ACLS 2005 Update ACLS 2005 Update The EssentialsThe EssentialsWhistler Whistler - September 2006 September 2006 ACLS 2005 Update ACLS 2005 Update The EssentialsThe EssentialsWhistler Whistler - September 2006 September 2006 Dr. John Pawlovich Dr. John Pawlovich Fraser Lake, BC Fraser Lake, BC CCFP , Assistant Clinical Professor UBC CCFP , Assistant Clinical Professor UBC
28
Embed
Case Management of ACLS Handouts - Power Point 879
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
8/6/2019 Case Management of ACLS Handouts - Power Point 879
The 5 major changes in the 2005 guidelines:The 5 major changes in the 2005 guidelines:The 5 major changes in the 2005 guidelines:The 5 major changes in the 2005 guidelines:
1.1. improve delivery of effective chest compressionsimprove delivery of effective chest compressions
2.2. single compressionsingle compression--toto--ventilation ratio (30:2)ventilation ratio (30:2)(except newborns)(except newborns)
3.3. each rescue breath should be given over 1 secondeach rescue breath should be given over 1 secondto produce visible chest riseto produce visible chest rise
4.4. single shock followed by immediate CPR without single shock followed by immediate CPR without pulse or rhythm check for VF/ PVT cardiac arrest pulse or rhythm check for VF/ PVT cardiac arrest
5.5. AED use in children (1 AED use in children (1--8 years)8 years)
1.1. improve delivery of effective chest compressionsimprove delivery of effective chest compressions
2.2. single compressionsingle compression--toto--ventilation ratio (30:2)ventilation ratio (30:2)(except newborns)(except newborns)
3.3. each rescue breath should be given over 1 secondeach rescue breath should be given over 1 secondto produce visible chest riseto produce visible chest rise
4.4. single shock followed by immediate CPR without single shock followed by immediate CPR without pulse or rhythm check for VF/ PVT cardiac arrest pulse or rhythm check for VF/ PVT cardiac arrest
5.5. AED use in children (1 AED use in children (1--8 years)8 years)
8/6/2019 Case Management of ACLS Handouts - Power Point 879
One Universal CompressionOne Universal Compression--toto--Ventilation VentilationRatio for All Lone RescuersRatio for All Lone Rescuers
One Universal CompressionOne Universal Compression--toto--Ventilation VentilationRatio for All Lone RescuersRatio for All Lone Rescuers
2005 (New):2005 (New): 30:2 for all lone rescuers30:2 for all lone rescuers
2000 (Old):2000 (Old): 15:2 adults, 5:1 child and infant.15:2 adults, 5:1 child and infant.
Why:Why: ByBy--stander CPR is on the order of 30% or less.stander CPR is on the order of 30% or less.Simplify guidelines to increase bystander CPR.Simplify guidelines to increase bystander CPR.
2005 (New):2005 (New): 30:2 for all lone rescuers30:2 for all lone rescuers
2000 (Old):2000 (Old): 15:2 adults, 5:1 child and infant.15:2 adults, 5:1 child and infant.
Why:Why: ByBy--stander CPR is on the order of 30% or less.stander CPR is on the order of 30% or less.Simplify guidelines to increase bystander CPR.Simplify guidelines to increase bystander CPR.
8/6/2019 Case Management of ACLS Handouts - Power Point 879
RationaleRationale -- 1 Shock followed by Immediate1 Shock followed by ImmediateCPRCPR
RationaleRationale -- 1 Shock followed by Immediate1 Shock followed by ImmediateCPRCPR
1.1. The rhythm analysis by current AEDs afterThe rhythm analysis by current AEDs aftereach shock typically results ineach shock typically results in 37 sec 37 sec delaydelay
in CPRin CPR2.2. first shock eliminates VF in more than 85% of first shock eliminates VF in more than 85% of cases. If first shock fails, resumption of CPR iscases. If first shock fails, resumption of CPR islikely more beneficiallikely more beneficial
3.3. it takes several minutes for a normal heart it takes several minutes for a normal heart rhythm to return and more time for the heart rhythm to return and more time for the heart to create blood flow after VF is eliminated.to create blood flow after VF is eliminated.CPR can bridge that gap.CPR can bridge that gap.
4.4. Immediate CPR after defibrillation is not Immediate CPR after defibrillation is not
harmful.harmful.
1.1. The rhythm analysis by current AEDs afterThe rhythm analysis by current AEDs aftereach shock typically results ineach shock typically results in 37 sec 37 sec delaydelay
in CPRin CPR2.2. first shock eliminates VF in more than 85% of first shock eliminates VF in more than 85% of cases. If first shock fails, resumption of CPR iscases. If first shock fails, resumption of CPR islikely more beneficiallikely more beneficial
3.3. it takes several minutes for a normal heart it takes several minutes for a normal heart rhythm to return and more time for the heart rhythm to return and more time for the heart to create blood flow after VF is eliminated.to create blood flow after VF is eliminated.CPR can bridge that gap.CPR can bridge that gap.
4.4. Immediate CPR after defibrillation is not Immediate CPR after defibrillation is not
harmful.harmful.
