2013 ACLS Handbook

AIRWAY AND BREATHING

Waveform capnography
1. Measures eha!e" #$%
%. Recommen"e" for a!! &n'u(a'e" pa'&en's
). Mos' re!&a(!e *ay 'o mon&'or pa'&en's resp&ra'&ons
+. #on'&nue 'hroughou' 'he per&, arres' per&o"
Reasons 'o use *aveform capnography
1. #onf&rm p!acemen' of 'he ET 'u(e
%. De'ec' R$-# (ase" on #$% changes
). Mon&'or #.R /ua!&'y
-upp!emen'a! oygen 0espec&a!!y h&gh f!o*1
1. No' nee"e" for .$-# pa'&en's
W&'hou' resp&ra'ory "&s'ress
W&'h an -.$% 23+4
%. T&'ra'e 'o ma&n'a&n -.$% 2 3+4 &n hypo&c pa'&en's
). Hyper,oygena'&on &n R$-# pa'&en's
May re"uce cere(ra! (!oo" f!o* "ur&ng resusc&'a'&on
5ong 'erm may crea'e oygen 'o&c&'y
App!y oygen 'o pa'&en's *&'h A#- 'ha'6
Have an oygen sa'ura'&on 7 3+4
Are &n car"&ac or resp&ra'ory fa&!ure
ACLS CHANGES 2010
2013 ACLS Handbook
.HARMA#$5$GY
A'rop&ne
1. Is no' recommen"e" for .EA an" asys'o!e
%. Has (een remove" from 'he a!gor&'hms
). Ev&"ence sugges's no 'herapeu'&c (enef&'
A"enos&ne
1. May (e use" &n &n&'&a! "&agnos&s of s'a(!e monomorph&c *&"e comp!e
'achycar"&a
%. I' shou!" no' (e use" &f pa''ern &s &rregu!ar
). May (e use" 'o "&agnose an" 'rea' *&"e comp!e 'achycar"&a for -8T *&'h
a(erran' con"uc'&on
Dopam&ne an" ep&nephr&ne &nfus&ons
1. Recommen"e" as an a!'erna'&ve 'o pac&ng for a!! symp'oma'&c
(ra"ycar"&as
%. E&'her "opam&ne or ep&nephr&ne &nfus&ons may (e use"
Morph&ne
1. #au'&on &n a!! non,-TEMI pa'&en's *&'h uns'a(!e ang&na
%. Morph&ne &s &n"&ca'e" for -TEMI pa'&en's *&'h ches' "&scomfor' no' re!&eve"
(y n&'ra'es
ACLS CHANGES 2010
2013 ACLS Handbook
DE9IBRI55ATI$N AND #ARDI$8ER-I$N
8en'r&cu!ar 'achycar"&a
1. -'a(!e monomorph&c 8Tach : car"&over'
%. -'ar' a' 1;;< an" &ncrease s'ep*&se
). A (&phas&c "ose has (een a""e"
+. Trea' po!ymorph&c 8Tach *&'h unsynchron&=e"
shoc>
A,f&( an" A :f!u''er
1. Recommen"e" (&phas&c "ose A,f&( 1%; : %;; <
%. In&'&a! "ose for monophas&c car"&overs&on &s %;;<
). A'r&a! f!u''er an" -8T 0 ?;,1;;@1 e&'her
monophas&c or (&phas&c
ACLS CHANGES 2010
2013 ACLS Handbook
#HAIN $9 -AR8I8A5
Ear!y recogn&'&on of car"&ac arres'
Ear!y /ua!&'y #.R
Rap&" "ef&(r&!!a'&on
Effec'&ve a"vance" !&fe suppor'
In'egra'e" pos' arres' care
MEDI#A5 RE-.$N-E TEAM
.urpose
Improve pa'&en' ou'comes (y &"en'&fy&ng an" 'rea'&ng ear!y
c!&n&ca! "e'er&ora'&on
Team
The 'eam &s compose" of spec&a!&=e" an" h&gh!y 'ra&ne"
profess&ona! personne! cover&ng me"&ca! an" resp&ra'ory
"&sc&p!&nes
SYSTEMS OF CARE
2013 ACLS Handbook
GENERA5
If pa'&en' &s unconsc&ous
Ase B5- survey for &n&'&a! assessmen'
Ase A#5- survey for a"vance" assessmen'
If pa'&en' &s consc&ous
Ase A#5- survey for &n&'&a! assessmen'
B5- -AR8EY
#hec> respons&veness
Ac'&va'e 311 an" ge' 'he AED
#&rcu!a'&on
#hec> for caro'&" pu!se 7 1; secon"s
-'ar' #.R
Def&(r&!!a'&on
If no pu!se assess shoc> a(!e rhy'hm B AED
.rov&"e shoc> &f &n"&ca'e"
Resume #.R fo!!o*&ng shoc>s
BLS AND ACLS SURVEYS
2013 ACLS Handbook
A#5- -AR8EY
A&r*ay
A&r*ay pa'en'
Is an a"vance" a&r*ay &n"&ca'e"
#onf&rm an" secure 'u(e
Brea'h&ng
A"e/ua'e oygena'&on an" ven'&!a'&onC
Arres' 1;;4 $% :Non arres' $% &f -.$% 73+4
#&rcu!a'&on
A"e/ua'e ches' compress&ons &f &n arres'
Rhy'hm &n'erpre'a'&on B 1% !ea"
Is "ef&(r&!!a'&onD car"&overs&onD pac&ng &n"&ca'e"
Has I8BI$ (een es'a(!&she"
A"m&n&s'er f!u&"s an" me"&ca'&ons
D&fferen'&a! "&agnos&s
Why "&" pa'&en' "eve!op symp'oms or arres'
Is 'here a revers&(!e cause 'ha' can (e 'rea'e"
BLS AND ACLS SURVEYS
2013 ACLS Handbook
$.ENING THE AIRWAY
No ev&"ence of 'rauma0Hea" '&!' ch&n !&f'1
Ev&"ence of 'rauma 0<a* 'hrus'1
AIRTWAY AND BREATHING
2013 ACLS Handbook
B5- AIRWAY MAINTENE#E
$ropharyngea!
Eeeps 'ongue from (!oc>&ng 'he a&r*ay
In"&ca'&ons
Anconsc&ous pa'&en'
A(sence of a gag ref!e
-&=&ng
#orner of 'he mou'h 'o 'he ang!e of 'he
man"&(!e
Inser'&on
Aps&"e "o*n 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'
-&"e*ays 'o uvu!a 'hen ro'a'e 'o fu!!y &nser'
Mus' (e f!ush *&'h 'he mou'h
AIRWAY AND BREATHING
2013 ACLS Handbook
B5- AIRWAY MAINTENAN#E
NA-$.HARANGEA5
In"&ca'&ons
#onsc&ous or sem& consc&ous pa'&en'
.a'&en' *&'h a gag ref!e
-&=&ng
Nose 'o 'ragus of 'he ear
Inser'&on
5u(r&ca'e *e!!
#hoose 'he !arges' nos'r&!
Gen'!y use a sp&ra! mo'&on 'o &nser'
#hec> pa'&en' ven'&!a'&on
If res&s'ance &s encoun'ere" remove an" 'ry 'he
o'her nos'r&!
#au'&on
Do no' use on pa'&en's *&'h ser&ous hea" &n@ur&es
#on'ra&n"&ca'e" *&'h (as&!ar s>u!! frac'ures
AIRWAY AND BREATHING
2013 ACLS Handbook
B5- AIRWAY MAINTENAN#E
-A#TI$NING
-of' ca'he'ers
Asp&ra'es 'h&n secre'&ons oro an" naso pharyn
.erform&ng en"o'rachea! suc'&on&ng
-uc'&on 'hrough an &n p!ace a&r*ay
R&g&" ca'he'ers
-uc'&on&ng oropharynD 'h&c> par'&cu!a'e ma''er
En"o'rachea! suc'&on&ng
Ase s'er&!e 'echn&/ue
Inser' ca'he'er &n'o 'he en"o'rachea! 'u(e
Ase 'he !arges' 'u(e poss&(!e
Do no' &nser' (e!o* 'he en" of 'he ET 'u(e
Be sure open&ng &s no' occ!u"e" "ur&ng &nser'&on
App!y suc'&on&ng (y occ!u"&ng 'he
ca'he'er open&ng "ur&ng *&'h"ra*a!
Do no' suc'&on !onger 'han 1; secon"s
AIRWAY AND BREATHING
2013 ACLS Handbook
AD8AN#ED AIRWAY-
-A.RAG5$TI#
#om(&'u(e
E&ng a&r*ay
5MA 0!aryngea! mas> a&r*ay1
-A5T a&r*ay
NA-$TRA#HEA5 INTABATI$N
#onsc&ous or sem& consc&ous pa'&en's
Inser' &n !arges' nos'r&! 05u(r&ca'e *e!!1
Do no' use a s'y!e''e
G!o''&c open&ng !oca'e" (y soun" an" vapor &n 'he
'u(e
Mos' usefu! &n pu!monary e"ema an" pa'&en's
una(!e 'o open 'he mou'h
-'op &nser'&on &f res&s'ance &s encoun'ere"
#on'ra&n"&ca'e" &n hea" 'rauma
AIRWAY AND BREATHING
2013 ACLS Handbook
AD8AN#ED AIRWAY-
END$TRA#HEA5 INTABATI$N
Essen'&a! for unconsc&ous pa'&en's
May (e use" on consc&ous pa'&en's *&'h R-I
0Rap&" se/uence &n'u(a'&on1
.erforme" *&'h
5aryngoscope
M&!!er (!a"e , s'ra&gh'
Mac&n'osh (!a"e : curve"
#hec> scope pr&or 'o &nser'&on
En"o'rachea! 'u(e
Tr&a! &nf!a'e 'he 'u(e cuff pr&or 'o &nser'&on
-'y!e''e
1; cc syr&nge
5u(r&can'
#onf&rm p!acemen'
Auscu!'a'&on
#apnography
#hes' ray
-ecure 'he 'u(e
AIRWAY AND BREATHING
2013 ACLS Handbook
8ENTI5ATI$N 0B5-1
Mou'h 'o mou'h an" mou'h 'o mas>
Does no' preven' "&sease 'ransm&ss&on
Mus' prov&"e a goo" sea!
