ACLS 2000

1
ACLS 2000

• The Tachycardia Algorithms
• ???

2
Major New Concepts for the International
Guidelines 2000

• Unstable tachycardias ? Cardioversion
• Stable tachycardias
• Making a specific rhythma diagnosis
• Recognizing patients who have significantly
  impaired cardiac function ( EF lt 40, overt
  signs of heart failure )

3
Specific Rhythm Diagnosis Rationale

• Overuse of adenosine has often delayed more
  appropriate treatment
• Unpleasant side effects of adenosine, the
  possibility of worse rhythms, and a
  destablilization of heart rate and blood pressure
• Lidocaine is ineffective for termination of
  hemodynamically stable sustained VT

4
Specific Rhythm Diagnosis

• 12-lead ECG
• Esophageal lead
• Looking for AV dissociation

5
Specific Rhythm Diagnosis

• History
• CAD, structural heart disease
• accessory pathways, preexisting BBB,
  rate-dependent BBB, previous aberrant rhythms
• Physical signs of AV dissociation
• Irregular cannon A waves in the jugular venous
  pulse
• Varying intensity of S1
• Beat to beat changes in SBP

6
Antiarrhythmics or Proarrhythmics

• Negative inotropic effects
• Proarrhythmic effects
• never use more than 1 agent unless absolutely
  necessary

7
Af/ AF with Normal Cardiac Function
8
Af / AF with Impaired Heart Function
9
Af/Af gt 48 hrs or unknown duration

• Delayed cardioversion
• Anticoagulation x 3 wks
• DC cardioversion
• Anticoagulation x 4 more weeks
• Early cardiovesion
• Begin IV heparin at once
• TEE to exclude atrial clot
• Cardioversion within 24 hrs
• Anticoagulation x 4 more weeks

10
Af / AF with WPW syndrome (lt 48hrs)Normal Heart
11
Af / AF with WPW syndrome (lt 48hrs)Impaired Heart

• DC cardioversion
• Amiodarone (IIb)

12
Af / AF with WPW syndrome( gt 48 hrs or unknown )

• Anticoagulation
• DC cardioversion