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ACLS FOR DUMMIES!!

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Pulseless V-FIB/V-TAC, what is the treatment?
Check LOC,A-open airway,b-ventilate,c-chest compressions,D-defib-shock-200-300-360,#2A-ETT,B-check placement-secure airway-ventilate,C-IV access-monitor-meds,D-differential DX,EPI 1mg IVq 3-5 mins or vasopressin 40u x1,Defib 360j,Antiarrhymics-Amio 300mg IV-Lido 1-1.5mg IV or ETT-Mag 2g in 10ml of NS-Procainamide 20mg/min-Consider HCO3 1mEq/kg,D/fib 360j after each drug D/fib, i.e.(epi,D/fib,lido,D/fib)
What is the Tx for Asystole?
Check LOC,1st-ABCD's,2nd-ABCD's,EPI 1mg IV or 2mg ETTq 3-5mins,Atropine 1mg IV or 2mg ETTq 3-5mins to a total of 0.04mg/kg,Consider treatable causes,Consider termination of code
REMEMBER!!! LOOK IN TWO LEADS, AND IF YOUR MONITOR LEADS ARE STILL CONNECTED!!
What does the A stand for in the first ABCD's of ACLS?
AIRWAY- open the AIRWAY!!
What does the B stand for in the first ABCD'S?
Breathing- Provide ventilation
BLS manuvers
What does the C stand for in the first ABCD'S of ACLS?
Circulation-
Chest Compressions
80-100 for adult
What does the D stand for in the first ABCD's of ACLS?
Defibrillation-Either by quick look with the paddles, or with quick pads.
What is the Tx for Pulseless Electical Activity, or PEA as some might know it as?
Check LOC,1st ABCD's,2nd ABCD's,Consider treatable causes
H-Hypovolemia
H-Hypoxia
A-Acidosis
H-Hyper- Hypokalemia
H-Hypothermia

T-Tablets (OD)
T-Tamponade
T-Tension pneumo
T-Thrombosis (Coronary or Pulmonary)
What is the Tx for Narrow Complex Tachycardia?
Evaluate Patient?
*stable or un-stable?
Stable-IV,O2,Monitor
Vagel manuvers, Adenosine 6mg RIVP
++Junctional Tach-Stable-
NO DC Cardioversion,Amiodarone,B-Blockers,CA++channel blockers
JUNCT TACH-UNSTABLE-With serious S/S
NO DC Cardioversion
Amiodarone-150mg in 250cc over 10mins
++PSVT-Stable-
CA++channel blockers
B-blockers
Digoxin-
DC Cardioversion-100j,200j,300j,360j
Consider Procain or Cordarone
PSVT-UNSTABLE-
Digoxin
Amiodarone
Cardizem
Cardiovert-100j,200j,300j,360j
++Ectopic-Multifocal Atrial Tach-Stable
NO DC cardiovert
Ca++channel blockers
B-blockers
Amiodarone
E-Multifocal Atrial Tach-UNSTABLE-
NO DC cardiovert
Amiodarone
Cardizem
What constitutes serious signs and symptoms per ACLS?
Serious signs are:
Pulmonary Edema
Rales
Rhonci
Hypotension
Orthostasis
JVD
Peripheal Edema
Ischemia
ECG changes
Symptoms:
SHOB
Chest pain
Dyspnea on exertion
AMS
What is the Tx for V-TAC with a pulse. (sustained)
You can go directly to Sync-Cardiovert with serious signs and symptoms.
For Monomorphic V-TAC STABLE
ABC'S IV,O2 MONITOR
CONSIDER ONE:
PROCAINAMIDE
AMIODARONE
LIDOCAINE
THEN- SYNC-CARDIOVERT 100J,200J,300J,360J
++UNSTABLE V-TAC WITH SERIOUS S/S
SYNC-CARDIOVERT 100J,200J,300J,360J
(NOTE IF VF OCCURS WHILE SYNC-CARDIOVERT, TURN SYNC OFF AND DEFIB)
CONSIDER ONE:
AMIODARONE(150 OVER 10MINS)
LIDOCAINE(0.5-0.75MG/KG IV)
++POLYMORPHIC(TORSADES)STABLE
ABC'S,IV,O2,MONITOR
CORRECT ELECTROLYTES
CONSIDER ONE:
B-BLOCKER
LIDOCAINE
AMIODARONE
PROCAINAMIDE
PRIOR TO CARDIOVERT ADMIN SEDATION WHENEVER POSSIBLE
SYNC-CARDIOVERT 100J,200J,300J,360J
++UNSTABLE TORSADES(POLYMORPHIC V-TAC)
SYNC-CARDIOVERT 100J,200J,300J,360J
MAGNESIUM
OVERDRIVE PACING(NOT DONE IN THE PREHOSPITAL SETTING)
ISOPROTERONOL
PHENYTOIN

NOTE!!! HAVE YOUR ALS EQUIPMENT READY!!
