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Medical Exchange & Discovery 2017
Takayuki OSHIMI MD
BLS & ACLS 1011
BLS vs ACLS2
CaseA 57-year-old man is experiencing many of the warning signs of acute coronary syndrome or ACS with chest discomfort, indigestion, and feeling faint. Suddenly he has passed out in the middle of his business meeting.
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Step 1. Check for responsiveness No breathing or no normal breathing (only gasping)
Basic Life Support Survey4
Step 2. Activate emergency response system and get an automated external defibrillator (AED)
Basic Life Support Survey5
Step 3. Circulation: Check for carotid pulse
Basic Life Support Survey6
Step 4. Start cardiopulmonary resuscitation
30 chest compressions, 2 ventilations
Basic Life Support Survey7
• Push hard and push fast
• Allow complete chest recoil after each compression
• Minimize interruptions in chest compressions
• Switch providers every 2 minute to avoid fatigue
• Avoid excessive ventilations
Compressions & Ventilations8
Step 5. Check rhythm and shock if indicated
Repeat every 2 minutes
Basic Life Support Survey9
Airway Advanced airway
Advanced Cardiac Life Support Survey10
Breathing
Quantitative waveform capnography
Advanced Cardiac Life Support Survey11
Circulation Drug delivery
Advanced Cardiac Life Support Survey12
H’s
• Hypovolemia
• Hypoxia
• Hydrogen ion excess (acidosis)
• Hypokalemia
• Hyperkalemia
• Hypothermia
Advanced Cardiac Life Support Survey
Differential diagnosis
Diagnose and treat causes using H’s & T’s
T’s • Tension pneumothorax
• Tamponade (cardiac tamponade)
• Toxins
• Thrombosis (pulmonary embolus)
• Thrombosis (myocardial infarction)
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CaseA 57-year-old man is experiencing many of the warning signs of acute coronary syndrome or ACS with chest discomfort, indigestion, and feeling faint. Suddenly he has passed out in the middle of his business meeting.
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You Stay Classy MED!
oshimi@iuhw.ac.jp
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