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The document provides guidelines for basic and advanced cardiac life support. It outlines the steps for adult CPR, including chest compressions and rescue breaths. It also describes the ACLS survey process, airway management techniques, pharmacological interventions and their uses, and automated external defibrillator operation.

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0% found this document useful (0 votes)
42 views7 pages

Acls Reviewer - Complete

The document provides guidelines for basic and advanced cardiac life support. It outlines the steps for adult CPR, including chest compressions and rescue breaths. It also describes the ACLS survey process, airway management techniques, pharmacological interventions and their uses, and automated external defibrillator operation.

Uploaded by

ek.9006001
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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● Resume chest compressions quickly.

Switch quickly
ACUTE CARDIAC LIFE SUPPORT between compressions and rescue breaths.

BASIC LIFE SUPPORT


CHAIN OF SURVIVAL

CPR GUIDELINE CHANGES


● The importance of early initiation of CPR by lay rescuers
has been re-emphasized.
● Recovery was added to the chain of survival.
● Care of the patient after return of spontaneous circulation
(ROSC) requires close attention to oxygenation, blood
pressure control, evaluation for percutaneous coronary
intervention, targeted temperature management, and
multimodal neuroprognostication.
● Patients should have formal assessment and support for
their physical, cognitive, and psychosocial needs.
● After a resuscitation, debriefing for lay rescuers, EMS
providers, and hospital-based healthcare workers may be
beneficial to support their mental health and well-being.
● Management of cardiac arrest in pregnancy focuses on
maternal resuscitation.

BLS FOR ADULTS


● Watch out for dangers; be sure to not injure yourself. ADVANCED CARDIAC LIFE SUPPORT
● Tap hard on their shoulder and shout “Hey, are you OK?”;
check if they are breathing ACLS SURVEY (ABCD)
● Call for help and to get an AED. Airway ● Maintain airway in an unconscious
● Check pulse while checking for breathing. patient.
● Immediately begin chest compressions. ● Consider advanced airways.
● Attach AED if available. ● Monitor advanced airway if placed with
qualitative waveform capnography.
● If the chest is rising without an
CPR STEPS FOR ADULTS advanced airway, continue CPR
● Check for the carotid pulse on the side of the neck. Feel without pausing.
for no more than 10 seconds.
● Begin with the CPR → 30 compressions:2 breaths Breathing ● Give 100% oxygen.
● Compressions should be 2 to 2.4 (5 to 6 cm) into the ● Assess effective ventilation with
person’s chest at a rate of 100 to 120 compressions per qualitative waveform capnography.
● Do NOT over-ventilate.
minute. ● Normal partial pressure of CO2 is
● Allow chest recoil. CPR is less effective without recoil. 35-40 mmhg.
● After 30 compressions, open the airway using the ● ETCO2 should be between 10-20
head-tilt/chin-lift maneuver; jaw thrust maneuver for mmHg.
injured individuals.
Circulation ● Evaluate rhythm and pulse.
● Give a breath while watching the chest rise. Deliver
● Defibrillation/cardioversion
breaths over 1 second. ● IV/IO access
○ Drugs can take up to two minutes to reach central
● Rhythm-specific medications
● IV/IO fluids if needed. circulation; continue high-quality CPR to help circulate
drugs.
Differential ● Identify and treat reversible causes. ● INTRAOSSEOUS ROUTE: Preferred if IV is not available;
Diagnosis ● Cardiac rhythm and patient history are can be used for all age groups and can be placed in one
the keys to differential diagnosis. minute.
● Assess when to shock versus when to
○ Any ACLS drug or fluid can be administered both
medicate.
● Minimize interruptions in perfusion. intravenously and intraosseously.

