ACLS

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ACLS IN PATIENTS WITH CARDIAC ARREST

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ADVANCED CARDIO VASCULAR LIFE SUPPORT : 

ADVANCED CARDIO VASCULAR LIFE SUPPORT DR. ROLLY MALHOTRA S N Medical College, Agra

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) : 

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) The foundation of ACLS care is good BLS care beginning with- Prompt high quality bystander CPR VF/pulseless VT-attempted defibrillation within minutes of collapse

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) : 

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) For victims of witnessed VF arrest, prompt bystander CPR and early defibrillation can significantly increase the chance for survival to hospital discharge

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) : 

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) Advanced airway interventions: Combitube LMA ET Intubation Advanced circulation interventions: Drugs to control heart rhythm & BP Differential Diagnosis

ACLS SECONDARY SURVEY :ABCD : 

ACLS SECONDARY SURVEY :ABCD Airway : patency advanced airway Breathing : oxygenation& ventilation advanced airway Head tilt,chin lift,OPA,NPA LMA,Combitube,ET tube Supplemental oxygen Assess adequacy Confirm proper placement Secure the device

ACLS SECONDARY SURVEY :ABCD : 

ACLS SECONDARY SURVEY :ABCD Circulation: assess the pulse assess the rhythm access for drug avl.? Differential diagnosis cause of arrest? reversible cause? Obtain iv/io access Attach ECG leads Medications to manage rhythm Give iv/io fluids if needed Search ,find &treat reversible causes

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM PULSELESS ARREST BLS ALOGRITHM: CALL FOR HELP, CPR GIVE OXYGEN ATTACH MONITOR/DEFEBRILLATOR CHECK RHYTHM (SHOCKABLE RHYTHM) SHOCKABLE NOT SHOCKABLE VF/VT ASYSTOLE/PEA

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM VF/VT GIVE 1 SHOCK manual biphasic: device specific AED: device specific monophasic: 360 J RESUME CPR IMMEDIATELY(5cycles) CHECK RHYTHM (shockable rhythm) NO REFER (shockable) continue cpr while defibrillator is charging GIVE 1 SHOCK mannual biphasic: device specific AED: device specific monophasic: 360 J RESUME CPR IMMEDIATELY when IV/IO avl give vasopressor during CPR EPINEPHRINE 1 mg IV/IO repeat every 3 to 5 min or give 1 dose of vasopressin 40 U IV/IO GIVE 5 CYCLES of CPR cont…

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CHECK RHYTHM (NOT Shockable) IF ASYSTOLE IF ELECTRICAL ACTIVITY, CHECK PULSE IF NO PULSE IF PULSE PRESENT BEGIN POSTRESUSCITATION CARE

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM CHECK RHYTHM NO REFER (Shockable Rhythm) Shockable CONTINUE CPR while defibrillator is charging GIVE 1 SHOCK manual biphasic: device specific AED: device specific monophasic: 360 J RESUME CPR IMMEDIATELY Consider antiarrhythmics; during CPR AMIODARONE(300mg IV/IO once then additional 150 mg) or LIDOCAINE(1 to 1.5 mg/kg first dose then 0.5mg to 0.75 mg/kg Max 3 doses of 3mg/kg Consider Magnesium, loading dose 1to 2g IV/IO

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM ASYSTOLE/PEA RESUME CPR IMMD FOR 5 CYCLES when IV/IO avl, give VASOPRESSOR EPINEPHRINE 1 MG IV/IO Repeat every 3-5min.or give 1 dose of vasopressin 40 U consider ATROPINE 1 mg IV/IO for asystole or slow PEA rate repeat every 3 to 5 MIN CPR 5 CYCLES CHECK RHYTHM

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM Important points to remember: Chest compressions should ideally be interrupted only for ventilations,rhythm checks& shock delivery. Establishing iv access is imp.but it should not interfere with CPR & delivery of shocks. Do not interrupt CPR to give medications. The drug should be administered during CPR as soon as possible after the rhythm is checked.CPR-RHYTHM CHECK-CPR(while drug given& defib charged)-SHOCK.

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM Rhythm checks should be very brief. Give drug by bolus injection followed by 20ml bolus iv fluid& elevate the extremity for 10-20 sec. Dose of drug given by ET route is 2-2.5 times the iv route. drugs that can be given-epinephrine, atropine, vasopressin, lidocaine, naloxone.

ACLS PULSELESS ARREST ALOGRITHM : 

ACLS PULSELESS ARREST ALOGRITHM If a perfusing rhythm is transiently restored but not successfully maintained between repeated shocks(recurrent VT/VF)—early treatment with antiarrythmic medication. If a palpable pulse is present& rhythm is organized, begin post resuscitative care

ACLS PULSELESS ARREST ALOGRITHMSearch &Treat Contributing Factors : 

ACLS PULSELESS ARREST ALOGRITHMSearch &Treat Contributing Factors Hypoxia Hypovolumia Acidosis Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Temponade Tension pneumothorax Thrombosis Trauma

ACLS TACHYCARDIA ALGORITHM : 

ACLS TACHYCARDIA ALGORITHM Tachycardia with pulses Assess & support ABC’s as needed Give Oxygen Monitor ECG,BP, Oximetry Identify & treat reversible causes Symptoms Persist Is patient stable Stable Unstable Immediate synchronized cardio version: I/V access sedation expert consultation

ACLS TACHYCARDIA ALGORITHM : 

ACLS TACHYCARDIA ALGORITHM Stable I/V access 12 lead ECG Is QRS narrow(<.12 sec )? Wide Narrow QRS Is rhythm regular? cont…

ACLS TACHYCARDIA ALGORITHM : 

Regular Rhythm Irregular vagal maneuvers adenosine 6mg i.v 12 mg rapid i.v (may repeat 12mg once) Check rythm Converts Does not convert Re entry SVT Observe Atrial flutter, Ectopic Atrial tachycardia, Adenosine Junctional tachycardia Diltiazem, beta blockers control rate: diltiazem, beta blockers treat underlying causes consider expert consultation ACLS TACHYCARDIA ALGORITHM AF, Atrial flutter,MAT Expert consultation Control rate: Diltiazem,beta blockers

ACLS TACHYCARDIA ALGORITHMWIDE QRScheck Rhythm(expert consultation advised) : 

ACLS TACHYCARDIA ALGORITHMWIDE QRScheck Rhythm(expert consultation advised) Regular VT or uncertain rhythm: amiadarone 150 mg i.v over 10 min synchronized cardio version SVT with Aberrancy: adenosine Irregular AF with Aberrancy Pre excited AF (AF+WPW): expert consultation, amiadarone 150mg i.v avoid adenosine, digoxin, diltiazem,verapamil Recurrent polymorphic VT Torsades de pointes: Mg

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BRADYCARDIA ALGORITHM

Terminating resuscitative efforts : 

Terminating resuscitative efforts The decision to terminate resuscitative efforts is based on many factors: Time to CPR Time to defibrillation Comorbid disease Prearrest state Initial arrest rhythm Response to resuscitative measures

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) : 

ADVANCED CARDIO VASCULAR LIFE SUPPORT(ACLS) The resuscitation team must make a conscientious & competent effort to give patients a trial of CPR & ACLS.the final decision to stop rescuscitative efforts can never be simple as an isolated time interval