De!&ver enough (rea'h 'o ma>e 'he ches' r&se
Your eha!e" (rea'h can on!y supp!y 1F4 oygen
Am(u (ag
-afes' me'ho" 'o preven' "&sease 'ransm&ss&on
#an supp!y 1;;4 oygen
$pen 'he a&r*ay
#omp!e'e!y sea! 'he mas>
De!&ver (rea'h vo!ume enough 'o ma>e 'he ches'
r&se
Each (rea'h shou!" (e 1 secon" "ura'&on
Re/u&res % rescuers 'o assure a goo" mas> sea!
AIRWAY AND BREATHING
2013 ACLS Handbook
8ENTI5ATI$N 0A#5-1
Au'oma'e" pneuma'&c ven'&!a'ors
.rov&"es au'oma'&c ven'&!a'&on 'o &n'u(a'e"
pa'&en's
-e's ra'eD '&"a! vo!umeD .EE. pressureD 9&$% an"
m&nu'e vo!ume
#.A.
.rov&"es .EE. 0pos&'&ve en" ep&ra'ory pressure1
Re/u&res a mas> an" a #.A. mach&ne
Mos' usefu! for consc&ous pu!monary e"ema
pa'&en's
Epan"s 'erm&na! (ronch& an" a!veo!ar sacs
BI.A.
.rov&"es (o'h pos&'&ve &nsp&ra'ory an" ep&ra'ory
pressure
Mos' usefu! on as'hma'&c an" #$.DD an"
pneumon&a pa'&en's 'ha' re/u&re a""&'&ona!
&nsp&ra'ory pressure suppor' *&'h .EE..
AIRWAY AND BREATHING
2013 ACLS Handbook
Why use *aveform capnography
#apnography measures #$% resu!'&ng from (rea'h&ng
I' &s 'he on!y accura'e *ay 'o assess (rea'h&ng
AHA re/u&res &' on a!! &n'u(a'e" pa'&en's
Ho* *aveform capnography *or>s
#$% &s a(sor(e" &n 'he IR a' +.) nm
Eha!e" (as passes 'hrough an IR a"ap'or a''ache" 'o
'he ET 'u(e
Th&s prov&"es an e!ec'r&ca! s&gna! 'o 'he car"&ac mon&'or
The mon&'or prov&"es eha!e" #$%D resp&ra'&on ra'e an"
a capnograph&c *aveform ana!ys&s
Waveform capnography &s use" 'o
Measure #$% !eve!
De'erm&ne 'he resp&ra'&on ra'e
-ho* 'he capnography *aveform
In"&ca'e a m&sse" 'u(e
To &n"&ca'e a m&sse" &n'u(a'&on
WAVEFORM CANOGRAHY
2013 ACLS Handbook
MANAA5 M$NIT$R B DE9IBRI55$R-
Genera!
A!! manua! mon&'or "ef&(r&!!a'ors prov&"e
'he same func'&ons
You mus' (ecome fam&!&ar *&'h 'he one
'ha' you use
Mo"es
Bas&c )D+ !ea"s for rhy'hm &n'erpre'a'&on
A 1% !ea" capa(&!&'y
A "ef&(r&!!a'or mo"e
#ar"&overs&on : synchron&=e"
Def&(r&!!a'&on , unsynchron&=e"
A pac&ng mo"e
-e's 'he ra'e
Increases curren' 'o o('a&n cap'ure
ELECTRICAL THERAY
2013 ACLS Handbook
MANAA5 M$NIT$R B DE9IBRI55AT$R-
)D +D an" ? !ea" p!acemen'
) !ea" RA 0*h&'e1 5A 0(!ac>1 55 0re"1
+ !ea" RA 0*h&'e1 5A 0(!ac>1 550re"1 R5 0green1
? !ea" RA 0*h&'e1 5A 0*h&'e1 550re"1 R5 0green1 81
0(ro*n1
ELECTRICAL THERAY
2013 ACLS Handbook
1% 5EAD .5A#EMENT 5E9T -IDE
1% 5EAD .5A#EMENT RIGHT -IDE
ELECTRICAL THERAY
2013 ACLS Handbook
#ARDI$8ER-I$N
#ar"&overs&on &s use" 'o 'rea' rap&" hear'(ea's 'ha'
are no' re!a'e" 'o a 'rea'a(!e cause an" comprom&se
hemos'as&s
To car"&over' 'he un&' mus' (e &n 'he DE9IB mo"e
Be sure 'o push 'he -YN# (u''on (efore your &n&'&a!
"ose an" aga&n (efore each su(se/uen' "ose.
9a&!ure 'o push 'he -YN# (u''on *&!! resu!' &n
"ef&(r&!!a'&on
When 'he un&' &s &n 'he sync mo"e a !&gh' *&!! appear
over each R *ave as sho*n.
ELECTRICAL THERAY
2013 ACLS Handbook
#ARDI$8ER-I$N
If 'he pa'&en' &s consc&ous cons&"er se"a'&on
8a!&um or verse"
#harge 'he un&' 'o 'he appropr&a'e @ou!e !eve!
Be sure 'ha' 'he un&' &s &n 'he synchron&=e"
mo"e
Be sure 'ha' everyone &s c!ear or 'he pa'&en'
IM #5EAR Y$AR #5EAR WERE A55 #5EAR
De!&ver 'he charge
Ho!" 'he charge (u''on un'&! 'he R *ave cap'ures
If you &ncrease 'o 'he ne' @ou!e !eve! (e sure
'o re synchron&=e.
ELECTRICAL THERAY
2013 ACLS Handbook
EGTERNA5 .A#ING
E'erna! pac&ng &s "one us&ng mu!'&func'&on pa"s
The an'er&or pos'er&or pos&'&on for pa" !oca'&on &s
mos' effec'&ve
-e"a'e 'he pa'&en' &f consc&ous
-e' a hear' ra'e of a' !eas' F; (ea's per m&nu'e
A"@us' 'he curren' un'&! (o'h e!ec'r&ca! an"
mechan&ca! cap'ure &s a''a&ne"
Mechan&ca! cap occurs *hen a caro'&" pu!se &s fe!'
'ha' ma'ches 'he se' ra'e
-*&'ch 'o 'rans ,venous pac&ng A-A.
#on'ra&n"&ca'&ons
Asys'o!e
.u!se!ess 8Tach
-&"e effec's
->&n (urns
#hes' musc!e con'rac'&on
#hes' "&scomfor'
ELECTRICAL THERAY
2013 ACLS Handbook
DE9IBRI55ATI$N
Ho* "ef&(r&!!a'&on *or>s
An e!ec'r&ca! charge &s p!ace" across 'he hear'
Th&s crea'es asys'o!e
E&'her 'he hear' *&!! rema&n &n asys'o!e or a ne*
rhy'hm *&!! occur
Rhy'hms 'ha' re/u&re ear!y "ef&(r&!!a'&on
8en'r&cu!ar f&(r&!!a'&on
.u!se!ess ven'r&cu!ar 'achycar"&a
Mu!'& form ven'r&cu!ar 'achycar"&a 0Torsa"es1
ELECTRICAL THERAY
2013 ACLS Handbook
DE9IBRI55ATI$N
.a" con'ac'
Goo" pa" con'ac' &s essen'&a! for successfu!
"ef&(r&!!a'&on.
Be sure 'o "ry 'he pa'&en' (efore app!y&ng 'he pa"s
-have ches' ha&rs &n pa" app!&ca'&on areas
Remove any n&'ro pas'e or o&n'men's
Avo&" pacema>er !oca'&ons
.a" p!acemen'
.a"s may (e p!ace" &n e&'her 'he an'er&or an'er&or or
'he an'er&or pos'er&or pos&'&on
The an'er&or pos'er&or pos&'&on &s preferen'&a! &f pac&ng &s
an'&c&pa'e"
ELECTRICAL THERAY
2013 ACLS Handbook
DE9IBRI55ATI$N
Def&(r&!!a'or opera'&on
-e' 'he un&' &n 'he "ef&(r&!!a'or mo"e
#harge 'he "ef&(r&!!a'or
#!ear 'he pa'&en' (efore a"m&n&s'er&ng 'he
shoc>
Th&s &nc!u"es any'h&ng 'ouch&ng 'he pa'&en'
IM #5EAR Y$AR #5EAR WERE A55 #5EAR
De!&ver 'he shoc>
Remem(er
Do #.R *h&!e 'he "ef&(r&!!a'or &s charg&ng
-'ar' #.R &mme"&a'e!y af'er 'he shoc> &s
"e!&vere"
ELECTRICAL THERAY
2013 ACLS Handbook
GENERA5
The pharmaco!og&ca! approach
Wor>s *e!! for non, arres' pa'&en's
Is s!o*er ac'&ng &n arres'e" pa'&en's
9ac'ors con'r&(u'&ng 'o pharmaco!og&ca!
success
The /ua!&'y of #.R
The "o*n '&me (efore me"&ca'&on
a"m&n&s'ra'&on
The con"&'&on of 'he pa'&en'Hs ar'er&es
MEDI#ATI$N A##E-- R$ATE-
In'ravenous
G&ve me"&ca'&ons 'hrough !arge (ore I8H-
The preferre" s&'es are
An'ecu(&'a!
