Updates to ACLS in As we learn more about resuscitation science and medicine, physicians and researchers realize what works best and what works fastest in a critical, life-saving situation.
If a feedback device is in place, depth can be adjusted to maximum of 2. In the community, call and send for an AED. Check the carotid pulse for no more than 10 seconds. If there is a shockable rhythm, pulseless ventricular tachycardia or ventricular fibrillation, provide a shock.
Select an airway that is the correct size for the patient Too big and it will damage the throat Too small and it will press the tongue into the airway. Choose the device that extends from the corner of the mouth to the earlobe. Clear the mouth or blood or secretions with suction, if possible. Insert the device so that the point is toward the roof of the mouth or parallel to the teeth Do not press the tongue back into the throat.
Once the device is almost fully inserted, turn it so that the tongue is cupped by the interior curve of the device. Select an airway that is the correct size for the patient. Lubricate the airway with a water-soluble lubricant. Insert the device slowly, straight into the face not toward the brain! Adequate suctioning usually requires negative pressures of — 80 to mmHg.
Rapid heart rate, narrow QRS complex,. Fluid resuscitation. Decreased heart rate. Airway management, oxygen. Hydrogen Ion Acidosis. Fingerstick glucose testing. IV Dextrose. Flat T waves, pathological U wave. IV Magnesium. Peaked T waves, wide QRS complex. History of cold exposure. Tension Pneumothorax. Slow heart rate, narrow QRS complex, acute dyspnea, history of chest trauma. Thoracotomy, needle decompression. Tamponade Cardiac. Rapid heart rate and narrow QRS complex.
Variable, prolonged QT interval, neuro deficits. Thrombosis pulmonary. Rapid heart rate, narrow QRS complex. Fibrinolytics, embolectomy. Thrombosis coronary. Fibrinolytics, Percutaneous intervention. Second or third degree heart block; tachycardia due to poisoning. Pulseless ventricular tachycardia Ventricular fibrillation. First dose: mg bolus Second dose: mg Max: 2.
Second or third degree heart block; hypotension may result with rapid infusion or multiple doses. Symptomatic bradycardia No longer recommended for PEA or asystole. Cardiac arrest Anaphylaxis Symptomatic bradycardia instead of dopamine. Cocaine-induced ventricular tachycardia May increase oxygen demand.
Symptomatic bradycardia if atropine fails Pressor for hypotension. Wide complex bradycardia Should not be used in cases of acute myocardial infarction Observe for signs of toxicity. Wide complex tachycardia with pulse: 0. Rapid bolus may cause hypotension and bradycardia; Can also be used to reverse digitalis poisoning. Deliver through central line Peripheral IV administration can cause tissue necrosis. Inclusion Criteria. Exclusion Criteria.
Ischemic stroke with neurological deficit. Onset of symptoms 3 hours. History of brain. Age 18 years old. Brain tumor, arteriovenous malformation, or aneurysm.
Brain or spine surgery in last. Arterial line or blood draw in last week. Possible subarachnoid hemorrhage. Serum glucose. Currently bleeding internally or bleeding diathesis. Elevated aPTT if known. Currently taking anticoagulants. Hemorrhage on CT.
Relative Exclusion Criteria. Minor neurologic deficits. Rapidly improving neurologic deficits. Heart attack in last 3 months. Seizure with stroke with postictal period. Meets all criteria for fibrinolytic use at 3 hours plus these criteria:.
Ischemic stroke with neurological deficit Currently taking anticoagulants. Onset of symptoms 3 to 4. Age 18 to 79 years old. Previous ischemic stroke and diabetes. Usually stands at the foot of the bed. Stands in a position dictated by role. Competent in all ACLS duties. Competent in specific role at least. Directs Team Members in a professional, calm voice.
Responds with eye contact and voice affirmation. Assigns roles. Listens for confirmation from Team Member. Informs Team Leader when task is complete.
Ask for ideas from Team Members when needed. Openly share suggestions if it does not disrupt flow. Provides constructive feedback after code. Documents resuscitation in patient chart. Provides information for documentation as needed. Check for response by tap and shout Call for help and Activate the area emergency response system Obtain an AED Check breathing and pulse at same time If no pulse, begin chest compressions Defibrillate.
Systematic Approach Primary Assessment name change. Airway Breathing Circulation Disability Exposure. Systematic Approach Secondary Assessment new. High Quality CPR. Compression rate at least per minute Compression depth of at least 2 inches in adults Allow complete chest recoil after compressions Compressions should not be interrupted for more than 10 seconds Excessive ventilation should be avoided Switch providers of compressions every 2 minutes.
Compression rate of to per minute Compression depth of at least 2 inches in adults. Consider hypothermia treatment for 12 to 24 hours in comatose patients. Consider hypothermia treatment for at least 24 hours in comatose patients Not recommended to cool patients in out of hospital setting with cold IV fluids. Common checkpoints on every checklist, however, also include a monthly check of the battery power by checking the green indicator light when powered on, condition and cleanliness of all cables and the unit, and check for the adequate supplies [15].
An AED is 'automatic' because of the unit's ability to autonomously analyse the patient's condition. To assist this, the vast majority of units have spoken prompts, and some may also have visual displays to instruct the user. When turned on or opened, the AED will instruct the user to connect the electrodes pads to the patient. Once the pads are attached, everyone should avoid touching the patient so as to avoid false readings by the unit.
The pads allow the AED to examine the electrical output from the heart and determine if the patient is in a shockable rhythm either ventricular fibrillation or ventricular tachycardia. If the device determines that a shock is warranted, it will use the battery to charge its internal capacitor in preparation to deliver the shock. This system is not only safer charging only when required , but also allows for a faster delivery of the electric current. When charged, the device instructs the user to ensure no one is touching the patient and then to press a button to deliver the shock; human intervention is usually required to deliver the shock to the patient in order to avoid the possibility of accidental injury to another person which can result from a responder or bystander touching the patient at the time of the shock.
Depending on the manufacturer and particular model, after the shock is delivered most devices will analyze the patient and either instruct CPR to be performed, or prepare to administer another shock. Many AED units have an 'event memory' which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. Some units also have voice recording abilities [16] to monitor the actions taken by the personnel in order to ascertain if these had any impact on the survival outcome.
All this recorded data can be either downloaded to a computer or printed out so that the providing organisation or responsible body is able to see the effectiveness of both CPR and defibrillation. Some AED units even provide feedback on the quality of the compressions provided by the rescuer. The first commercially available AEDs were all of a monophasic type, which gave a high-energy shock, up to to joules depending on the model. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites.
Newer AEDs manufactured after late have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of — joules, with each shock moving in an opposite polarity between the pads. This lower-energy waveform has proven more effective in clinical tests, as well as offering a reduced rate of complications and reduced recovery time. A standard logo is clearly advertised. Unlike regular defibrillators, an automated external defibrillator requires minimal training to use. It automatically diagnoses the heart rhythm and determines if a shock is needed.
Automatic models will administer the shock without the user's command. Semi-automatic models will tell the user that a shock is needed, but the user must tell the machine to do so, usually by pressing a button. In most circumstances, the user cannot override a 'no shock' advisory by an AED. Some AEDs may be used on children — those under 55 lbs 25 kg in weight or under age 8. If a particular model of AED is approved for pediatric use, all that is required is the use of more appropriate pads.
All AEDs approved for use in the United States use an electronic voice to prompt users through each step. While the ACLS manual is easy to understand, some interventions can only be performed by a medical provider with the correct tools and equipment. However, we still recommend that the general populous become familiar with these techniques as they or their loved ones may require these treatments in the future.
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