PHARMACOLOGICAL TOOLS
AIRWAY MANAGEMENT
BASIC AIRWAY ADJUNCTS DRUGS MAIN USE DOSE/ROUTE
● OROPHARYNGEAL AIRWAY (OPA): J-shaped device
Adenosine Tachycardia, aside 6 mg IV bolus, repeat
that fits over the tongue to hold the soft hypopharyngeal from irregular wide with 12 mg in 1 to 2
structures and the tongue away from the posterior wall of QRS min.
the pharynx; for unconscious patients without gag reflex.
○ Too large or too small may obstruct the airway. Causes flushing and
● NASOPHARYNGEAL AIRWAY (NPA): Soft rubber or chest heaviness
plastic uncuffed tube that provides a conduit for airflow
Amiodarone VF/pVT VF/VT: 300 mg in 20
between nares and pharynx; used in conscious individuals VT with pulse to 30 mL dilution,
with intact cough and gag reflex; use with caution in Tachycardia repeat 150 mg in 3-5
patients with facial trauma. minutes
○ NPAs sized incorrectly may enter the esophagus.
● SUCTIONING: Suction immediately if there are copious Anticipate HTON,
secretions, blood, or vomit; should not exceed 10 bradycardia, and GI
toxicity.
seconds.
Do not use in 2nd or
○ When suctioning OPA, do not insert the catheter too 3rd-degree AV block
deeply.
○ When suctioning an ET, use sterile technique Atropine Symptomatic 0.5 mg IV/IO q3-5min
because you are suctioning near the bronchi or lung. bradycardia Max dose: 3mg
○ Monitor VS during suctioning and stop immediately if Toxins/overdose
Do not use in
a person experiences hypoxemia.
glaucoma or
tachyarrhythmias
ADVANCED AIRWAY ADJUNCTS Minimum dose is
● ENDOTRACHEAL TUBE: inserted through the mouth or 0.5mg
nose; most secure airway available; uses laryngoscope
● LARYNGEAL MASK AIRWAY: alternative to ET tube Dopamine Symptomatic 2-20 mcg/kf/min
bradycardia
● LARYNGEAL TUBE: more compact, less complicated to
(2nd-line Fluid resuscitation
insert management) first
● ESOPHAGEAL-TRACHEAL TUBE: combitube; two
separate balloons that must be inflated and two separate Shock/CHF
ports.
Epinephrine Cardiac arrest Cardiac arrest: 1.0
Anaphylaxis mg (1:10000) IV or 2
ROUTES OF ACCESS
Symptomatic to 2.5 mg (1:1000)
● INTRAVENOUS ROUTE: preferred unless central line is bradycardia/shock
already available; does not require CPR interruption Bradycardia: 2-10
○ Push bolus, flush with 20 mL of fluid or saline, raise mcg/min infusion
extremity for 10 to 20 seconds to enhance delivery
Give via central line
when possible
● Once the rhythm is analyzed, the device will direct you to
Lidocaine VF/VT VF/VT: 1 to 1.5 mg/kg
Wide complex IV, half of first dose in shock the individual if a shock is indicated.
tachycardia with 5 to 10 min ● The shock is intended to reset the heart’s abnormal
pulse Tachycardia: 0.5 to electrical activity into a normal rhythm.
1.5 mg/jg IV ● KEY POINTS:
○ Assure oxygen is not flowing across the patient’s
Rapid bolus can chest when delivering shock
cause HTON and
bradycardia ○ Do NOT stop chest compressions for more than 10
Use with caution in seconds when assessing the rhythm.
RF ○ Stay clear of patients when delivering shock.
○ Assess pulse after the first two minutes of CPR.
Magnesium Cardiac Cardiac arrest: 1 to 2 ○ If the end-tidal CO2 is less than 10 mmHg during
Sulfate arrest/pulseless gm diluted in 10 mL
CPR, consider adding a vasopressor and improve
torsades
If not cardiac arrest: 1 chest compressions. However, after 20 minutes of
Torsades de to 2 gm IV over 5 to CPR for an intubated individual, you may consider
Pointes with pulse 60 min stopping resuscitation attempts.
● BASIC AED OPERATION:
Calcium chloride can ○ Attach the pads to bare chest (not over medication
reverse patches) and make sure cables are connected. (Dry
hypermagnesemia
the chest if necessary.)
Procainamide Wide QRS 20 to 50 mg/min IV ○ Place one pad on upper right side and the other on
tachycardia until rhythm improves the chest a few inches below the left arm.
Max: 17 mg/kg ○ Clear the area to allow AED to read rhythm, which
Preferred for VT may take up to 15 seconds.
with pulse (stable) Caution with acute MI ○ If the AED states “no shock advised”, restart CPR.
Do not give with
○ Press the “Shock” button.
amiodarone
○ Immediately resume CPR starting with chest
Sotalol Tachyarrhythmia 100 mg (1.5mg/kg) IV compressions.
Monomorphic VT over 5 minutes ● If the AED is not working properly, continue CPR. Do not
3rd line waste excessive time troubleshooting the AED. CPR
antiarrhythmic Do not used in always comes first, and AEDs are supplemental.
prolonged QT
● Do not use the AED in water.
● AED is not contraindicated in individuals with implanted
PRINCIPLES OF EARLY DEFIBRILLATION defibrillator/pacemaker; however, do not place pad directly
● The earlier the defibrillation occurs, the higher the survival over the device.
rate.
● The purpose of defibrillation is to disrupt a chaotic rhythm ACLS CASES
and allow the heart’s normal pacemakers to resume RESPIRATORY ARREST
effective electrical activity. ● Individuals with ineffective breathing patterns are
● Monophasic: 360 J single shock; biphasic: depending on considered to be in respiratory arrest.
manufacturer (for VT/VT → 120J-200J) ● If with a pulse, start rescue breathing. Without a pulse,
● Continue CPR while the defibrillator is charging. start CPR.
● Clear the individual by ensuring that oxygen is removed,
and no one is touching the individual prior to delivering the VENTRICULAR FIBRILLATION AND PULSELESS
shock. VENTRICULAR TACHYCARDIA