LIDOCAINE
What is the Tx for bradycardia per ACLS?
STABLE OR UNSTABLE?
ABC'S
IF PT IS UNSTABLE AND HAS SERIOUS S/S THEN BEGIN IMMEDIATE PACING!
STABLE PT's WITH HEART RATE LESS THAN 60.
FOR BRADYCARDIA,JUNCTIONAL FIRST DEGREE HB, SECOND DEGREE HB TYPE 1(WENKEBACH)
1.ATROPINE 0.5-1.0MG IVQ 3-5 MINS TO A TOTAL DOSE OF 0.4MG/KG
2.PREMEDICATE TO SEDATE
3.TCP
4.DOPAMINE DRIP 2-20MCG/KG/MIN
5.EPI DRIP 2-10MCG/KG/MIN **NOTE THIS IS THE LAST STRAW**

FOR SECOND DEGREE TYPE II(MOBITZ II)AND THIRD DEGREE HB
1.IMMEDIATE TCP(PACING)
2.MEDICATE FOR PAIN
How does the Suspected stroke algorhythm go?
PREHOSPITAL(EMS)
1.ASSESSMENT CINNCINATI STROKE SCALE, LOS ANGELES STROKE SCREEN, ALERT STROKE SCREEN, RAPID STROKE SCREEN
2.IV,O2,MONITOR,OBTAIN BLOOD(CBC,LYTES,COAG),CHECK FSBS,PERFORM STROKE SCREEN, ALERT STROKE TEAM
10MINS IS GOAL TIME FOR EMS
IMMEDIATE NEURO ASSESSMENT
PMH
ESTABLISH ONSET(<3HRS REQUIRED FOR CLOT BUSTERS)
GCS
LEVEL OF STROKE SEVERITY(NIH OR HUNT/HESS SCALE)
OBTAIN NON-CONTRAST CT(<25MINS)
READ CT(<45MINS)
X-RAY NECK(IF COMATOSE OR HX OF TRAUMA)
DOES CT SHOW INTRACEREBRAL BLEED OR SUBARACNOID BLEED?
NO! THEN
1. PROBABLE ACUTE ISCHEMIC STROKE(IF SUSPICION OF SUBARACNOID BLEED THEN PERFORM LP)
IF NO BLOOD THEN PT GET THROMBOLYTIC WITH CONSULT OF RISKS WITH FAMILY.
DOOR TO TREATMENT IS <60MINS
What is the Tx for A-FIB/A-Flutter per ACLS?
CONTROL RATE!!
1.ABC'S, IV,O2,MONITOR
ASSESS IN DURATION IS >48HRS. USE CAUTION WITH AGENTS TO CONVERT FOR POSSIBLE CLOTS TO FLOAT TO THE SQUASH OR LUNGS.
2. STABLE
CA++CHANNEL BLOCKER
B-BLOCKER, WITH WPW, THEN CHOOSE ONE:
AMIODARONE,FLECANIDE,PROCAINAMIDE,
PROPAFENONE
3. UNSTABLE WITH SERIOUS S/S
CONSIDER ONE: DIGOXIN,CARDIZEM,AMIODARONE
IF NO SUCCESS WITH MEDS THEN SYNCCARDIOVERT<48HRS 75J,100J,200J,300,360J
CONTROL RYH!!
DURATION <48HRS
CONSIDER DC SYNC-CARDIOVERSION
OR TRY ONE:
AMIODARONE,IBUTILIDE,FLECINIDE,
PROPAFENONE, PROCAINAMIDE
DURATION >48HRS
NO DC SYNC-CARDIOVERSION
DELAYED CARDIOVERSION(ANTICOAG FOR 3 WEEKS,CARDIOVERT,ANTICOAG FOR 4 WEEKS)
EARLY CARDIOVERSION(HEPARIN IV, TEE TO EXCLUDE ATRIAL CLOT, ANTICOAG FOR 4 WEEKS.
