Advanced Cardiovascular Life Support 2015 AHA Guidelines Updates

Transcription

1 Advanced Cardiovascular Life Support 2015 AHA Guidelines Updates The ACLS Provider exam is 50-mutiple-choice questions. Passing score is 84%. Student may miss 8 questions. For students taking ACLS for the first time or renewing students with a current card, exam remediation is permitted should student miss more than 8 questions on the exam. Viewing the ACLS book ahead of time with the online resources is very helpful. The American Heart Association link is and has an ACLS Precourse Self-Assessment, supplementary written materials and videos. The code for these online resources is in the ACLS Provider Manual page ii. The code is acls15. Basic Dysrhythmia knowledge is required. The exam has at least 9 strips to interpret. A-B-C to C-A-B Circulation-Airway-Breathing quickly initiating chest compressions Chest Compression Changes During CPR: depress the adult sternum inches allowing chest to completely recoil compressions per minute without advanced airway - 30 compressions : 2 breaths with advanced airway - continuous compressions - give 10 breaths a minute or 1 breath every 6 seconds Checking a pulse should require less than 10 seconds Emergency Care Priorities The use of advanced airways, gaining vascular access, and administering drugs does not take priority over high quality CPR and access to immediate defibrillation LMA or King Airway if the healthcare provider is not proficient to intubate or difficult airway Defibrillation for VF or pulseless VT 1 shock followed by 5 cycles of CPR before pulse check Quantitative Waveform Capnography Recommended for confirmation and monitoring of ET tube placement CO2 detectors and capnography are for ET placement and to monitor CPR Provides a monitor of effective chest compressions during CPR: 10mmhg minimum. ROSC or patient with pulse: 35-40mmhg

2 Medication Protocols Adenosine is recommended for the treatment of stable SVT is recommended for the treatment of VT with pulse when rhythm is regular and QRS waveform is monomorphic Amiodarone is now preferred to Lidocaine, but either is still acceptable Atropine is only recommended for bradycardia and heart blocks dose is 0.5 mg, maximum 3.0 mg Dopamine infusion for bradycardia is 2-20 mcg/kg/min infusion for post-cardiac arrest care for blood pressure is 5-10 mcg/kg/min Epinephrine infuse 2-10 mcg/min for bradycardia when Atropine is ineffective Intravenous chronotropic agents are recommended as an effective alternative to external pacing for individuals: symptomatic bradycardia unstable bradycardia Intraosseous for drug therapy rather than ET when IV is not established Oxygen supplementation for acute coronary syndromes is no longer routinely indicated only if the oxyhemoglobin saturation is 90% Post-cardiac arrest care SPO2 and ETCO2 saturation is the number one priority saturation levels must meet: SPO % ETCO mmhg Reperfusion therapy PCI for STEMI and AMI Systolic blood pressure mmhg or administer NS/LR 1L Dopamine 5-10 mcg/kg/min Cooling measures ( TTM = Targeted Temperature Management) if patient remains comatose check LOC glucose > 80 mg/dl celsius

3 BLS Overview CAB Push Hard and Fast - Repeat every 2 minutes *If person unresponsive next step is to check breathing and pulse simultaneously. Pulse check no more than 5-10 seconds Anytime there is no pulse or unsure - COMPRESSIONS Elements of good CPR COMPRESSIONS Rate-at least Compression depth at least 2 inches, not more than 2.4 inches or 6 cm Switch compressors every 2 min or 5 cycles Minimize interruptions (less 10 secs) Fatal mistake to interrupt compressions continue compress while charging RECOIL VENTILATION With perfusing rhythm squeeze the bag once every 5 to 6 seconds Excessive ventilation decreases cardiac output Stroke Cincinnati Pre-Hospital Stroke Scale Facial Droop, Arm Drift, Abnormal Speech Non-contrast CT scan of the head Start fibrinolytic therapy as soon as possible Alerting the hospital will expedite patient s care on arrival Acute Coronary Syndromes, STEMI *STEMI door-to-balloon within 90 minutes *12 Lead for CP, epigastric pain, or rhythm change Recommended dose of aspirin is mg Right ventricular MI - caution with NTG Cardiac Rhythm Strips to Interpret Ventricular Tachycardia o Stable o Unstable o Monomorphic Supraventricular tachycardia, unstable Heart Blocks o Second-degree atrioventricular Type I o Second-degree atrioventricular Type II o Third degree atrioventricular

4 Ventricular Fibrillation PEA, Pulseless Electrical Activity Bradycardia Need to assess stable versus unstable If stable... Monitor, observe, and obtain expert consultation If unstable... Atropine 0.5mg IV. Can repeat Q 3-5 minutes to 3 mg o Maximum dose is 3mg (Including heart blocks) If Atropine ineffective o Dopamine infusion (2-10mcg/kg/min) o Epinephrine infusion (2-10mcg/min) o Transcutaneous pacing Tachycardia with a Pulse If unstable (wide or narrow)-go straight to synchronized cardioversion (sedate first) If stable narrow complex o obtain 12 lead o vagal maneuvers o adenosine 6mg RAPID IVP, followed by 12mg Pulseless Rhythms - Cardiac Arrest - CPR Oxygen, monitor, IV, Fluids, Glucose Check Agonal gasps are a likely indicator 2 minute cycles of compressions, shocks (if VF/VT), and rhythm checks Epinephrine 1 mg first every 3-5 minutes (preferred method peripheral IV) Shockable Rhythms Defibrillation Ventricular Fibrillation (VF) Ventricular Tachycardia (VT) without pulse Biphasic: J Monophasic: 360J Refractory Amiodarone 300 mg, then 150 mg After defibrillation resume CPR, starting with chest compressions Synchronized Cardioversion Unstable VT, unstable SVT Non-Shockable Rhythms PEA Asystole

5 Waveform Capnography in ACLS (PETC02) Allows for accurate monitoring of CPR Most reliable method to confirm and monitor ETT placement Team Dynamics Closed Loop repeat orders Incorrect order? address immediately Task out of scope? ask for new task or role Clearly delegate tasks Treat Reversible Causes (H s and T s) Hypoxia or ventilation problems Hypovolemia Hypothermia Hypo /hyper kalemia Hydrogen ion (acidosis) Tamponade, cardiac Tension pneumothorax Toxins poisons, drugs Thrombosis coronary (AMI) pulmonary (PE) Return of Spontaneous Circulation (ROSC) Post Resuscitation Care 12 Lead Coronary reperfusion-capable center is the most appropriate EMS destination Hypothermia if DOES NOT follow verbal commands (target temperature, at least 24 hours, 32 to 36 degrees C) Points to Ponder Medical Emergency Teams (MET)/ Rapid Response Teams (RRT) can improve outcome by identifying and treating early clinical deterioration OPA measure from corner of mouth to angle of the mandible Minimal systolic blood pressure is 90 Don t suction for more than 10 seconds Pulse oximeter reading low, give oxygen Contact Us for your ACLS training needs. Florida Training Academy 103 Century 21 Drive, Suite 205 Jacksonville, Florida Phone: (904) Web: