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E M T S: Advanced Cardiac Life Support 2010 Guidelines
E M T S: Advanced Cardiac Life Support 2010 Guidelines
Table of Content
GENERAL TOPICS
2 Advanced Airway Management
2 Airway Care Prior to Advanced Airway
Placement
2 Airway Placement Confirmation
3 Automated External Defibrillator
1 Basic Airway Management
3 Cardioversion
9 Conveying News of Death to Family
3 Defibrillation
8 Electrical Shock & Lightning Strikes
3 Emergency Pharmacology
2 Endotracheal Tube Intubation
2 Esophageal-Tracheal Combitube
1 Evaluating Airway Delivery & Tools
7 Hypoperfusion/Shock
7 Hypothermia
2 Laryngeal Mask Airway
3 Monophasic vs. Biphasic
1 Mouth-to-Mask & Bag-Valve-Mask
9 Miscellaneous ACLS Information
1 Nasopharyngeal Airway
7 Near-Drowning
1 Opening the Airway
1 Oropharyngeal Airway
3 Pacing (TCP)
2 Pharyngotracheal Lumen Airway
3 Precordial Thump
8 Pregnancy & Cardiac Arrest
2 Sellicks (Criocoid Pressure) Maneuver
7 Special Resuscitation Situations
8 Stroke
2 Suction
1 Tidal Volume & Inspiratory Times
8 Traumatic Cardiac Arrest
3 Vascular Access
10 12-Lead EKG (Basics Only)
PHARMACOLOGY
4 ADENOSINE
5 AMIODARONE
4 ATROPINE SULFATE
5 BETA-BLOCKERS
5 CALCIUM CHANNEL BLOCKER
5 CALCIUM CHLORIDE
5 CARDIZEM (Calcium Channel Blocker)
5 DILTIAZEM (Calcium Channel Blocker)
5 DISOPYRAMIDE
6 DOBUTAMINE
6 DOPAMINE
4 EPINEPHRINE
5 ESMOLOL (Beta-Blocker)
6 FUROSEMIDE
5 LIDOCAINE
6
5
6
6
6
4
5
5
6
6
4
5
MAGNESIUM SULFATE
METOPROLOL (Beta-Blocker)
MORPHINE SULFATE
NITROGLYCERIN
NOREPINEPHRINE
OXYGEN
PROCAINAMIDE
PROPRANOLOL (Beta-Blocker)
SODIUM BICARBONATE
THROMBOLYTIC AGENTS
VASOPRESSIN
VERAPAMIL (Calcium Channel Blocker)
ALGORITHMS
11 V-Fib & Pulseless V-Tach
12 Asystole
13 Pulseless Electrical Activity
14 Bradycardia
15 Narrow Complex Tachycardia
16 V-Tach: Monomorphic & Polymorphic
17 Pulmonary Edema, Hypotension, & Shock
Head-tilt, Chin-Lift
Jaw Thrust
Page 2
Pacing (TCP)
Vascular Access
The largest and most accessible vein that does not interfere
with resuscitation efforts is the best choice. The
antecubital vein is the preferred IV site in most cardiac
arrests for initial IV placement. Complications include
extravasation, thrombosis and tissue trauma. An added
concern with IV establishment is catheter shear. Under the
current guidelines intraosseous (IO) is now acceptable on
any aged patient, if needed as a last resort.
Emergency Pharmacology
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Page 9
Page10
V-Tach
11
Asystole
Primary Assessment
Airway (basic) - Breathing - Circulation (CPR)
Epinephrine 1mg every 3-5 minutes
or
Vasopressin 40 U IV bolus given once. May substitute 1st or 2nd dose of EPI.
May resume epinephrine after 5-10 minutes.
Secondary Assessment
Airway (advanced)
Breathing (confirm by at least 2 methods)
Circulation (IV access)
pulmonary embolism
acidosis
tension pneumo
cardiac tamponade
hypovolemia
hypoxia
heat/cold
hyper/hypokalemia
hypoglycemia
MI
drug overdose
Consult needed
1mEq/kg Sodium Bicarb
Needle chest decompression
Pericardiosentesis
Fluid bolus 250-500mL may repeat
Oxygen delivery
Monitor and maintain based on condition
Consult needed
Glucose administration
STEMI protocol
Narcan 2mg may repeat
Asystole
12
pulmonary embolism
acidosis
tension pneumo
cardiac tamponade
hypovolemia
hypoxia
heat/cold
hyper/hypokalemia
hypoglycemia
MI
drug overdose
13
Bradycardia
Primary Assessment
Airway (basic) - Breathing - Circulation
Secondary Assessment
Airway (advanced)
Breathing (confirm by at least 2 methods)
Circulation (IV access)
TCP
(Rate) Dopamine 2-10mcg/kg/min
Page 14
A Vagal stimulation
A Adenosine 6mg rapid push IV, may repeat in 1-2 minutes at 12mg.
Stable Junctional tachycardia
Stable Ectopic or
Multifocal Atrial Tachycardla
15
Note!!!!!
May go directly to
cardioversion
16
Systolic BP
BP defines 2nd
line of action
2nd - Acute pulmonary edema
A Nitroglycerin/nitroprusside if
BP >100 mmHg
A Dopemine if BP = 70 to 100
mmHg, signs/symptoms of
shock
A Dobutamine if BP >100 mmHg,
no signs/symptoms of shock
Volume Problem
Pump Problem
Rate Problem
Blood
Pressure?
Go to
Bradycardia
or
Tachycardia
algorithms
Administer
A Fluids
A Blood transfusions
A Cause-specific
interventions
Consider vasopressors
17