How do you treat wide-complex tachycardia?
SVT-CONFIRMED
SEE NARROW COMPLEX TACHYCARDIA
SYNC- CARDIOVERT OR PROCAINAMIDE OR AMIODARONE
V-TAC-CONFIRMED
SEE STABLE VT
SYNC-CARDIOVERT
OR AMIODARONE OR ANY OF THE OTHER ANTIARRYHMICS IN THAT ALGORITHM
What are the indications, dosages, and administration pearls for Adenosine?
1. Indications
Narrow PSVT
2. Dosage
6mg,12mg,and a 3rd dose of 12mg can be give
3. Administration
Rapid IV push(RIVP)
What is the indications, dosage, and administration pearls for Amiodarone?
1. Indications
V-FIB/Pulseless VT, VT with a pulse, and may be given for rate control in A-FIB
2. Dosage
300mg IV(never ETT)for cardiac arrest. Repeat dose at 150mg in 3-5 mins
VT w/pulse
150 mg over 10mins(150mg in 250cc), and repeat if ectopy is not abolished at 150mg
Slow drip 360mg IV over 6 hrs, maintenance 540mg over 18hrs
Not to exceed 2.2g in 24hrs
3. Admin
It is a soapy solution, and if shaken will take a few mins to settle.
Never give this med in the ETT. It will eat the surfactent away.
Atropine?
1. Indications
Symptomatic sinus brady, second drug after epi and vasopressin for treatment of asystole, or brady PEA.
2. Dosage
Asystole and brady PEA 1mg IV or 2mg ETTq 3-5mins not to exceed 0.04mg/kg
Bradycardia 0.5mg-1.0mg every 3-5mins not to exceed 0.04mg/kg
3. Admin
Will not be effective in 2nd degree hb type II or 3rd degree hb use pacing or dopamine or epi drips
Don't give less than 0.5mg IV
Does not work with transplant pt's
What are the indication, dosage, and administraion pearls for Calcium Cloride?
1. Indications
Known or suspected hyperkalemia(renal failure). Hypocalcemia(after multiple blood transfusion. Antidote for Calcium Channel Blockers or Beta blocker overdoses.
2. Dosage 8-16mg/kg for hyoerkalemia and CCB overdoses.
3. Admin
DON"T GIVE WITH HCO3(bicarb)
What are the indication, dosage, admisitration pearls for Dopamine?
1. Indications
Second drug for symptomatic bradycardia after Atropine. Used for hypotension with signs and symptoms of shock.
2. Dosage
Mixed 400mg in 250cc NS
Consentration of 1600mcg/ml
Renal dose- 1-5mcg/kg/min
Moderate dose- 5-10mcg/kg/min
High dose- 10-20mcg/kg/min
An easy way to figure out the drop/min is. If the patient weighs 100kg, and you want to give 5mcg/kg/min. The drops/min will be will be 19gtt/min. For every kg the Pt is above 100kg add 2gtt's. For every kg the Pt is under 100kg subtract 2gtt's. An example of this is, the Pt weighs 110kg's. (19gtt's for a 100kg pt + 2gtt's for every kg above 100kg's= 39gtt/min)
3. Admin
IV MUST BE GOOD!!!!!
DON'T MIX WITH HCO3(bicarb)
NEVER RUN DOPAMINE IN TILL YOU GET THE DESIRED EFFECT!!!
What are the indications, dosage, and administration pearls for Epinephrine?
1. Indications
Cardiac Arrest, VF, pulseless VT, asystole, PEA, symtpmatic bradycardia, severe hypotension, anaphylaxis
2. Dosage
Cardiac Arrest- 1mg of 1:10q 3-5mins
ETT dose- Double down
Bradycardia and hypotension-
2-10mcg/min- add 30mg of EPI to 250cc NS
Anaphylaxis- .3-.5mg 1:1 SQ
3. Admin
May be given IO,ET,and IV.
1mg in 250cc= 1mcg/min= 15cc/hr
What are the indications, dosage, and administration pearls for Lidocaine?
1. Indications
Cardiac Arrest- VF,pulseless VT,stable VT, Wide complex Tachycardia
2. Dosage-
Cardiac Arrest- 1.0-1.5mg/kg IVP
ETT- Double Down
q 3-5mins to a total dose of 3mg/kg
3. Admin
Mix either 1gm is 250cc NS, or 2gm in 500cc NS. Then infuse at 1-4mg/min
Can be given IO,ET,IV
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