Advanced Cardiac Life Support (ACLS)

Transthoracic Impedance Factors

• Distance between paddles is a factor.
• Energy setting of the defibrillator is a factor.
• Contact material type (e.g., paddle to skin) is a factor.
• Types of defibrillators (monophasic/biphasic) are not a factor affecting transthoracic impedance.
• Amount of pressure applied to the chest is a factor.

PEA Patient Management

• If a patient with PEA is intubated and, 3 minutes after receiving 1 mg IV adrenaline, the heart rate remains at 50 bpm, the next step is to administer IV dopamine at 15 mcg/kg/min.

Arrhythmia Management

• Electrical cardioversion is necessary for supraventricular tachycardia (SVT).
• Sinus bradycardia of 56 beats per minute in a fit young adult does not require treatment.
• IV amiodarone is not recommended for pulseless electrical activity (PEA) or asystole.
• Underlying causes of cardiac arrest should be excluded.
• Repeat emergency drug administration every 3-5 minutes is not recommended.

Immediate Action for Pulseless, Apneic Patient

• Continue CPR, establish IV access, and administer a rapid bolus of 1 mg adrenaline. Intubate the patient.

Defibrillation

• Correct defibrillation pad placement is one pad below the right clavicle and the other pad to the left of the nipple in the mid-axillary line.
• 160J is the recommended energy level for ventricular fibrillation (VF).
• A pacemaker is not an absolute contraindication.
• Synchronized mode is turned on for VT with a pulse.

Chest Compression Post-Defibrillation

• CPR should be started immediately after defibrillation.
• If the ECG shows sinus rhythm (SR) after defibrillation, and upon completion of 2 minutes of CPR, check the pulse.
• Continue CPR for another 2 minutes after confirming return of spontaneous circulation (ROSC).

Advanced Airway Compressions

• Compressions are delivered at a rate of 100-120 per minute with 2 breaths every 15 compressions.

Singapore Resuscitation Guidelines

• Initial head-tilt chin-lift maneuver is omitted.
• Check breathing and pulse within 5 seconds.
• Chest compression landmark is the upper mid-sternum.
• Continue CPR for 1 minute after defibrillation.

Synchronized Cardioversion

• Synchronized cardioversion should be considered for ventricular tachycardia (VT) with a pulse.

ECG in a 40-Year-Old Man

• Iliac fossa pain is not a reason to do an ECG.
• Other symptoms include breathlessness, acute confusion, syncope, and epigastric discomfort.

AMI Evaluation

• Key evaluation parameters for acute myocardial infarction (AMI) are clinical history, cardiac markers, and electrocardiogram (ECG).

Morphine Use

• Morphine is often recommended for AMI patients and is useful in pulmonary edema.
• IV anti-emetics should be given with morphine.
• Flumazenil is the reversal agent.

Aspirin Use

• Aspirin is indicated in AMI patients if they don't have an NSAID allergy.
• Use caution with peptic ulcer disease history.
• Aspirin is often given intravenously in AMI.
• Aspirin is generally given with an IV anti-emetic.

Endotracheal Intubation

• If SpO2 drops to 85% during endotracheal intubation, stop the intubation procedure, bag-valve-mask the patient with 100% oxygen, and repeat intubation.

ECG Rhythm Recognition

• Patient with the ECG rhythm described may be hemodynamically stable, experience a seizure, complain of palpitations, or have a syncopal attack.
• Multiple possible diagnoses should be considered and ruled out (e.g., arrhythmia or seizure versus syncope).

Intramuscular Injections in AMI

• Intramuscular injection should be avoided due to poor absorption, risk of hematoma, and potential for altered cardiac markers and arrhythmias.

Code Team Arrival

• Upon the arrival of the code team, the nurse should prepare drugs, attach monitor leads and check the ECG rhythm, assess responsiveness, continue chest compressions, and give a brief verbal report to the doctor.

ROSC Maintenance

• Maintain blood glucose ≤10 mmol/L.
• Maintain Glasgow Coma Scale ≥8.
• Maintain oxygen saturation (SpO2) at 100%.
• Maintain mean arterial pressure (MAP) ≥ 60 mmHg.
• Maintain temperature at 34-36°C for 12-24 hours.

Child Pronouncement of Death

• A child can be pronounced dead after 30 minutes of continuous resuscitation efforts if no response is observed.
• Pregnant women with pulmonary conditions and near-drowning cases increase the risk of regurgitation and pulmonary aspiration.

Early CPR

• Early CPR, defibrillation, and access to EMS increase survival rates for out-of-hospital cardiac arrest patients.

Chain of Survival

• Early CPR, early defibrillation, advanced cardiac life support, and emergency medical services make up the chain of survival.

Unconscious Casualty Approach

• Before approaching an unconscious person, check for potential danger and ensure the area is safe.
• Assess level of consciousness and if there's spontaneous breathing.
• Activate EMS if needed.

Lethal Arrhythmias in AMI

• Ventricular fibrillation is the most lethal arrhythmia in acute myocardial infarction (AMI).

Torsades de Pointe Treatment

• Magnesium sulfate is the drug of choice for torsades de pointes.

Lignocaine Use

• Lignocaine can cause seizures if given in overdose, but it can be used for persistent ventricular tachycardia, controlling premature ventricular contractions, and in cardiac collapse situations.
• It also can be used to treat atrial fibrillation.