In Team CPR, the provider giving chest compressions changes every 2 minutes Keep going until EMS arrives or the victim regains spontaneous circulation. Cardiac Arrest Cardiac arrest is the sudden sensation cessation of blood flow to the tissues in brain the results from a heart that is not pumping effectively.
Ventricular fibrillation is recognized by a disordered waveform, appearing as rapid peaks and valleys as shown in this ECG rhythm strip: Ventricular tachycardia may provide waveform similar to any other tachycardia; however, the biggest difference in cardiac arrest is that the patient will not have a pulse and, consequently, will be unconscious and unresponsive.
Ventricular Fibrillation and Pulseless Ventricular Tachycardia Algorithm Once you have determined that a patient has a shockable rhythm, immediately provide an unsynchronized shock. If you are using biphasic energy, use recommended settings on the device. If you do not know what that setting is, use the highest available setting, to J.
If you are using a monophasic energy source, administer J. Resume CPR immediately after a shock. Minimize interruptions of chest compressions. Provide 2 rescue breaths for each 30 compressions. Lidocaine may replace amiodarone when amiodarone is not available. First dose: Pulseless Electrical Activity and Asystole Pulseless electrical activity or PEA is a cardiac rhythm that does not create a palpable pulse is even though it should. After 2 min. Remember, chest compressions are a means of artificial circulation, which should deliver the epinephrine to the heart.
Without chest compressions, epinephrine is not likely to be effective. Chest compressions should be continued while epinephrine is administered. Rhythm checks every 2 min. Respiratory Arrest While cardiac arrest is more common in adults than respiratory arrest, there are times when patients will have a pulse but are not breathing or not breathing effectively e. Airway Management In ACLS, the term airway is used to refer both to the pathway between the lungs and the outside world and victim in the devices that help keep that airway open.
Choose the device that extends from the corner of the mouth to the earlobe Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device. Choose the device that extends from the tip of the nose to the earlobe.
Use the largest diameter device that will fit. Lubricate the airway with a water-soluble lubricant Insert the device slowly, straight into the face not toward the brain! It should feel snug; do not force the device. If it feels stuck, remove it and try the other nostril. Tips on Suctioning Adequate suctioning usually requires negative pressures of — 80 to mmHg.
Wallmounted suction can deliver this, but portable devices may not. When suctioning the oropharynx, do not insert the catheter too deeply. Extend the catheter to the maximum safe depth and suction as you withdraw.
Therefore sterile technique should be used. Each suction attempt should be for no longer than 10 seconds. Monitor vital signs during suctioning and stop suctioning immediately if the patient experiences hypoxemia O2 sats 94 has a new arrhythmia, or becomes cyanotic.
You can detect spontaneous circulation by feeling a palpable pulse at the carotid artery. The patient is at risk for reentering cardiac arrest at any time. Therefore, the patient should be moved to an intensive care unit. If so, it should be placed. If not, there may be neurological compromise.
Does the person have signs of myocardial infarction by ECG? Move to ACS algorithm. Rapid Differential Diagnosis of Cardiac Arrest Many different disease processes and traumatic events can cause cardiac arrest, but in an emergency, it is important to be able to rapidly consider and eliminate or treat the most typical causes of cardiac arrest. Bradycardia Bradycardia Algorithm. Bradycardia is any heart rate less than 60 bpm. In practice, however, bradycardia is only a concern if it is unusual or abnormal for the patient or causing symptoms.
New cases of bradycardia should be evaluated, but most will not require specific treatment. Evaluation of bradycardia includes cardiac and blood oxygen monitoring and a 12 lead ECG if available.
Unstable bradycardia i. Unstable bradycardia is first treated with intravenous atropine at a dose of 0. Additional doses can be given every 3 to 5 min. Pulseless bradycardia is considered PEA. If atropine is unsuccessful in treating symptomatic, unstable bradycardia, consider transcutaneous pacing, dopamine or norepinephrine infusion, or transvenous pacing.
An intensive or cardiologist may need to be consulted for these interventions and the patient may need to be moved to the intensive care unit.
Tachycardia Atrial fibrillation is the most common arrhythmia. Tachycardia Algorithm Tachycardia is any heart rate greater than bpm.
In practice, however, tachycardia is usually only a concern if it is New cases of tachycardia should be evaluated with cardiac and blood oxygen monitoring and a 12 lead ECG if available.
Consider beta-blocker or calcium channel blocker. Wide QRS tachycardia may require antiarrhythmic drugs. Acute Coronary Syndrome Acute coronary syndrome or ACS is a spectrum of signs and symptoms ranging from angina to myocardial infarction.
Cardiac chest pain any new chest discomfort should be evaluated promptly. This includes high degree of suspicion by individuals in the community, prompt rapid action by EMS personnel, assessment in the emergency department, and definitive treatment.
