Comprehensive ECC Algorithm TUPI ka ee ead VENT Attempt defibrillation (up to 3 chocks if VFIVT porsicte) + Person collapses + Possible cardiac arrest + Assess responsiveness Unresponsive Begin Primary ABCD Survey (Begin BLS Algorithm) + Acthvate emergency response + Cal for defritator 1 A Assess breathing (open airway, look, listen, and feel) Not Breathing + B Give 2 slow breaths + © Assess pulse, ito pulse > Start chest compressions + D Attach monitor/defibrilator when available CPR continues + Assess rhythm American Heart Association: Fighting Hoart Disease and Stroke 70-2507 (1616) 5.01 © 2001 American Heart AscciaionVentricular Fibrillation/ ueee a neae Pulseless Ventricular Tachycardia ‘Associaton QD (VE/VT) Algorithm Fighting Heart Disease and Stroke Adult Advanced Cardiovascular Life Support lation: assess for and shock VFipulseless VT, up to 3 times (200 4 200 to 300 J, 3 39 eer open Vereey + Epinephrine 1 mq IV push, repeat every 3 to 5 minutes or + Vasopressin 40 U IV, single dose, 1 time only Resume attempts to defibrillate 1 x 360 J (or equivalent biphasic) within 30 to 60 seconds Breage urpose-made tube holders preferred Breathing: confirm effective ‘oxygenation and ventilation Circulation: establish IV access Consider antiare + Amiodarone (bx prs orooutert VFiceles V7) + Lidocaine (Indeterminate for porsitent or recurrent VF/puiscless VT) + Magnesium (bf kecwn hypomagnesemic state) + Procainamide (Indeterminate for persisont VFfpuseless VT; Ip or recurrent VFipuiseless VT) © 00 @ 7 Circulation: administer drugs Spore foe iytra ana Different Diagnosis: search ‘for and treat identified reversible causes Resume attempts to defibrillatePulseless Electrical He: Activity Algorithm Fahtng Heart aces and Stroke ETT ke ee ed Roview for most frequent causes. + “Tablets” (drug OD, accidents) + Tamponade, cardiac + Hydrogen ion — acidosis, + Tension pneumothorax + Hyper-;hypokalemia + Thrombosis, coronary (ACS) + Hypothermia + Thrombosis, pulmonary (embolism) Epinephrine 1 mg IV push, Atropine 1 mg IV if PEA rate is slow), repeat every 3 to 5 minutes repeat every 3 to 5 minutes as needed, toa total dose of 0.04 mg/kg 702507 (2016) 5.01 ©2001 Ametcan Heat Associatonfe Asystole: American Heart @ Association. The Silent Heart Algorithm Fhtng Heart Disease and Stoke PEM kee ead ‘Transcutaneous pacing: lf considered, perform immediately Epinephrine 1 mg \V push, repeat every 3 to 5 minutes _ Asystole persists Withhold or cease resuscitative efforts? Atropine 1 mg IV, + Consider quality of resuscitation? repeat every 3 to 5 minutes * Atypical clinical features present? Up to a total of 0.04 mgikg + Support for cease-ettorts protocols in place? ©2001 Amercan Heart AssoutonBradycardia Algorithm American Heart i : é Association. (Patient Not in Cardiac Arrest) Fighting Heart Disease and Stroke UMP te ed es Bradycardias + Slow (absolute bradycardia = rate <60 bpm) + Relatively slow (rate less than relative to underlying condition or cause) + Prepare for transvenous pacer + If symptoms develop, use transcuta- neous pacemaker until ransvenous. pacer placed 702507 (2150 bpm, prepare for immediate cardioversion. May give brief trial of medications based on ‘speaicarthythmias. immediate cardioversion is generaly not needed if heart rate is +150 bpm. Premedicate whenever possible ‘Synchronized cardioversion = Vasilis cca 1004, 2004, : 5a 300 J, 360 J + Paroxysmal supraventiular Peasy tachycardia | — dose (or lnc + Atrial firitation ‘equivalent biphasic + Atrial futer Notes: Etloctve regimens havo incuded a sedative (og, ofazepam, ‘mlaazolam, berbiturates, etomidate, Ketamine, methonexital) with ‘or whut an analgesic agent (eg, fentanyl, morphine, meperidine). Many excerte recommend anesthesia # service 6 ready avaiable, Both monophasic and biphasic waveorms are acceptable if documented as ciically equvalont o reports of monophasic shock success. Note possitie need 1 resynchrorize after each cardioversion. I ooiays in synchronization occur ang einica! conten ie erica, go immediataly o unsynctronized shocks. “Tea! potymorph venrculartachycarca (regular form and rate) Eke ‘Yeninuler felon: cee ventewsarfiilaton pulseless veiniclar tachyearelaalgorthin. Paroxysmal supravonticular tachycardia and atrial ter often respond to lower eneray level (start with 50 J). Steps for American Heart Associatione’ Fighting Heart Disease and Stroke Synchronized Cardioversion ™ 9. 