ACLS Arrhythmias and Treatment Modalities

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1 ACLS Arrhythmias and Treatment Modalities Presented by CMR CPR (a division of CMR Medical Supply, LLC) An American Heart Association Affiliated Training Site

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 Normal Sinus Rhythm

5 1 st Degree Heart Block Usually benign, very common Not treatable in ACLS Progressively gets worse over time Not actually a block- just a delay in conduction PRI- >20 (4 small boxes) Normally regular

6 2nd Degree Heart Block, type 1 Usually Irregular aka Wenckebach Not treatable in ACLS PRI- Long, long, longer, DROP- must be a Wenckebach!

7 2 nd Degree, Type 2 Heart Block Blocked P waves/dropped QRS Complexes Usually 1 or 2 additional P waves This is getting worse

8 Malignant 3 rd Degree Heart Block (Complete Heart Block) Usually Bradycardic, Irregular Won t take long NEED TO TREAT! P waves regular, not associated w/ QRS complexes

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

10 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)

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

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

13 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!

14 Asystole (Flat line) Heart not producing ANY electrical activity NON-Shock-able Rhythm Patient is DEAD

15 Acute M.I. (Leads 2,3 & avf)

16 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

17 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

18 ACLS DRUGS Anti-arrythmic Amiodarone Bolus Works on the Atria and the Ventricles DOSE: 300 mg then 150 mg. MAX: 450 mg

19 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) (electricity and rate) DOSE: 1.0 mg NO MAX DOSE!

20 Anti-diuretic hormone ACLS DRUGS Vasopressin Retains water in the body and constricts blood vessels May be used in cardiac arrest in place of 1 st or second dose of epinephrine Half life is minutes DOSE: 40 units

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 with pulses present Dose: 1-2 Grams

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

25 Circular Algorithm

26 Treatment Modalities per ACLS V-FIB or (V-TACH w/o pulses) are the only shock-able rhythms. Start at 360J, and continue at 360J* (With a MONO-phasic Defibrillator) High Quality CPR EPI or (Vasopressin, 1 st or 2 nd dose) 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) 100 J,200J, 300J 360J* (discussed in class) MAKE SURE YOU PUSH SYNCH BUTTON! Be careful w/ rapid A fib- throw a clot BAD

28 V-TACH w/pulses (Regular) Dangerous arrhythmia- PT. wont last long Valsalva maneuver first (Think BLS) Stable= Use Adenosine Unstable= Electricity (Monophasic) 100J,200J, 300J 360J Try to sedate first. Don t delay treatment. PT. will usually be UNSTABLE!

29 V-Tach (Irregular, Torsades) Dangerous arrhythmia- PT. wont last long Valsalva maneuver first (Think BLS) Stable= Adenosine- not indicated. Magnesium Sulfate Electricity. 100J,200J, 300J 360J (Monophasic)

30 Bradycardias Less than 60 BPM Stable= DO NOT 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 (Pulsless 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!

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

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