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BASIC ACLS. DRUG DOSE CHEAT SHEET PLEASE COMPLETE THE WORKSHEET AS WE GO OVER EACH MED YOU CAN USE THIS FOR YOUR PRACTICAL SCENARIOS SORRY ! CANT USE.

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Presentation on theme: "BASIC ACLS. DRUG DOSE CHEAT SHEET PLEASE COMPLETE THE WORKSHEET AS WE GO OVER EACH MED YOU CAN USE THIS FOR YOUR PRACTICAL SCENARIOS SORRY ! CANT USE."— Presentation transcript:

1 BASIC ACLS

2 DRUG DOSE CHEAT SHEET PLEASE COMPLETE THE WORKSHEET AS WE GO OVER EACH MED YOU CAN USE THIS FOR YOUR PRACTICAL SCENARIOS SORRY ! CANT USE IT FOR THE WRITTEN TEST RED IS VERY IMPORTANT

3 ADENOSINE ADENOCARD TREAT STABLE FAST RHYTHMS 6MG –SLAM 12 MG SLAM 10 SEC HALF LIFE

4 ASPIRIN TREAT CHEST PAIN UP 325 MG BABY ASA 81 MG

5 AMIODARONE USED TO TREAT VENTRICULAR DYSRHTHYMIAS V-FIB AND V-TACH 300 MG CARDIAC ARREST/REFRACTORY V-FIB 150 MG FOR LIVE PT CAN BE USED IN PLACE OF LIDO

6 ATROPINE USED FOR STABLE SLOW RHYTHM.5 MG MAX DOSE 3 MG NOT FOR CARDIAC ARREST

7 CARDIAZEM DIALTIAZEM SECOND LINE FOR STABLE FAST SVT.25 MG/KG.35 MG /KG SECOND DOSE

8 DOPAMINE INCREASE BP IN HYPOTENSIVE PT TREAT HYPOVOLEMIA FIRST 2-10 MCG/KG/MIN 5 MCG/KG/MIN

9 EPI FIRST LINE DRUG FOR CARDIAC ARREST 1MG NO MAXIMUM EPI DRIP FOR BRADYCARDIA BEST GIVEN BY PERIPHERAL IV IN CARDIAC ARREST

10 LIDOCAINE TREAT VENTRICULAR DYSRHYTHMIAS V-FIB OR V TACH MG/KG NO DRIP REQUIRED

11 MAGNESIUM SULFATE TREAT –TORSADES OR HYPOMAGNESIA REFRACTORY V-FIB 1-2 GM IN 50cc ADMINISTERED OVER 5-10 MINUTES

12 MORPHINE USED FOR CHEST PAIN 2-6 MG

13 NARCAN USED TO TREAT NARCOTIC OVERDOSE 2MG FOR CARDIAC ARREST

14 NITRO USED TO TREAT CHEST PAIN 4 MG UP TO 3X 5 MINUTES APART BP >90 MM/HG NO ED NO RVI

15 NORMAL SALINE FLUID REPLACEMENT HYPOVOLEMIA 1-2 LT

16 SODIUM BICARBONATE USED TO TREAT KNOWN ACIDOSIS 1MEQ/KG

17 VERSED MIDAZOLAM USED AS PREMEDICATION FOR ELECTRICAL THERAPY AMNETIC 5 MG

18 DEFIBRILLATION V-FIB OR PULSE LESS V-TACH DEFIBRILLATE THE DEAD 200 JOULES FOR BIPHASIC 360 JOULES FOR MONOPHASIC KNOW YOUR EQUIPMENT

19 CARDIOVERSION SYNCHRONIZED DEFIBRILLATION 100/200/300/360 CARDIOVERT 100 J– CENTURY 100 YEARS ROMAN NUMERAL FOR 100 ?

20 Hs and Ts Hypovolemia Hypoxia Hypothermia Hypo-/Hyperkalemia Hydrogen ion n (acidosis) Hypomagnesia Hypoglycemia Tamponade, cardiac Tension pneumothorax Thrombosis: lungs Thrombosis: heart Tablets/toxins: drug overdose

21 WORKBOOK SLIDES WITH THE BLUE BACKGROUND WILL BE IN YOUR WORK BOOK FILL IN THE BLANKS AS WE GO THRU THE SLIDES IT WILL BE VERY HELPFUL !!!