E'erna! @ugu!ar
Try 'o s'ar' I8H- (efore arres' occurs
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N A##E-- R$ATE-
In'ra,osseous 0I$1 access
D&rec' &n@ec'&on 'hrough 'he (one *a!! &n'o 'he
(one marro* venous p!e&s
-afe an" re!&a(!e
You can a"m&n&s'er f!u&"sD co!!o&"sD an" a!!
me"&ca'&ons
In"&ca'&ons for I$ access
Ina(&!&'y 'o ach&eve I8 access
.rev&ous!y re/u&re" cen'ra! !&nes
Emergen' nee" for "rugs or f!u&"s
#ar"&ac arres' *&'hou' I8 access
#on'ra&n"&ca'&ons 'o I$
9rac'ure &n 'he e'rem&'y
.rev&ous &nser'&on a''emp' &n 'he same (one
Infec'&on a' 'he &n@ec'&on s&'e
Ina(&!&'y 'o !oca'e !an"mar>s or ecess&ve '&ssue
HARMACOLOGY
2013 ACLS Handbook
In'ra,osseous "ev&ces
<amsh&"& nee"!e
BIG 0Bone &n@ec'&on gun1
EII$ 0In@ec'&on "r&!!1
In'ra,osseous &n@ec'&on s&'es
.ro&ma! '&(&a
D&s'a! '&(&a a(ove 'he me"&a! ma!!eo!us
Hea" of 'he humerus
HARMACOLOGY
2013 ACLS Handbook
INTRA,$--E$A-
#onf&rma'&on of ca'he'er p!acemen'
#a'he'er &s f&rm!y sea'e" &n 'he (one
9!ash of (!oo" or (one marro*
.ressur&=e" f!u&"s f!o* *&'hou' "&ff&cu!'y
.harmaco!og&ca! effec's are no'e"
Af'er I$ &nser'&on
-'a(&!&=e I$
Remove 'rocar
Asp&ra'e 'he I$
A''ach a shor' connec'&ng 'u(&ng *&'h a ) *ay
s'opcoc>
9!ush I$ 'o &nsure pa'ency
.ressur&=e" f!u&"s shou!" f!o* free!y
There shou!" (e no ev&"ence of e'ravas&on
9or consc&ous pa'&en's cons&"er !&"oca&ne for pa&n
9!ush *&'h 1;,%; cc N.-. af'er each me"&ca'&on
HARMACOLOGT
2013 ACLS Handbook
END$TRA#HEA5 R$ATE
5eas' effec'&ve rou'e of a"m&n&s'ra'&on
Me"s 'ha' can (e g&ven ET 0NA8E51
Narcan
A'rop&ne
8asopress&n
Ep&nephr&ne
5&"oca&ne
Ru!es for ET a"m&n&s'ra'&on
Ase %,%.? '&mes 'he I8 "ose 0ecep'
vasopress&n1
-'op compress&ons
Ase 1; m! 'o'a! vo!ume 0"&!u'e *&'h N.-. or
s'er&!e *a'er1
8en'&!a'e severa! '&mes
Resume compress&ons
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N- T$ -TIMA5ATE THE HEART
E.INE.HERINE
In"&ca'&ons
#ar"&ac arres'
Bra"ycar"&a refrac'ory 'o a'rop&ne an" T#.
Ac'&ons
Increases hear' ra'eD con'rac'&!&'yD au'oma'&c&'y an"
vasocons'r&c'&on
Dose
1,) mg every ),? m&nu'es
Infus&on
M& J mg B?;;m! &n D?W or N.-.
Infuse a' %,1; mcgBm&n for (ra"ycar"&a
Infuse a' J,+; mcg B m&n for hypo'ens&on
Rou'e
I8 or I$
-&"e effec's
Tachycar"&a
Hyper'ens&on
.8-H-
Increase" oygen "eman"
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N- T$ -TIMA5ATE THE HEART
8A-$.RE--IN
#!ass&f&ca'&on
An'&"&ure'&c hormone
Non, a"renerg&c vasocons'r&c'or
In"&ca'&ons
#ar"&ac arres' as an a!'erna'&ve 'o ep&nephr&ne
Ac'&ons
8asocons'r&c'&on, s'&mu!a'es smoo'h musc!e
recep'ors
Increases coronary perfus&on "ur&ng #.R
Increases v&'a! organ (!oo" f!o* an" cere(ra!
oygen
Dosage : +; un&'s
Rou'e : I8D I$D ET
-&"e effec's :.o'en'&a! vasocons'r&c'&on
HARMACOLOGY
2013 ACLS Handbook
ANTI,ARRHYTHMIA MEDI#ATI$N-
AMI$DAR$NE 0#$RDAR$NE1
#!ass&f&ca'&on : an'&,"ysrhy'hm&c
In"&ca'&ons
8TB89
Rap&" a'r&a! arrhy'hm&as
Ac'&ons
.ro!ongs recovery per&o" of car"&ac ce!!s
Affec's so"&umD po'ass&umD an" ca!c&um channe!s
Affec's a!pha an" (e'a
Dosage 0I8BI$1
#ar"&ac arres', );; mg &n 1; m! Repea' 1?; mg ),? m&n
.erfus&ng pa'&en's 1?; mg over 1; m&n. Repea' &n 1; m&n.
Infus&on 03;; mg B ?;; m!1
1 mg B m&n for F hours 'hen ;.? mg Bm&n for 1J hours
-&"e effec's
HTND (ra"ycar"&aD A8 (!oc>sD #H9D arrhy'hm&as
#on'ra&n"&ca'&ons
#ar"&ogen&c shoc>
-econ" or 'h&r" "egree hear' (!oc>s
HARMACOLOGY
2013 ACLS Handbook
ANTI,ARRHYTHMIA MEDI#ATI$N-
5ID$#AINE
#!ass&f&ca'&on
An'&,"ysrhy'hm&c
In"&ca'&ons
8TD 89D .8#H-
Ac'&ons
-o"&um channe! (!oc>er
Depresses ven'r&cu!ar &rr&'a(&!&'y an" au'oma'&c&'y
Dosage
#ar"&ac arres', 1,1.? mgB>g repea' ha!f "ose 'o )mgB>g
8T B.8#H- ;.?,;.K? mgB>g L ?,1; m&n as nee"e"
Infus&on
Ma&n'enance : M& % gm B?;;m! 0+mgBm!1
Infuse a' 1,+ mgBm&n 01?,F; m!Bhr1
Rou'e
I8DI$DET
-&"e effec's
Musc!e 'remors
se&=ures
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N- T$ #$NTR$5 HEART RATE
ATR$.INE
#!ass&f&ca'&on
.arasympa'he'&c (!oc>er
In"&ca'&ons
-ymp'oma'&c (ra"ycar"&a
Ac'&on
Increases hear' ra'e an" con"uc'&on
'hrough 'he A8 no"e
Dosage
;.? mg Repea' every ),? m&nu'es
Ma&mum "ose ) mg
Rou'e
I8DI$DET
-&"e effec's
Tachycar"&aD "&!a'e" pup&!sD ang&na
-ma!! "oses may cause (ra"ycar"&a
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N- THAT #$NTR$5 HEART RATE
ADEN$#ARD 0ADEN$-INE1
#!ass&f&ca'&on
An'&,"ysrhy'hm&c
In"&ca'&ons
-8T 0-pec&f&ca!!y a'r&a! 'achycar"&a1
W&"e comp!e un"&agnose" 'achycar"&a
Ac'&on
A(o!&shes reen'ry
-!o*s A8 con"uc'&on
Dosage
Fmg rap&" I8 push fo!!o*e" (y a sa!&ne f!ush
1% mg I8 rap&" push fo!!o*e" (y a sa!&ne f!ush
Rou'e
I8D I$D Rap&" push
-&"e effec's
Br&ef per&o" of asys'o!e
Trans&en' reen'ry "ysrhy'hm&as
#hes' pa&nD pa!p&'a'&onsD f!ush&ng
HARMACOLOGY
2013 ACLS Handbook
MEDI#ATI$N- THAT #$NTR$5 HEART RATE
#ARDIIEM 0DI5TIAIEM1
#!ass&f&ca'&on
An'&,"ysrhy'hm&c
In"&ca'&ons
-8T 0Espec&a!!y A,f&( an" A, f!u''er1
Ac'&on
#a!c&um channe! an'agon&s'
-!o*s con"uc'&on
-moo'h musc!e "&!a'&on
Dosage
G&ve ;.%? mgB>g over % m&nu'es 01?,%; mg1
May repea' ;.)? mgB>g &n 1? m&nu'es
Infuse 1%? mgB1;;m! a' ?,1? mgBhr
Rou'e
-!o* push fo!!o*e" (y an &nfus&on
-&"e effec's
Bra"ycar"&a
Hypo'ens&on
HARMACOLOGY
2013 ACLS Handbook
E5E#TR$5YTE-
-$DIAM BI#ARB$NATE
#!ass&f&ca'&on
A!>a!&=erD (uffer
In"&ca'&ons
Me'a(o!&c ac&"os&s
Tr&cyc!&c an'&"epressan' over"ose
Hyper>a!em&a
Ac'&on
Increases pH revers&ng ac&"os&s
Dosage
1 mE/B>g &v pushD 'hen ;.? mE/B>g every 1;
m&nu'es
May g&ve as an &nfus&on for cer'a&n over"oses
Rou'e
I8 push or &nfus&on
-&"e effec's
Hyperna'rem&aD hyperosmo!a!&'y
Me'a(o!&c a!>a!os&s
HARMACOLOGY
2013 ACLS Handbook
E5E#TR$5YTE-
#A5#IAM #H5$RIDE
#!ass&f&ca'&on
E!ec'ro!y'e
In"&ca'&ons
Hypoca!cem&a
Hyper>a!em&a
Hypermagnesem&a
#a!c&um channe! (!oc>er over"ose
Ac'&on
Increase" &no'rop&c force an" con'rac'&!&'y
Dosage
%,+ mgB>g of a 1;4 so!u'&on. Repea' &n 1; m&n. &f
re/u&re"
Asua! "ose &s ?;;mg 'o 1 gm
Rou'e
I8DI$
-&"e effec's
Hyperca!cem&a
8en'r&cu!ar f&(r&!!a'&on
Eacer(a'es "&g&'a!&s 'o&c&'y
HARMACOLOGY
2013 ACLS Handbook
E5E#TR$5YTE-
MAGNE-IAM -A59ATE
#!ass&f&ca'&on
An'&,"ysrhy'hm&c B e!ec'ro!y'e
In"&ca'&ons
Refrac'ory "ysrhy'hm&as
Torsa"es
Hypomagnesem&a
Ac'&on
-'a(&!&=es '&ssue mem(ranes
Ra&ses magnes&um !eve!s
-moo'h musc!e re!aan'
Dosage
89 Bpu!se!ess 8T : 1,% gm over 1,% m&nu'es
8T *&'h pu!se : 1,% gm &n 1; m! over 1,% m&nu'es
Hypomagnesem&a *Bo ec'opy ;.?,1 mgBhr &nfus&on
Rou'e
I8 or &nfus&on
-&"e effec's
Bra"ycar"&a
Hypo'ens&on
#au'&on
.a'&en's *&'h !&''!e or no ur&ne ou'pu'
HARMACOLOGY
2013 ACLS Handbook
8A-$.RE--$R-
D$.AMINE
#!ass&f&ca'&on
A"renerg&c s'&mu!a'or B &no'rope
In"&ca'&ons
-ymp'oma'&c hypo'ens&on 0-B.K;,1;; -hoc>1
Refrac'ory (ra"ycar"&a
Ac'&on
Dopam&nerg&c 01,% mcgB>gBm&n1 D&!a'es rena! ar'er&es an"
mesen'ery
Be'a, %,1; mcgB>gBm&n Increase" hear' ra'e an" car"&ac
ou'pu'
A!pha, 1;,%; mcgB>gBm&n 8asocons'r&c'&on &ncrease"
af'er!oa"
Dosage
%,%; mcgB>gBm&n 0usua! s'ar' "ose ,?mcgB>gBm&n1
Es'&ma'e s'ar' "ose as 1;4 of 'he pa'&en'Hs *e&gh'
Rou'e
I8D I$ &nfus&on on!y
-&"e effec's
#hes' pa&n
Tachycar"&a
Hyper'ens&on
.8#H-
HARMACOLOGY
2013 ACLS Handbook
8A-$.RE--$R-
N$RE.INE.HERINE 05E8$.HED1
#!ass&f&ca'&on
8asopressor
In"&ca'&ons
Hypo'ens&on refrac'ory 'o "opam&ne
-B. 7K; mmHg an" !o* per&phera! res&s'ance
Ac'&on
.r&mar&!y a!pha
Dosage
M& + mgB%?;m! D?W or N.-.
