You are on page 1of 60

Advance Cardiac

Life Support

Christian Gallardo, MD
CPR Milestones
• 1966 1st conference on CPR
• 1973 AHA Guidelines for ACLS
• 1979 3rd conference
• 1985 4th conference
• 1992 5th conference. ILCOR
• 2000 Guidelines 2000 for CPR and ECC
International Consensus on Science
Essentials of ACLS
• CORE of ACLS Concepts
– Cerebral Resuscitation is the
most important goal!
• Returning the patient to the pre-
arrested level of neurological
functioning
• Cardio-Pulmonary-Cerebral
resuscitation (CPCR) – had been
proposed to replace CPR
– Focuses on Airway and
Ventilation, Basic CPR,
Defibrillation of Ventricular
fibrillation and Drugs
Essentials of ACLS
– The probability of survival
declines with each passing minute
of cardiopulmonary compromise
– Medical conditions that lead to
cardiac arrest must be identified
as quickly as possible (e.g. AMI)
– The chain of survival applies in all
settings.
– Good ACLS requires a careful
thought about when to start and
when to stop resuscitative efforts.
The Chain of Survival
Acute Coronary Syndrome (ACS)
• 52% deaths of AMI
occurs out of the
hospital within the 1st
hour after the onset of
symptoms (chest
discomfort, nausea,
SOB etc)
Stroke
• Number 3 killer and
leading cause of severe,
long term disability
• EMS provider should be
trained to suspect
stroke, rapid dispatch of
EMS and rapid delivery
to a hospital capable of
providing acute stroke
care
Adult BLS Algorithm
Adult BLS Algorithm
Adult BLS Algorithm

•Push hard, push fast (rate of 100 compressions per minute),


allow complete chest recoil between compressions (Do not bend
elbows!!)
•Compress in the center of the chest at the nipple line (2 fingers
width above the xyphoid process)
•Compress the chest approximately 11⁄2 to 2 inches, using the
heel of both hands
•Minimize interruptions in chest compressions
Adult BLS Algorithm
Automated External Defibrillator
Adult Basic Life Support
• Recovery Position
– For unresponsive adult victims who have
normal breathing
– Should be stable, near a true lateral position,
with the head dependent and no pressure on
the chest to impair breathing
ACLS Algorithm
ACLS Pulseless Arrest Algorithm
ACLS Pulseless Arrest Algorithm
When using a bagmask device (ie, no advanced airway
is in place), the rescuer should deliver a tidal volume
sufficient to produce chest rise (approximately 6 to 7
mL/kg or 500 to 600 mL) over 1 second
ACLS Pulseless Arrest Algorithm
ACLS Pulseless Arrest Algorithm
ACLS Bradycardia Algorithm
ACLS Bradycardia Algorithm
ACLS Bradycardia Algorithm
ACLS Tachycardia Algorithm
ACLS Tachycardia Algorithm
ACLS Tachycardia Algorithm
ACLS Tachycardia Algorithm
ACLS Tachycardia Algorithm
ACLS Tachycardia Algorithm
Electrical
Cardioversion
Electrical Cardioversion Algorithm
Electrical Cardioversion Algorithm
Initial Energy Levels for
synchronized cardioversion:
• 50J: Atrial flutter and
SVT
• 100J: AF and
Monomorphic VT
• Polymorphic VT (Torsade):
Synchronize is impossible, treat
as VF and deliver a high energy
synchronize shock (360J)
Defibrillation Injuries
Gibbs et al Am J Emerg Med 3/90
arm touching side of rail -tingling arm x 30 min
hand contact with gel -sore arm
checking femoral pulse -thrown clear of patient
holding bag mask -shock to fingers
thumb in contact with breast -shock to hand
leg touching stretcher -shock to leg
arc from paddle to electrode -burn to hand and patient
hands over paddle electrode -shock to arms
crack in paddle -PVC’s, muscle spasms
pt’s arm between MD’s legs -contusion to groin
discharge with paddles on head -LOC x 5 min, burns
Case
Discussions
& Summary
Emergency Case 1
• A 64 y/o male came in at the ER. Relative
claims that patient suddenly had lost of
consciousness 3 mins ago. What will you
do?
•Assess patient: Get Vital Signs
•Administer Oxygen
•Hook to Defibrillator
Emergency Case 1
• Patient has no pulse and is cyanotic. Then you
check the rhythm. It revealed:
Emergency Case 2
• Patient comes in due to palpitations and chest
discomfort. BP= 60/40 CR= 189 RR= 28. You
administer oxygen and hooked the patient to a
defibrillator. Rhythm reveled:
Emergency Case 2
• Initial Energy Levels for synchronized
cardioversion:
– 50J: Atrial flutter and SVT
– 100J: AF and Monomorphic VT
Emergency Case 3
• Patient comes in due to palpitations and
shortness of breath. Patient is unconscious.
BP= 60/40 CR= 190 RR= 28. You administer
oxygen and hooked the patient to a defibrillator.
Rhythm reveled:

Torsade de Pointes
Emergency Case 3
Torsade de Pointes
• Do synchronize cardioversion 360J (for
unstable patients).
• Do it for 3 to 4x. If still not converted,
consider Magnesium.
– How to give: 1-2 g diluted in 50 - 100 ml D5W
administer over 5 to 60 minutes followed by an
infusion of 0.5 – 1.0 g (4 to 8 mEq) per hour.
Emergency Case 4
• Patient comes in due to chest heaviness of about 1 week.
BP= 100/60, RR= 18. Oxygen was given. ECG revealed:
Acute
Coronary
Syndrome
Algorithms
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm
Fibrinolytic Checklist
Fibrinolytic Therapy
Acute Coronary Syndrome
Acute Coronary Syndrome
Acute Coronary Syndrome
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm
Acute Coronary Syndrome Algorithm

You might also like