ACLS

ACLSFOR DUMMIES (PARAMEDICS)

Algorhythms are your best friend

Main Algorhythms CPR AlgorhythmPulseless ArrestTachycardia with pulseBradycardiaROSC

CPR Algorhythm (BLS Code)Hey, hey, are you okay?You are 911Jaw thrust or head tilt chin liftUse an Ambu bag and at least one basic airway adjunctONLY 10 secondsHard and fast 30:2Turn on your AED / MonitorRhythm checkShockStart CPR again

Algorhythm

Pulseless Arrest

Pulseless ArrestCall for assistance if not already thereUse Ambu bagAttach cardiac monitorCheck rhythmConfirm V-fib or V-tach

Pulseless ArrestShock at 200 JResume CPRIf you did not secure an airway yet, do it now.Attach Auto PulseEstablish IV or IO accessGet ready with the EPI

Pulseless ArrestCheck rhythmShock at 200 JRestart CPRGive either one:EPINEPHRINE 1mgVASOPRESSSIN 40 units

Pick One

Pulseless ArrestRhythm CheckShockGive an antiarrhythmic:LIDOCAINE 1 1.5 mg/kgAMIODARONE 300 mgMag Sulfate if Torsades

Pulseless Arrest Package patientInitiate transportReconfirm airwayContinue to give EPINEPHRINE q 3 -5 minutesRepeat antiarrhythmics:LIDOCAINE (0.5- 0.75 mg / kg ) half first doseAMIODARONE (150 mg) half first doseIf you get a pulse back with one of these drugs, set up a drip.

Pulseless Arrest Not shockablePEAAsystole

Pulseless ArrestAssure adequate CPRSecure AirwayEstablish IV or IOAdminister medications:EPINEPHRINE 1 mg q 3-5 minVasopressin 40 Units (one time)Atropine (Asystole or slow PEA)

Pulseless ArrestRecheck rhythm after 5 cycles of cprIf shockable, then shockIf there is a pulse, treat as indicated

Pulseless Arrest

Pulseless ArrestIf patient is intubated, do continuous compressionsRecheck tube placement oftenDocument tube placement confirmations

Tachycardia with Pulse

Is there a pulse?

Is he stable or unstable?

TachycardiaOXYGENECGGOOD SET OF VITALSANY CAUSES?HyperventilationOverdose

TREAT THE PATIENTNOT THE MONITOR

TACHYCARDIASTABLE OR UNSTABLEGO BACK TO GENERAL IMPRESSIONHOW LONG WILL PATIENT TOLERATE THE RHYTHM ?HOW LONG HAS THE PATIENT BEEN IN THIS RHYTHM ?

TACHYCARDIA: Unstable

Establish IVSedate patient if possibleCardioversion:Press Sync buttonPress Shock (hold down until it discharges)

TACHYCARDIA: StableEstablish IV12 lead ECGIdentify the rhythm

Tachycardia: NarrowSVT Vagal ManeuversAdenosine6 mg (Rapidly)12 mg12 mgA-FibThink about cardizem A- Flutter

Tachycardia: NarrowTransport patientTransmit 12 leadCall for additional orders

TACHYCARDIA:Wide complex Ventricular TachycardiaAmiodaroneCardioversionAtrial fib with aberrancyThink about cardizemSVT with aberrancyAdenosine

TACHYCARDIA

Hs and TsLook for possible causes

ELECTRICAL CARDIOVERSIONNot usually needed for HR < 150 bpmCheck O2 Sats; IV; Intubation equipmentPremedicate if possible: valium or versed

CARDIOVERSIONV- Tach: start at 100 JPSVT: start at 50 J

BRADYCARDIALess than 60 bpmIs patient symptomatic ?Some causes of bradycardiaHealthy, athletic personPatient on beta blockersPatient on digoxinOverdose of narcotics

BRADYCARDIA

BRADYCARDIA (SYMPTOMATIC)Use atropine while you are setting up the pacemakerDoes not last very longPace 3rd degree

BRADYCARDIA

Transmit ECG if availableSedate patient if necessary Dont delay pacingAtropine may not work for transplanted hearts

Causes of Arrest / Arrhythmia

Treatments of these causesCauseTreatmentHypoxiaHypvolemiaHypothermiaHypokalemiaHypoglycemiaToxinsThrombosisTraumaCardiac TamponadeTension PneumothoraxHyperkalemiaMetabolic AcidosisRespiratory AcidosisVentilationIV FluidsWarm PatientRestore electolyte imbalanceSugarDetoxifyThrombolysisSurgery / bleeding controlPericardialcentesis Thoracic decompressionBicarbBicarbVentilation

HOW TO WORK MEGACODES IN CLASSUse all help availableIf you are working with a partner and you have a helperPerson 1 - AirwayPerson 2- Monitor then IV / drugsPerson 3 (1st responder or bystander)- Chest compressions

Be seriousUse the event button on LP 12

Amiodarone 3 Ways:For VF/Pulseless V-TachV-Tach or wide complex regularMaintenance Drip

Amiodarone #1: VF or Pulseless VT300 mg2 vials of 150 mg

Amiodarone #2: V-tach with pulse150 mg over 10 minutes150 mg in 100 mL spiked with macro is 100 gtt/min

Amiodarone #3: Maintenance1 mg / min100 mg in 100 mL bag spiked with micro drip = 60 gtt/min