BASIC ACLS. DRUG DOSE CHEAT SHEET PLEASE COMPLETE THE WORKSHEET AS WE GO OVER EACH MED YOU CAN USE THIS FOR YOUR PRACTICAL SCENARIOS SORRY ! CANT USE.

BASIC ACLS

DRUG DOSE “CHEAT SHEET” PLEASE COMPLETE THE WORKSHEET

AS WE GO OVER EACH MED YOU CAN USE THIS FOR YOUR

PRACTICAL SCENARIOS SORRY ! CAN’T USE IT FOR THE

WRITTEN TEST RED IS VERY IMPORTANT

ADENOSINE

ADENOCARD TREAT STABLE FAST

RHYTHMS 6MG –”SLAM” 12 MG “SLAM” 10 SEC HALF LIFE

ASPIRIN

TREAT CHEST PAIN UP 325 MG BABY ASA 81 MG

AMIODARONE

USED TO TREAT VENTRICULAR DYSRHTHYMIAS

V-FIB AND V-TACH 300 MG CARDIAC

ARREST/REFRACTORY V-FIB

150 MG FOR “LIVE” PT CAN BE USED IN

PLACE OF LIDO

ATROPINE

USED FOR STABLE SLOW RHYTHM

.5 MG MAX DOSE 3 MG NOT FOR CARDIAC

ARREST

CARDIAZEM

DIALTIAZEM SECOND LINE FOR

STABLE FAST SVT .25 MG/KG .35 MG /KG SECOND

DOSE

DOPAMINE

INCREASE BP IN HYPOTENSIVE PT

TREAT HYPOVOLEMIA FIRST

2-10 MCG/KG/MIN 5 MCG/KG/MIN

EPI

FIRST LINE DRUG FOR CARDIAC ARREST

1MG NO MAXIMUM EPI DRIP FOR

BRADYCARDIA BEST GIVEN BY

PERIPHERAL IV IN CARDIAC ARREST

LIDOCAINE

TREAT VENTRICULAR DYSRHYTHMIAS

V-FIB OR V TACH 1-1.5 MG/KG NO DRIP REQUIRED

MAGNESIUM SULFATE

TREAT –TORSADES OR HYPOMAGNESIA

REFRACTORY V-FIB

1-2 GM IN 50cc ADMINISTERED OVER

5-10 MINUTES

MORPHINE

USED FOR CHEST PAIN

2-6 MG

NARCAN

USED TO TREAT NARCOTIC OVERDOSE

2MG FOR CARDIAC ARREST

NITRO

USED TO TREAT CHEST PAIN

4 MG UP TO 3X 5 MINUTES APART

BP >90 MM/HG NO ED NO RVI

NORMAL SALINE

FLUID REPLACEMENT

HYPOVOLEMIA 1-2 LT

SODIUM BICARBONATE

USED TO TREAT KNOWN ACIDOSIS

1MEQ/KG

VERSED

MIDAZOLAM USED AS

PREMEDICATION FOR ELECTRICAL THERAPY

AMNETIC 5 MG

DEFIBRILLATION

V-FIB OR PULSE LESS V-TACH DEFIBRILLATE THE DEAD 200 JOULES FOR BIPHASIC 360 JOULES FOR MONOPHASIC

KNOW YOUR EQUIPMENT

CARDIOVERSION

SYNCHRONIZED DEFIBRILLATION 100/200/300/360 CARDIOVERT 100 J– CENTURY 100

YEARS ROMAN NUMERAL FOR 100 ?

Hs and Ts

Hypovolemia Hypoxia Hypothermia Hypo-/Hyperkalemia Hydrogen ion n

(acidosis) Hypomagnesia Hypoglycemia

Tamponade, cardiac Tension pneumothorax Thrombosis: lungs Thrombosis: heart Tablets/toxins: drug

overdose

WORKBOOK

SLIDES WITH THE BLUE BACKGROUND WILL BE IN YOUR WORK BOOK

FILL IN THE BLANKS AS WE GO THRU THE SLIDES

IT WILL BE VERY HELPFUL !!!

Components of Basic Life Support Recognition of signs of:

Stroke Heart Attack Cardiac arrest FBAO

How to perform: Abdominal thrust CPR Early Defibrillation with an AED

TEAM CONCEPT ALL MEMBERS NEED TO BE PROFICIENT

IN THEIR SKILLS EVERY MEMBER NEEDS TO BE ABLE TO

OPERATE/TROUBLESHOOT THEIR EQUIPMENT

CONSTRUCTIVE INTERVENTIONS OUR PURPOSE AS MEMBERS OF M.E.T. IS TO PREVENT PT DETERIORATION BY

EARLY INTERVENTIONS

STABLE VS. UNSTABLE

STABLE –A & OX3 SKIN WARM DRY COLOR GOOD NORMAL V.S.

