2015 ACLS Review. (877) FL PA NJ

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1 2015 ACLS Review (877) FL PA NJ

2 DISCLAIMER The following information is provided by the American Heart Association. Monies collected do not represent income for the American Heart Association. Please review and study your American Heart Association ACLS Manual before attempting to complete the AHA ACLS Course.

3 QRS Complex P wave indicates Atrial depolarization. QRS complex indicates Ventricular depolarization T wave indicates re-polarization

4 Rhythm Recognition Fast or slow? Regular or irregular? QRS narrow or wide? Is there a P wave? Is the P wave close or far from QRS? Is the P wave in the same place?

5 Normal Sinus Rhythm

6 1 st Degree Heart Block Usually benign, very common Not treatable in ACLS unless symptomatic Not actually a block- just a delay in conduction PRI- >20 (4 small boxes) If the Rs are far from Ps, then you have a 1 st Degree

7 2nd Degree Heart Block, type 1 Usually Irregular aka Wenckebach Not treatable in ACLS unless symptomatic PRI- Long, long, longer, DROP- must be a Wenckebach!

8 2 nd Degree, Type 2 Heart Block Blocked P waves/dropped QRS Complexes If some Ps don t have Qs, then you have a Mobitz 2 This is getting worse

9 Malignant 3 rd Degree Heart Block (Complete Heart Block) Usually Bradycardic, Irregular Won t take long NEED TO TREAT! If the Ps and Qs do not agree, then you have a 3 rd degree!

10 Supra Ventricular Tachycardia (SVT) Firing somewhere above the Ventricles Treatable over 150 BPM per ACLS Regular and FAST!

11 Ventricular Tachycardia (V- tach with or w/o Pulses) Extremely dangerous arrhythmia Patient wont last long Wide and Bizarre pattern, but regular Shock-able rhythm (if no pulse present)

12 Torsades de Pointes Translates to: Twisted of the Spikes Described as Polymorphic Tachycardia May degenerate to V-Fib if persistent Caused by HYPOkalemia/HYPOmagnasemia

13 Ventricular Fibrillation (V-Fib) Won t have a pulse Fine or coarse Shock-able rhythm Patient is in CARDIAC ARREST at this point

14 Pulseless Electrical Activity (PEA) ANY rhythm can be PEA as long as it doesn t have a PULSE! YOU MUST CHECK A PULSE WITH EVERY RHYTHM- In a Cardiac Arrest!

15 Asystole (Flat line) Heart not producing ANY electrical activity NON-Shockable Rhythm Patient is DEAD

16 Acute M.I. (Where do you see STEMI?)

17 ACLS DRUGS Atropine Derived from the Nightshade Plant (deadly) Dilates pupils, increases heart rate Used to treat symptomatic bradycardia No longer used for PEA DOSE: 0.5 mg with a maximum of 3.0 mg

18 ACLS DRUGS Adenosine Inhibits neurotransmitters Resets heart Asystole for 3-5 seconds Causes a transient heart block in the AV node Used to treat Asymptomatic SVT over 150bpm NOT for wide complex IRREGULAR V -Tach DOSE: 6.0 mg then 12.0 mg

19 ACLS DRUGS Amiodarone Bolus Anti-arrhythmic Works on the Atria and the Ventricles If you can shock, use Amiodarone DOSE: 300 mg then 150 mg. MAX: 450 mg

20 ACLS DRUGS Epinephrine (Bolus) Hormone naturally occurring in the body Affects the Sympathetic Nervous System Constricts blood vessels, increases peripheral resistance Increases Heart Rate (Inotropic effects and Chronotropic effects) (contractility and rate) DOSE: 1.0 mg NO MAX DOSE!

21 ACLS DRUGS Dopamine Second-line drug for symptomatic bradycardia when atropine is not effective Used for cardiogenic shock in the absence of hypovolemia Dose: 2-10 micrograms/kg/min infusion

22 ACLS DRUGS Epinephrine (Infusion) Second-line drug for symptomatic bradycardia when atropine is not effective. Choose EPI or Dopamine Dose: 2-10 micrograms/kg/min infusion*

23 ACLS DRUGS Magnesium Sulfate For the treatment of Torsades Dose: 1-2 Grams (Slow Push)

24 H s and T s Hypovolemia Hypoxia Hydrogen Ions (acidosis) Hyper/Hypo kalemia Hypothermia Toxins Tamponade (cardiac) Tension Pneumothorax Thrombosis (coronary) Thrombosis (Pulmonary)

25 Circular Algorithm

26 Treatment Modalities per ACLS V-FIB or (V-TACH w/o pulses) are the only shock-able rhythms. 360J Monophasic Defibrillator/ 200J Bi-Phasic High Quality CPR BPM EPI 1mg Amiodarone- 300mg, then 150mg (450mg MAX)

27 SVT Treatable at 150 BPM Use Valsalva Maneuver First (Think BLS) Stable= Drugs. Adenosine 6mg, 12mg, done Unstable= Electricity. Synchronized Cardioversion. (sedate first) Joule Settings discussed in class MAKE SURE YOU PUSH SYNCH BUTTON!

28 V-TACH w/pulses (Regular) Dangerous arrhythmia- PT. wont last long Stable= Use Adenosine Unstable= Electricity (Cardioversion) Joule Settings discussed in class Try to sedate first. Don t delay treatment. PT. will usually be UNSTABLE!

29 V-Tach (Irregular, Torsades) Dangerous arrhythmia- PT. wont last long Stable= Adenosine- not indicated. Magnesium Sulfate (DEFIBRILLATE- Won t be able to sync)

30 Bradycardias Less than BPM Stable= DO NOT AGGRESSIVELY TREAT- watch patient Unstable= (1) Atropine (2) Dopamine or EPI Drip (3)Pacing

31 Pacing Apply D-Fib Pads on Pt Set Pacer at 80 BPM* Increase ma until 1 pacer spike precedes QRS Check Femoral Artery for pulse that matches monitor If is doesn t, increase ma until it does

32 PEA (Pulseless Electrical Activity) A rhythm that appears on a monitor to have a pulse, but does not when the pulse is checked High quality CPR Epinephrine, 1.0 mg NON- SHOCKABLE! Push Epi Always

33 Complete Heart Block (3 rd degree) The use of Atropine is not indicated Transcutaneous pacing Fluids Oxygen Cardiology consult

34 Hypothermia Protocol (Targeted Temperature Management) Patient MUST be Intubated and Comatose Cool to Celsius At least 24 hours Optimizes Neurologic Recovery Maintain Hemodynamics

35 THE END! THANK YOU!!!

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