ACLS (Main): Difference between revisions
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== Tachycardia == | == Tachycardia == | ||
3 questions | 3 questions | ||
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#Is the rhythm regular or irregular? | #Is the rhythm regular or irregular? | ||
=== Regular | ===Narrow Regular=== | ||
*1. Sinus Tachycardia | *1. Sinus Tachycardia | ||
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****Metoprolol 5mg IVP x 3 followed by 50mg PO | ****Metoprolol 5mg IVP x 3 followed by 50mg PO | ||
=== Irregular | ===Narrow Irregular === | ||
*1. MAT | *1. MAT | ||
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***Digoxin (good in setting of CHF) | ***Digoxin (good in setting of CHF) | ||
=== Regular | ===Wide Regular=== | ||
*1. V-Tach (until proven otherwise!) | *1. V-Tach (until proven otherwise!) | ||
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***Sotalol 100mg IV over 5min | ***Sotalol 100mg IV over 5min | ||
****Avoid if prolonged QT | ****Avoid if prolonged QT | ||
**Elective synchronized cardioversion | **Elective synchronized cardioversion (100J) | ||
**Adenosine may be used for diagnosis and treatment only if: | **Adenosine may be used for diagnosis and treatment only if: | ||
***Rhythm is regular and monomorphic | ***Rhythm is regular and monomorphic | ||
*2. SVT w/ aberrancy | *2. SVT w/ aberrancy | ||
=== Irregular | ===Wide Irregular=== | ||
*DO NOT use AV nodal blockers! | *DO NOT use AV nodal blockers! | ||
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*2. A fib w/ aberrancy | *2. A fib w/ aberrancy | ||
*3. Polymorphic V-Tach / Torsades | *3. Polymorphic V-Tach / Torsades | ||
**Emergent defibrillation | **Emergent defibrillation (NOT synchronized) | ||
**Correct electrolyte abnormalities | **Correct electrolyte abnormalities | ||
***HypoK, hypoMag | ***HypoK, hypoMag | ||
Revision as of 05:57, 16 April 2011
Recommendations
- Routine use of cricoid pressure is NOT recommended
- Airway adjunct is recommended while performing ventilation
- Pulse/rhythm checks should only occur q2min
- Most critical component is high-quality compressions
- Atropine and cardiac pacing are NOT recommended for asystole/PEA
BLS
- Compressions
- Push hard (2cm) and fast (100pm)
- Do everything possible to minimize compression interruption
- Ventilation
- 30:2 ratio when do not have advanced airway
- Do not overventilate! (leads to decr venous return)
- 8-10 breaths per min when intubated
- 30:2 ratio when do not have advanced airway
ECG Analysis
- Is the rhythm fast or slow?
- Are the QRS complexes wide or narrow?
- Is the rhythm regular or irregular?
Ventricular fibrillation and pulseless ventricular tachycardia
- Shock as quickly as possible
- Resume CPR immediately after shocking
- Biphasic - 200J
- Monophasic - 360 J
- Give Epi 1mg if shock + 2min of CPR fails to convert the rhythm
- Consider aniarrhytmic if 2nd shock + 2min CPR again fails
- Amiodarone 300mg w/ repeat dose of 150mg as indicated
- Magnesium 2g IV, followed by maintenance infusion
- Only for polymorphic Vtach
Asystole and PEA
- Give Epi 1mg q3-5min
- Consider H's and T's
- Hypovolemia
- Hypoxia
- Hydrogen ion
- Hypo/hyperkalemia
- Hypothermia
- Tension pneumo
- Tamponade
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
Bradycardia
- Only intervene if pt is symptomatic
- Hypotension, AMS, chest pain, pulm edema
- 1st Line
- Transcutaneous pacing
- Chronotropes
- Dopamine 2-10mcg/kg/min
- Epineprhine 2-10mcg/min
- 2nd Line
- Atropine 0.5mg q3-5m can be given as temporizing measure
- Do not give if Mobitz type II or 3rd degree block is present
- Atropine 0.5mg q3-5m can be given as temporizing measure
- TransQ pacing and chronotropes ineffective = need for transvenous pacing
Tachycardia
3 questions
- Is the pt in a sinus rhythm?
- Is the QRS wide or narrow?
- Is the rhythm regular or irregular?
Narrow Regular
- 1. Sinus Tachycardia
- Treat underlying cause
- 2. SVT
- Vagal maneuvers (convert up to 25%)
- Adenosine 6mg IVP (can follow with 12mg if initially fails)
- If adenosine fails initiate rate control with CCB or BB
- Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
- Metoprolol 5mg IVP x 3 followed by 50mg PO
- If adenosine fails initiate rate control with CCB or BB
Narrow Irregular
- 1. MAT
- Treat underlying cause (hypoK, hypomag)
- 2. Sinus Tachycardia w/ frequent PACs
- 3. A Fib / A Flutter w/ variable conduction
- Rate control with:
- Dilt
- MTP (good in setting of ACS)
- Amiodarone (good in setting of hypotension, CHF)
- Digoxin (good in setting of CHF)
- Rate control with:
Wide Regular
- 1. V-Tach (until proven otherwise!)
- If stable:
- Antiarrhytmics
- Procainamide 20mg/min
- Cont until rhythm suppressed, hypotensive, or max dose (17mg/kg)
- Avoid if prolonged QT
- Amiodarone 150mg over 10min, repeated as needed
- Sotalol 100mg IV over 5min
- Avoid if prolonged QT
- Procainamide 20mg/min
- Elective synchronized cardioversion (100J)
- Adenosine may be used for diagnosis and treatment only if:
- Rhythm is regular and monomorphic
- Antiarrhytmics
- 2. SVT w/ aberrancy
Wide Irregular
- DO NOT use AV nodal blockers!
- Can precipitate V-Fib
- 1. A fib w/ preexcitation
- 1st line - electric cardioversion
- 2nd line - Procainamide, amiodarone, or sotalol
- 2. A fib w/ aberrancy
- 3. Polymorphic V-Tach / Torsades
- Emergent defibrillation (NOT synchronized)
- Correct electrolyte abnormalities
- HypoK, hypoMag
- Stop prolonged QT meds
See Also
Source
- AHA 2010 Guidelines for ACLS