UNSTABLE – A.M.S. / PALE OR CYANOTIC/ SWEATY/ABNORMAL V.S.

UNSTABLE PT IS IN SHOCK

IMPORTANT !!

STABLE PATIENTS ARE TREATED WITH MEDS

UNSTABLE PATIENTS ARE TREATED WITH ELECTRICITY

DEFIB/ PACER/ CARDIOVERSION

CABD SEQUENCE

WHAT DO AEDS AND EASTER EGGS HAVE IN COMMON ? POWER UP ATTACH

ELECTRODES ANALYZE

RHYTHM SHOCK/NO

SHOCK

Emergency Action StepsAssess-Alert-Attend to ABCDs

D=DEFIBRILLATION SHOCK/NO SHOCK.

If AED instructs “shock indicated” yell “CLEAR” or something similar.

Press shock button. Immediately resume chest compressions.

If no shock is indicated, immediately resume chest compressions.

Then follow instructions as given by AED

TROUBLESHOOTING AED

USUALLY PROBLEM LIES WITH POOR PADS ADHESION OR CABLE NOT CONNECTED

ANY MALFUNCTION WITH THE AED IMMEDIATELY START CPR

Emergency Action StepsAssess-Alert-Attend to ABCDs

D=DEFIBRILLATION (Summary) SHOCK advised

CLEAR and give 1 shock. Immediately resume CPR. Continue 30:2 x 5 cycles (2 min.). Reassess rhythm.

NO SHOCK advised Immediately resume CPR Continue 30:2 x 5 cycles (2 min.). Reassess rhythm.

CRITICAL THINKING AFTER PULSE CHECK –START CPR 30:2

AND A RATE OF 100 COMPRESSIONS PER MINUTE

INTERRUPTIONS IN CPR SHOULD BE KEPT TO LESS THAN 10 SECS

HIGH QUALITY CPR IN PT WITH ADVANCED AIRWAY UNINTERRUPTED CHEST COMPRESSIONS

AND 10 VENTILATION PER MINUTE

For high quality CPR

SWITCH COMPRESSORS EVERY 5 CYCLES (2 MINUTES)

HIGH QUALITY CPR HARD FAST UNINTERRUPTED AND ALLOW FOR COMPLETE CHEST RECOIL

INTERRUPTIONS TO LESS THAN 10 SECS

CRITICAL THINKING

NO PULSE = CHEST COMPRESSIONS NO PULSE = CHEST COMPRESSIONS NO PULSE = CHEST COMPRESSIONS IF YOU ARE NOT SURE IF PT HAS PULSE-

START CPR

SUCTIONING

SELECT PROPER SIZE/TYPE CATHETER

SUCTION ON THE WITHDRAWAL NO MORE THAN 10 SECS

WATCH O2 SATS AND HEART RATES

VENTILATION RATES

VENTILATION RATE WITH PULSE –EVERY 5-6 SECS

WITH ADVANCED AIRWAY- ONE EVERY 6-8 SECONDS

DELIVER OVER 1 SEC. JUST ENOUGH TO MAKE CHEST RISE

Capnography

CONFIRMATION …..

Monitor for changes in color (colorimetric device) or number (digital device) on an exhaled CO2 detector

CONTINUOUS WAVEFORM MOST RELIABLE METHOD OF VERIFYING ET TUBE PLACEMENT

CAUTIOUSLY SECURE ET TUBE –CIRCUMFRENTIAL TIES AROUND NECK CAN RESTRICT BLOOD FLOW

What is capnography?

Capnography measures exhaled PETCO2. Used to determine the effectiveness of

respiration and/or ventilation. CO2 is measured in mmHg Normal is defined as 35-45mmHg Post ROSC we want 35-40 mmHg

What’s the Difference

SpO2 = Pulse oximetry – measures oxygenation

EtCO2 = Capnography – measures ventilation

Devices used for Capnography Measured using qualitative and quantitative

devices Qualitative gives you a color change (purple

to yellow) Quantitative gives you a number

value(EtCO2 and Respirations) Most effective is Waveform Capnography

What does it mean in ACLS?

CO2 measures the effectiveness of our compressions, ventilations and overall patient care in resuscitation

Compressions only 25-35% as effective as heart beating on its own

Therefore CO2 during cardiac arrest may drop as low as 10mmHg

What does it mean in ACLS?