22 Components of Basic Life Support Recognition of signs of : Stroke Heart Attack Cardiac arrest FBAO How to perform : Abdominal thrust CPR Early Defibrillation with an AED

23 TEAM CONCEPT ALL MEMBERS NEED TO BE PROFICIENT IN THEIR SKILLS EVERY MEMBER NEEDS TO BE ABLE TO OPERATE/TROUBLESHOOT THEIR EQUIPMENT CONSTRUCTIVE INTERVENTIONS OUR PURPOSE AS MEMBERS OF M.E.T. IS TO PREVENT PT DETERIORATION BY EARLY INTERVENTIONS

24 STABLE VS. UNSTABLE STABLE –A & OX3 SKIN WARM DRY COLOR GOOD NORMAL V.S. UNSTABLE – A.M.S. / PALE OR CYANOTIC/ SWEATY/ABNORMAL V.S. UNSTABLE PT IS IN SHOCK

25 IMPORTANT !! STABLE PATIENTS ARE TREATED WITH MEDS UNSTABLE PATIENTS ARE TREATED WITH ELECTRICITY DEFIB/ PACER/ CARDIOVERSION

26 CABD SEQUENCE

27 WHAT DO AEDS AND EASTER EGGS HAVE IN COMMON ? POWER UP ATTACH ELECTRODES ANALYZE RHYTHM SHOCK/NO SHOCK

28 Emergency Action Steps Assess-Alert-Attend to ABCDs D=DEFIBRILLATION SHOCK/NO SHOCK. If AED instructs shock indicated yell CLEAR or something similar. Press shock button. Immediately resume chest compressions. If no shock is indicated, immediately resume chest compressions. Then follow instructions as given by AED

29 TROUBLESHOOTING AED USUALLY PROBLEM LIES WITH POOR PADS ADHESION OR CABLE NOT CONNECTED ANY MALFUNCTION WITH THE AED IMMEDIATELY START CPR

30 Emergency Action Steps Assess-Alert-Attend to ABCDs D=DEFIBRILLATION (Summary) SHOCK advised CLEAR and give 1 shock. Immediately resume CPR. Continue 30:2 x 5 cycles (2 min.). Reassess rhythm. NO SHOCK advised Immediately resume CPR Continue 30:2 x 5 cycles (2 min.). Reassess rhythm.

31 CRITICAL THINKING AFTER PULSE CHECK –START CPR 30:2 AND A RATE OF 100 COMPRESSIONS PER MINUTE INTERRUPTIONS IN CPR SHOULD BE KEPT TO LESS THAN 10 SECS HIGH QUALITY CPR IN PT WITH ADVANCED AIRWAY UNINTERRUPTED CHEST COMPRESSIONS AND 10 VENTILATION PER MINUTE

32 For high quality CPR SWITCH COMPRESSORS EVERY 5 CYCLES (2 MINUTES) HIGH QUALITY CPR HARD FAST UNINTERRUPTED AND ALLOW FOR COMPLETE CHEST RECOIL INTERRUPTIONS TO LESS THAN 10 SECS

33 CRITICAL THINKING NO PULSE = CHEST COMPRESSIONS IF YOU ARE NOT SURE IF PT HAS PULSE- START CPR

34 SUCTIONING SELECT PROPER SIZE/TYPE CATHETER SUCTION ON THE WITHDRAWAL NO MORE THAN 10 SECS WATCH O2 SATS AND HEART RATES

35 VENTILATION RATES VENTILATION RATE WITH PULSE –EVERY 5-6 SECS WITH ADVANCED AIRWAY- ONE EVERY 6-8 SECONDS DELIVER OVER 1 SEC. JUST ENOUGH TO MAKE CHEST RISE

36 Capnography

37 Exhaled Carbon Dioxide Detection

38 CONFIRMATION ….. Monitor for changes in color (colorimetric device) or number (digital device) on an exhaled CO 2 detector CONTINUOUS WAVEFORM MOST RELIABLE METHOD OF VERIFYING ET TUBE PLACEMENT CAUTIOUSLY SECURE ET TUBE – CIRCUMFRENTIAL TIES AROUND NECK CAN RESTRICT BLOOD FLOW

39 What is capnography? Capnography measures exhaled PETCO2. Used to determine the effectiveness of respiration and/or ventilation. CO2 is measured in mmHg Normal is defined as 35-45mmHg Post ROSC we want mmHg

40 Whats the Difference SpO2 = Pulse oximetry – measures oxygenation EtCO2 = Capnography – measures ventilation

41 Devices used for Capnography Measured using qualitative and quantitative devices Qualitative gives you a color change (purple to yellow) Quantitative gives you a number value(EtCO2 and Respirations) Most effective is Waveform Capnography

42 What does it mean in ACLS? CO2 measures the effectiveness of our compressions, ventilations and overall patient care in resuscitation Compressions only 25-35% as effective as heart beating on its own Therefore CO2 during cardiac arrest may drop as low as 10mmHg

43 What does it mean in ACLS? CO2 less than 10mmHg means something is wrong PETCO2 >10mmHg=Good CPR CO2 should never drop below 10mmHg in Cardiac Arrest

44 Troubleshooting Low CO2 Check compressions and confirm carotid pulse with compressions Confirm tube placement Check equipment WHEN IN DOUBT PULL ENDOTRACHEAL TUBE AND GO BACK TO BASICS.

