ACLS (Advanced Cardiovascular Life Support) ?????????

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ACLS(Advanced Cardiovascular Life
Support)?????????

• ??? ???
• http//www.disaster.org.tw

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Universal Algorithm????
3
????

• ? ????
• ? ??
• A ????? (airway)
• B ???? (breathing)
• C ???? (circulation)
• D ???? (defibrillation)

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????

• A ????? (airway)
• ???? ? ????
• B ???? (breathing)
• ?
• ?
• ??
• 2 Slow Breaths

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????

• C ???? (circulation)
• ??
• ???? ???? ???? ??
• (????)
• D ???? (defibrillation)
• 200J 300J 360J (for VF)

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????
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????

• A ??? (airway)
• ????
• B ?? (breathing)
• ??????
• ????
• ????

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????

• C ?? (circulation)
• ??????
• ????
• VF/VT Vasopression OR Epinephrine
• Non-VF/VT Epinephrine
• D ???? (defibrillation)
• Drug-Shock-Drug-Shock

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????
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Special Resuscitation

• Hypothermia(???)

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??

• ???????lt35?
• ??????3542?
• ?????????????
• Severity
• Mild3436?
• Moderate30-34?
• Severelt30?(86?)

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????

• ?????
• ????, ABC(???3045?)
• ????
• ????????????
• ????
• CPR/????(VT/VF)
• ??gt30????????????

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?????

• ?????
• ??????
• ????????????????
• ?????????VF
• ??????(?/??)
• ????(needle electrode)

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??

• Mild(34-36?)
• ???????????
• Moderate(3034?)
• ?????????????(??afterdrop)
• Severe(lt30?)
• ??????
• ?????????????

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??????

• ???????(43?)150-200cc/h
• ???????(4246?)
• ????(KCL-free,??2L)
• ????(chest tubes2)
• ???????
• Goalgt35?

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???,?????CPR

• VT/VF????(200-300-360J)
• ??????
• ??????????(4246?)
• ????
• ?????????(43?)150-200cc/h
• ???????gt30????????????

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Key Points

• Not dead until warm and dead(32?)
• ETT, NG, CVP, PCWP, TVP????VF
• ????????,??????,????????
• ????,????,????,??
• Bretylium???????VF????
• Thiamine 100mg????,???

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Special Resuscitation

• Near-Drowing(??)

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??

• Drowing ??
• Near-drowing ??

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???BLS?????

• ???????
• ??????
• ??
• ???
• ???
• ???
• ????????

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???BLS????

• ????
• ??????????????????
• ????
• ?????????
• ????
• Neutral position
• Jaw thrust/ chin lift without head tilt

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Special Resuscitation

• Electric Shock (????)

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??????

• ??????????
• ???????????(??)
• ???????,??,????,????(?/?),????
• ?????,??
• ?????,??,??,??????

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???

• ??????????
• ???????????
• ???VF(R-on-T??)
• ??????gt1000V
• ??????110V

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????

• ????
• ?????Asystole(???)
• ?????VF
• ????
• ?????????????
• ???,??
• ???????VS???????
• ????????gt?????
• ???????????gt?????

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?????BLS

• ??????????
• ???????????????,????????BLS/-defibrillation??
• ????????????????
• ???????????

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???????????(1)

• ?????
• ???????,?????
• Arrhythmias(VF, asystole, etc)
• ?????ACLS?????
• ??????????
• ??
• NS or LR??????50-100cc/h??
• ?????????

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???????????(2)

• ?????(Myoglobinuria)???
• NaHCO3NS(50mEq/1000cc)??????1-1.5cc/kg/h,
  pH???7.45??
• ????mannitol??(25g st and 12.5g/h)
• ?????(Compartment syndrome)
• ????????(fasciotomy)
• ??????(Associated injuries)
• ????,????,??,?????

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??

• ?????3070???????
• ????1-20???,200??
• Flashing over
• ??????????,????
• ???????(asystolegtVF)?????
• ?????????
• ??????(??BLS)
• ??????????(????)

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????????

