ACLS 2010 updates
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Transcript of ACLS 2010 updates
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“ACLS 2010”
Basic Review and Possible changes in the next guideline ?
นพ. ปริญญา คุณาวุฒิ
ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ รพ. รามาธิบดี
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“ACLS 2005”
American Heart Association Guidelines for Cardiopulmonary Resuscitation
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2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care:
Circulation. 2005; 112: (Suppl I): IV-1 - IV-210.
December 13, 2005
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The 10 Core Situations 2000-10
Core 1: Respiratory ArrestCore 2: VF/Pulseless VT With AEDsCore 3: VF/Pulseless VTCore 4: AsystoleCore 5: PEACore 6: BradycardiaCore 7: Wide QRS TachycardiasCore 8: Narrow QRS TachycardiasCore 9: Acute Coronary SyndromesCore 10: Stroke
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Ped
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Shockable rhythm
• VF
• Fast VT
• Torsades de pointes
• SVT
AED not synchronized !!
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“ACLS 2010”
Tips and techniques ?
นพ. ปริญญา คุณาวุฒิ
ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ รพ. รามาธิบดี
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IV-58
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IV-58
Cardiac arrest
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Shock No shock
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BP ปกติBP drop
No BP = Pulseless VT
Shock
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Biphasic 360/Tri
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การ set Joules
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ความคิดเห็น
1. ไม่ได้ต้องการให้ท่องจ า
2. ต้องการให้ทราบเปน็ team เดยีวกัน?
3. พยาบาลเรยีน ควรมีแพทยเ์ป็น leader
4. เน้น team dynamic
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1% xylocaine หมายความว่า
100 ml มี xylocaine 1 gm = 1,000 mg
ดังนั้น
1 ml มี xylocaine 10 mg
10 ml มี xylocaine 100 mg
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VF / Pulseless VT
2 4 6 8 10 12 14 16 18 20
E Ami300
E Ami150
E
0
E E
E Li E Li E Li E E
Time
Med
E = Epinephrine
Ami = Amiodarone
Li = Lidocaine
Med
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VF / Pulseless VT
2 4 6 8 10 12 14 16 18 20
E Ami300
E Ami150
E
0
E E
E Li E Li E Li E E
Time
Med
Med
Adrenaline เป็น vasopressor จึงควรให้ทันทีเมื่อผู้ป่วยเกิด cardiac arrest
?
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1 2 3
ควรฉีดยาตรงต าแหน่งใด ?
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10 ml syringe
การต่ออุปกรณ์
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Amiodarone Rx VF หวังผลอะไร
1. ท าให ้shock VF หายได้ง่ายขึ้น2. prevent recurrent ของ VF
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VF - Amiodarone 150 mg/3 ml ฉีดอย่างไร?
คนไข้ VF ก าลัง CPR
แพทย์ order amiodarone 300 mg
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300 mg = 6 cc
1. dilute เป็น 100 cc แล้ว drip ใน 10 นาที
2. 300 mg(6 cc) push เร็วๆ แล้วเปิด iv free flow ตาม
3. 300 mg dilute เป็น 10 cc ฉีดใน 2 นาที
4. 150 mg dilute เป็น 10 cc ฉีดใน 1 นาที x 2 doses
5. 300 mg dilute เป็น 30 cc ฉีดใน 3 นาที
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• Cardioversion
• Defibrillation
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สอนได้สองแบบ
• Synchronized VS Unsynchronized
• Shockable rhythm
• No pulse --- Unsynchronized
R
TR on T phenomenon
VF
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BP drop
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Prolong press
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The 10 Core Situations 2000-10
Core 1: Respiratory ArrestCore 2: VF/Pulseless VT With AEDsCore 3: VF/Pulseless VTCore 4: AsystoleCore 5: PEACore 6: BradycardiaCore 7: Wide QRS TachycardiasCore 8: Narrow QRS TachycardiasCore 9: Acute Coronary SyndromesCore 10: Stroke
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Asystole
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Asystole 2000-2005
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Asystole 2000-2005
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No Pacing
2005-2010
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Asystole
2 4 6 8 10 12 14 16 18 20
E A2 E A2 E
0
E E
22
EA1A2
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Guideline แนะน าครั้งละ 1 mg
Atropine 0.6 mg/amp
2 amps = 1.2 mg ใช้ครั้งละ 2 amps
Max dose ตาม guideline 3 mg
2 – 2 – 1 = 5 amps ---- 3 mg OK
2 – 2 – 2 = 6 amps ---- 3.6 mg (เกิน) 56
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Pulseless Electrical Activity
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Pulseless Electrical Activity(PEA = rhythm on monitor, without detectable pulse)
6 Hs + 6 Ts
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Point เวลาใช้งานจริง
1. Need team dynamic มาก
2. ต้องมกีารคดิเตรียมการไวก้่อน
3. มีการขอความช่วยเหลือระหว่างแพทย์
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Need lab, lavage, echo, set หัตถการ ฯลฯ
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The 10 Core Situations 2000-10
Core 1: Respiratory ArrestCore 2: VF/Pulseless VT With AEDsCore 3: VF/Pulseless VTCore 4: AsystoleCore 5: PEACore 6: BradycardiaCore 7: Wide QRS TachycardiasCore 8: Narrow QRS TachycardiasCore 9: Acute Coronary SyndromesCore 10: Stroke
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IV-68
ต้องมีชีพจร
Other med
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ความคิดเห็น
1. น่าจะจัดการได้ แม้อ่าน EKG ยากๆไม่ได้
2. เข้าใจข้อจ ากดัของการใช ้ext. pace
3. ต้องสามารถคิด dose ยา drip ได้
4. Dose atropine
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Epinephrine 2-10 microgm/min
2 - 10 microgram / min
1 microgram / min = 10 cc/hr
2 20
3 30
4 40
… …
10 100 cc/hr
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ตัวอย่างวิธีคิด
10 cc/hr ---- 1 microgram/min
---- 60 micrograms / 60 min.