Infuse a' ;.1,;.? mcgB>gBm&n
Rou'e
I8 &nfus&on on!y
-&"e effec's
Increase" myocar"&a! *or> !oa" an" $% "eman"
-evere '&ssue necros&s &f &nf&!'ra'e"
HARMACOLOGY
2013 ACLS Handbook
8A-$.RE--$R-
D$BATAMINE 0D$BATEREG1
#!ass&f&ca'&on
A"renerg&c s'&mu!a'or
In"&ca'&ons
#H9 *&'h hypo'ens&on
Hypo'ens&on -B. 7 K;,1;; mmHg *&'h no s&gns of
shoc>
Ac'&on
.r&mar&!y (e'a
Increase &n s'ro>e vo!ume *Bo &ncrease &n hear' ra'e
Dosage
M& ?;; mgB %?;m! D?W M %;;; mcgBm!
Infuse a' %,%; mcgBm! 0average M + m!Bhr1
Rou'e
I8 &nfus&on on!y
-&"e effec's
Tachycar"&a
#hes' pa&ns
.a!p&'a'&ons
HARMACOLOGY
2013 ACLS Handbook
8A-$DI5AT$R-
NITR$G5Y#ERINE 0N&'ros'a'D Tr&"&!1
#!ass&f&ca'&on
An'&hyper'ens&ve
In"&ca'&ons
Ang&naD MID #H9
Ac'&on
-moo'h musc!e "&!a'or
Re"uces pre!oa" an" af'er!oa"
Re"uces ar'ery spasm
Dosage
Ta(!e' B spray 1 -5 every ? m&nu'es
1 &nch of n&'ro pas'e
Infus&on : M& ?; mg &n %?; m!.
-'ar' a' 1; mcgBm&n 0)m!Bhr1
Rou'e
-5D I8 &nfus&onD pas'e
-&"e effec's
Hypo'ens&onD hea"acheD 'achycar"&a
#au'&on
Erec'&!e "ysfunc'&on "rugs
R&gh' s&"e" &nfarc'
HARMACOLOGY
2013 ACLS Handbook
8A-$DI5AT$R-
NITR$.RA--IDE 0NI.RIDE1
#!ass&f&ca'&on
An'&,hyper'ens&ve
In"&ca'&ons
Hyper'ens&on
#H9 *&'h pu!monary e"ema
Ac'&on
-moo'h musc!e "&!a'or
Decreases pre!oa" an" af'er!oa"
Wor>s more &n 'he ar'er&es 'han 'he ve&ns
Dosage
Infus&on : M& ?; mg B %?;m! D?WM %;;mcgBm!
-'ar' a' ;.? : ;.J mcgB>gBm&n
Rou'e
I8 &nfus&on on!y
-&"e effec's
Hypo'ens&on
Hea"ache
#yan&"e 'o&c&'y
HARMACOLOGY
2013 ACLS Handbook
8A-$DI5AT$R-
A#E INHIBIT$R- 0Ena!apr&!D #ap'opr&!D 5&s&nopr&!1
#!ass&f&ca'&on
An'&,hyper'ens&ve
In"&ca'&on
Hyper'ens&onN#H9
.os' MI
Ac'&on
.reven's convers&on of ang&o'ens&on I 'o ang&o'ens&on II
-uppresses ren&n, ang&o'ens&on a!"os'erone sys'em
Dosage
Ena!apr&!, ?,+; mg .$
;.F%?,1.%?mg I8 over ? m&n. every F hours
#ap'opr&! : 1%.?,?; mg .$ BIDBTIB
5&s&nopr&!, 1;,+; mg .$ OB"ay
Rou'e
I8D .$
-&"e effec's
Hypo'ens&on
#hes' pa&n
Tachycar"&a an" "ysrhy'hm&as
HARMACOLOGY
2013 ACLS Handbook
DIEARETI#-
9AR$-EMIDE 05A-IG1
#!ass&f&ca'&on
5oop "&ure'&c
In"&ca'&ons
.u!monary e"ema
Ac'&on
8aso"&!a'&on : re"uce" venous pressure
Inh&(&'s rea(sorp'&on of so"&um &n 'he >&"neys
Dosage
+; : J; mg0&ncrease &n %; mg &ncremen's1
Rou'e
I8 s!o* push
-&"e effec's
Dehy"ra'&on
T&nn&'us
Hypo>a!em&a
HARMACOLOGY
2013 ACLS Handbook
ANA5GE-I#-
M$R.HINE
#!ass&f&ca'&on
Narco'&c ana!ges&c
In"&ca'&ons
#hes' pa&n "ur&ng a -TEMI unre!&eve" (y
n&'rog!ycer&ne
.u!monary e"ema
Ac'&on
.o'en' ana!ges&c
.romo'es venous poo!&ng : re"uces pre!oa"
Re"uces an&e'y
Dosage
%,+ mg &n % mg &ncremen's
Rou'e
-!o* I8 push
-&"e effec's
Resp&ra'ory "epress&onD nausea an" hypo'ens&on
#au'&on : uns'a(!e ang&na B non -T e!eva'e"
pa'&en's 0mor'a!&'y1
HARMACOLOGY
2013 ACLS Handbook
ANA5GE-I#-
DI5AADID
#!ass&f&ca'&on
$p&o&" ana!ges&c
In"&ca'&ons
#hes' pa&n "ur&ng a -TEMI unre!&eve" (y
n&'rog!ycer&ne
.u!monary e"ema
Ac'&on
.o'en' ana!ges&c much s'ronger 'ha' morph&ne
) mg D&!au"&" M %; mg morph&ne
Re"uces an&e'y
Does no' a!'er (!oo" pressure
Dosage
;.? : 1 mg s!o* I8 push
Rou'e
-!o* I8 push
-&"e effec's
Resp&ra'ory "epress&on
#au'&on *&'h e!"er!y pa'&en's
Rap&" push &n "oses a(ove 1 mg may (e a pro(!em
HARMACOLOGY
2013 ACLS Handbook
BETA B5$#EER-
#ommon (e'a (!oc>ers
Me'opro!o! 05opressor1
-o'a!o! 0Be'apace1
Esmo!o! 0(rev& (!oc>1
In"&ca'&ons
Dur&ng MI 'o "ecrease oygen consump'&on
-8T refrac'ory 'o o'her 'herap&es
Ac'&on
Decreases
Hear' ra'e
-'ro>e vo!ume
Au'oma'&c&'y an" con"uc'&v&'y
Dosage
Me'opro!o!, ? mg "ose L ? m&nu'es 0 1? mg ma1
-o'a!o! : 1;; mg over ? m&nu'es for 8Tach
Esmo!o! : ?;; mgB>g over 1 m&n. Then ?; mcgB>g
for + m&nu'es
Rou'e
$ra!D I8
#on'ra&n"&ca'&ons
#H9D hypo'ens&on D(ra"ycar"&aD hear' (!oc>s
HARMACOLOGY
2013 ACLS Handbook
ANTI.5ATE5ET-
A-.IRIN
#!ass&f&ca'&on
An'&,p!a'e!e'
In"&ca'&ons
#ar"&ac ches' pa&n
Ans'a(!e ang&na
Ac'&on
B!oc>s 'hrom(oane
.reven's p!a'e!e' aggrega'&on
Eeeps p!a'e!e's from occ!u"&ng ar'er&es
Rou'e
$ra!
Dosage
1F%,)%? mg 0che*a(!e1
HARMACOLOGY
2013 ACLS Handbook
ANTI.5ATE5ET-
#5$.ID$GRE5 0.5A8IG1
In"&ca'&ons
-TEMI
H&gh r&s> -T "epress&on or T *ave &nvers&on
.a'&en's *&'h p!anne" .#I
.a'&en's 'ha' canno' 'a>e asp&r&n
Ac'&on
Inh&(&'s g!ycopro'e&n
Dosage
);; mg .$ fo!!o*e" (y K? mg .$
#ons&"era'&ons
H&s'ory of (!ee"&ng
.a'&en's *&'h &mpa&re" !&ver func'&on
.!anne" surgery &n 'he near fu'ure
HARMACOLOGY
2013 ACLS Handbook
ANTI.5ATE5ET-
INTEGRI55IN
#!ass&f&ca'&on
G!ycopro'e&n II( BIIIa &nh&(&'or
In"&ca'&ons
#hes' pa&n -T "epress&on or e!eva'&on
Ans'a(!e ang&na
Non,O *ave MI
Ac'&on
B!oc>s en=yme essen'&a! 'o p!a'e!e' aggrega'&on
Dosage
1J; mg B>g over 1,% m&nu'es
Infuse L % mcgB>gBm&n.
