Advance cardiac life support (ACLS)

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Advance cardiac life support(ACLS)

• Phakapan Buppha

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Shockable
Not shockable
VF/VT
Asystole / PEA
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VF/VT

• Give 1 shock
• Manual biphasic 120-200 J
• Monophasic 360 J
• Resume CPR immediately

Box 4
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Check rhythm Shockable rhythm ?

• Continue CPRwhile DF is charging
• Give 1 shock
• Resume CPR immediately
• Give vasopressor (before/after shock)
• Vasopressin 40 U IV
• Epinephrine 1 mg IV
• Repeat q 3-5 min or

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Check rhythm Shockable rhythm?

• Continue CPRwhile DF is charging
• Give 1 shock
• Resume CPR immediately
• Consider antiarrhythmics
• Amiodarone
• 300 mg IV
• Consider additional 150 mg IV or
• Lidocaine
• 1-1.5 mg/kg then 0.5-0.75 mg/kg
• Max 3 dose or 3 mg/kg
• Consider Mg
• 1-2 g IV for torsades de pointes

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Asystole / PEA

• Resume CPR immediately for 5 cycle
• Give vasopressor
• Epinephrine 1 mg IV
• Repeat q 3-5 min or
• Vasopressin 40 U IV
• Consider atropine for asystole or slow PEA
• Dose 1 mg iv
• Repeat q 3-5 min (up to 3 dose)

BOX 10
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Check rhythm Shockable rhythm ?
NO
YES

• If asystole go to box 10
• If electrical activity,
• check pulse
• No pulse go to box 10
• Pulse present begin
• Postresuscitation care

Go to box 4
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During CPR

• Push hard fast (100/min)
• Ensure full chest recoil
• Minimize interruption in chest compression
• One cycle of CPR
• 30 compressions then 2 breaths
• 5 cycle 2 min
• Avoid hyperventilation
• Secure airway confirm placement
• No longer cylces after advance CPR is placed
• Give 8 10 breaths/min
• Rotate compression q 2 mins with rhythm check

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During CPR
6 H, 6 T

• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo/hyperkalemia
• Hypoglycemia
• Hypothermia

• Toxins
• Tamponade cardiac
• Tension pneumothorax
• Thrombosis (coronary or pulmonary)
• Trauma

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Medication

• Epinephrine
• Vasopressin
• Atropine

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Epinephrine

• a-adrenergic receptor-stimulating
• Increase coronary and cerebral perfusion pressure
  
• ß-adrenergic effects
• May increase myocardial work reduce
  subendocardial perfusion
• Dose
• Epinephrine 1 mg IV
• Repeat q 3-5 min or

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Atropine

• Reverses cholinergic-mediated decreases in HR,
  SVR, BP
• Inexpensive, easy to administer, few side
  effects
• Dose
• 1 mg iv
• Repeat q 3-5 min (up to 3 dose)

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Vasopressin

• Nonadrenergic peripheral vasoconstrictor
• Dose
• Vasopressin 40 U IV

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Antiarrhythmics

• Amiodarone
• Lidocaine
• Magnesium

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Amiodarone

• Affects
• Sodium, potassium, and calcium channels
• a - and ß-adrenergic blocking properties
• Improvement in defibrillation response
• Side effect
• Vasodilation hypotension
• Dose
• 300 mg IV
• Consider additional 150 mg IV

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Lidocaine

• Alternative antiarrhythmic for ventricular
  arrhythmias of
• Fewer immediate side effects
• Dose
• 1-1.5 mg/kg then 0.5-0.75 mg/kg
• Max 3 dose or 3 mg/kg
• Intervals 5-10 mins

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Magnesium

• Terminate torsades de pointes
• ( Irregular/polymorphic VT associated with
  prolonged QT interval )
• Dose
• 1-2 g IV for torsades de pointes
• Push typically over 5-20 minutes

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Bradycardia tachycardia arrhythymia
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Bradycardia HRlt60 bpm Inadequate for cinical
ventilation

• Maintain pt. airway
• Give oxygen
• Monitor ECG (rhythm, BP, SpO2)
• IV access

Sign or symptoms of poor perfustion (acute
altered mental status, hypotension, ongoing chest
pain)
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Yes
No

• Prepare for transcutaneous pacing
• (typeII 2 degree block,
• 3 degree AV block)
• Consider atropine 0.5 mg IV
• May repeat max 3 mg
• Consider epinephrine or dopamine

Observe/ monitor
6H, 6T

• Prepare for transvenous pacing
• Treat contributing causes
• Consider expert consultation

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No
Yes
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During evaluation

• Secure airway vascular access
• Consider expert consultation
• Prepare for cardioversion
• Treat contributing factors
• 6 H 6T

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Quiz
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Sinus bradycardia
Sign or symptoms of poor perfustion (acute
altered mental status, hypotension, ongoing chest
pain)
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Ventricular tachycardia
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• Magnesium
• Dose
• 1-2 g IV for torsades de pointes
• Push typically over 5-20 minutes

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Asystole
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Postresuscitation support

• Optimize hemodynamic, respiratory, neurologic
• Treat reversible causes of arrest
• Monitor temperature and consider treatment for
  disturbances of temperature regulation and
  metabolism.

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Postresuscitation support

• BP MAP gt 90-100 mm Hg
• Ventilation
• Keep normoventilation
• PaO2 gt100 mm Hg
• Correction of acidosis pH 7.3-7.5
• Permissive hypothermiagt33,
• Maintain blood chemistry Hct, osmolality,
  electrolyte, glucose
• Decrease cerebral metabolism
• Sedation, anesthesia, paralysis
• Anticonvulsant

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Any questions ?