10, 14 12, 13. 14. 15. 702807 ote) 501 Consider sedation ‘Turn on defibritator (monophasic or biphasic) ‘Attach monitor leads to the patient (white to right, red to ribs, what's left over to the left shoulder’) and ensure proper display of the patient's rhythm, Engage the synchronization mode by pressing the “sync” control button. Look for markers on R waves indicating syne mode, necessary, adjust monitor gain until syne ‘markers occur with each R wave. Select appropriate energy level - Position conductor pads on patient {or apply gel to paddles). Position paddle on patient (sternum-apex) ‘Announce to team members: “Charging defiprilator—stand clear!” Press "charge" button on apex paddle (right hand) When the defbrilator is charged, begin the ‘inal clearing chant. State frmiy ina forceful voice the folowing chant betore each shook + "Tam going to shock on three. One, I'm clear (Check to make sure you are clear Cf contact withthe patient, the stretcher, and the equipment) + “Two, you are clear.” (Make a visual check to ensure that no one continues to touch the patient or stretcher. In particular, do not forget about the person providing ven- tiations. That person’s hands should not be touching the ventilatory adjuncts, including the tracheal tube!) “Three, everybody's clear” (Check yoursel ‘one more time before pressing the “shock” buttons.) Apply 25 Ib pressure on both paddles. Press the “discharge” buttons simultaneously. (Check the monitor. If tachycardia persists, increase the joules according to the electrical cardioversion algorithm. Reset the sync mode after each synchro- nized cardioversion because most defib- rillators default back to unsynchronized ‘mode. This default allows an immediate shock ifthe cardioversion produces VF. (© 20 American Hert AsoostonTachycardia: Atrial American Hear sociation: Fibrillation and Flutter aha Onaioe ands ee Ces eine: Normal cardiac | Note 1: AF >48 hours’ | (Dose a aoa) Conse * Aa mnemerertcardiesson ures fincton rata ise agons | Se easonsson Sfoomane cameos te | + Note: Comerson oo NSA with | Use ony tof tho flour apans |” dug ost may ome alton of Sea witgon oe Soe ‘ei eran ooh ape Seopa croc Tee eo) ‘icoanamcn a Soe a tg + Canaan arts an ene card (lass ‘Guaon AP seb here ton men ly “Segre a eae “an chao ears “Foradamra sume | petyed cao + {Bebe css 9 SevGucnnercencisrae | Aezottaton : 3 wets a proper * Socaestbracceenn: eae, ‘dations, see Gudeines fe ssestak sissteeee ADS Ely cartoversion lev hepa at once Sree towakce arel cot + Confovrsion win hours + Arbsagdtion more Woks impared eant_| Dossnatanaiy Noe WAP aa irs | Conair Ack premergatcrdorrion nese Potoe ech, PB catoverson ‘congue or cot precauonse o tater oe Note 3 abo) + Amiodarone (Beas It) + ficoagultion os doses above, tahoe by = Be caracversion + roca (la I) wew Note 1 AF sab rows | Note TAF =aa hare | + OC cardiverson ~ fig ponemargnlcadversonunese Strate ise apons win | eran, use agents wa) > ‘rconguator ay cot roars ae | mero comet stynn | pte io cet ryan ry amare tater oe Note 9 abo.) ipeaerecann” |'meewemecascnm |" ae ‘recogni a0 Daten not scaning ois rece Beaty 1 Fe owing rowed ‘Sdoquieaicongution | Scouts antccapuason || agar (sv0 Mote 2 bab) | » DC cardwesion| ‘oeaso of psstie anole | fevause of possbe ambot| “Arrant (las I) Canptcaions ‘eampicators + Plocarie (Cass) OC cantoverson OC eaoveron + Prosanamade (Gast) or or Propane (Cas) + Primary aniartytimic | + Ariocarona Cassis) |... Setsol (Cas Trey 1 ote oun Ganter ny 1 ‘2 (ean be nvm) ‘rs (sn Note 2 blo: Saanoane “environ (Ces 8) 1 pelosers Pecan (Cassi) 1 Eat Bootes + BecaPemige Cas) Boar 1 Reprenore (Cass Ib) Pie 1 Sala os my Ingaied heart (Geto or CHE) ‘ies an be parts) 1S cero ‘Mecine + moder (Coste) + Gast Bootes | Boom Wr betcates Wo Parson. Whte syncrone; AF ae Roan; NSA, noral su hy: TEE, raneesophageaechocarogramy and EF eect acon [Note 2: Occasional 2 of he named arta agers ray be usd, bt use of hse agents n combaion may have preaniyeens patra The