Decrease 'o ;.? mcgB>gBm&n pre ca'he'er&=a'&on
-&"e effec's
B!ee"&ng 0&ncrease" *&'h hepar&n runn&ng1
NauseaD vom&'&ngD
Hypo'ens&on an" (ra"ycar"&a
#on'ra&n"&ca'&ons
Ac'&ve &n'erna! (!ee"&ng
.!a'e!e's 7 1;;;;;
-ys'o!&c B. 21J;
HARMACOLOGY
2013 ACLS Handbook
ANTI#$AGA5ANT-
HE.ARIN
#!ass&f&ca'&on
An'&coagu!an'
In"&ca'&ons
.a'&en's un"ergo&ng ang&op!as'y
-e!ec'e" pa'&en's rece&v&ng f&(r&no!y'&c 'herapy
MID pu!monary em(o!&smD D8T
Ac'&on
.reven's convers&on of pro'hrom(&n 'o 'hrom(&n
Dosage
Bo!us "ose of F;; un&'sB>g
Infus&on of 1% un&'sB>gBhr
-&"e effec's
Hemorrhage
Throm(ocy'open&a
#on'ra&n"&ca'&ons
Ac'&ve (!ee"&ng Dpep'&c u!cers D hepa'&c "&sease
Hemoph&!&a
HARMACOLOGY
2013 ACLS Handbook
9IBRIN$5YTI#-
In"&ca'&ons
Ac'&ve MI !ess 'han 1% hours
1% !ea" *&'h -T e!eva'&on &n % con'&guous !ea"s
Ne* (ranch (un"!e (!oc>
Acu'e &schem&c s'ro>e 7 ) hours
Ac'&on
5ys&s of f&(r&n ho!"&ng 'oge'her 'hrom(& (!oc>&ng 'he ar'ery
A!!o*s (!oo" f!o* 'o "&s'a! ar'er&es (!oc>e" (y 'he c!o'
Dosage
TNE : -&ng!e (o!us );,?; mg I8 push over ? m&n.
Re'ep!ase, 1; un&'s fo!!o*e" (y 1; un&' (o!us ); m&n apar'
A!'ep!ase,1? mg (o!usD 'hen ;.K? mgB>g over ); m&nu'es
-&"e effec's
B!ee"&ng
A!!erg&c reac'&ons
Reperfus&on arrhy'hm&as
HARMACOLOGY
2013 ACLS Handbook
9IBRIN$5YTI#-
#on'ra&n"&ca'&ons
Ac'&ve (!ee"&ng
Hemorrhag&c s'ro>e
In'racran&a! neop!asm
Aor'&c "&ssec'&on
Hea" 'rauma or pr&or s'ro>e ) mon'hs
-u(arachno&" hemorrhage
Ancon'ro!!e" B. 21J? sys'o!&c or 11; "&as'o!&c
.!a'e!e' coun' 7 1;;;;;Bmm or INR 21.K
#T "emons'ra'es mu!'&p!e &nfarc'&ons
HARMACOLOGY
2013 ACLS Handbook
TY.E- $9 -TR$EE-
Ischem&c
#ause" (y an occ!us&on of an ar'ery &n 'he (ra&n
Accoun's for JK4 of a!! s'ro>es
5&>e!y can"&"a'es
D&a(e'&cs
H&s'ory of a'herosc!ero'&c "&sease
H&s'ory of c!o''&ng a(norma!&'&es
H&s'ory of ph!e(&'&s
H&s'ory of a'r&a! f&(r&!!a'&on
Hemorrhag&c
#ause" (y a rup'ure of a (!oo" vesse! &n 'he (ra&n
Accoun's for 1)4 of a!! s'ro>es
T.A &s con'ra&n"&ca'e"
A non con'ras' #T &s re/u&re"
5&>e!y can"&"a'es
H&s'ory of hyper'ens&on
Afr&can Amer&cans
H&s'ory of A8 ma!forma'&ons
H&s'ory of aneurysms
H&s'ory of .#. or coca&ne use
STRO!E "CVA
2013 ACLS Handbook
-TR$EE 9$#A-
.RE,H$-.ITA5
Rap&" s'ro>e &"en'&f&ca'&on
Rap&" 'ranspor'
IN H$-.ITA5
Rap&" "e'erm&na'&on of f&(r&no!y'&c e!&g&(&!&'y
Non con'ras' #T scan
Ec!us&on cr&'er&a
T&ne from s'ro>e onse'
A"m&n&s'ra'&on of a f&(r&no!y'&c agen'
In&'&a'&on of 'he s'ro>e pa'h*ay
A"m&ss&on 'o a s'ro>e un&'
STRO!E "CVA
2013 ACLS Handbook
-TR$EE -IGN- AND -YM.T$M-
In&'&a! assessmen' 0#&nc&nna'& sca!e1
A!*ays chec> (!oo" g!ucose
9ac&a! "roop B non symme'r&ca! sm&!e
Arm "r&f' : affec'e" arm "r&f's "o*n*ar"
A(norma! speech
-!urre" *or"s
Wrong *or"s
Ina(&!&'y 'o spea>
-econ"ary neuro!og&ca! assessmen'
Num(ness &n 'he e'rem&'&es
.up&!!ary responseD s&=eD an" eye movemen'
8&s&on 'rou(!e 0one or (o'h eyes1
B&!a'era!!y e/ua! gr&p s'reng'h
E/ua! e'ens&on an" prona'&on of (o'h fee'
5eve! of consc&ousness
-u""en confus&on
.er&o"s of aphas&a
Trou(!e *a!>&ngD ga&' "&s'ur(ances
D&==&nessD !oss of (a!ance
-evere hea" ache 0*ors' hea"ache I ever ha"1
STRO!E " CVA
2013 ACLS Handbook
I-#HEMI# -TR$EE
.a'ho!ogy
$ccurs *hen a cere(ra! ar'ery (ecomes occ!u"e"
Th&s causes an area of 'he (ra&n 'o &nfarc'
The &nfarc'e" area &s surroun"e" (y a !arger
&schem&c area ca!!e" 'he penum(ra
The goa! of s'ro>e managemen' &s 'o preven' 'he
penum(ra from &nfarc'&ngD *orsen&ng the stroke.
.ro'ec'&on of 'he penum(ra
The (es' *ay 'o save 'he penum(ra &s 'o open 'he
occ!u"e" vesse! *&'h T.A.
T.A mus' (e g&ven *&'h&n ) hours of 'he onse' of
s'ro>e symp'oms
Beyon" ) hours 'he r&s> of g&v&ng T.A "oes no'
ou'*e&gh 'he (enef&'s
Before g&v&ng T.A a!! pa'&en's mus' (e g&ven a non
con'ras' #T scan.
STRO!E " CVA
2013 ACLS Handbook
I-#HEMI# -TR$EE
Inc!us&on cr&'er&a
An &schem&c s'ro>e caus&ng measura(!e
neuro!og&c "amage
$nse' of symp'oms 7 ) hours (efore (eg&nn&ng
'rea'men'
Age 2 1J years
Ec!us&on cr&'er&a
Hea" 'rauma or s'ro>e &n 'he prev&ous ) mon'hs
-ymp'oms of a su(arachno&" hemorrhage
H&s'ory of a prev&ous &n'ra,cran&a! hemorrhage
Ancon'ro!!e" B. 21J? sys'o!&c or 11; "&as'o!&c
.!a'e!e' coun' 7 1;;;;; B mm or INR 21.K
#T "emons'ra'es mu!'&,!o(a! &nfarc'&on
STRO!E " CVA
2013 ACLS Handbook
I-#HEMI# -TR$EE
.os' T.A managemen'
Mon&'or pa'&en' for (!ee"&ng
Mon&'or EEG
#on'ro! B. 'o ma&m&=e perfus&on.
Avo&" ecess&ve (!oo" pressures
#on"uc' fre/uen' neuro!og&ca! chec>s
Every 1? m&nu'es for 'he f&rs' hour
Every ); m&nu'es for 'he ne' hour
Then every % hours
Mon&'or coagu!a'&on fac'ors
A"m&' pa'&en' 'o a s'ro>e cen'er
STRO!E "CVA
2013 ACLS Handbook
HEM$RRHAGI# -TR$EE
.a'ho!ogy
$ccurs *hen a (!oo" vesse! &n 'he (ra&n rup'ures
The rup'ure" vesse!
5ea>&ng (!oo" &s &nf!amma'ory
Th&s crea'es an &ncrease &n cere(ra! sp&na! f!u&"
Th&s &ncreases &n'racran&a! pressure
Managemen'
A rap&" non con'ras' hea" #T &s essen'&a!
In'u(a'e 'he pa'&en' as soon as poss&(!e
A''ach 'he pa'&en' 'o a ven'&!a'or
Eeep 'he #$% !eve! 'o %?,); 'o hyper oygena'e
Hyper oygena'&on cons'r&c's 'he cere(ra! ar'er&es
Th&s he!ps con'ro! (!ee"&ng
#on'ro! (!oo" pressure 'o !o*es' !eve! 'ha' *&!!
ma&n'a&n a"e/ua'e organ perfus&on
#ons&"er mann&'o! as an osmo'&c "&ure'&c
Transpor' rap&"!y 'o a neurosurg&ca! opera'&ng
fac&!&'y
STRO!E "CVA
2013 ACLS Handbook
STRO!E " CVA ALGORITHM
2013 ACLS Handbook
STRO!E ALGORITHM
#UIC! VIEW
BP EKG- SPO2
HISTORY PHYSICAL EXAM
IV BGL - LABS
NON CONTRAST CT ISCHEMIC HEMORRHAGIC
NEUROSURGERY FIBRINOLYTIC
S
IF LESS THAN
3 HOURS
FROM ONSET
FREQUENT NEURO
EVALUATIONS
SYMPTOMS
IMPROVING
(TIA)
FREQUENT NEURO
EVALUATIONS
ONSET TIME O2 IF
REQUIRED
2013 ACLS Handbook
.a'hophys&o!ogy
An acu'e coronary syn"rome occurs *hen a
coronary ar'ery (ecomes par'&a!!y or 'o'a!!y
(!oc>e".
