ACLS Lecture PDF

# ACLS ## ACLS Flowchart A flowchart is presented, depicting the steps to take in a suspected cardiac arrest situation. ### Initial Steps - **Start CPR:** - Give oxygen - Attach monitor/defibrillator - **Determine Rhythm:** - **If VF/pVT:** Shock - **If Asystole/PEA:** Epinephrin...

# ACLS ## ACLS Flowchart A flowchart is presented, depicting the steps to take in a suspected cardiac arrest situation. ### Initial Steps - **Start CPR:** - Give oxygen - Attach monitor/defibrillator - **Determine Rhythm:** - **If VF/pVT:** Shock - **If Asystole/PEA:** Epinephrine ASAP ### CPR Cycle - **CPR 2 min** - IV/IO Access - Determine Rhythm - **Shockable:** Shock - **Not Shockable:** - **Epinephrine every 3-5 min** (Consider advanced airway, capnography) - **CPR 2 min** - Determine Rhythm - **Shockable:** Shock - **Not Shockable:** - **Amiodarone or lidocaine** (Treat reversible causes) - **CPR 2 min** (Treat reversible causes) ### Post CPR - **If no signs of return of spontaneous circulation (ROSC), go to 10 or 11.** - **If ROSC, go to Post-Cardiac Arrest Care** ### Post-Cardiac Arrest Care - **Consider appropriateness of continued resuscitation.** ## CPR Basic ### CPR Quality - Push Hard (at least 2 inches [5 cm]) and fast (100-120/min) - Allow complete chest recoil - Minimize interruptions in compressions - Avoid excessive ventilation - Change compressor every 2 minutes or sooner if fatigued - If no advanced airway, 30:2 compression-ventilation ratio - Quantitative waveform capnography - If PETCO2 is low or decreasing, reassess CPR quality ### Shock Energy for Defibrillation - **Biphasic:** Manufacturer recommendation (eg, initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered. - **Monophasic:** 360 J ### Drug Therapy - **Epinephrine IV/IO dose:** 1 mg every 3-5 minutes - **Amiodarone IV/IO dose:** - First dose: 300 mg bolus - Second dose: 150 mg - **Lidocaine IV/IO dose:** - First dose: 1-1.5 mg/kg - Second dose: 0.5-0.75 mg/kg ### Advanced Airway - Endotracheal intubation or supraglottic advanced airway - Waveform capnography or capnometry to confirm and monitor ET tube placement - Once advanced airway in place, give 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions ### Return of Spontaneous Circulation (ROSC) - Pulse and blood pressure - Abrupt sustained increase in PETCO2 (typically ≥40 mm Hg) - Spontaneous arterial pressure waves with intra-arterial monitoring ### Reversible Causes - Hypovolemia - Hypoxia - Hydrogen ion (acidosis) - Hypo-/hyperkalemia - Hypothermia - Tension pneumothorax - Tamponade, cardiac - Toxins - Thrombosis, pulmonary - Thrombosis, coronary ## Rules for Rhythm Identification ### Ventricular Fibrillation (VF) Figure 24, a graphic representing a VF rhythm, is presented. | Feature | Description | |--------------|------------------------------------------------------------------------------------| | Regularity | There is no regular shape of the QRS complex because all electrical activity is disorganized. | | Rate | The rate appears rapid, but the disorganized electrical activity prevents the heart from pumping. | | P Wave | There are no P waves present. | | PR Interval | There are no PR intervals present. | | QRS Complex | The ventricle complex varies. | ### Ventricular Tachycardia (Regular/Rapid Wide Complex Tachycardia) Figure 25, a graphic representing a Ventricular Tachycardia rhythm, is presented. | Feature | Description | |--------------|------------------------------------------------------------------------------------------------------------------------------------------------------| | Regularity | R-R intervals are usual, but not always, regular. | | Rate | The atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats per minute. | | P Wave | QRS complexes are not preceded by P waves. There are occasionally P waves in the strip, but they are not associated with the ventricular rhythm. | | PR Interval | PR interval is not measured since this is a ventricular rhythm. | | QRS Complex | QRS complex measures more than 0.12 seconds. The QRS will usually be wide and bizarre. It is usually difficult to see a separation between the QRS complex and the T wave. | ### Torsades de Pointes (Irregular Wide Complex Tachycardia) Figure 26, a graphic representing a Torsades de Pointes rhythm, is presented. | Feature | Description | |--------------|--------------------------------------------------------------------------------------------------------| | Regularity | There is no regularity. | | Rate | The atrial rate cannot be determined. Ventricular rate is usually between 150 and 250 beats per minute. | | P Wave | There are no P waves present. | | PR Interval | There are no PR intervals present. | | QRS Complex | The ventricle complex varies. | ### Asystole | Feature | Description | |--------------|----------------------------------------------------------------------------------------------------------| | Regularity | The rhythm will be a nearly flat line. | | Rate | There is no rate. | | P Wave | There are no P waves present. | | PR Interval | PR interval is unable to be measured due to no P waves being present. | | QRS Complex | There are no QRS complexes present. | ## CPR Team (Code Blue Team) A graphic of a CPR team (Code Blue Team) is presented. - **Team Leader:** Directs the team and maintains situational awareness - **Compressor:** Performs chest compressions - **Airway:** Manages the patient's airway - **AED/Monitor/Defibrillator:** Operates the AED and monitor for the patient's rhythm - **Timer/Recorder:** Tracks the time of each cycle and keeps a record of events ## CPR Comics CPR Comics is stated as a resource. This document provides a detailed description of the content of the image. It includes headings, lists, and tables. It formats information in a logical and clear way. It converts the graphic into a structured format, and also includes a description of the graphics.