asses 'Stearpresat Us Class of Rccrmensaton rater fan the vain lame Satan ot aamyhmcs, 1© 2001 Amanesn Heart Assocatenaf American Heart Narrow-Complex “Associations Tachycardia Potting Heart Disease and Soke COMP Teak ee eed ‘Attempt therapeutic diagnostic maneuver * Vagal stimulation Preserved heart function. EF <40%, CHE heart function, EF <40%, CHE nv Preserved heart function eee} — a a EF <40%, CHF 1 702507 (of6) 501 ©2001 Amarican Heat AssocationStable Ventricular Tachycardia ae. Associations Monomorphic and PolyMorphic rnin sea: ese ane sioie EMP ke a ed Prolonged baseline QT interval (suggests torsades) Normal baseline QT interval Preserved heart function | Poor ejection fraction Normal baseline GT interval Long baseline QT interval + Treat ischomia * Correct elecirolyies + Correct abnormal electrolytes Cardiac function impaired ‘Amiodarone *+ 150 mg IV over 10 minutes or Lidocaine + 0.50 0.75 malkg IV push ‘Then use + Synchronized cardioversion ©2001 American Heart AssociationIschemic Chest Pain Algorithm American Heart Associations Fighting Hoart Disease and Stroke Adult Advanced Cardiovascular Life Support Immediate assesement(<10 minutes) «Meas vil sgrs (tosticsandrd BP ca) Moascre organ stration + Ooran v accoss + Obtain faces eco + Retr rel gts Naty and pal exam Sone nmasenay anata eee trees aa tle at getters Sian acluncve reaimenis iseinaeuias no repertison lay) | iterenoceptr biockers ae (eter 8 hours oF netted ination 0080 Fgh velume conor 1 Galuze sues! apabity Immediate general treetment POrygen at Lime fe 38 + Atloghcenn Sto spay + Hr Ye eed wan eee ee {torphine Oxygen Nirogyeara apn) ‘Start adjunctive weatments {Gs indstos no sonrandeatons) Sepann (Uren) “Raimi 6 ED chest pain tnt ‘rte montored bed n@ieiow Seal tac maiace « Ape 8a + Soglger aing tc ster aoa study (@ echocarourony or raion) “Admit io CCUimonitore bea Comino ost adunctve ‘reaimans ox ndeated + Sera caer mares Sotal ECG * Consider imaging study 2D chocarogapy odors) This algo provides general guidlines ta may no apply oa pallens. Carel Considey proper indications and conaindications. 702507 (Bot) S01 ©2001 Amevean Heat AssocationAlgorithm for Suspected Stroke Adult Advanced Cardiovascular Life Support 1 Detection Dispatch 2 Delivery, 7 é American Heart Associations Fighting Heart Disease and Stroke immediate general assessment: ‘SO minates tom arrival + Assess ABCS, val signs + Provide axygen by nasal cannula +|+ Obtain IV access obtain tod samples (CBC, sedtolies, coagulation studies) + Check blood sugar: ret ince + Obian 12ead ECG: check for arya + Perform general neurological screening assessment + Alert Svoke Team: nourlogst, acleegs, CFiecmncen + Review patient history ‘Hunt and Hess. ‘of trauma) v Data Immediate neurological assessment: <25 minutes from arrival + Establish onset (<3 hours required fr fbrinolytics) + Perform physical examination + Perform neurological examination 1 Datormine level of consciousness (Giasgow Coma Scale) Determine level of stroke severity (NIH Stroke Scale or ‘Scaie) + Order urgent noncontrast CT scan (door-1o-CT scan performed: goal <25 minutes from arrival) + Read CT scan (door-o-CT read: goal <45 minutes from arrival) + Perform lateral cervical spine xray (patient comatosejhistory Probable acute Iechomie stroke + Review for CT exclusions: are any observed? + Repeat neurological exam: are deficits variable or rapidly improving? + Review fibrinolytc exclusions: are any observed? + Review patient data: is symptom onset now >3 hows? Decision Mo blood on LP + leview rsks/bonefis with patient and family Wacceplable — ‘Begin fibrinolytic treatment (dcor-o-reatment goal <60 minutes): + Monitor neurological status: emergent CT Hf deterioration + Monitor BP; real as indicated * Admit to ertical care unt + No anticoagulants or antiplatelet treatment fr 24 hours Initiate actions for acule hemorrhage + Reverse any anticoagulants + Reverse any bleeding disordor + Monitor neurological conction ‘Treat hypertension in awake patients Initiate supportive therapy as indicated ‘Consider admiscion ‘Consider anticoagulation ‘Consider additonal conditions needing ‘reatment + Consider alternatwe diagnoses © 2001 American Heat Associaton