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ACLS Notes

ACLS Quick and Comprehensive Reviewer *Samsung Notes

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Yane T
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23 views

ACLS Notes

ACLS Quick and Comprehensive Reviewer *Samsung Notes

Uploaded by

Yane T
Copyright
© © All Rights Reserved
Available Formats
Download as PDF or read online on Scribd
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ACLS CHAIN OF SURVIVAL OHCA- ACDAPR IHCA - EACDPR Pedia - EACAPR BLS (Unconscious pt.) Assess scene safety, activate ERS Breathing,pulse,responsiveness CPR(100-120cpm) Adult(2in/Scm) Pedia(1.5in/4cm) Trescuet 30:2 30:2 x Scycles 2rescuer 30:2 15:2 x10 cycles *Chest Compression Fraction=Total CPR time (>=80%) Total Code time *Interruptions <10 secs Waveform capnography(PETCO2=35-45mmHg) Cardiac Arrest <10mmHg ROSC >10mmHg preferrably 40mmHg Hyperventilation <35mmHg -decrease cardiac output -increase intrathoracic pressure Hypoventilation >45mmHg Defibrillation Placement:Lower R clavicle, Lower L chest X place on implanted device/transdermal patch Analyze>AED prompt>"Everyone Clear, Shocking" PRIMARY ASSESSMENT(Conscious pt.) Advanced airway Mask Readjust ‘Suction -80-120mmHg(Portable) -300mmHg(Wall-mounted) -limit to <10 ses Obstruction Pressure Advance airway Breathing,ventilation Circulation Vitals wo Monitor Drugs Disability Awake, Verbal, Pain, Unresponsive Exposure Trauma, Abuse SECONDARY ASSESSMENT(Conscious pt. Signs and symptoms Allergy Medication Past Medical Hx Last meal Events 6H's Hypothermia <32-35 Hypo/hyperkalemia Hypoxia Hypovolemia Hydrogen ions(Acidosis) Hypoglycemia ST's Tension pneumothorax Tamponade, Cardiac -Beck’s Triad:JVD hypotension,muffled heart sounds Toxin Troponin Thrombosis, pulmonary/coronary 1 Coursework ith videps (72 questions) 2 Preassessment ‘ACLS notes? ACLS aipplementny 3 ECG acing 4 Guzzes RESCUE BREATHS xbreathing, with pulse Adult Q6 secs (1 breath=17%02) 10 breaths/min Pedia Q2-3 secs 20-30 breaths/min TV-500-600 CHOKING If pt. is unresponsive 1. CPR 2. Check for obstruction -No blind finger sweeps Adult/Child “Abdominal thrust Chest thrust Infant ~5 back slaps (heel of hand) “between shoulder blades -5 chest thrust (2 fingers, 2 thumbs) *below nipple line Nasalcannula 1-6 ipm Simple facemask 6-10 Ipm NRM 10-15 pm BASIC ADJUNCTS Oropharyngeal -unconscious/without gag reflex mouth to angle of mandible Nasopharyngeal -conscious/unconscious/with/ without gag reflex snose-earlobe -contraindication‘epistaxis, skull injury. trauma, ICP ‘ADVANCED AIRWAY Laryngeal Mask Airway for unstable neck injury when ETT is impossible lubricate posteriot surface size 4-women, size men avoid cricoid pressure Laryngeal Tube EIT size 7-7.S-women, size 7.5-8-men ‘dose must be 2x than IV dose -drug + 5-10ce sterile water STROKE Batonce *Check RBS. Detect pole eel Dispatch eel Delivery/Transport Door to hospital “Neuro assessment <10mins *cTscan/MRI <25mins Drug Disposition Treatment: 1. Fibrinolytic(3-4.5hours) -Tt-PA(Alteplase) -hold Aspirin for 24h if rt-PA given Endovascular procedure(24hours) -Thrombolytic-capable stroke center -Comprehensive stroke center nN 7 ACUTE CORONARY SYNDROME(AONM Nitroglycerin Contfaindications: Aspirin 162-325 chewable tab x 3 doses pect ate Bradycardia Oxygen/ECG Hypotension Nitroglycerin 0.3-0.4mg Q3-5 mins x 3 doses PDE within 24H Morphine 2-4mng Q5-15mins R ventricular infarction STEMI(PF) NSTEMI(NH) 1. PC (Percutaneous Coronary intervention) (90mins) 1. Nitroglycerin 2. Fibrinolytics(30mins-3 hrs from sx onset) 2. Heparin Heparin 4000 units LD then 7,000 units q hourly “Aspirin CARDIAC ARREST PEA/Asystole CECE \VFib/PVT CSCS CES CAS CES CAS CES. ADULT PEDIA. Monophasic 120-2005 2u/kg DEFIBRILLATOR giphasic 3605 Ad/kg Max: 10J/kg EPINEPHRINE Img 0.01kg Max: Img AMIODARONE 300mg>150mg Smg/kg Max: 3 doses LIDOCAINE 1-1.5mg/kg>0.5-0.75mg/kg aInarkg fees eee BRADYCARDIA0,2secs(>1big box) 2. 1st degree AV block QRS QRS dropped 3. 2nd degree AV block/Mobitz I|/Wenckebach Constant a red 4. 2nd degree AV block/Mobitz II Varies 3 21 5. 3rd degree AV block/Intranodal/Junctional TACHYCARDIA>150b0m cap, -oommic sBP-12m9_ Expert Garioleion| Benet ccaree. ‘Adenosine 6mg>T2m9Q2mins 01-0.2mg/kg (Max 2doses) Expert Expert ‘Amiodarone 150mg+100PNSS Q10mins (Max 229) lsedathe/enelgesic prior to Gandiovereion ‘Adenosine not given for _4Procainamide 1g+S0DSW/ 2oma/imin__(Max 17mg) Diazepan/Midazolam/Mocphine/Fentanyl Polymorphic Tachycardiadll Lidocaine 1-1.5mg/kg Q10mins 0.5-0.75mg/kg (Max3mg/kg) __*Naloxone-opioid overdose Sotalol 100mg Smg/kg)+1 OODSW x Smins 2mq intranasal/0.4mg IM *Pedia Cardioversion-.5I/kg ECG Monomorphic Biphasic 1. Sinus Tachycardia 2. Supreventricular Tachycardia(-\sossm) 2005 50-100 J 3. Atrial Flutter Verapamil 255mg then 510mg Q1530mins (Max 20mg) Inderal O.1ma/kg Qamins (Max doses) A Diltiazem 120mg then’ 20-28mg”Q15-30mins (Max 51Smg/he) 4. Atrial Fibrillation 200 J 120-200 J 5. Monomorphic Tachycardia 100J 6. Polymorphic Tachycardia/Torsades 1005 Ig 1-29 + 10ce PNSS x20 mins Calcium chloride/Calcium gluconate pregnant Rosc Heart rate = 1500/#of small boxes Airway (10 breaths/min) Normal = 3-5 big boxes (R to R) Breathing (PetC02 35-45mmHg, 02 sat >94%) ‘small box=0.04secs Cculation (S2P>90mmHg MAP>65) a (CARDIAC INTERVENTION/Circulatory support (WV/Meds/Trensfer) 1 big box=0,208eds DisABiLiTY “TTM (42-36 withing 24H), 4 degree celslus PNSS at 30cc/kp x 24H BPM 300 150 100 75 60 Cranial CT scan Smallboxes 5 10 15 20 25 £0G pRo.12.20,0RS0:12 Big boxes ie ee ees (Check: 1. Rate 2. PRinterval 3. QRS

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