The syn"romes &nc!u"e
Ans'a(!e ang&na
-TEMI an" non -TEMI a''ac>s
-u""en car"&ac "ea'h
ACUTE CORONARY
SYNDRONES
2013 ACLS Handbook
In&'&a! eva!ua'&on
-ymp'oms sugges'&ve of &schem&a or an MI
5$#D 1% !ea" EEGD v&'a! s&gns -.$%D oygen
.hys&ca! eamD h&s'oryD 0'hrom(o!y'&c can"&"a'e1
I8 accessD e!ec'ro!y'esD car"&ac mar>ersD
coagu!a'&on
#hes' ,ray
In&'&a! 'rea'men'
$ygen 0&f -.$% 7 3+41
Asp&r&n 1F;,)%? mg
N&'rog!ycer&ne : -5 or spray
Morph&ne I8 &f pa&n &s no' re!&eve" (y )
n&'rog!ycer&ne
1% !ea" &n'erpre'a'&on
-T e!eva'&on or ne* !ef' (ranch (un"!e (!oc>
-TEMI : h&gh r&s>
-T "epress&on or T *ave &nvers&on
In"&ca'es &schem&a h&gh r&s> uns'a(!e ang&na
Norma! or non "&agnos'&c changes 0-T or T *ave1
5o*er r&s> re/u&res mon&'or&ng
ACUTE CORONARY
SYNDROMES
2013 ACLS Handbook
-TEMI 7 1% H$AR-
H&gh r&s>
-T e!eva'&on &n % or more re!a'e" !ea"s
Ne* !ef' (ranch (un"!e (!oc>
Trea'men'
I8 n&'rog!ycer&ne
An'&p!a'e!e' B an'&coagu!an's
Hepar&n
In'egr&!&n
5oveno
.!av&
.repare for .#IB-TENT B#ABG
7 3; m&nu'es "oor 'o 'a(!e
9&(r&no!y'&cs &f .#I &s "e!aye"
7 ); m&nu'es EM- 'o "rug '&me
A#E &nh&(&'ors af'er F hours
Be'a (!oc>ers *hen s'a(!e
ACUTE CORONARY
SYNDROMES
2013 ACLS Handbook
N$N -TEMI HIGH RI-E A#-
-T "epress&on
T *ave &nvers&on
Ans'a(!e ang&na
Trea'men'
I8 n&'rog!ycer&ne &f (!oo" pressure uncon'ro!!e"
#on'ro! c!o''&ng
An'& p!a'e!e's
.!av&
In'egr&!&n
An'& coagu!an's
Hepar&n
5oveno
A#E &nh&(&'ors 0af'er F hours1
Be'a (!oc>ers *hen s'a(&!&=e"
#ar"&ac ca'he'er&=a'&on
.#I or #ABG &f &n"&ca'e"
ACUTE CORONARY
SYNDROMES
2013 ACLS Handbook
A#- A5G$RITHM
ACUTE CORONARY
SYNDRONES
2013 ACLS Handbook
ACS ALGORITHM
#UIC! VIEW
VITALS BP EKG SPO2 HX
EXAM
IV 12 LEAD O2 IF REQUIRED
OXYGEN
NITROGLYCERINE
ASA MORPHINE IF
REQUIRED
STEMI
NON STEM
HIGH RISK
CATH PCI STENT
CABG
ST ELEVATION 2
LEADS
NE!LEFT BBB
IV NITROGLYCERINE
HEPARIN
INTEGRILIN
BETA BLOCKERS
(STABLE)
ST DEPRESSION
T!AVE INVERSION
UNSTABLE ANGINA
IV NITRO HEPARIN
INTEGRILIN BETA
BLOCKERS ACE
INHIBITORS
CATH PCI STENT
CABG
2013 ACLS Handbook
ULMONARY EDEMA
#UIC! VIEW
FO!LERS POSITION"O
2
BP EKG SPO2
PHYSICAL EXAM "
HOSTORY " LABS
BIPAP " CPAP IF CONSCIOUS
INTUBATE IF UNCONSCIOUS
NITROGLYCERINE IF BP#
1$$
MORPHINE 2-% &' SLO! IV
PUSH
LASIX $()-1 &'"*' +, -.#1$$
CHF !ITH
HYPOTENSION
DOPAMINE -2()-2$
&/'"*'"&+0
DOBUTAMINE
2-2$MCG"KG"MIN
CHF SYSTOLIC
BP #1$$
NITROGLYCERIN1$-
2$ &/'"&+0
NITROPRUSSIDE $()-
1 &/'"*'"&+0
2013 ACLS Handbook
HYOTENSION ALGORITHM
#UIC! VIEW
-ymp'oma'&c *&'h sys'o!&c B. 7 3; mmHg
ADMINISTER OXYGEN
EKG SPO2 MONITOR
IV LABS
PHYSICAL EXAM "
HISTORY
FLUID BOLUS 1-2 L
IF LUNGS CLEAR
REASSESS BP
DOPAMINE DRIP
)-2$ &/'"*'"&+0
SBP 2 3$
SIGNS OF
SHOCK
NOREPINEPH
RINE
SBP #3$
EPINEPHERINE
2-1$ &/'"&+0
2013 ACLS Handbook
-YM.T$MATI# BRADY#ARDIA-
-&nus
<unc'&ona!
9&rs' "egree hear' (!oc>
Mo(&'= 1 0Wenc>e(ach1
Mo(&'= % 0secon" "egree 'ype % hear' (!oc>1
#omp!e'e hear' (!oc> 0)
r"
"egree1
-YM.T$M-
Many (ra"ycar"&as are norma! espec&a!!y for
a'h!e'es an" pa'&en's 'a>&ng (e'a (!oc>ers
-ymp'oma'&c (ra"ycar"&as &nvo!ve perfus&on
&na"e/uac&es.
-ome s&gns &nc!u"e
Decrease" !eve! of consc&ousness
Hypo'ens&on
Dyspnea
.a!e co!or
D&aphores&s
Genera!&=e" *ea>ness
BRADYCARDIAS
2013 ACLS Handbook
BRADY#ARDIA A5G$RITHM
BRADYCARDIAS
2013 ACLS Handbook
SYMTOMATIC BRADYCARDIA
#UIC! VIEW
EVALUATE
RHYTHM
N
O
ATROPINE $() &'
3&' &45
TCP 6 7$-3$ BPM
D8.4&+09 "
9.+09.:;+09
I0,<=+80 HR#7$
P;9.4;9 ,8; TVP
!+>9 /8&.?95
2
0>
8; 3
;>
>9';99 HB
MAY TRY ATROPINE
TCP 6 7$-3$
BPM
D8.4&+09 "
9.+09.:;+09
I0,<=+80 HR#7$
P;9.4;9 ,8; TVP
2013 ACLS Handbook
Tachycar"&as &nc!u"e
-&nus 'achycar"&a
-upraven'r&cu!ar 'achycar"&a
A'r&a! f&(r&!!a'&on B f!u''er
8en'r&cu!ar 'achycar"&a *&'h a pu!se
Asymp'oma'&c 'achycar"&as
B.D HRD -.$% s'a(!e *&'h goo" perfus&on
.a'&en' consc&ous an" fu!!y a!er'
-ymp'oma'&c 'achycar"&as
A!'ere" !eve! of consc&ousness
Ina"e/ua'e perfus&on
#hes' pa&n
Dyspnea
-&nus 'achycar"&as
$ccur from a revers&(!e cause
9everD an&e'yD shoc>D s'ressD s'&mu!an'sD eer'&on
Are 7 1?; (ea's per m&nu'e
Trea' 'he cause 'rea' 'he 'achycar"&a
TACHYCARDIAS
2013 ACLS Handbook
-8T A5G$RITHM
TACHYCARDIAS
2013 ACLS Handbook
TREATMENT ALGORITHM
STABLE SVT
#UIC! VIEW
Hemo"ynam&ca!!y s'a(!e D a(sence of ches' pa&n
5$#D EEGD 8-D-.$%D $% &f nee"e"
.hys&ca! eam an" h&s'ory BR$ non car"&ac causes
I8 accessD !a(sD car"&ac mar>ers #GR
@
8aga! maneuvers
@
A"enos&ne Fmg rap&" push B f!ush
A"enos&ne 1% mg rap&" push B f!ush
@
#ar"&=em ;.%?mgB>g 'hen ;.)?mgB>g &n 1? m&n
$R
8erapam&! %.?,?mg Brepea' ?,1;mg 1?,); m&n
@
Me'opro!o! ?mg over ? m&n Brepea' ?m&n %
$R
A'eno!o! ?mg over ? m&n may repea' &n 1; m&nu'es
@
#ar"&over', ?;,1;; < (&phas&c &n&'&a! "ose &ncrease &n
&ncremen's
2013 ACLS Handbook
TREATMENT ALGORITHM
UNSTABLE SVT
#UIC! VIEW
Hemo"ynam&ca!!y uns'a(!e A5$# or
unconsc&ous
@
5$#. EEGD 8-D -.$%D $% &f re/u&re"
Br&ef h&s'oryB eam B R$ non car"&ac
causes
@
I8 B I$ access "o no' "e!ay car"&overs&on
-e"a'&on &f consc&ous an" B. a!!o*s
@
-ynchron&=e" car"&overs&on
?;,1;;< &n&'&a! "ose (&phas&c B&ncrease &n
&ncremen's
@
If unsuccessfu! com(&ne *&'h
pharmaco!og&ca! 'rea'men' use" for
s'a(!e -8T
2013 ACLS Handbook
ATRIA5 9IBRI55ATI$N B 95ATTER
-'a(!e *&'h R8R 7 +J hours
Hemo"ynam&ca!!y s'a(!e no ches' pa&n
INITIA5
5$#D EEGD 8-D -.$% oygen &f re/u&re"
.hys&ca! eam an" h&s'ory B R$ non car"&ac causes
I8D !a(sD car"&ac mar>ersD ches' ,ray
TREATMENT
#on'ro! ra'e : #a!c&um channe! (!oc>er 0choose 11
#ar"&=em ;.%? mgB>g 'hen ;.)? mgB>g &n1? m&n. &f re/u&re"
8erapam&!, %.?,? mg repea' ?,1; mg 1?,); m&n &f re/u&re"
Be'a (!oc>er 0choose one1
Me'opro!o! ? m" over ? m&n. repea' ? mg %
$'her (e'a (!oc>ers :!a(e'a!o!D a'eno!o! D so'a!o!D esmo!o!
#ar"&over' &f "rug 'herapy &s unsuccessfu!
?;,1;; @ou!es (&phas&c &n&'&a! "ose. Increase &n &ncremen's
#ons&"er an'&coagu!an' 'herapy
N$TE A,f&( BA f!u''er shou!" (e 7 11; (ea's B m&n
'o (e cons&"ere" con'ro!!e".
TACHYCARDIAS
2013 ACLS Handbook
A,9IB B A 95ATTER 2 +J H$AR-
-'a(!e *&'h R8R no ches' pa&n
INITIA5
5$#DEEGD-.$% oygen &f re/u&re"
.hys&ca! eam an" h&s'ory B R$ non car"&ac
causes
I8D !a(sD car"&ac mar>ersD ches' G,ray
TREATMENT
De!ay car"&overs&on un!ess uns'a(!e
Ans'a(!e : .oor perfus&onD #.D A5$#
#on'ro! ra'e *&'h
#a!c&um channe! (!oc>ers
Be'a (!oc>ers
.a'&en' nee"s 'o (e curren' *&'h an'&coagu!an'
'herapy
R$ em(o!& for + *ee>s (efore car"&overs&on
TACHYCARDIAS
2013 ACLS Handbook
A,9IB BA, 95ATTER AN-TAB5E WITH R8R
Hemo"ynam&c &ns'a(&!&'yD ches' pa&n a!'ere" !eve!
of consc&ousnessD unrespons&ve
In&'&a!
5$#DEEGD -.$%D oygen &f re/u&re"
Br&ef h&s'ory
I8 I$ access. D$ no' "e!ay car"&overs&on
Trea'men'
#ar"&over'
A'r&a! f!u''er ?;,1;; @ (&phas&c &n&'&a! "ose
Increase &n &ncremen's
A'r&a! f&(r&!!a'&on : 1%;,%;; @ (&phas&c &n&'&a! "ose
Increase &n &ncremen's
.harmaco!ogy 0&f car"&overs&on &s unsuccessfu!1
Am&o"arone : 1?; mg over 1; m&nu'es
D&go&n : 1;,1? mgB>g 0;.?,1.; mg
Rap&" an'&coagu!a'&on
TACHYCARDIAS
2013 ACLS Handbook
-TAB5E 8 TA#H WITH A .A5-E
W&"e comp!e 2 1?; (Bm&n
no . *aves no a'r&a! f&(r&!!a'&on
INITIA5
5$#D EEGD -.$%D $% &f re/u&re"
.a'&en' eam an" h&s'ory
I8D !a(sD car"&ac mar>ersD ches' ,ray
#ons&"er a"enos&ne
TREATMENT
An'&,"ysrhy'hm&c
Am&o"arone : 1?; mg over 1; m&nu'es May repea'
5&"oca&ne ,;.?,1;? mgB>g repea' a' ha!f "ose 'o ) mg
.roca&nam&"e : %;,?; mgBm&n &nfus&on
Magnes&um 1,% gm
-o'a!o! : 1;; mg over ? m&nu'es
#ar"&over' 0If pharmaco!ogy &s unsuccessfu!1
1;;D%;;D);;D)F; @ou!es monophas&c
1%;,%;; <ou!es (&phas&c
TACHYCARDIAS
2013 ACLS Handbook
AN-TAB5E 8TA#H WITH A .A5-E
Ra'e 21?;
Decrease" 5$#
Hypo'ens&on *&'h ches' pa&n
.oss&(!e pu!monary e"ema
INITIA5
5$#DEEGD8-D-.$%D $% &f re/u&re"
I8BI$ access
Br&ef h&s'ory &f poss&(!e
Do no' "e!ay car"&overs&on
TREATMENT
#ar"&overs&on
-e"a'&on &f respons&ve
1%;,%;; @ou!es (&phas&c
1;;,)F; @ou!es monophas&c
.harmaco!ogy
Ase 'he same as for s'a(!e 8Tach &f car"&overs&on &s
unsuccessfu!
TACHYCARDIAS
2013 ACLS Handbook
CARDIAC ARREST
ASYSTOLE " EA
2013 ACLS Handbook
ULSELESS ELECTRICAL
ACTIVITY AND ASYSTOLE
#UIC! VIEW
Beg&n #.R
A''ach mon&'or B"ef&(r&!!a'or
#on'&nue #.R &n % m&nu'e
cyc!es
In'u(a'e
I8 BI$ access
@
A"m&n&s'er vasopressor
Ep&nephr&ne 1 mg
8asopress&n +; un&'s
@
#on'&nue #.R
@
5oo> for revers&(!e causes 0?
HHs an" THs1
HYPOXIA
HYPOVOLEMIA
HYDROGEN ION
(ACIDOSIS)
HYPERKALEMIA
HYOPKALEMIA
HYPOTHERMIA
TOXINS
THROMBUS
PULMONARY
THROMBUS
CORONARY
THROMBUS
CARDIAC
TENSION
PNEUMOTHORAX
TAMPONADE
)H
)T
2013 ACLS Handbook
CARDIAC ARREST VFIB
ULSELESS V TACH
2013 ACLS Handbook
VENTRICULAR FIBRILLATION
ULSELESS VTACH
#UIC! VIEW
Beg&n #.R
-H$#E 0 %;;< (&phas&c B)F;< monophas&c1
#on'&nue #.R 'hroughou' en'&re co"e
-ecure a&r*ay an" s'ar' I8BI$ *&'h N- or 5R
@
Drug 8asopressor +; A
Ep&nephr&ne 1mg every ),? m&nu'es "ur&ng co"e
@
-H$#E 0ma. "ose1 P%;; @ (&phas&c B )F; @
monophas&cQ
@
Drug An'&,arrhy'hm&c
Am&o"arone );;mg
5&"oca&ne 1.? mgB>g
@
-H$#E 0ma "ose1 P%;; @ (&phas&c B )F; @ monophas&cQ
@
Repea' "rug shoc> se/uence
Am&o"arone M 1?;mg
5&"oca&ne : 1.?mgB>g 'o )mg ma
@
5oo> for revers&(!e causes ? HHs an" ? THs
2013 ACLS Handbook
#$N-IDERATI$N- BE9$RE ARRE-T
The non arres'e" pa'&en'
Recogn&=e a cr&'&ca! pa'&en'
I' &s eas&er 'o preven' an arres' 'han 'o resusc&'a'e
$('a&n 'he fo!!o*&ng as ear!y as poss&(!e
1% !ea" EEG
8&'a! s&gns &nc!u"&ng -.$% an" 'empera'ure
$('a&n a comp!e'e h&s'ory (efore an arres' occurs
Dra* !a(sD #T scans ,raysD (!oo" 'ype &f nee"e"
Ma&n'a&n hemo"ynam&c an" resp&ra'ory s'a(&!&'y
#ons&"er ? HHs an" THs (efore arres'
Hypo&a To&ns
Hypovo!em&a Throm(os&s 0pu!monary1
Hy"rogen &on 0ac&"os&s1 Throm(os&s 0coronary1
HyperBhypo>a!em&a Tampona"e
Hypo'herm&a Tens&on pneumo'hora
ARREST CONSIDERATIONS
2013 ACLS Handbook
Wha' causes .EA
.u!monary em(o!&
Ac&"os&s
Acu'e myocar"&a! &nfarc'&on
Hyper>a!em&a
Drug over"ose
Trauma
.neumo'hora
Tampona"e
Hypovo!em&a
Hypo&a
Wha' causes asys'o!e
Hypo&a
Hypo'herm&a
HypoBhyper>a!em&a
Ac&"os&s
Hypog!ycem&a
Drug over"ose
Trauma
.neumo'hora
Tampona"e
Hypovo!em&a
Hypo&a
ARREST CONSIDERATIONS
2013 ACLS Handbook
Bas&c arres' managemen' 'rauma
-'ar' an" con'&nue #.R
Ma&n'a&n h&gh /ua!&'y #.R 'hroughou'
A''ach mon&'or an" "ef&(r&!!a'e A-A. &f &n"&ca'e"
#on'ro! 'he a&r*ay 0a"vance" a&r*ay1
5arge (ore I8 or I$
G&ve "rugs per 'he appropr&a'e a!gor&'hm
Trea' hypo&a
In'u(a'e 0cr&co'hyro'omy or 'racheo'omy1
.neumo'hora
#hes' "ecompress&on
#hes' 'u(e
Tampona"e
.er&car"&a! cen'es&s
Trea' hypovo!em&a
#on'ro! (!ee"&ng
% 5arge (ore I8Hs or I$Hs *&'h a crys'a!!o&"
Rap&" (!oo" 'ype an" 'ransfus&on
In an emergency 'ype $ nega'&ve (!oo" can (e use"
A!*ays cons&"er 'he ?HHs an" THs
ARREST CONSIDERATIONS
2013 ACLS Handbook
E!ec'ro!y'e un(a!ance
Rena! "&a!ys&s
Ac&"os&s
Hyper>a!em&a
Hypog!ycem&a
D&a(e'&cs
Ac&"os&s
Hypog!ycem&a
Hyper>a!em&a
Hypo>a!em&a
A!coho!&cs
Hypo>a!em&a
Hypog!ycem&a
Hypomagnesem&a
#ons&"er a (ra&n (!ee" from a fa!!
