advanced cardiac life support Flashcards
ACLS is an attempt at restoration of
spontaneous circulation using…..
basic CPR + advanced management of airway , Endotreacheal ET tube defibrillation , cardioversion , IV medication,
Causes of cardiac arrest…..*9( dieases related to heart…. , which part .–> 2 , family history , OD? / eating ? , e-? , imbalance of sth. ??» arrhythmia
- Coronary artery disease
- Left ventricular dysfunction
- Dissecting, ruptured aortic or ventricular aneurysm
- Congenital heart disease
- Cardiac drug toxicity
- Choking
- Electrical shock
- Electrolyte imbalance
- Acid-base imbalance………………leads to arrhythmia
Clinical manifestations of Cardiac Arrest ( LOC? breath? pulse? HR? Pupils ? physical movement ? )
- Loss of consciousness
- Absence of breathing
- Absence of pulses and audible heart sounds
- Dilation of the pupils of the eyes
- Convulsions 抽搐
Medical management of Cardiac Arrest
- Cardio–> correct dysrhythmia ; concious patiant with AF/
supraventricular tachycardiaversion; restablish stable rhythm from SA node.
Transcutaneous pacing ( for what? astysole<? how to perform it (2 ways)
;) Noninvasive,
For hemodynamically unstable bradycardia e.g. low
BP
* Asystole with a short time (<10 mins)
* Instituted rapidly by delivering electricity from an
external power source through large electrodes
attached to the patient’s chest
* The electric current pass through the thorax
anteriorly to posteriorly (or sternum-apex) causing
depolarization of the myocardium, resulting
contraction
how to management pulseless VT and VF ? think about the procedure …
Defibrillation–> cardiac arrest–> 360 J ,no anesthetic drug, must not on button of syn
how to perform cardioversion ( how many J need for AF & Arterial flutter and SVT ? phrasic energy? any anesthesia ? synchorized button on/off ? any contradiction on ECG?
Low electrical energy: 50J
* for AF: monophasic—200J; biphasic– 120-200J (Warfarin)
* Atrial flutter and SVT: monophasic or biphasic– 50-100J
* VT with pulse: monophasic or biphasic– 100J
* An anesthetic drug is given before the procedure
* Synchronized button of the defibrillator must be pressed on
during the procedure
* Inappropriate sensing of the QRS complex may result in
improper timing of the discharge of the current e.g. T wave
Outline the step of C-A-B
C-A-B
* Step 1: Check for responsiveness (tab and shout “Are you
alright?”)
* Step 2: Activate emergency response system and get an AED
* Step 3: Look and scan the chest for movement
* Step 4: Check the carotid pulse for no more than 10 seconds
Do Step 3 and 4 simultaneously
* Step 5: With pulse: support the patient by rescue breath with
6 seconds per breathe
Without pulse: Start 30 compressions and 2 ventilation –> FOR complete chest recoil between compressions , < 10second interruptions , avoid ventilation…
* Step 6: Defibrillation either by AED or defibrillator
CPR technique
CPR technique, rate, depth, rotation
- Simultaneous ventilation-compression CPR for
protected airway (compression: 100-120 beats
per minute; ventilation: 1 breath every 6
seconds) - Compression rate: 100-120 compressions per
minute - Compression depth of at least 2 inches (5cm),
no more than 2.4 inches - 2 rescuers available: Rotate compressors every
2 minutes
Primary CABD Survey
Focus: Basic CPR and defibrillation (AED)
* Location: street and home without equipment
1. Check responsiveness
2. Activate emergency response system
3. Call for defibrillator
4. Look and scan the chest for movement; Check the carotid
pulse for no more than 10 seconds
5. C– Circulation: give chest compressions
6. A– Airway: open the airway
7. B– Breathing: provide 2 breaths
8. D– Defibrillation: assess for and shock VF/ pulseless VT by
AED
Secondary CABD Survey
Secondary CABD Survey
- Focus: advanced management
- Location: A&E department or hospital
1. Check responsiveness
2. Look and scan the chest for movement; Check the carotid pulse for no
more than 10 seconds
3. Activate crash call system; Call for E-trolley
4. C– Circulation: give intravenous access, give fluid, adrenergic agent,
consider anti-arrhythmics, pacing, defibrillation, cardioversion
5. A—Airway: inserted advanced airway device as soon as possible (ETT,
laryngeal mask airway, Combitube)
6. B– Breathing: confirm and secure tube placement, use a commercial
tube holder to prevent dislodgement, confirm effective oxygenation by
ventilator
7. D– Differential diagnosis: search for and reversible causes
C- Circulation
Rhythm: VF and pulseless VT
* Useless quivering of heart no blood flow cardiac 唔blood flow點都搓唔二
arrest
* Treatment: only one therapy works!
* DEFIBRILLATION
* Defibrillation success: chances drop every minute
* Reduce the time between compression and shock
delivery and the time between shock delivery and
resumption of compressions immediately after shock
delivery
C- Circulation
- Approximately 50% survival after 5 minutes
- Survival reduced by 7% to 10% per minute
- Rapid defibrillation is KEY
*
XCPR
CPR prolongs VF, slows deterioration
A- Airway ( how and any equiment to help?)
Opening the airway:
* Head tilt chin lift
* Jaw thrust]
*The oropharyngeal airway
* Nasopharyngeal airway
B- Breathing 1) Pocket mask device 2) Bag-mask ventilation* Given in approximately one second
any advantages and complication???
