Advanced Cardiac Life Support

(ACLS) PART II
ACP 202 Module 6
Random Questions

What are some indications for What is Peak Inspiratory

mechanical ventilation? Pressure?
 pH: 7.20
Random
Question?
PaO2: 72 CO2: 55
What is this?

HCO3: 25
Random Question?

What is the purpose of a chest tube?

What are the risks and complications of

chest tube insertion?
ACLS PART II

 Ventricular Fibrillation (VF)

 Pulseless Ventricular Tachycardia (pVT)
 Asystole
 Pulseless Electrical Activity
 Bradycardia
Managing
VF/Pulseless VT

 Two pathways
 VF/pVT (Left side of algorithm)
 Asystole/PEA (Right side of
algorithm)
 High quality CPR with minimized
interruptions
 Cerebral Perfusion Pressure (CPP)
Rhythm Checks

When do you perform a rhythm check?

The pause in chest compressions to check the rhythm should
not exceed _______ ?
Shock and Vasopressors
  Amiodarone
 300mg IV
 150mg IV
Shock and  Lidocaine
Antiarrhythmics
 1 – 1.5 mg/kg IV 1st dose
 0.5 – 0.75 mg/kg at 5 – 10 min intervals
 Maximum dose of 3mg/kg
What is this rhythm?
Physiologic monitoring

Central Venous
EtCO2 Oxygen
Saturation
Hypothermia

Is defibrillation indicated in Hypothermia?

Routes of Access for
Medications

IV/IO/ET Routes
Central Access
Administration Steps
Opioid
Associated
Emergency
Pulseless Electrical
Activity

 Rhythm Rate fast or slow

 Rhythm Wide or Narrow
 Asystole
 IV/IO access
Asystole

 Approach to Asystole
 Technical Problems
 When to with hold efforts
 Asystole as an end point
 Management of asystole
 Terminating Resuscitative Efforts
Asystole In hospital Out of hospital
termination termination
Continued

Asystole frequently in 2 situations

Case Study

 Timmy O’Toole is a 65 year old male (who oddly enough still goes by Timmy) and has developed fatigue,
diaphoresis and chest pain. On arrival to his residence you find him sitting on a chair at the table, pale and
conscious.
Case Study
Bradycardia

 Bradycardia
 “Any rhythm disorder with a heart rate less than
60/min e.g., third-degree AV block – or sinus
bradycardia. When bradycardia is the cause of
symptoms, the rate is generally less than 50/min”
 Symptomatic Bradycardia
 “Signs and symptoms due to the slow heart rate”
Bradycardia

 Identify Bradycardia
 BLS & Primary Assessment
 S/S Related To rhythm?
 Poor perfusion?
 Treatments
 Expert consultation
Bradycardia

 Identify bradycardia
 Perform your assessment
 Identify S/S of poor perfusion
  Atropine 0.5mg IV q 3-5 min max 3mg
 Sequence is determined by patient presentation

Poor Perfusion  Will with work with all brady rhythms?

 TCP – Temporizing measure
 Dopamine/Epi infusions temporizing measure
Transcutaneous
Pacing (TCP)

 When would you consider TCP?

 How do you perform TCP?
 Is there a goal rate?
 Epinephrine 2-10
Epinephrine
and
mcg/min
Dopamine
Infusions Dopamine 5-20
mcg/kg/min
Questions?
Reference

 Advanced Cardiovascular Life Support (ACLS) Provider Manual. (2016a). Advanced Cardiovascular Life
Support (ACLS) Provider Manual (16th ed.). Aha.