45 What does no CO2 Mean? CO2 readings of 0 or straight-line mean no CO2 is being registered. Access tube placement Check ventilator WHEN IN DOUBT PULL ENDOTRACHEAL TUBE

46 CRITICAL THINKING COMMON FATAL MISTAKE IS PROLONGED INTERRUPTIONS IN CHEST COMPRESSIONS- USUALLY FOR AIRWAY COMPONENT OF HIGH QUALITY CPR IS ALLOWING COMPLETE CHEST RECOIL

47 EKG RECOGNITION

48 12 Lead EKG Except for unstable pt – any pt with chest pain/pressure/ discomfort gets 12 lead immediately Looking for STEMI – ST elevation MI

49 Six Steps in Analyzing a Rhythm Strip 1. Assess the rate 2. Assess rhythm/regularity 3. Identify and examine P waves 4. Assess intervals 5. Evaluate overall appearance of rhythm 6. Interpret rhythm/evaluate clinical significance

50 Rate Measurement Six-second method

51 Large Box Method Count the number of large boxes between two consecutive waveforms (R-R interval or P-P interval) and divide into 300

52 Sinus Rhythm

53 TWO PARTS TO A BEATING HEART ELECTRICAL –ALL RHYTHMS (EXCEPT ASYSTOLE ) HAVE ELECTRICAL ACTIVITY MECHANICAL- ALL PERFUSING RHYTHMS ARE SUPPORTED BY ELECTRICAL COMPONENT AND MECHANICAL. MEASURED BY BLOOD PRESSURE

54 Ventricular Fibrillation (VF) SQUIGGLY LINE-LOOKS LIKE A KID DRAWING ON A WALL !!

55 Ventricular Fibrillation (VF) Fine VF Coarse VF

56 Monomorphic Ventricular Tachycardia

57 Polymorphic Ventricular Tachycardia ALSO CALLED TORSADES

58 Ventricular Tachycardia (VT) Treat the following as VF: Pulseless monomorphic VT Pulseless polymorphic VT

59 Asystole (Cardiac Standstill)

60 P-wave Asystole Asystole

61 Check leads Long down time 25 minutes or greater 2 rounds of drugs with no rhythm change indicates death CONSULT MED CONTROL TO TERMINATE EFFORTS

62 Sinus Bradycardia

63

64 Second-Degree AV Block, Type II

65 Second-Degree AV Block, 2:1 Conduction (2:1 AV Block)

66 Third-degree AV Block

67 BRADY IS A BRADY WIDE OR NARROW – STABLE GETS MEDS UNSTABLE GETS PACED ASYMPTOMATIC- LEAVE IT ALONE

68 Sinus Tachycardia

69 Monomorphic Ventricular Tachycardia

70 NARROW VS WIDE NARROW QRS USUALLY IS SUPRAVENTRICULAR WIDE COMPLEX ORIGINATES IN THE VENTRICLES

71 Sinus TachycardiaCauses Fever Pain Anxiety Hypoxia CHF Acute MI Infection Shock Hypovolemia Exercise Fright Dehydration Medications Epinephrine Atropine Caffeine, nicotine Cocaine

72 Pulseless Electrical Activity (PEA) PEA exists when organized electrical activity (other than VT) is present on the cardiac monitor, but the patient is apneic and pulseless

73 Critical Resuscitation Tasks Airway management Chest compressions Monitoring and defibrillation Vascular access/medication administration

74 DefibrillationIndications Pulseless ventricular tachycardia Ventricular fibrillation

75 Paddles/Electrodes

76 Paddle/Pad Position

77 HANDS FREE SAFER ALLOWS FOR MORE RAPID DEFIBRILLATION CONTINUE CPR DURING CHARGING OF DEFIBRILLATOR

78 CRITICAL THINKING CPR IMMEDIATELY AFTER DEFIB SIGNIFICANTLY INCREASES THE CHANCES OF CONVERSION

79 VAGAL MANEUVERS USED TO SLOW FAST HEART RATES Gagging. Holding your breath and bearing down (Valsalva maneuver). Immersing your face in ice-cold water (diving reflex). Coughing.

