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Acls 2015

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ACLS

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Acls 2015

  1. 1. ACLS FOR DUMMIES (PARAMEDICS)
  2. 2. Algorhythms are your best friend Does he have a pulse ? No Are you sure? Transport to hospital. Treat as indicated Yes Transport to hospital. Treat as indicated Is the patient talking ? No Give oxygen Transport to hospital. Treat as indicated Yes Take him to the hospital. Treat as indicated.
  3. 3. Main Algorhythms  CPR Algorhythm  Pulseless Arrest  Tachycardia with pulse  Bradycardia  ROSC
  4. 4. CPR Algorhythm (BLS Code) 1. “Hey, hey, are you okay?” 2. You are 911 3. Jaw thrust or head tilt chin lift 4. Use an Ambu bag and at least one basic airway adjunct 5. ONLY 10 seconds 6. Hard and fast 30:2 7. Turn on your AED / Monitor 8. Rhythm check 9. Shock 10.Start CPR again
  5. 5. Pulseless Arrest  Call for assistance if not already there  Use Ambu bag  Attach cardiac monitor  Check rhythm  Confirm V-fib or V- tach
  6. 6. Pulseless Arrest  Shock at 200 J  Resume CPR  If you did not secure an airway yet, do it now.  Attach Lucas  Establish IV or IO access  Get ready with the EPI
  7. 7. Pulseless Arrest  Check rhythm  Shock at 200 J  Restart CPR  Give either one:  EPINEPHRINE 1mg  VASOPRESSSIN 40 units
  8. 8. Pick One
  9. 9. Pulseless Arrest  Rhythm Check  Shock  Give an antiarrhythmic:  LIDOCAINE 1 – 1.5 mg/kg  AMIODARONE 300 mg  Mag Sulfate if Torsades
  10. 10. Pulseless Arrest  Package patient  Initiate transport  Reconfirm airway  Continue to give EPINEPHRINE q 3 -5 minutes  Repeat antiarrhythmics:  LIDOCAINE (0.5- 0.75 mg / kg ) half first dose  AMIODARONE (150 mg) half first dose  If you get a pulse back with one of these drugs, set up a drip.
  11. 11. Pulseless Arrest  Not shockable  PEA  Asystole
  12. 12. Pulseless Arrest  Assure adequate CPR  Secure Airway  Establish IV or IO  Administer medications:  EPINEPHRINE 1 mg q 3-5 min  Vasopressin 40 Units (one time)  Atropine (Asystole or slow PEA)
  13. 13. Pulseless Arrest  Recheck rhythm after 5 cycles of cpr  If shockable, then shock  If there is a pulse, treat as indicated
  14. 14. Pulseless Arrest
  15. 15. Pulseless Arrest  If patient is intubated, do continuous compressions  Recheck tube placement often  Document tube placement confirmations
  16. 16. Tachycar dia with Pulse
  17. 17. Is there a pulse?
  18. 18. Is he stable or unstable?
  19. 19. Tachycardia  OXYGEN  ECG  GOOD SET OF VITALS  ANY CAUSES?  Hyperventilation  Overdose TREAT THE PATIENT NOT THE MONITOR
  20. 20. TACHYCARDIA  STABLE OR UNSTABLE  GO BACK TO GENERAL IMPRESSION  HOW LONG WILL PATIENT TOLERATE THE RHYTHM ?  HOW LONG HAS THE PATIENT BEEN IN THIS RHYTHM ?
  21. 21. TACHYCARDIA: Unstable  Establish IV  Sedate patient if possible  Cardioversion:  Press Sync button  Press Shock (hold down until it discharges)
  22. 22. TACHYCARDIA: Stable  Establish IV  12 lead ECG  Identify the rhythm
  23. 23. Tachycardia: Narrow  SVT  Vagal Maneuvers  Adenosine  6 mg (Rapidly)  12 mg  12 mg ? ?  A-Fib  Think about cardizem  A- Flutter
  24. 24. Tachycardia: Narrow  Transport patient  Transmit 12 lead  Call for additional orders
  25. 25. TACHYCARDIA: Wide complex • Ventricular Tachycardia • Amiodarone • Cardioversion •Atrial fib with aberrancy • Think about cardizem •SVT with aberrancy • Adenosine
  26. 26. TACHYCARDIA  H’s and T’s  Look for possible causes
  27. 27. ELECTRICAL CARDIOVERSION  Not usually needed for HR < 150 bpm  Check O2 Sats; IV; Intubation equipment  Premedicate if possible: valium or versed
  28. 28. CARDIOVERSION  V- Tach: start at 100 J  SVT: start at 50 J
  29. 29. BRADYCARDIA
  30. 30. BRADYCARDIA  Less than 60 bpm  Is patient symptomatic ?  Some causes of bradycardia  Healthy, athletic person  Patient on beta blockers  Patient on digoxin  Overdose of narcotics
  31. 31. BRADYCARDIA (SYMPTOMATIC)  Use atropine while you are setting up the pacemaker  Does not last very long  Pace 3rd degree
  32. 32. BRADYCARDIA  Transmit ECG if available  Sedate patient if necessary  Don’t delay pacing  Atropine may not work for transplanted hearts
  33. 33. Treatments of these causes Cause Treatment  Hypoxia  Hypvolemia  Hypothermia  Hypokalemia  Hypoglycemia  Toxins  Thrombosis  Trauma  Cardiac Tamponade  Tension Pneumothorax  Hyperkalemia  Metabolic Acidosis  Respiratory Acidosis  Ventilation  IV Fluids  Warm Patient  Restore electolyte imbalance  Sugar  Detoxify  Thrombolysis  Surgery / bleeding control  Pericardialcentesis  Thoracic decompression  Bicarb  Bicarb  Ventilation
  34. 34. Amiodarone 3 Ways:  For VF/Pulseless V-Tach  V-Tach or wide complex regular  Maintenance Drip
  35. 35. Amiodarone #1: VF or Pulseless VT  300 mg  2 vials of 150 mg
  36. 36. Amiodarone #2: V-tach with pulse  150 mg over 10 minutes  150 mg in 100 mL spiked with macro is 100 gtt/min
  37. 37. Amiodarone #3: Maintenance  1 mg / min  100 mg in 100 mL bag spiked with micro drip = 60 gtt/min

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