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ACLS Algorithms Adult 2010

ACLS Algorithms Adult 2010

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12/03/2013

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Dr. Brian Weitzman, Department of Emergency Medicine, Ottawa Hospital
International ACLS Guidelines 2010
Ventricular Fibrillation/ Pulseless Ventricular Tachycardia
SHOCK FIRST x 1
(
If defibrillator not immediately available start CPR 
)
200 J Biphasic, 360 J Monophasic
 
High Quality CPR* x 2 min
(
prior to rhythm or pulse check)
(Ventilate, IV/IO Access)
 
SHOCK 
 
CPR x 2 min
(Intubate, Drugs-give during CPR)
Treat reversible causes
 
EPINEPHRINE 1 mg IV
(may be given after 1
st
or 2
nd
shock)(REPEAT Q 3-5 MIN)
(
Vasopressin 40 U IV may be an alternate to 1
st
or 2
nd
dose of epinephrine)
 
 
SHOCK 
 
 
CPR x 2 min
AMIODARONE 300 mg IV bolus (Preferred)
(may give 2
nd
dose 150 mg IV)
 
or
 
LIDOCAINE
1.5 mg/kg IV
(REPEAT in 3-5 min) (Max. 3 mg/kg)
or
MAGNESIUM SULFATE
2 G IV
 (with torsades)
 
SHOCK 
 
*High Quality CPR: Push hard (
2 inches) and fast (
100/min), complete chestrecoil, minimize interruptions, avoid excessive ventilations (8-10/min), changecompressors q2min, monitor end-tidal C02Hypothermia (32-34ºC) recommended for resuscitated v. fib. patients who remaincomatose and intubated with a BP >90.Treat Reversible Causes: hypovolemia, hypoxia, acidosis, K, hypothermia, toxins,ischemia
 
International ACLS Guidelines 2010
 
WIDE COMPLEX TACHYCARDIA
ASSESS ABC’S IF STABLE, O2, MONITOR, O2 SAT, VITALSIGNS (Hx, P/E, ECG, CXR)
Unstable
 
Stable
(Chest pain, SOB, LOC, low BP, CHF, AMI)
(consider cardioversion first, as medsonly work about 30% of the time
) 
Likely VT Regular, monomorphic,uncertain origin
Procainamide
 
Dr. Brian Weitzman, Department of Emergency Medicine, Ottawa Hospital
20-50 mg/min (max 17mgkg) no change
Adenosine
6-12 mg
OR 
(defibrillator at bedside)
Amiodarone*
 150 mg over 10 min (repeat prn)Infusion: 1 mg/min x 6 hrs,then 0.5 mg/min over 24 hrs(Max: 2.2m in 24 hrs)
Prepare for cardioversionConsider premedicationSYNCHRONIZED Biphasic
: 100-150-200
CARDIOVERSION Monophasic:
200–300–360
 If Ventricular Tachycardia is polymorphic (Torsades) consider: magnesium 2 gm,overdrive pacing, isoproterenol, Phenytoin, Lidocaine, amiodorone.
*
Avoid giving multiple antidysrhythmics sequentially (to prevent proarrhythmias). If oneantidysrhythmic fails, go to electrical cardioversion.
 
 
International ACLS Guidelines 2010
 
PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA(AVnRT, AVRT)
STABLE
UNSTABLE CARDIOVERSION(Consider premedication)
VAGAL MANOEUVRES
Dr. Brian Weitzman, Department of Emergency Medicine, Ottawa Hospital
Adenosine 6 mg IV over 3 seconds, may repeat 12 mg in 1-2 min
(Class I)
 or Verapamil
2.5 – 5 MG I.V. over 2 min, may repeat 5-10 mg in 10 minutes (Class I)or
Diltiazem
20 mg IV over 2 min, may repeat 25 mg IV in 15 min (Class I)
or Metoprolol
5 mg IV, may repeat x 2: max 15 mg total (Class I)
Others to consider:Procainamide
30mg/min to 17/kg (Class IIa)
Amiodarone
150 mg over 10 min (Class IIa)orSYNCHRONIZED CARDIOVERSION (consider premedication)Monophasic:,100,200,300 jBiphasic: 70, 100, 150 j

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