.ro!onge" vom&'&ng
Dehy"ra'&on
Ac&"os&s
Hypo>a!em&a
.ro!onge" "&arrhea
Dehy"ra'&on
Ac&"os&s
Hypo>a!em&a
Hypomagnesem&a
ARREST CONSIDERATIONS
2013 ACLS Handbook
Trea'men' of e!ec'ro!y'e un(a!ances
Hyper>a!em&a
.erform s'an"ar" A5- an" B5-
#a!c&um ch!or&"e : ?;;mg,1 gm 'o s'a(&!&=e ce!!s
-o"&um (&car(ona'e : ?; mE/ 'o sh&f' po'ass&um
&n'o ce!!s
M& %? gm g!ucose an" 1; un&'s &nsu!&n &nfuse over
1? m&nu'es
Hypomagnesem&a
.erform s'an"ar" B5- an" A5-
Mos'!y foun" &n a!coho!&csD "ehy"ra'&on an"
ma!nour&she" pa'&en's
Asua!!y presen's as po!ymorph&c 8Tach 0Torsa"es1
G&ve 1,% gm magnes&um I8 (o!us
Me'a(o!&c ac&"os&s
E'en"e" per&o" of arres' an" over"oses
Trea' per appropr&a'e B5- an" A5- pro'oco!s
9&rs' a''emp' 'o correc' *&'h #.R an" &n'u(a'&on
Ase 1 mE/ B>g "ose of so"&um (&car(ona'e
Repea' a' ha!f "ose &f re/u&re"
AREST CONSIDERATIONS
2013 ACLS Handbook
.REGNAN#Y ARRE-T-
Bas&c B5- an" A5- per a!gor&'hms
9or suspec'e" em(o!us : f&(r&no!y'&cs
9or magnes&um over"ose 1 gm ca!c&um
ch!or&"e
May a!so use ca!c&um g!ucona'e
INTABATED .ATIENT-
D$.E A5G$RITHM
D&s!o"ge" 'u(e
$(s'ruc'e" ET 'u(e
.neumo'hora
E/u&pmen' fa&!ure
ARREST CONSIDERATIONS
2013 ACLS Handbook
TREATMENT- D$NE T$ .RE8ENT ARRE-T-
I' &s a!*ays (e''er 'o 'rea' 'o preven' an arres' 'han 'o "ea! *&'h an
arres' s&'ua'&on
Anaphy!a&s per&,arres's
5arge (ore I8D EEGD 8-D -.$%D oygen &f re/u&re"
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
A"m&n&s'er ?; mg "&phenhy"ram&ne I8
A"m&n&s'er 1 mg ep&nephr&ne or +; un&'s vasopress&n
A"m&n&s'er up 'o +,J ! crys'a!!o&" 1 !&'er a' a '&me
#ons&"er 1%? mg -o!u,Me"ro! I8
As'hma per&,arres's
5arge (ore I8D EEGD 8-D -.$% h&gh f!o* oygen
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
M& %.?mg a!(u'ero! an" ;.?mg A'roven' ne(u!&=e"
May con'&nue a!(u'ero! ne(u!&=e" 'rea'men'
A"m&n&s'er 1 mg ep&nephr&ne -O
In'u(a'e &f severe an" pu' pa'&en' on a ven'&!a'or
#ons&"er -o!u,Me"ro! 1%? mg
.u!monary e"ema per&,arres's
5arge (ore I8DEEGD8-D-.$%D oygen &f re/u&re"
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
If pa'&en' &s consc&ous use #.A. or BI.A. A-A.
If pa'&en' &s unconsc&ous &n'u(a'e an" suc'&on
#on'ro! (!oo" pressure *&'h NTG or n&'ropruss&"e
Ins'a! a 9o!ey ca'he'er
A"m&n&s'er +;,J; mg 5as& I8
ERI$ARREST SITUATIONS
2013 ACLS Handbook
$ver"oses
#oca&ne
5arge (ore I8DEEGD8-D-.$%D 'empera'ure oygen
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
A"m&n&s'er a (en=o "&a=epam
.ressure ven'&!a'e" oygen for pu!monary e"ema
#on'ro! (!oo" pressure
N&'rog!ycer&ne B N&pr&"e
.hen'o!am&ne 0a!pha (!oc>er1
An'&,"ysrhy'hm&c as re/u&re"
Tr&,cyc!&c an'&"epressan's
-ymp'oms
#onvu!s&ons
#oma
#ar"&ac arrhy'hm&as
Ac&"os&s
Hypo'ens&on
Trea'men'
5arge (ore I8DEEGD8-D -.$%D $GYGEN I9 REOAIRED
Trea' rhy'hm "&s'ur(ances per appropr&a'e a!gor&'hm
Non,arres',ac'&va'e" charcoa! 07 1 hour1
Ben=o "&a=epam for se&=ures
-o"&um (&car(ona'e for ac&"os&s
9!u&" (o!us NA#5 for hypo'ens&on
Arres',a"m&n&s'er 1 mE/ B>g so"&um (&car(ona'e
ERI$ARREST SITUATIONS
2013 ACLS Handbook
$8ERD$-E-
#a!c&um channe! (!oc>ers
I8D EEGD 8-D -.$%D chec> BG5D oygen &f re/u&re"
9!u&"s for hypo'ens&on N- ?;;,1;;; m!
Ac'&va'e" charcoa! 7 hour of &nges'&on
Insu!&n for &mprove" energy
Ep&nephr&ne &nfus&on %,1; mg Bm&n
#a!c&um ch!or&"e ;.% mE/B>g or ca!c&um g!ucona'e ;.) mE/ B>g
.ac&ng for (ra"ycar"&as
Be'a (!oc>ers
-ame 'rea'men' as ca!c&um channe! (!oc>ers ecep' g&ve ),1; mg
g!ucagon IM or I8
Narco'&cs
I8D EEGD 8-D -.$%D oygen &f re/u&re"
A"m&n&s'er %,+ mg Narcan Bmay have 'o repea'
Ben=o "&a=epams
I8DEEGD 8-D -.$%. oygen &f re/u&re"
Roma=&con, on!y &f a >no*n (en=o "&a=epam over"ose
If uncer'a&n a!!o* pa'&en' 'o na'ura!!y process
HY.$THERMIA
#.R
Ho!" "ef&(r&!!a'&on un'&! core 'empera'ure &s 2)) "egrees #
Warm *&'h (!an>e'sD *arm I8Hs or per&'onea! !avage
When *arm 'rea' per appropr&a'e a!gor&'hm
They are no' "ea" un'&! 'hey are *arm an" "ea"
ERI$ARREST SITUATIONS
2013 ACLS Handbook
Reasons 'o 'erm&na'e resusc&'a'&on
Re'urn of effec'&ve spon'aneous
c&rcu!a'&on
#r&'er&a for &rrevers&(!e "ea'h
Ehaus'&on of 'he hea!'h care prov&"er
A va!&" DNR
Au'hor&=a'&on (y a phys&c&an
Transfer 'o a h&gher !eve! of care
If pa'&en' rema&ns &n arres' af'er repea'e"
a''emp's *&'h h&gh /ua!&'y #.R an" A#5-
TERMINATE
RESUSCITATION
2013 ACLS Handbook
Hemo"ynam&c s'a(&!&'y
Bas&c
1% !ea" car"&ac mon&'or
An'&,arrhy'hm&c "r&p as re/u&re"
$ygen 'o >eep -.$% 23+4
Ra'e con'ro!
#on'ro! ra'e per A#5- pro'oco!s
B!oo" pressure con'ro!
9!u&"s are 'he f&rs' !&ne
8asopressors are 'he secon" cho&ce
un!ess f!u&"s are con'ra&n"&ca'e" (y
'he pa'&en'Hs con"&'&on.
OST ARREST
MANAGEMENT
2013 ACLS Handbook
Hemo"ynam&c an" ven'&!a'&on op'&m&=a'&on
Ase 1;;4 oygen &n 'he &n&'&a! resusc&'a'&on
T&'ra'e &nsp&re" oygen 'o ma&n'a&n -.$% 2 3+4
Avo&" ecess&ve ven'&!a'&on 'o re"uce &n'ra'horac&c
pressure
Recommen"e" ven'&!a'&on ra'es 1;,1% B.M
.ET#$ : )?,+;
.a#$% ,+;,+?
A"m&n&s'er f!u&"s an" vasoac'&ve "rugs 'o
$p'&m&=e (!oo" pressure
Improve car"&ac ou'pu'
$p'&m&=e sys'em&c perfus&on
M&!" hypo'herm&a
Ase" on a!! pa'&en's unrespons&ve af'er R$-#.
.reven's (ra&n "e'er&ora'&on "ue 'o g!o(a! &schem&a
Tempera'ure goa! &s )%,)+ "egrees #
T&me a' hypo'herm&a 1%,%+ hours
Trea' hypo'ens&on *&'h f!u&"s 01,% !&'ers 1
8asopressors may (e use" &f f!u&"s "o no' *or>
Targe' g!ycem&c con'ro! 'o 1++,1J; mgBm!
Imme"&a'e coronary reperfus&on *&'h a .#I
OST ARREST
MANAGEMENT
2013 ACLS Handbook
OST ARREST
MANAGEMENT
2013 ACLS Handbook
OST ARREST ALGORITHM
#UIC! VIEW
OPTIMIAE
VENTILATION
AND
OXYGENATION
OPTIMIAE
CARDIAC
FUNCTION
ADVANCED
CRITICAL CARE
12 LEAD
PCI
INAPROPRIATE
NEUROLOGICA
L
MILD
HYPOTHERMI
A
INTUBATE
RATE 1$ BPM
OXYGEN SAT
B%-BB
CO2 3)-%$
&&H'
RATE # 7$
RHYTHM
INFUSION
BLOOD
PRESSURE
FLUIDS
VASOPRESSORS
2013 ACLS Handbook
Ro!e of 'he 'eam !ea"er
$rgan&=es 'he group
Mon&'ors performance of 'eam mem(ers
Bac>s up 'eam mem(ers
Mo"e!s ece!!en' 'eam (ehav&or
Tra&ns an" coaches
9ac&!&'a'es un"ers'an"&ng
9ocuses on comprehens&ve pa'&en' care
Ro!e of 'eam mem(ers
#!ear a(ou' ro!e ass&gnmen's
.repare" 'o f&!! 'he&r ro!e ass&gnmen's
We!! prac'&ce" &n resusc&'a'&on s>&!!s
Eno*!e"gea(!e a(ou' 'he a!gor&'hms
#omm&''e" 'o success
Team mem(er ass&gnmen's
#ompressor #.R
A&r*ay managemen'
I8 B I$ me"&ca'&ons
Mon&'or B "ef&(r&!!a'or
$(server B recor"er B '&me >eeper
TEAM CONCET
2013 ACLS Handbook
TEAM CONCET
TY.I#A5 #$DE 5AY$AT
2013 ACLS Handbook
Eno*!e"ge shar&ng
Team mem(ers shou!" (e free 'o share
>no*!e"ge an" &"eas 'ha' may (e he!pfu! 'o 'he
resusc&'a'&on effor's
#ons'ruc'&ve &n'erven'&on
If an &ncorrec' proce"ure or "rug "ose &s no'&ce"
(y a 'eam mem(er 'hey shou!" (e free 'o offer an
&n'erven'&on. Eamp!e : *&!! you repea' 'he "oseC
Reeva!ua'&ng an" summar&=&ng
.er&o"&c reeva!ua'&ng an" summar&=&ng >eeps
everyone &n 'ouch *&'h 'he arres's procee"&ng an"
assures pro'oco!s are fo!!o*e"
Mu'ua! respec'
A!*ays 'rea' (o'h 'he 'eam !ea"er as *e!! as 'he
'eam mem(ers *&'h respec' an" rema&n ca!m
TEAM CONCET