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