• DC(???)
• AsystolegtVF?????????
• ???????????
• ????????????????
• ????????????
• ????fluid loading

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Special Resuscitation

• ??????????

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??????????

• ???????????????
• ????,????,?????,?????????????
• ???????????
• ????????VF???????
• ?????????????PEA
• ???????PEA
• ????????????

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???????

• VT/VF?????????ACLS
• ???????PEA??????????????????
• ????????PEA???????????????????
• ??????????????????
• ???????,???,??????,????????,??????

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????????

• ????????????????
• ???????
• ????????(lt15min)
• ?????????????????????
• ??????????,EKG????
• Best outcome???

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???????

• ????
• ?????????
• ?????
• ?????????
• ????

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Special Resuscitation

• Pregnancy and cardiac arrest
• (???????)

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?????????

• ???
• ????,???,????,??????,?????
• ???
• ??????,????????,oncotic pressure
• ???????
• ???????????25

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???????????

• ?????
• ??
• ??/???????
• ????
• ????????
• ????????(????)
• ????

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?????????

• CPR?,??????
• ?????????????
• ??????,??
• ??????????
• ACLS???????
• ??VF??????Bosmin??

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?????????-???

• ????????????
• ??????
• ???CPR
• ???
• ACLS(??,??,??)
• ???????
• ???????,Doppler??????
• ?????????(4-5???)
• Preterm NB resuscitation team available

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Special Resuscitation

• Acute Stroke (Brain Attack)

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ClassificationCT Scan

• ?????(75)
• ???/????????
• ???/???????,??
• ?????(25)
• ??????????
• ???????

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Management 7D--NINDS(National Institude of
Neurological Disorders and Stroke)

1. Detection(????)
2. Dispatch(????119)
3. Delivery(??????????)
4. Door (????)
5. Data(NE?CT)
6. Decision(????/??)
7. Drug(TPAlt3h)

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6DDecision

• ?????????????
• TPA???
• Onsetlt3h
• ???CT, NE, severity (4ltNIHDDlt22)
• ?TPA???(checkist)
• ????????

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7DDrug

• ?????
• ??TPA?FDA???
• ??
• 0.9mg/kg, maximum 90mg
• 10 as bolus, 90 over 60 min

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??????????

• ????TPA???
• DBPgt140 mmHg
• Nipride
• SBPgt220 mmHg, DBPgt120mmHg, MAPgt130 mmHg
• Trandate
• ?????????
• DAA, AMI, CHF, HE

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Cocaine ???)

• ??
• ????,nasal, smoked (crack)
• ??
• ??norepinephrine, epinephrine, dopamine,
  serotonin?????????
• ????
• ????,????,????,??
• ????
• ??,????,????,???,??

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???????????

• PSCR, AfRVR, AF
• ????????????
• ????????
• Oxygen
• Valium 5-20mg IV
• ?????????
• ????

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??????????

• VPCs, runs of VT, VF
• ????????????
• ????????
• Oxygen
• Valium 5-20mg IV
• Propranolol 0.5-1 Omg q5min ?Labetolol
• Lidocaine 1-1.5mg/kg (?????)
• ?????????
• ???????

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???VF

• Shock-shock-shock (200-300-360J)
• CPR Intubation
• Epinephrine 1mg and shock (360J)
• Lidocaine 1.5mg/kg and shock (360J)
• Propranolol 1mg q1min and shock
• Epinephrine 1mg q5-10min and shock
• ??????lidocaine

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????????

• Benzodiazepine(Valium)
• NTG(esp. if chest pain)
• Nitroprusside
• Alpha-blockerphentolamine(1-10mg)
• Labetolol(Trandate)
• ??????propranolol or esmolol(???????)

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??????????

• ???????,?????????????,????????
• ??50 thrombus, 50 vasospasm
• ??O2, Valium, aspirin, NTG, morphine, Mg
• ??????propranolol or esmolol(???vasospasm)
• TPAheparin?????,????????????

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???????

• Hypokalemia
• Hypomagnesemia
• Drug interaction
• Hypoxemia
• Hypothyroidism
• Renal insufficiency
• Volume depletion
• Loss of muscle mass