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ACLS ALGORITHMS

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ACLS ALGORITHMS Ventricular Fibrillation (VF) & Pulseless Ventricular Tachycardia (VT) ACLS ALGORITHMS Ventricular Fibrillation (VF) & Pulseless Ventricular ... – PowerPoint PPT presentation

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Title: ACLS ALGORITHMS


1
ACLSALGORITHMS
2
Acute Pulmonary Edema / Hypotension / Shock
Algorithm
Clinical signs of hypoperfusion, congestive
heart failure, acute pulmonary edema Assess
ABCs Assess vitals Secure airway Review
history Administer O2 Perform physical
exam Start IV 12 lead ECG, chest x-ray Attach
monitor, pulse oximetry and B/P Cuff
Figure 8
What is the nature of the problem?
Volume problem Includes PVR problems
Rate Problem
Pump Problem
What is the BP ?
  • Administer
  • Fluids
  • Blood transfusions
  • Cause-specific interventions
  • Consider vasopressors

Too Slow Go to Fig 5
Too Fast Go to Fig 6
Systolic BP lt 70 Signs of shock
Systolic BP 70 - 100 mmHg Signs of shock
Systolic BP gt 100 mmHg
Systolic BP 70 - 100 mmHg No Signs of shock
3
Bradycardia Algorithm(Patient is not in Cardiac
Arrest)
Assess ABCs Assess vitals Secure airway Review
history Administer O2 Perform physical
exam Start IV 12 lead ECG, chest x-ray Attach
monitor, pulse oximetry and B/P Cuff
Figure 5
Bradycardia, either absolute (lt60 BPM) or relative
Serious signs and symptoms?a,b
Yes
No
Type II second-degree AV heart block or Third-degr
ee AV heart Block?e
  • Intervention sequence
  • Atropine 0.5 - 1.0 mcg,d (I and IIa)
  • TCP, if available (I)
  • Dopamine 5 - 20 mcg/kg/min (IIb)
  • Epinephrine 1 - 10 mcg/min (IIb)
  • Norepinephrine 0.5 30 mcg/min (IIb)

No
Yes
Observe
  • Prepare for transvenous pacer
  • Use TCP as a bridge device

4
Tachycardia Algorithm (Patient is not in Cardiac
Arrest)
Assess ABCs Assess vitals Secure airway Review
history Administer O2 Perform physical
exam Start IV 12 lead ECG, chest x-ray Attach
monitor, pulse oximetry and B/P Cuff
Figure 6
  • If ventricular rate gt 150 BPM
  • Prepare for cardioversion
  • May give brief trial of Rx
  • Immediate cardioversion is seldom
  • needed for heart rates lt 150 BPM

Yes
Unstable, with serious signs or symptoms?a
No
Ventricular Tachycardia (VT)
Atrial Fibrillation Atrial Flutter
Wide-complex tachycardia of uncertain type
Paroxysmal Supraventricular Tachycardia (PSVT)
5
Pulseless Electrical Activity (PEA)
Algorithm(Electromechanical Dissociation EMD)
Figure 3
Includes Electromechanical dissociation
(EMD) Postdefibrillation idioventricular rhythms
Pseudo - EMD Bradyasystolic rhythms
Idioventricular rhythms Ventricular escape
rhythms
  • Continue CPR / Intubate at once / Obtain IV
    Access
  • Assess blood flow using Doppler ultrasound,
    endtidal CO2,
  • echocardiography, or arterial line

Consider possible causes Hypovolemia
(volume infusion) Drug overdoses - tricyclics,
digitalis Hypoxia (ventilation) Beta-blockers,
calcium channel blockers Cardiac tamponade
(pericardiocentesis) Hyperkalemia Tension
Pneumothorax Acidosis Hypothermia ( see
hypothermia algorithm) Massive acute myocardial
infarction Massive pulmonary embolism (surgery,
lysine) Massive acute MI (go to Fig 9)
Epinephrine 1 mg IV push,a,c repeat q 3 - 5 min
  • If absolute bradycardia (lt 60 BPM) or relative
    bradycardia
  • give atropine 1 mg IV
  • Repeat q 3 -5 min to a total of 0.03 - 0.04 mg/kg

6
Asystole Treatment Algorithm
  • Continue CPR
  • Intubate at once
  • Obtain IV Access
  • Confirm asystole in more than 1 lead

Consider possible causes Hypoxia Pre-existing
acidosis Hyperkalemia Drug Overdose
Hypokalemia Hypothermia
Consider immediate transcutaneous pacing (TCP)a
Figure 4
  • Epinephrine 1mg IV push,b,c
  • repeat q 3 - 5 min
  • Atropine 1 mg IV push
  • repeat q 3 - 5 min up to a total
  • of 0.03 - 0.04 mg/kgd,e

Consider termination of efforts
7
Ventricular Fibrillation (VF) Pulseless
Ventricular Tachycardia (VT)
Figure 2
  • ABCs
  • Perform CPR until defibrillator Arrives
  • VF/VT present on defibrillator

Defibrillate up to 3 times if needed for
persistent VF/VT 200 J, 200 - 300 J, 360 J
Rhythm after the first 3 shocks? b
Asystole Go to Fig 4
PEA Go to Fig 3
VF/VT
ROSC
8
Figure 2
VF Pulseless VT
  • Continue CPR
  • Intubate / IV Access

Epinephrine c,d 1 mg/IV 2 mg/ETT q 3
- 5 min
Defibrillate 360 J within 30 - 60 sec
Administer Rx Class IIa probable benefit f, g
Defibrillate 360 J, 30 - 60 sec after Rx
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