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Primary assessment
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Secondary assessment
- Signs and symptoms
- Allergies
- Medications (including last dose taken)
- Past medical history
- Last meal consumed
- Events
H's & T's
- Hypovolemia - Tension pneumothorax
- Hypoxia - Tamponade (cardiac)
- Hydrogen ion (acidosis) - Toxins
- Hypo/hyperkalemia - Thrombosis (pulmonary)
- Hypothermia - Thrombosis (coronary)
Hypovolemia causing PEA shows as?
- rapid, narrow-complex tachycardia (sinus tachycardia) narrow QRS complex
- increased diastolic
- decreased systolic
Average respiratory rate & tidal volume
- 12-16/min
- 8-10 mL/kg
- pt in respiratory arrest 6-7 mL/kg would work and shown with chest rise
Causes of excessive ventilation
- Regurgitation & aspiration
- ↑ intrathoracic pressure - ↓ venous return to the heart and diminishes cardiac output
BLS assessment
- 1. Check responsiveness
- 2. Activate the emergency response system and get the AED/defibrillator
- 3. Check breathing and pulse
- 4. Defibrillation
Ventilation and pulse check process
- Deliver ventilations once every 5 to 6 seconds
- Recheck pulse every 2 minutes (take at least 5 seconds but no more than 10)
3 ECG categories for ACS
- 1. ST-segment elevation (ongoing acute injury)
- 2. St-segment depression (ischemia)
- 3. Nondiagnostic or normal ECG
Reperfusion time goals for ACS
- 1.Door to balloon inflation (PCI) - 90 min
- 2.Door to needle (fibrinolysis) - 30 min
- 3. Non PCI facility - First medical contact to device - 120 min
Criteria for administering nitro
- Hemodynamically stable
- 1. Systolic > 90 mmHg or no lower than 30 mmHg below baseline if known.
- 2.Heart rate is 50-100/min
4 agents used in ischemic-type chest discomfort
- 1. oxygen
- 2. aspirin
- 3. nitrates
- 4. morphine
STEMI classification
- 1.ST-segment elevation in 2 or more contiguous leads or new LBBB.
- 2. J-Point elevation >2mm(0.2mV) in leads V2 & V3 and 1mm or more in all other leads
NSTE-ACS classificatin
- 1. Ischemic ST depression 0.5mm (0.05 mV) or greater or
- 2. dynamic T-wave inversion with pain or discomfort
- 3. Transient ST elevation 0.5 mm or greater for less than 20 min
4 D's of reperfusion treatment delay
- Door to Data
- Data to Decision
- Decision to Drug
Normal sinus rhythm
- Rate: 60-100 beats/min
- Rhythm: Regular
- P wave: uniform and upright
- PRI: .12-.20 sec
Sinus Bradycardia
- Rate: < 60 beats/min
- Rhythm: regular
- P wave: uniform and upright
Sinus Tachycardia
- Rate: 100-160 beats/min
- Rhythym: Regular
- P wave: uniform and upright
Sinus arrhythmia
- Rate: usually 60-100 beats/min but may be faster or slower
- Rhythm: irregular
- P wave: uniform and upright
Supraventricular Tachycardia (SVT)
- Rate: 150-250 beats/min
- Rhythm: regular
- P wave: usually identifiable at the lower end of the rate, but may be lost in T wave
Atrial flutter
- Rate: Atrial 250-350
- Rhythm: usually regular
- P wave: Saw toothed, flutter waves
Atrial flutter
- Rate: Atrial > 400
- Rhythm: irregular
- P wave: not identifiable
First Degree AV block

normal except PRI > .20 seconds
Second degree AV block
Mobitz I
Wenckebach

P wave lengthens with each cycle until a p wave appears without a QRS
Second degree AV block
Mobitz II

P waves are constant and then you get multiple p waves without QRS complexes.
Atropine dosing for bradycardia with pulse
- first dose - 0.5 mg bolus
- repeat every 3-5 minutes
- max of 3 mg
Dopamine dosing for bradycardia with pulse
- 2-20 mcg/kg per minute infusion
- titrate to patient response
- taper slowly
epinphrine dosing for bradycardia with pulse
- 2-10 mcg per minute infusion
- titrate to patient response
procainamide dosing for tachycardia with a pulse
- 20-50 mg/min infusion until
- arrhythmia suppressed
- hypotenstion ensues
- QRS duration increases > 50%
- maximum dose 17 mg/kg given
- maintenance infusion 1-4 mg/min
amiodarone dosing for tachycardia with a pulse
- 1st dose - 150 mg over 10 minutes
- repeat as needed if VT recurs
- follow with maintenance infusion of 1 mg/min for first 6 hours
sotalol dosing for tachycardia with a pulse
- 100mg (1.5 mg/kg) over 5 minutes
- avoid if prolong QT
persistent signs from tachy and brady cardia to treat
- 1. hypotension
- 2. acutely altered mental status
- 3. signs of shock
- 4. ischemic chest discomfort
- 5. acute heart failure
epinephrine dosing for post cardiac arrest

0.1 - 0.5 mcg/kg per minute infustion
dopamine dosing for post cardiac arrest

5-10 mcg/kg per minute
norepinephrine dosing for post cardiac arrest

0.1 - 0.5 mcg/kg per minute
first drug for symptomatic sinus bradycardia

atropine
second line drug of symptomatic bradycardia

dopamine
first drug of choice for most forms of stable narrow complex svt.

adenosine
adenosine dosing for tachycardia
- first dose 6 mg rapid IV push
- second dose 12 mg
tachycardia rhythm to admin adenosin

regular narrow complex
tachycardia rhythm for stable wide QRS tachycardia
- procainamide
- amiodarone
- sotalol
lidocaine dosing for VF/pVT
- 1 - 1.5 mg/kg
- refractory give 0.5 - 0.75 mg/kg push repeat in 5 to 10 minute
- max of 3 doses or total 3 mg/kg
magnesium dosing for cardiac arrest due to hypomagnesemia or torsades

1-2 g (2-4 mL of a 50% solution diluted in 10 ml (D5W, NS)
magnesium dosing for torsades with a pulse or AMI with hypomagnesimia
- loading dose 1-2g mixed in 50-100 ml of diluent over 5-60 minutes
- follow with 0.5 - 1 g per hour, titrate to control torsades

Author

Angus

332446

Card Set

ACLS

Description

ACLS

Updated

2017-06-23T14:17:14Z

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