto:“TwistedoftheSpikes”• DescribedasPolymorphicTachycardia• MaydegeneratetoV-Fibifpersistent• CausedbyHYPOkalemia/HYPOmagnasemia
Ventricular Fibrillation(V-Fib)
• Won’thaveapulse• Fineorcoarse• Shock-ablerhythm• PatientisinCARDIACARRESTatthispoint
Pulseless Electrical Activity (PEA)
• ANY rhythmcanbePEA aslongasitdoesn’thaveaPULSE!
• YOUMUSTCHECKAPULSEWITHEVERYRHYTHM- InaCardiacArrest!
ACLS DRUGSAtropine
• DerivedfromtheNightshadePlant(deadly)• Dilatespupils,increasesheartrate• Usedtotreatsymptomaticbradycardia• NolongerusedforPEA
DOSE:0.5mgwithamaximumof3.0mg
ACLS DRUGS
Adenosine• Inhibitsneurotransmitters• “Resets”heart• Asystolefor3-5seconds• CausesatransientheartblockintheAVnode• UsedtotreatAsymptomaticSVTover150bpm• NOT forwidecomplexIRREGULARV-Tach
DOSE:6.0mgthen12.0mg
ACLS DRUGSAmiodaroneBolus
• Anti-arrhythmic• WorksontheAtriaandtheVentricles• Ifyoucanshock,useAmiodarone
DOSE:300mgthen150mg.MAX:450mg
ACLS DRUGSEpinephrine(Bolus)
• Hormonenaturallyoccurringinthebody• AffectstheSympatheticNervousSystem• Constrictsbloodvessels,increasesperipheralresistance
• IncreasesHeartRate(InotropiceffectsandChronotropiceffects)(contractilityandrate)
DOSE:1.0mgNOMAXDOSE!
ACLS DRUGSDopamine
• Second-linedrugforsymptomaticbradycardiawhenatropineisnoteffective
• Usedforcardiogenicshockintheabsenceofhypovolemia
Dose:2-20micrograms/kg/mininfusion
ACLS DRUGSEpinephrine(Infusion)
• Second-linedrugforsymptomaticbradycardiawhenatropineisnoteffective.ChooseEPIorDopamine
Dose:2-10micrograms/mininfusion
H’s and T’s• Hypovolemia• Hypoxia• HydrogenIons(acidosis)
• Hyper/Hypokalemia• Hypothermia
• Toxins• Tamponade(cardiac)• TensionPneumothorax• Thrombosis(coronary)• Thrombosis(Pulmonary)
Treatment Modalities per ACLS• V-FIBor(V-TACHw/opulses)aretheonlyshock-ablerhythms.
• 360JMonophasicDefibrillator/200JBi-Phasic• HighQualityCPR100-120BPM• EPI1mg• Amiodarone- 300mg,then150mg(450mgMAX)
SVT• Treatableat150BPM• UseValsalva ManeuverFirst(ThinkBLS)• Stable=Drugs.Adenosine6mg,12mg,done• Unstable=Electricity.SynchronizedCardioversion.(sedatefirst)JouleSettingsdiscussedinclass
• MAKESUREYOUPUSHSYNCHBUTTON!
V-TACH w/PULSES (Regular)• Dangerousarrhythmia- PT.wontlastlong• Stable= UseAdenosine• Unstable=Electricity(Cardioversion)• JouleSettingsdiscussedinclass• Trytosedatefirst.Don’tdelaytreatment.• PT.willusuallybeUNSTABLE!
V-Tach (Irregular, Torsades)• Dangerousarrhythmia- PT.wontlastlong• Stable=Adenosine- notindicated.• MagnesiumSulfate• (DEFIBRILLATE-Won’tbeabletosync)
Bradycardias
• Lessthan50-60BPM
• Stable=DONOTAGGRESSIVELYTREAT-watchpatient
• Unstable=(1)Atropine(2)DopamineorEPIDrip(3)Pacing…
Pacing• ApplyD-FibPadsonPt• SetPacerat80BPM*• IncreasemAuntil1pacerspikeprecedesQRS• CheckFemoralArteryforpulsethatmatchesmonitor
• Ifisdoesn’t,increasemAuntilitdoes
PEA (Pulseless Electrical Activity)
• Arhythmthatappearsonamonitortohaveapulse,butdoesnotwhenthepulseischecked
• HighqualityCPR• Epinephrine,1.0mg• NON- SHOCKABLE!• PushEpiAlways
Complete Heart Block (3rd degree)
• TheuseofAtropineisnotindicated• Transcutaneouspacing• Fluids• Oxygen• Cardiologyconsult
Hypothermia Protocol (Targeted Temperature Management)
• PatientMUSTbeIntubatedandComatose• Coolto32-36Celsius• Atleast24hours• OptimizesNeurologicRecovery• MaintainHemodynamics