People with symptoms of cardiac ischemia should be given oxygen, aspirin if not allergic , nitroglycerin, and possibly morphine. The patient should be assessed in the ED within 10 min. Draw and send labs e. Give statin if not contraindicated. Obtain chest Xray. Unstable angina is new onset cardiac chest pain without ECG changes, angina that occurs at rest and lasts for more than 20 min. People with unstable angina will not have elevated cardiac markers.
His may include anti-platelet drug s , anticoagulation, a beta-blocker, an ACE inhibitor, a statin, and either PCI or a fibrinolytic. Patients with unstable angina are admitted and monitored for evidence of MI. While in transit, the EMS team should try to determine the time at which the patient was last normal, which is considered the onset of symptoms.
EMS administer oxygen via nasal cannula or face mask, obtain a fingerstick glucose measurement, and alert the stroke center. Within 10 min. They should obtain vital signs and IV access, draw and send labs e. Within 25 min. Within 45 min. Within 60 min. If the patient with an ischemic stroke is not a candidate for fibrinolytic, administer aspirin if the patient is not allergic. If the patient is having a hemorrhagic stroke, neurosurgery should be consulted. Time is Brain! Stroke Time Goals for Evaluation and Therapy In people who are candidates for fibrinolytics, the goal is to ad mister the agent within 3 hours of the onset of symptoms.
Fibrinolytic Checklist for 3 to 4. Stroke Time Goals for Evaluation and Therapy…………………………………………………. Overview of Advanced Cardiovascular Life Support Advanced Cardiac Life Support, or ACLS, is a system of algorithms and best practice recommendations intended to provide the best outcome for patients in cardiopulmonary crisis.
Updates to ACLS in As we learn more about resuscitation science and medicine, physicians and researchers realize what works best and what works fastest in a critical, life-saving situation.
If a feedback device is in place, depth can be adjusted to maximum of 2. In the community, call and send for an AED. Check the carotid pulse for no more than 10 seconds. If there is a shockable rhythm, pulseless ventricular tachycardia or ventricular fibrillation, provide a shock. Select an airway that is the correct size for the patient Too big and it will damage the throat Too small and it will press the tongue into the airway.
Choose the device that extends from the corner of the mouth to the earlobe. Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat. Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device.
Select an airway that is the correct size for the patient. Lubricate the airway with a water-soluble lubricant. Insert the device slowly, straight into the face not toward the brain! Adequate suctioning usually requires negative pressures of — 80 to mmHg. Rapid heart rate, narrow QRS complex,. Fluid resuscitation. Decreased heart rate. Airway management, oxygen. Hydrogen Ion Acidosis. Fingerstick glucose testing.
IV Dextrose. Flat T waves, pathological U wave. IV Magnesium. Peaked T waves, wide QRS complex. History of cold exposure. Tension Pneumothorax.
Slow heart rate, narrow QRS complex, acute dyspnea, history of chest trauma. Thoracotomy, needle decompression. Tamponade Cardiac. Rapid heart rate and narrow QRS complex. Variable, prolonged QT interval, neuro deficits. Thrombosis pulmonary.
Rapid heart rate, narrow QRS complex. Fibrinolytics, embolectomy. Thrombosis coronary. Fibrinolytics, Percutaneous intervention. Second or third degree heart block; tachycardia due to poisoning. Pulseless ventricular tachycardia Ventricular fibrillation.
First dose: mg bolus Second dose: mg Max: 2. Second or third degree heart block; hypotension may result with rapid infusion or multiple doses.
Symptomatic bradycardia No longer recommended for PEA or asystole. Cardiac arrest Anaphylaxis Symptomatic bradycardia instead of dopamine. Cocaine-induced ventricular tachycardia May increase oxygen demand. Symptomatic bradycardia if atropine fails Pressor for hypotension.
Wide complex bradycardia Should not be used in cases of acute myocardial infarction Observe for signs of toxicity. Wide complex tachycardia with pulse: 0. Rapid bolus may cause hypotension and bradycardia; Can also be used to reverse digitalis poisoning. Deliver through central line Peripheral IV administration can cause tissue necrosis.
Inclusion Criteria. Exclusion Criteria. Ischemic stroke with neurological deficit. Onset of symptoms 3 hours. History of brain. Age 18 years old. Brain tumor, arteriovenous malformation, or aneurysm. Brain or spine surgery in last. Arterial line or blood draw in last week. Possible subarachnoid hemorrhage. Serum glucose. Currently bleeding internally or bleeding diathesis.
Elevated aPTT if known. Through instruction and active participation in case-based scenarios, learners enhance their skills in the differential diagnosis and treatment of pre arrest, arrest and post arrest patients.
Our education training material is created maintained by practicing physicians, adhering to American Heart Association ducks AHA guidelines — This ACLS for health care providers let you know about health care law and ethics. If you notice someone in distress, lying down in a public place, or possibly injured, call out to them. The content contained herein is based on the most recent AHA publications on ACLS and will periodically compare previous and revised recommendations for a comprehensive review.
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