10 cc = 60 micrograms
100 cc = 600 micrograms
1 amp = 1 mg = 1000 micrograms
0.6 amp / 100 cc
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mg
ml
ccX
hrX
1000
60X
1
kg= µgm/kg/min
Dopamine 2-10 microgm/kg/min
ยาที่ท่านใช้ drip
ท่านผสมยากี ่mg ในน้ ากี ่ml
ก็แทนคา่ลงไป
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Dopamine 2-10 microgm/kg/min
mg x cc/hr x 1000 x 1 = microgm/kg/min
cc 60 kg
100 x cc/hr x 1000 x 1 = 10
100 60 50
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mg
ml
ccX
hrX
1000
60X
1
kg= µgm/kg/min
ตัวอย่างการ modified สูตร
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การหา mg ของยาที่ใช้ผสม = ?
mg x cc/hr x 1000 x 1 = microgm/kg/min
100 60 50
Syringe pump 50 ml
หรือ NSS ขวด 100 ml ที่ท่านใช้ผสมยา
น.น. ของคนไข้
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Complete loop connection
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Find out pacer button
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Check Pacemaker Function
1. Normal Pace – Demand Mode
2. Asyn Pace – Fixed Mode
What function for what situation?
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Check pulse
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Tachycardia
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IV-70
Narrow Wide
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VT, TdP, AF ----- sync 200 J (360 J)
SVT, A flutter ---- sync 50 J
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Narrow complex
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ความเห็น
1. อ่าน SVT ได้
2. ฉีด adenosine เป็น
3. ไม่ลืม run EKG
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ตัวแคบ เต้นเร็ว จังหวะการเต้นสม่ าเสมอดี
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ตัวกว้าง ตัดกันที่ สาม ช่องเล็ก
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Regular NCT(Regular narrow complex tachycardia)
1. Re-entry SVT
2. Atrial tachycardia
3. Atrial flutter 1:1 conduction
4. Junctional tachycardia
5. Sinus tachycardia
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Re-entry SVT
Atrial tachycardia
Atrial flutter 1:1 conduction
Junctional tachycardia
Sinus tachycardia
Med
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Adenosine 6 mg iv
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IV-70
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Wide complex
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BP ปกติBP drop
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BP 80/40
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Choice
1. Magnesium 1-2 amps slow iv push
2. Sedate and D/C 200 J sync
3. ท า ๑ ก่อน ถ้าไมห่าย ต่อด้วย ๒
4. ท า ๒ ก่อน ถ้าไมห่าย ใช้ ๑ แล้วมา ๒ อีกรอบ
5. ให้ amiodarone 300 mg slow iv push
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BP 100/60
1. Magnesium 1-2 amps slow iv push
2. Sedate and D/C 200 J sync
3. ท า ๑ ก่อน ถ้าไมห่าย ต่อด้วย ๒
4. ท า ๒ ก่อน ถ้าไมห่าย ใช้ ๑ แล้วมา ๒ อีกรอบ
5. ให้ amiodarone 300 mg slow iv push
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Mechanical CPR
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The 10 Core Situations 2000-10
Core 1: Respiratory ArrestCore 2: VF/Pulseless VT With AEDsCore 3: VF/Pulseless VTCore 4: AsystoleCore 5: PEACore 6: BradycardiaCore 7: Wide QRS TachycardiasCore 8: Narrow QRS TachycardiasCore 9: Acute Coronary SyndromesCore 10: Stroke
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Question / Contact
น.พ. ปริญญา คุณาวฒุิRamathibodi CPR Training Center
อาคารบ้าบัดน้้าเสีย ชั้น 3 ร.พ. รามาธิบดีเขตราชเทวี กทม. 10400
02-201-2821 / 02-201-2822
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