ACLS (Main): Difference between revisions

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== 2010 AHA Recommendation Changes==
''See [[critical care quick reference]] for drug doses and equipment size by weight.
*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


== ECG Analysis ==
==ECG Analysis==
#Is the rhythm fast or slow?
#Is the rhythm fast or slow?
#Are the QRS complexes wide or narrow?
#Are the QRS complexes wide or narrow?
#Is the rhythm regular or irregular?
#Is the rhythm regular or irregular?


== [[BLS]] ==
==Algorithms==
 
*[[Adult Pulseless Arrest]]
==Adult Cardiac Arrest==
*[[ACLS: Bradycardia]] (with pulse)
=== V-Fib and Pulseless V-Tach ===
**Use [[Adult Pulseless Arrest]] algorithm if no pulse = PEA
*Shock as quickly as possible and resume CPR immediately after shocking
*[[ACLS: Tachycardia]]
**Biphasic - 200J
**Monophasic - 360 J
*Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm
*Give antiarrhythmic if (2nd shock + 2min of CPR) again fails
**1st line: Amiodarone 300mg IVP w/ repeat dose of 150mg as indicated
**2nd line: Lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min
**Magnesium 2g IV, followed by maintenance infusion
***Only for polymorphic V-tach
 
=== Asystole and PEA ===
*Give [[epinephrine|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 (with Pulse)]]==
 
== Tachycardia (with Pulse) ==
3 questions:
#Is the pt in a sinus rhythm?
#Is the QRS wide or narrow?
#Is the rhythm regular or irregular?
 
===Narrow Regular===
#'''See also [[Tachycardia (Narrow)]]'''
# Sinus Tachycardia
##Treat underlying cause
# [[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
##Synchronized cardioversion (50-100J)
 
===Narrow Irregular ===
# MAT
##Treat underlying cause (hypoK, hypomag)
# Sinus Tachycardia w/ frequent PACs
# [[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)
##Synchronized cardioversion (120-200 J)
 
===Wide Regular===
*If unstable: shock (synchronized 100J)
**Hhypotension, AMS, shock, ischemic chest discomfort, acute heart failure)
*If stable:
**Meds
***Procainamide
****20-50mg/min; then maintenance infusion of 1mg/min x6hr
****Tx until arrhythmia suppressed, QRS duration increases >50%, hypotension, 17m/kg given
****Avoid if prolonged QT or CHF
***Amiodarone
****150mg over 10min (repeat as needed); then maintenance infusion of 1mg/min x6hr
***Adenosine
****May be considered for diagnosis and treatment only if rhythm is regular and monomorphic
**Synchronized cardioversion (100J)
 
===Wide Irregular===
*DO NOT use AV nodal blockers
**Can precipitate V-Fib
 
# A fib w/ preexcitation
##1st line - Electric cardioversion
##2nd line - Procainamide, amiodarone, or sotalol
# A fib w/ aberrancy
# Polymorphic V-Tach / Torsades
##Emergent defibrillation (NOT synchronized)
##Correct electrolyte abnormalities
###HypoK, hypoMag
##Stop prolonged QT meds


==See Also==
==See Also==
*[[AHA ACLS Recommendation Changes by Year]]
*[[ACLS (Treatable Conditions)]]
*[[ACLS (Treatable Conditions)]]
*[[Adult Quick Drug Card]]
*[[BLS (Main)]]
*[[SVT]]
*[[Critical care quick reference]]
*[[Antiarrhythmics]]
*[[Post cardiac arrest]]
*[[Arrhythmias (DDX)]]
*[[PALS (Main)]]
*[[Cardiac Arrest Management]]
*[[Synchronized Cardioversion]]


== Source ==
==References==
*AHA 2010 Guidelines for ACLS
<references/>


[[Category:Airway/Resus]]
==External Links==
*[http://www.blog.numose.com/emed-basics/pulseless Numose EMed: The Pulseless Patient]
*[http://www.blog.numose.com/emed-cardiology/bradycardia Numose EMed: ACLS Bradycardia]
*[http://www.blog.numose.com/emed-cardiology/svt Numose EMed: ACLS Narrow Complex Tachycardia]
*[http://www.blog.numose.com/emed-cardiology/wct Numose EMed: ACLS Wide Complex Tachycardia]


[[Category:Cards]]
[[Category:Cardiology]]
[[Category:EMS]]
[[Category:Critical Care]]

Revision as of 23:51, 8 August 2018