8/6/2019 Case Management of ACLS Handouts - Power Point 879
DefibrillationDefibrillation General concept General concept DefibrillationDefibrillation General concept General concept Immediate defibrillation if witnessed arrest andImmediate defibrillation if witnessed arrest and
AED available AED available
Compressions before defibrillation if unwitnessedCompressions before defibrillation if unwitnessedor arrival at the sceneor arrival at the scene >4>4--5 minutes.5 minutes.
One shockOne shock followed by immediate CPRfollowed by immediate CPR(beginning with chest compressions)(beginning with chest compressions)
rhythm check after 5 cycles of CPR or 2 minutesrhythm check after 5 cycles of CPR or 2 minutes
Immediate defibrillation if witnessed arrest andImmediate defibrillation if witnessed arrest and AED available AED available
Compressions before defibrillation if unwitnessedCompressions before defibrillation if unwitnessedor arrival at the sceneor arrival at the scene >4>4--5 minutes.5 minutes.
One shockOne shock followed by immediate CPRfollowed by immediate CPR(beginning with chest compressions)(beginning with chest compressions)
rhythm check after 5 cycles of CPR or 2 minutesrhythm check after 5 cycles of CPR or 2 minutes
8/6/2019 Case Management of ACLS Handouts - Power Point 879
Drug AdministrationDrug AdministrationDrug AdministrationDrug Administration I V or IO drug administration is preferred to ETTI V or IO drug administration is preferred to ETT
routeroute
Drugs should be delivered during CPR as soon asDrugs should be delivered during CPR as soon aspossible after rhythm checks.possible after rhythm checks.
timing of drug administration is less important thantiming of drug administration is less important thanthe need to minimize interruptions in chest the need to minimize interruptions in chest
compressionscompressions
I V or IO drug administration is preferred to ETTI V or IO drug administration is preferred to ETTrouteroute
Drugs should be delivered during CPR as soon asDrugs should be delivered during CPR as soon aspossible after rhythm checks.possible after rhythm checks.
timing of drug administration is less important thantiming of drug administration is less important thanthe need to minimize interruptions in chest the need to minimize interruptions in chest
compressionscompressions
8/6/2019 Case Management of ACLS Handouts - Power Point 879
Use of Advanced AirwaysUse of Advanced AirwaysUse of Advanced AirwaysUse of Advanced Airways
LM A and Combitube should be considered (ClassLM A and Combitube should be considered (ClassIIa).IIa).
Advanced airway may be placed several minutes Advanced airway may be placed several minutesinto the resuscitationinto the resuscitation
clinical assessment plus a device such as ETCOclinical assessment plus a device such as ETCO22 or EDD toor EDD toconfirm ETT placement (Class IIa).confirm ETT placement (Class IIa).
LM A and Combitube should be considered (ClassLM A and Combitube should be considered (ClassIIa).IIa).
Advanced airway may be placed several minutes Advanced airway may be placed several minutesinto the resuscitationinto the resuscitation
clinical assessment plus a device such as ETCOclinical assessment plus a device such as ETCO22 or EDD toor EDD toconfirm ETT placement (Class IIa).confirm ETT placement (Class IIa).
8/6/2019 Case Management of ACLS Handouts - Power Point 879
summarized in a single algorithmsummarized in a single algorithm
branch points then become narrow versus widebranch points then become narrow versus widecomplex, and regular versus irregular rhythmscomplex, and regular versus irregular rhythms
polymorphic VT should be treated as VF withpolymorphic VT should be treated as VF withhighhigh--energy unsynchronized defibrillationenergy unsynchronized defibrillation
symptomatic bradycardiasymptomatic bradycardia
atropine 0.5mg I V (max 3mg)atropine 0.5mg I V (max 3mg)
summarized in a single algorithmsummarized in a single algorithm
branch points then become narrow versus widebranch points then become narrow versus widecomplex, and regular versus irregular rhythmscomplex, and regular versus irregular rhythms
polymorphic VT should be treated as VF withpolymorphic VT should be treated as VF withhighhigh--energy unsynchronized defibrillationenergy unsynchronized defibrillation
8/6/2019 Case Management of ACLS Handouts - Power Point 879
AH A ECC 2005 GUIDELINES AH A ECC 2005 GUIDELINESSUMM AR Y SUMM AR Y of of
AH A ECC 2005 GUIDELINES AH A ECC 2005 GUIDELINES
Eff ective ACLS begins with highEff ective ACLS begins with high--quality quality BLS...particularly highBLS...particularly high--quality CPR! quality CPR!
The potential eff ects of any drugs or ACLS The potential eff ects of any drugs or ACLS therapy on outcome from VF SCA arr esttherapy on outcome from VF SCA arr est ar e dwarf ed by the pot ential eff ects of ar e dwarf ed by the pot ential eff ects of hi ghhi gh--qualit y CPR.qualit y CPR.
Eff ecti ve ACLS begins with hi ghEff ecti ve ACLS begins with hi gh--qualit y qualit y BLS...particularl y hi ghBLS...particularl y hi gh--qualit y CPR! qualit y CPR!
T he pot ential eff ects of an y drugs or ACLS T he pot ential eff ects of an y drugs or ACLS therapy on outcome from VF SCA arr est therapy on outcome from VF SCA arr est ar e dwarf ed by the pot ential eff ects of ar e dwarf ed by the pot ential eff ects of hi ghhi gh--qualit y CPR.qualit y CPR.