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Advanced Cardiac Life Support

Advanced Cardiac Life Support

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Published by: aneeca on Dec 31, 2009
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If witnessed arrest, giveprecordial thump andcheck pulse. If absent,continue CPRAssess ResponsivenessUnresponsiveCall for code team and DefibrillatorAssess breathing (open the airway, look,listen and feel for breathing)If Not Breathing,give two slow breaths.Assess CirculationPULSENO PULSEInitiate CPRGive oxygen by bag maskSecure IV accessDetermine probable etiology of arrestbased on history, physical exam, cardiacmonitor, vital signs, and 12 lead ECG.Ventricularfibrillation/tachycardia(VT/VF) present onmonitor?Hypotension/shock,acute pulmonaryedema.Go to fig 8NOYESIntubateConfirm tube placementDetermine rhythm andcause.VT/VFGo to Fig 2ArrhythmiaBradycardiaGo to Fig 5TachycardiaGo to Fig 6Electrical Activity?YESNOPulseless electrical activityGo to Fig 3AsystoleGo to Fig 4
Fig 1 - Algorithm for Adult Emergency Cardiac CareEMERGENCY CARDIAC CARE
Advanced Cardiac Life Support
Continue CPRPersistent orrecurrent VF/VTEpinephrine 1 mgIV push, repeatq3-5min or 2 mg in10 ml NS via ET tubeq3-5min
Vasopressin 40 U IVP x1 dose onlyDefibrillate 360 J
Amiodarone (Cordarone) 300 mg IVP
Lidocaine 1.5 mg/kg IVP, and repeat q3-5 min, up to total max of 3 mg/kg
Magnesium sulfate (if Torsade de pointes or hypomagnesemic) 2 gms IVP
 Procainamide (if above are ineffective) 30 mg/min IV infusion to max 17 mg/kg
Continue CPRSecure IV accessIntubate if no responseDefibrillate immediately, up to 3 times at 200 J, 200-300 J, 360 J.Do not delay defibrillationReturn ofspontaneouscirculationPulseless ElectricalActivityGo to Fig 3Monitor vital signsSupport airwaySupport breathingProvide medications appropriate for bloodpressure, heart rate, and rhythm
Epinephrine, lidocaine, atropine may be given via endotracheal tube at2-2.5 times the IV dose. Dilute in 10 cc of saline.After each intravenous dose, give 20-30 mL bolus of IV fluid and elevateextremity.
Fig 2 - Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Assess Airway, Breathing, Circulation, Differential DiagnosisAdminister CPR until defibrillator is ready (precordial thump if witnessed arrest)Ventricular Fibrillation or Tachycardia present on defibrillatorAsystoleGo to Fig 4Check pulse and Rhythm
Continue CPRDefibrillate 360 J, 30-60 seconds after each dose of medication
Repeat amiodarone (Cordarone) 150 mg IVP prn (if reurrent VF/VT) ,up to maxcumulative dose of 2200 mg in 24 hoursContinue CPR. Administer sodium bicarbonate 1 mEq/kg IVP if long arrest periodRepeat pattern of drug-shock, drug-shock
Epinephrine 1.0 mg IV bolus q3-5 min, or high doseepinephrine 0.1 mg/kg IV push q3-5 min; may give viaET tube.Continue CPRIf bradycardia (<60 beats/min), give atroprine 1 mg IV, q3-5min, up to total of 0.04 mg/kgConsider bicarbonate, 1 mEq/kg IV (1-2 amp, 44 mEq/amp),if hyperkalemia or other indications.
Determine differential diagnosis and treat underlying cause:Hypoxia (ventilate)Hypovolemia (infuse volume)Pericardial tamponade (perform pericardiocentesis)Tension pneumothorax (perform needle decompression)Pulmonary embolism (thrombectomy, thrombolytics)Drug overdose with tricyclics, digoxin, beta, or calcium blockersHyperkalemia or hypokalemiaAcidosis (give bicarbonate)Myocardial infarction (thrombolytics)Hypothemia (active rewarming)Initiate CPR, secure IV access, intubate, assess pulse.Pulseless Electrical Activity Includes:Electromechanical dissociation (EMD)Pseudo-EMDIdioventricular rhythmsVentricular escape rhythmsBradyasystolic rhythmsPostdefibrillation idioventricular rhythms
Fig 3 - Pulseless Electrical Activity

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