ACLS 2010 Study Guide. Be proficient with BLS: Check carotid pulses for less than 10 seconds.
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From this document you will learn the answers to the following questions:
How many compressions are given for 2 minutes?
What is the acronym for Partial End - Tidal Change?
What percent of the time does the Shock Keep Saturation rate?
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1 1. BLS Primary Survey Be proficient with BLS: Check carotid pulses for less than 10 seconds. At least 100 compressions per minute 2 breaths are given with 30 compressions for 2 minutes (5 cycles of 30:2) Monitor RDR (Rate/ Depth/Recoil) during compressions BLS primary survey continues during ALS secondary survey (ABCD) If pulses are present with ineffective respirations, provide rescue breathing giving 1 breath every 5-6 seconds. Assess for bilateral chest rise and fall. 2. AED: Turn AED ON, Apply Pads, Analyzing (do not touch patient), Shock Advised, Charging (NOTE: Continue Compressions while charging), Clear and Shock 1 Page
2 3. ALS Secondary Survey AIRWAY Position (Head-tilt, Chin-lift, Suction (going out <10sec.), Oral Pharyngeal Airway, Nasal Pharyngeal Airway BREATHING BMV: give 1 breath every 5-6 sec. (10-12/min) ETT: give 1 breath every 6-8 sec. (8-10/min) CIRCULATION IV/IO, Monitor/12- Lead, Medications, Bolus, Compressions, Shock Keep Saturation >94-99%, BP >90 mm Hg, PETCO mm Hg DIFFERENTIAL DIAGNOSIS H & TS Waveform Capnography: PETCO₂ (Partial End-Tidal CO₂) - Normal range: mmhg - Used for quantitative measurement of perfusion - Reliable verification of ETT placement - Monitor s quality of compressions. Must have at least 10 mm Hg or greater to achieve perfusion. - Identifies ROSC (return of spontaneous circulation) during compressions with abrupt increase of PETCO₂. - Post- Arrest Care: PETCO₂ goal is to achieve mmhg or greater 2 Page
3 4. Ischemic Stroke CPSS (Cincinnati Pre-hospital Stroke Scale): One-sided weakness, Slurred speech, Facial droop 8 D s of Stroke: Detection, Dispatch, Delivery, Door, Data, Decision, Drug, Disposition Patient must be brought to closest stroke center. If none, then to closest hospital with CT scanner. If CT is unavailable, to closest hospital. If with negative CT scan, fibrinolytic can be administered if onset of symptoms is within 3 hours ( 4.5 hours on some patients).
4 4 Page
5 5. Acute Coronary Syndrome 5 Page
6 Focus on STEMI (ST Elevation MI) pathway, verified on 2 contiguous leads on 12-Lead Memorize MONA doses and contraindications specially for Nitro and Morphine Know atypical signs of MI Know contraindications of Right Ventricular Infarction (RVI) or Inferior Infarct 6 Page
7 6. Invtravenous/Intraosseous Preferred route of medication administration is via peripheral IV After multiple attempts of IV insertion without success, IO is inserted. Know IO insertion sites and be familiar with various IOs All medications given through IV can be administered via IO. Goals of IO: Insertion, Administration and Discontinuation (<24 hours) 7 Page
8 7. Bradycardia Sinus Bradycardia 3rd Degree AV Block 8 Page
9 NOTE: Know appropriate dosing of Dopamine and Epinephrine TCP is preferred for 3rd Degree AVB unless unavailable then Atropine is 8. Tachycardia Regular: Narrow Complex Tachycardia Supraventricular Tachycardia Rate: 150 > 9 Page
10 Irregular: Narrow Complex Tachycardia Atrial Fibrillation Regular: Monomorphic Wide Complex Tachycardia Ventricular Tachycardia Irregular: Polymorphic Wide Complex Tachycardia Torsade de Pointes Synchronize 10 P a g e
11 11 P a g e
12 9. Pulseless Arrest Ventricular Fibrillation No Pulse Pulseless Ventricular Tachycardi a Asystole No Pulse Pulseless Electrical Activity 12 P a g e
13 NOTE: VF, Pulseless VT, Asystole and Agonal are not 13 P a g e
14 10. Post- Resuscitation Care: ROSC ROSC (Return of Spontaneous Circulation) Maintain O₂ Sat 94%>, titrate breaths/min Consider advanced airway and maintain PETCO₂ mm Hg> 1-2 L NS/LR bolus (at 4 C to induce hypothermia if ALOC) Titrate vasopressors to keep BP 90 mm Hg> Identify and treat reversible causes 12-Lead ECG for possible PCI if STEMI or high suspicion of AMI 14 P a g e
15 Consider hypothermia for hours in ALOC for cerebral oxygenation and ventilation Keep glucose slightly above normal to avoid hypoglycemia during hypothermia 11. Termination of Resuscitation Effort DNAR (Do Not Attempt Resuscitation) Decapitation Presence of Rigor Mortis Continued decompensation during resuscitative efforts Inherent danger to team during resuscitation Unwitnessed arrest No defibrillation during BLS or ALS MD ordered termination 15 P a g e
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