AUTOMATED EXTERNAL DEFIBRILLATOR


● Attach the pads to the upper right side and lower left side
of the individual’s chest.
VENTRICULAR FIBRILLATION QRS complex Possible QRS complex or none

Regularity No regular shape of the QRS


complexes REVERSIBLE CAUSES
Rate The rate appears rapid H’s T’s
P Wave None Hypovolemia Tension pneumothorax
Hypoxia Tamponade
PR Interval None H+ (acidosis) Toxins
Hypo/Hyperkalemia Thrombosis (coronary)
QRS complex Varies Hypoglycemia Thrombosis (pulmonary)
Hypothermia Traume

POST-CARDIAC ARREST CARE (PCAC)


● THERAPEUTIC HYPOTHERMIA: recommended for
VENTRICULAR TACHYCARDIA comatose individuals with ROSC after cardiac arrest;
cooled to 32 to 36 degrees for at least 24 hours).
Regularity R-R intervals are usual, but not always, ● OPTIMIZATION OF HEMODYNAMICS AND
regular VENTILATION: 100% is acceptable for early intervention;
do not over-ventilate; 10-12 breaths per minute to achieve
Rate Atrial rate cannot be determined;
ventricular rate is 150-250 bpm ETCO2 at 35-40 mmHg
● PERCUTANEOUS CORONARY INTERVENTION:
P Wave QRS complexes are not preceded by P preferred over thrombolytics; transfer the patient to a
waves. center that offers PCI
● NEUROLOGICAL CARE: Specialty consultation should
PR Interval PR interval is not measured
be obtained to monitor neurologic signs and symptoms
QRS complex QRS complex more than 0.12 seconds
Airway ● Early placement of advanced airway
PEA AND ASYSTOLE Management ● Manage respiratory parameters:
○ Keep 10 breaths per minute
ASYSTOLE ○ Pulse ox goal 92-98%
○ Titrate to PaCO2 35-45 mmHg
Regularity Nearly a flat line ○ Waveform capnography for ETT
placement confirmation
Rate None
Blood Pressure ● Obtain early ECG
P Wave None
Support and ● Consider BP support if SBP is less
PR Interval None Vasopressors than 90 mmHg or MAp is less than
65.
QRS complex None ● 1-2L of IV saline or LR
● Consider vasopressors if very low.
○ Epinephrine is preferred
PULSELESS ELECTRICAL ACTIVITY ○ Dopamine and phenylephrine as
alternatives
Regularity Any rhythm including a flat line ○ Norepinephrine for severe HTON