CO2 less than 10mmHg means something is wrong

PETCO2 >10mmHg=Good CPR CO2 should never drop below 10mmHg in

Cardiac Arrest

Troubleshooting Low CO2

Check compressions and confirm carotid pulse with compressions

Confirm tube placement Check equipment WHEN IN DOUBT PULL ENDOTRACHEAL

TUBE AND GO BACK TO BASICS.

What does no CO2 Mean?

CO2 readings of 0 or straight-line mean no CO2 is being registered.

Access tube placement Check ventilator WHEN IN DOUBT PULL ENDOTRACHEAL

TUBE

CRITICAL THINKING

COMMON FATAL MISTAKE IS PROLONGED INTERRUPTIONS IN CHEST COMPRESSIONS- USUALLY FOR AIRWAY

COMPONENT OF HIGH QUALITY CPR IS ALLOWING COMPLETE CHEST RECOIL

EKG RECOGNITION

12 Lead EKG

Except for unstable pt –any pt with chest pain/pressure/ discomfort gets 12 lead immediately

Looking for STEMI – ST elevation MI

Six Steps in Analyzing a Rhythm Strip 1. Assess the rate

2. Assess rhythm/regularity 3. Identify and examine P waves 4. Assess intervals 5. Evaluate overall appearance of rhythm

6. Interpret rhythm/evaluate clinical significance

Rate Measurement

Six-second method

Large Box Method

Count the number of large boxes between two consecutive waveforms (R-R interval or P-P interval) and divide into 300

Sinus Rhythm

TWO PARTS TO A BEATING HEART ELECTRICAL –ALL RHYTHMS (EXCEPT

ASYSTOLE ) HAVE ELECTRICAL ACTIVITY MECHANICAL- ALL PERFUSING

RHYTHMS ARE SUPPORTED BY ELECTRICAL COMPONENT AND MECHANICAL. MEASURED BY BLOOD PRESSURE

Ventricular Fibrillation (VF)

SQUIGGLY LINE-LOOKS LIKE A KID DRAWING ON A WALL !!

Ventricular Fibrillation (VF)

Fine VF

Coarse VF

Monomorphic Ventricular Tachycardia

Polymorphic Ventricular Tachycardia

ALSO CALLED TORSADES

Ventricular Tachycardia (VT)

Treat the following as VF: Pulseless monomorphic VT Pulseless polymorphic VT

Asystole (Cardiac Standstill)

“P-wave” Asystole

Asystole

Asystole

Check leads Long down time 25 minutes or greater 2

rounds of drugs with no rhythm change indicates death CONSULT MED CONTROL TO TERMINATE EFFORTS

Sinus Bradycardia

Second-Degree AV Block, Type II

Second-Degree AV Block, 2:1 Conduction (2:1 AV Block)

Third-degree AV Block

BRADY IS A BRADY

WIDE OR NARROW –STABLE GETS MEDS UNSTABLE GETS PACED

ASYMPTOMATIC-LEAVE IT ALONE

Sinus Tachycardia

Monomorphic Ventricular Tachycardia

NARROW VS WIDE

NARROW QRS USUALLY IS SUPRAVENTRICULAR

WIDE COMPLEX ORIGINATES IN THE VENTRICLES

Sinus Tachycardia—Causes

Fever Pain Anxiety Hypoxia CHF Acute MI Infection Shock

Hypovolemia Exercise Fright Dehydration Medications

Epinephrine Atropine Caffeine, nicotine Cocaine

Pulseless Electrical Activity (PEA) PEA exists when organized electrical activity

(other than VT) is present on the cardiac monitor, but the patient is apneic and pulseless

Critical Resuscitation Tasks

Airway management

Chest compressions

Monitoring and defibrillation

Vascular access/medication administration

Defibrillation—Indications

Pulseless ventricular tachycardia

Ventricular fibrillation

Paddles/Electrodes

HANDS FREE

SAFER ALLOWS FOR MORE RAPID

DEFIBRILLATION CONTINUE CPR DURING CHARGING OF

DEFIBRILLATOR

CRITICAL THINKING

CPR IMMEDIATELY AFTER DEFIB SIGNIFICANTLY INCREASES THE CHANCES OF CONVERSION

VAGAL MANEUVERS

USED TO SLOW FAST HEART RATES

Gagging. Holding your breath

and bearing down (Valsalva maneuver).

Immersing your face in ice-cold water (diving reflex).

