ACLS Summary



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Description

CARDIAC ARREST / COLLAPSED PATIENTTIME IV line AED CPR Airway Scriber 00:00 Prepare IV/IO access Get CRASH TROLLEY/ AED Assess patient Response Get BAG VALVE MASK Write Patient Details Blood Ix: Check Breathing Time the event  ABG/VBG Check Pulse (remind every 2 minutes)  RP  Cardiac enzyme  Urine toxicology Vital signs:  BP  Temp (OC) If no pulse,  Dextrostix Start CPR ASAP,  HR, RR Apply ECG ASAP COUNT LOUND AND CLEAR Give Ventilation (30:2) Jot down every details When ECG attached, STOP all activities and CHECK PULSE & ASSESS RHYTHM, Shock only when VF & PULSELESS VT! PEA & ASYSTOLE continue CPR Shock energy: Monophasic 360J Biphasic 120-200J Presumably after first shock, 00:02 Check Blood Ix Restart CPR Ventilation Record details & time Prepare 1mg Adrenaline  Time of shock  Drug given  Ix result 00:04 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after second shock,  Check Blood Ix Restart CPR Ventilation Record details & time  Administer 1mg  Time of shock Adrenaline during CPR  Drug given  Prepare  Ix result 1mg Adrenaline 300mg Amiodarone (refractory VF/VT) 00:06 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after third shock,  Check Blood Ix Restart CPR Ventilation Record details & time  Administer 1mg  Time of shock Adrenaline during CPR  Drug given  Prepare  Ix result 1mg Adrenaline 150 mg Amiodarone 5-15mcg/kg/min (4OC fluid during bolus) Jot down every details . discuss with patient’s family RETURN OF SPONTANEOUS CIRCULATION (ROCS) TIME IV line AED CPR Airway Scriber Treat hypotension (SBP<90) Repeat ECG Maintain SpO2 >94% Write Patient Details  20ml/kg bolus NS Assess Rhythm Time the event  Vasopressor  Noradrenaline IV 0. until  Return of Spontaneous Circulation (ROCS)  Stop the resuscitation. if intubation is required.  Check Blood Ix Restart CPR & Ventilation Record details & time  Administer 1mg  Time of shock Adrenaline during CPR  Drug given  Prepare  Ix result 1mg Adrenaline Switch role if necessary 00:10 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after forth shock.5mcg/kg/min  Adrenaline IV 0.5mcg/kg/min  Dopamine IV 5-10mcg/kg/min  Inotropes If no neurological recovery.  Check Blood Ix Restart CPR Ventilation Record details & time  Administer 1mg Prepare intubation set  Time of shock Adrenaline during CPR  Drug given  Prepare  Ix result 1mg Adrenaline 00:12 ASSESS RHYTHM & SHOCK CHECK PULSE INTUBATE IN LESS THAN 10SEC OR STOP! Presumably after fifth shock and intubation successful.1-0.00:08 ASSESS RHYTHM & SHOCK CHECK PULSE Presumably after third shock.  Check Blood Ix CPR continuously for 2min Give a breath every 6sec Record details & time  Administer 1mg Get time from scriber  Time of shock Adrenaline during CPR  Drug given  Prepare  Ix result 1mg Adrenaline REMIND EVERY 2 MINUTES The above sequence is repeated every 2 minutes.  Dobutamine IV Induced hypothermia 2.1-0. repeat every 3-5min. patient should be given: Midazolam (1mg IV every 3-5min up to sedation/maximum 5mg cumulative dose) and Fentanyl (50mcg increments) Narrow regular (SVT) Narrow irregular (AF) Wide regular (VT) 50-100J Monophasic 200J 100J Biphasic 120-200J . 12mg. maximum 3mg feeling of heart stop for a moment  Dopamine IV 2-10mcg/kg/min  Adrenaline 2-10mcg/min  Transcutaneous pacemaker (TCP) DONE Tx for unstable tachycardia:  Medical treatment (IV Adenosine)  Mechanical treatment (Synchronized Cardioversion) Before synchronized cardioversion was given. 12mg). short T1/2  Acute heart failure?  Acute heart failure? Rapid IV push with 10-20ml NS @ antecubital fossa/large veins Tx for unstable bradycardia: Patient will anticipate DIZZINESS and  Atropine IV 0.5mg bolus. TACHYCARDIA (≥150BPM) BRADYCARDIA (<50BPM) STABLE UNSTABLE STABLE UNSTABLE  Vagal maneuvers (Carotid sinus  Hypotension? Refer Cardiologist  Hypotension? massage) 5-10min  Acute altered mental state?  Acute altered mental state?  IV Adenosine  Signs of shock? DONE  Signs of shock? Adenosine IV can be given 3 dose max  Ischemic chest discomfort?  Ischemic chest discomfort? (6mg.
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