Rate Any rate or no rate Hypothermia ● Maintain a core body temperature


between 89.6 to 96.8 degrees F (32
P Wave Possible P waves or none to 36 degrees C) for at least 24 hours
by using a cooling device with a
PR Interval Possible PR wave or none feedback loop.
SYMPTOMATIC BRADYCARDIA ● For Mobitz II and 3rd Degree AVB, proceed to
SYMPTOMS OF BRADYCARDIA transcutaneous pacing immediately.
● SOB
● Altered mental status TACHYCARDIA
● Hypotension ● Tachycardia is a heart rate of greater than 100 beats per
● Pulmonary edema/congestion minute.
● Weakness/dizziness/lightheadedness ● Ventricles are unable to fill completely, causing cardiac
output to decrease.
REVIEW ● Tachycardia is classified as stable or unstable.
● Heart rates greater than or equal to 150 beats per minute
usually cause symptoms.
● Unstable tachycardia always requires prompt attention.
● Stable tachycardia can become unstable.
Sinus Bradycardia: normal rhythm with slow rate
SYMPTOMS OF BRADYCARDIA
● Hypotension
● Sweating
● Pulmonary edema/congestion
First degree AV block: PR interval is longer than 0.20s ● JVD
● Chest pain/discomfort
● SOB
● Weakness/dizziness/lightheadedness
● Altered mental state
Type 1 Second Degree AVB (Mobitz I): PR interval increases
in length until QRS complex is dropped SYMPTOMATIC TACHYCARDIA WITH HR >150 BPM
● If unstable, provide immediate synchronized
cardioversion.
● Assess the individual’s hemodynamic status and begin
treatment by establishing IV, giving supplementary oxygen
Type 2 Second Degree AVB (Mobitz II): Constant PR and monitoring the heart.
intervals before a random QRS is dropped ● Assess the QRS complex.
○ Regular narrow complex tachycardia (SVT): vagal
maneuver, adenosine 6 mg IV rapid
○ Irregular narrow complex tachycardia (A-fib): 12-lead
ECG, diltiazem 15 to 20 mg
Third degree AVB: PR and QRS are not coordinated with
○ Regular wide complex tachycardia (VT): 12-lead
each other
ECG, amiodarone 150 mg over 10 minutes
○ Irregular wide complex tachycardia: 12-lead ECG,
INTERVENTIONS
anti-arrhythmic
● Atropine IV dose
○ Initial: 1 mg bolus
○ Repeat every 3 to 5 minutes up to 3 mg max dose
● Dopamine IV infusion
○ 5 to 20 mcg/kg per minute Sinus Tachycardia
○ Titrate to patient response; taper slowly
● Epinephrine IV infusion
○ 2 to 10 mcg per minute
○ Titrate to patient response
● If atropine does not work, proceed to transcutaneous Atrial Flutter
pacing with dopamine or epinephrine.
physical/occupational/speech therapy evaluation, body
temperature checks, and blood glucose monitoring.
● Certain individuals (age 18 to 79 years with mild to
moderate stroke) may be able to receive tPA.
Atrial Fibrillation ○ Intra-arterial tPA is possible up to six hours after
symptom onset
ACUTE CORONARY SYNDROME ○ When
● Unstable angina, non-ST-elevation myocardial infarction ○ the time of symptom onset is unknown, it is
(NSTEMI) and ST-elevation myocardial infarction (STEMI). considered an automatic exclusion for tPA
● Symptoms: chest pain, SOB, pain that radiates to the jaw, 10 minutes of General assessment
arm, or shoulder, sweating, and/or nausea or vomiting arrival Order urgent CT scan without
● If an individual appears unconscious, begin with a BLS contrast
survey and follow appropriate care.
25 minutes of Perform CT scan
arrival Neurological assessment
Read CT scan within 45 minutes

60 minutes of Evaluate criteria for use and


arrival administer fibrinolytic therapy
Fibrinolytic therapy may be used
within three hours of symptom onset

180 minutes of Admission to stroke unit


arrival
● Before giving anything (medication or food) by mouth, you
must perform a bedside swallow screening. All acute
stroke individuals are considered NPO on admission.
● The goal of the stroke team, emergency physician, or
other experts should be to assess the individual with
suspected stroke within 10 minutes of arrival in the
emergency department (ED).
ACUTE STROKE ● The CT scan should be completed within 25 minutes of
● In ischemic stroke, a clot lodges in one of the brain’s blood the individual’s arrival in the ED and should be read within
vessels, blocking blood flow through the blood vessel. 45 minutes.
● In hemorrhagic stroke, a blood vessel in the brain ○ If the CT scan displays hemorrhage, see
ruptures, spilling blood into the brain tissue. neurosurgeon or neurologist, transfer if not available.
● Symptoms: Weakness in the arm and leg or face, vision Admit to stroke or ICU and start stroke or hemorrhage
problems, confusion, nausea or vomiting, trouble speaking pathway
or forming the correct words, problem walking or moving, ○ If no hemorrhage, prepare for fibrinolytic therapy. If a
severe headache (hemorrhagic) candidate, go over risk benefits with family or patient.
● Cincinnati Prehospital Stroke Scale (CPSS) is used to If not a candidate, give aspirin and admit to the stroke
diagnose the presence of stroke. unit.
○ Facial droop, arm drift, abnormal speech
○ Ischemic stroke: 72% probability if one of these three
findings are present
○ Acute stroke: all three findings are present
● Individuals with ischemic stroke who are not candidates
for fibrinolytic therapy should receive aspirin.
● Stroke treatment includes blood pressure monitoring and
regulation per protocol, seizure precautions, frequent
neurological checks, airway support as needed,

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