Coughing.

Synchronized Cardioversion—Indications

Unstable supraventricular tachycardia

Unstable atrial fibrillation with rapid ventricular response

Unstable atrial flutter with rapid ventricular response

Unstable wide-complex tachycardia

Unstable ventricular tachycardia with a pulse

Electrical Therapy—Safety

Remove supplemental oxygen sources from area before defibrillation and cardioversion attempts Place them at least 3½-4 feet away from the

patient’s chest

Transcutaneous Pacing — Procedure

Transcutaneous Pacing (TCP)

Set the output (milliamps) setting Increase current slowly until capture achieved

Watch monitor closely for electrical capture

Transcutaneous Pacing (TCP)

Mechanical capture occurs when pacing produces a measurable hemodynamic response

Pulse Measurable blood pressure greater than 90

systolic

CPR SHOCK-200 J (BIPHASIC) EPI – 1MG or

VASOPRESSEN 40 UNITS SHOCK DRUG-LIDO (1MG/KG) OR

300 MG AMIODARONE SHOCK EPI-1MG

SHOCK LIDO/AMIODARONE SHOCK EPI EVERY 3-5 MIN 5H &5 T

PULSE LESS –TREAT LIKE V-FIB

STABLE ADENOSINE 6MG

“SLAM” REPEAT AT 12 MG AMIODARONE -

150MG LIDOCAINE 1MG/KG

UNSTABLE CARDIOVERT 100J DRUGS VERSED 5MG CARDIOVERT 200J

STABLE OXYGEN AND

AIRWAY IF O2 SATS >93%

ATROPINE .5MG DOPAMINE 2-10

MCG/KG/MIN EPI DRIP 1MG IN

100CC OVER 10 MINUTES

UNSTABLE OXYGEN AND

AIRWAY TCP-PACER ATROPINE – IF

PACER IS DELAYED

STABLE VAGAL MANEUVERS ADENOSINE 6MG ADENOSINE 12 MG CARDIAZEM-.25MG/KG

UNSTABLE CARDIOVERT 100J VERSED 5MG CARDIOVERT 200

PEA-NO PULSE BUT SHOULD BE ONE !

CPR/EPI/5H’S-5T’S HYPOVOLEMIA-FLUID HYPOKALEMIA-K+ HYPOXIA-O2 HYPOGLYCEMIA-D50 HYPOTHERMIA-TEMP HYDROGEN ION-

BICARB 1MEQ/KG

TAMPONADE-STEEL TOXIN-NARCAN 2MG TENSION PNEUMO-

SURGEON TRAUMA-SURGEON THROMBOSIS-FIBRO

TREAT LIKE PEA CONSIDER TERMINATING EFFORTS

AFTER EXTENDED TIME ( GREATER THAN 25 MIN ) AN 2 OR MORE ROUNDS OF DRUGS

POST ROSC

MAINTAIN BP>90 SYSTOLIC PETCO2 > 35-40 MMhG O2 SAT > 93 % OPTIMIZE VENTILATIONS AND

OXYGENATION THERAPEUTIC HYPOTHERMIA- NOT

NECESSARY IF PT A&OX3

ACS-HEART ATTACK

12 LEAD ASAP MONA REALLY- OANM ASA-325 MG NITRO -.4 MG UP TO 3

TIMES- NO RVI/NO E.D. / BP > 90 SYSTOLIC

MORPHINE – 2-6 MG 12 LEAD EKG FIBRONYLITICS

STROKE/CVA/BRAIN ATTACK SUDDEN ONSET NEUROLOGICAL

PROBLEM HEADACHE UNILATERAL WEAKNESS = CINCINNATI

OR OTHER STROKE ASSESSMENT NEEDS HEAD CT ASAP FIBRONOLYTICS WITHIN 3 HRS

CRITICAL THINKING WHAT IS THE ONE DRUG USED IN ALL

ARRESTS ? DOSE ??BEST ROUTE TO ADMINISTER

WHY IS ATROPINE USED IN HYPOTENSIVE PTS W/ SLOW RHYTHMS

WHAT IS THE WINDOW FOR THROMBOLYTICS

12 LEAD AS SOON AS POSSIBLE FOR CHEST PAIN “RACING HEART” OR “INDIGESTION”

CRITICAL THINKING

VENTRICULAR PROBLEMS NEED EITHER LIDO OR AMIODARONE

GOAL IS TO HAVE BREATHING PULSED PT WITH BP >90/ CO2 35-40mm/hg

THERAPEUTIC HYPOTHERMIA