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.

3

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)

13

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.

14

You Stay Classy MED!

oshimi@iuhw.ac.jp

15