Advantages:
* Eliminate direct contact
* Enables positive pressure ventilation
* Easier to perform than bag-mask ventilation
* Best for small-handed rescuers
Advantages:
* Provides immediate ventilation and oxygenation
* Operator gets sense of compliance and airway resistance
* May provide excellent short-term support of ventilation
* High oxygen concentrations are possible
* Can be used to assist spontaneous respirations
Potential complications:
* Gastric inflation
B- Breathing
*Endo-tracheal tube
* Tracheal tube holder
D- Defibrillation
Defibrillator; Automatic External Defibrillator; iphasic waveform allows lower energy
e.g. HeartStart FR3 ; Philips FR3; lofepak CR plus
How to use AED?
The three basic steps:
1. Press On/Off button
(A) –> green on
2. Follow the prompts to
apply the pads (B)
Remove clothing from
the chest
* Open the package you
will find
– a pair of pads connected
to a single cable with a
connector at the end.
* Place the sticky side of
the pads as the figure.
(sternum and apex of heart )
Place the pads correctly and
press firmly.
* Plug the connector at
illustrated
- Press the shock
button if prompted (C)
* Don’t touch the patient when
analysing rhythm
* It takes up to 15 seconds
* Stop CPR during the analysis
* AED will give you voice and screen
prompts if a shock is indicated
* Say “Clear” and make sure no one is in
contact with the patient
* Press the Shock button
* The shock will not be delivered unless
you press the button
Continue CPR as protocol if the AED gives a
“No Shock Advised” message
* Do not remove the pads during CPR
Medications : Describe indications, contraindications and dosages for:
Epinephrine (Adrenaline)
Epinephrine (Adrenaline) –> Rapid effect no.1 choice unless allergic
- Vasoconstrictor
- Increase peripheral vasoconstriction, increase BP, increase
contractility, increase coronary blood flow - Indication:
–Cardiac arrest: VF, pulseless VT, asystole, PEA ( pulseless electrical activity
–Bradycardia: after dopamine to treat bradycardia : , and transcutaneous pacing
–Anaphylaxis reactions: with corticosteriods and anti-histamine - Dosage:
–1 mg, repeat every 3-5 minutes
Vasopressin
(An adrenergic alternative to adrenaline)
slower action….
- Vasoconstrictor, effects duplicate adrenaline
- Less severe adverse effects
- 10-20 minutes half life (adrenaline: 3-5
minutes) - One time dose of 40 units
Amiodarone (Cordarone)
Antidysrhythmic drug
usage
* Increase action potential duration, increase PR and
QT intervals, decrease SA node automaticity
* Indications:
–First line antiarrhythmic for VF/ VT, wide
complex tachycardia
* Dosage:
–First dose: 300mg IV bolus
–Second dose: 0.5-0.75mg/kg IV
Lidocaine
- Ventricular antiarryhthmic drug
- Decrease ventricular automaticity, reduce the
disparity in action potential duration between
ischemic and normal zones - Indications:
–Suppress stable VT and wide complex
tachycardias associated with acute myocardial
ischemia and infarction - Dosages:
–First dose: 1-1.5mg/kg IV
–Second dose: 0.5-0.75mg/kg IV
Magnesium
Cofactor in numerous enzymatic reactions
* Indications:
–Cardiac arrest associated with suspected
hypomagnesemic state
–Life-threatening ventricular arrhythmia
due to digitalis toxicity, tricyclic overdose
* Dosage:
–1-2g diluted in 10 ml D5 IV
AF or SVT, AR –> use digoxin to –> lead to toxicity–> hyperkalemia–> bradycardia –> ventricular tachycardia -
Contradiction w/ K-depleting diurectics, Rifampin ( treat TB) due to decreased serum concentration, thyroid ….
Procainamide
Procainamide
- Ventricular antiarrhythmic
- Decrease automaticity of all pacemakers, decrease
intraventricular conduction - Indications:
–Recurrent VT not controlled by lidocaine
–Stable wide-complex tachycardia of unknown
origin, procainamide is recommended before
lidocaine and adenosine ( contradicted to 2nd/co3rd AV- block) SA node disease; contradict to carbamazepine , caffeine which lower effect if adenosine - Dosage:
–30mg/ min IV infusion, maximum 17mg/Kg
Sodium bicarbonate
Sodium bicarbonate
- Indications:
–Preexisting hyperkalemia
–Acidosis, tricyclic antidepressant overdose - Dosage:
–Use ABG to guide therapy
Asystole/ Pulseless electrical
activity (PEA)
Cardiac arrest rhythm associated with no
discernable ( visible) electrical activity on the ECG
* Successful resuscitation is rare
* Only if the cause of asystole is identified and
treated in a timely fashion can survive
Causes : 5H & 5T
5 “H”
* Hypoxia
* Hypokalemia/ hyperkalemia
* Hydrogen ion (acidosis)
* Hypothermia
* Hypovolemia
5 “T”
* Tamponade, cardiac
* Thrombosis (pulmonary)
* Thrombosis (coronary)
* Toxins (drug overdose)
* Tension, pneumothorax
x
Asystole/ PEA what to do?
Active search for “do not attempt
resuscitation” orders/ status
* Explicit criteria for stopping by physician
* Family presence at resuscitation efforts
* Survivor support plans
* More formal death notification
choking what to do ??
Abdominal maneuver
how to use ECG ????