80 Synchronized Cardioversion Indications Unstable supraventricular tachycardia Unstable atrial fibrillation with rapid ventricular response Unstable atrial flutter with rapid ventricular response Unstable wide-complex tachycardia Unstable ventricular tachycardia with a pulse

81 Electrical TherapySafety Remove supplemental oxygen sources from area before defibrillation and cardioversion attempts Place them at least 3½-4 feet away from the patients chest

82 Transcutaneous Pacing Procedure

83 Transcutaneous Pacing (TCP) Set the output (milliamps) setting Increase current slowly until capture achieved Watch monitor closely for electrical capture

84 Transcutaneous Pacing (TCP) Mechanical capture occurs when pacing produces a measurable hemodynamic response Pulse Measurable blood pressure greater than 90 systolic

85 CPR SHOCK-200 J (BIPHASIC) EPI – 1MG or VASOPRESSEN 40 UNITS SHOCK DRUG-LIDO (1MG/KG) OR 300 MG AMIODARONE SHOCK EPI-1MG SHOCK LIDO/AMIODARONE SHOCK EPI EVERY 3-5 MIN 5H &5 T

86 PULSE LESS –TREAT LIKE V-FIB STABLE ADENOSINE 6MG SLAM REPEAT AT 12 MG AMIODARONE - 150MG LIDOCAINE 1MG/KG UNSTABLE CARDIOVERT 100J DRUGS VERSED 5MG CARDIOVERT 200J

87 STABLE OXYGEN AND AIRWAY IF O2 SATS >93% ATROPINE.5MG DOPAMINE 2-10 MCG/KG/MIN EPI DRIP 1MG IN 100CC OVER 10 MINUTES UNSTABLE OXYGEN AND AIRWAY TCP-PACER ATROPINE – IF PACER IS DELAYED

88 STABLE VAGAL MANEUVERS ADENOSINE 6MG ADENOSINE 12 MG CARDIAZEM-.25MG/KG UNSTABLE CARDIOVERT 100J VERSED 5MG CARDIOVERT 200

89 PEA-NO PULSE BUT SHOULD BE ONE ! CPR/EPI/5HS-5TS HYPOVOLEMIA-FLUID HYPOKALEMIA-K+ HYPOXIA-O2 HYPOGLYCEMIA-D50 HYPOTHERMIA-TEMP HYDROGEN ION- BICARB 1MEQ/KG TAMPONADE-STEEL TOXIN-NARCAN 2MG TENSION PNEUMO- SURGEON TRAUMA-SURGEON THROMBOSIS-FIBRO

90 TREAT LIKE PEA CONSIDER TERMINATING EFFORTS AFTER EXTENDED TIME ( GREATER THAN 25 MIN ) AN 2 OR MORE ROUNDS OF DRUGS

91 POST ROSC MAINTAIN BP>90 SYSTOLIC PETCO2 > MMhG O2 SAT > 93 % OPTIMIZE VENTILATIONS AND OXYGENATION THERAPEUTIC HYPOTHERMIA- NOT NECESSARY IF PT A&OX3

92 ACS-HEART ATTACK 12 LEAD ASAP MONA REALLY- OANM ASA-325 MG NITRO -.4 MG UP TO 3 TIMES- NO RVI/NO E.D. / BP > 90 SYSTOLIC MORPHINE – 2-6 MG 12 LEAD EKG FIBRONYLITICS

93 STROKE/CVA/BRAIN ATTACK SUDDEN ONSET NEUROLOGICAL PROBLEM HEADACHE UNILATERAL WEAKNESS = CINCINNATI OR OTHER STROKE ASSESSMENT NEEDS HEAD CT ASAP FIBRONOLYTICS WITHIN 3 HRS

94 CRITICAL THINKING WHAT IS THE ONE DRUG USED IN ALL ARRESTS ? DOSE ??BEST ROUTE TO ADMINISTER WHY IS ATROPINE USED IN HYPOTENSIVE PTS W/ SLOW RHYTHMS WHAT IS THE WINDOW FOR THROMBOLYTICS 12 LEAD AS SOON AS POSSIBLE FOR CHEST PAIN RACING HEART OR INDIGESTION

95 CRITICAL THINKING VENTRICULAR PROBLEMS NEED EITHER LIDO OR AMIODARONE GOAL IS TO HAVE BREATHING PULSED PT WITH BP >90/ CO mm/hg THERAPEUTIC HYPOTHERMIA


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