CLINICAL SOLUTIONS Medical Education Training Centers Advanced Cardiac Life Support 2015 AHA Guidelines Pre Course Study Guide FBN#50-12426 CE Broker#i20-288966 Clinical Solutions Medical Training, ine 2800 West State Road 84, Suite 103 Ft lauderdale, FL 33312 (877)828-8723 www.clinicalsolutionsme.comWelcome to the ACLS Course Clinical Solutions Medical Training When and Where the Glass Will Be Given Check your receipt forthe date, ime, and lecation ofthe class, Plan to arrive on time, Students are expected to attend and to partopate mn the entre course What We Sent You We have enclosed the agenda and the home stuty packet. You are expected to purchase the ACLS student manual which inclides access to @ Stucent Website. We wil provide you witha loaner book the dayof te class. How To Get Ready Ineither an in-hospital or an out-ot- hospital seting the ACLS Provider Course is designed to teach you lifesaving skils required of a team leader and team member. This course covers exiansive matarial ina short time, so you wil need to prepare beforehand. Pre.course Requirements, ‘You shoud prepare for ne course by doing the folbwing: 41. Complote the pro-courte preparation chocktetthatwillbe leeatedin your ACLS Provider Manual. rng tho cnecktst win you 2. Revi the course agenda 3. Revew the nformation i yourAGLS Provicer Manuel, Pay patculerattenton tote 10 cases in Part 5 4. Thoresusctation seenarios quire hat your BLS sks and knowledge are current. You wil be testedon | rescuer adut CPR and AED sk atthe begnning of ne course. Yourrust know this acharce, since you will nat Be taught how fo do CPR or how to use ane AED, ‘8. Review, undersiend, and compete Ne ECG and Phermecaiogy Precourse Ser-Assessmenton ine Studenis Website (uw heart ars/eccatuden) 6. Pn your score forte Pre-course Sef-Assessment and bang twin you to cass What This Course Does Not Cover TheACLS Course does nat teach algorithms. ECG rhythm recognition or aharmacolagy. Ifyou do rot leam the ECG and pharmacology irformation in the Pre-course SaltAssessment, it is uriKely that you can successtuly complete the ACLS Provicer Course. Whattto Bring and What to Wear Bing your ACLS Provider Manual to each dass. You will need it curing each lesson in the course You may wish to purchase the AHA 2015 Handbook of Einergency Carciovasculer Care for Heath Gare Providers (optona), whici youmay bring to use as.a reference guide during some ofthe Stations in the coursa. Please wear loose, comfortable clothing 1b cass. You willbe practicing skis that requi you to work on yournands and knees, and the course requires, bending, standing, ard lifing. If you have any physical condition that might prevent you flom engaghg in these activites, please tell the insructor. They may Ue able 1ommake adjustments to facitate the laamning process Ityounave any questions about tie course, please callus al any sme at our tol ree number 1-877-243-8885 or locally at 954.590.6648, Respectury, Ktistopher Pidgeon MSHA, TCRN, CEN, NREMT-P. Drector ct Ecuoation and Qualty**+|MPORTANT*** . After purchasing your ACLS Provider Manual, please turn to page ii to find out about any updates or corrections to the manual. Also, in this section you will find the website you will need to access the ACLS Pre-Course Self-Assessment on ACLS, EKGs, and Pharmacology (www.heart.org/eccstudent). The code word we use to enter this site is acls15. Please check your provider manual for the code word issued to you. 2. After completing this Self-Assessment, YOU MUSTprint out the completion certificate and BRING ITwith you to class. This will enable the faculty to focus on those areas that may need improvement. 3. Bring the Pre-Course Preparation Checklist completed with you to class. 4. If the pre-course AHA mandated Self-Assessment test is not completed, you will not be allowed in the class. This i ‘ f the Ameri A anThe Systematic Approach BLS Survey Check for responsiveness Tap and shout...”Are you okay?" ‘Shout for help. Activate the emergency response system, Get the AED/defibrillator Check breathing and pulse © Check for absent/abnormal breathing looking at the chest for movement for no longer than 10 seconds. * Check carotid pulse for no longer than 10 seconds. Ideally, checking for breathing and a pulse is performed at the same time to minimize deley in detection of cardiac arrest and initiation of CPR * Ifno pulse within 10 seconds, Start CPR, beginning with compressions. Compress at a rate of 100-120 /minute. * _Ifthere is a pulse, start rescue breathing at 1 breath every 5-6 seconds. ‘Attach AED/defibrillator...provide shock as needed. Primary Assessment ‘Airway Maintain airway patency in unconscious patients... Use head tit-chin lif, OPA, or NPA. Use advanced airway if needed... LMA, laryngeal tube, esophageal-tracheal tube, ET tube. Confirm propor intogration of CPR and ventilation. Confirm proper placement of advanced airway devices. Secure the device to prevent dislodgment. Monitor airway placement... using continuous quantitative waveform capnography. Breathing | Give supplementary oxygen as needed... 100% oxygen for arrest patients...for others, titrate oxygen to achieve an oxygen saturation of 94% or greater by pulse oximetry, Monitor the adequacy of ventilation and oxygenation. Avoid excessive ventilation. Circulation | Monitor CPR quality. Attach monitor/defibriliator for arrhythmiasicardiac arrest rhythms. Provide defibrillationicardioversion, Obtain IVIIO access. Give appropriate drugs. Administor IVIO fluids as noodod. Check glucose levels and temperature. Check perfusion issues.Disability Check for neurologic function. Quickly assess for responsiveness (LOC & Pupil dilation) AVPU (Alert, Voice, Painful, Unresponsive) Exposure | Remove clothing. Assess for obvious signs of trauma, bleeding, buns, unusual markings, medical alert bracelets, etc. The Secondary Assessment Overview of __| Signs and symptoms Secondary Allergies Assessment —_| Medications Past medical history Last meallliquids consumes Events Hs and T's ‘The Most Common Causes of Cardiac Arrest H's T's Hypovolemia Tension pneumothorax Hypoxia Tamponade (cardiac) Hydrogen ion™ (acidosis) Toxins Hypo/hyper Kalemia Thrombosis (pulmonary) Hypothermia Thrombosis (coronary) Adult High-Quality BLS and AED Caso The following case will provide the information you need to pass the CPR and AED testing station. It shows how you would respond to an emergency when the only equipment av. ailable to you is an AED stocked with a pocket mask, Youwill use the BLS survey in all cases of cardiac arrest. If unsure about the presence of a pulse, begin cycles of compressions and ventilations. Unnecessary compressions are less harmful than failing to provide compressions when needed. Remember...the interval from collapse to defibrillation is one of the most importent determination: 's of survival from cardiac arrest. The earlier the defibrillation occurs a higher survival rate is noted. Restoring a perfusion rhythm is more successful when immediate CPR is given AND defibrillation occurs within a few minutes of the arrest.BLS Healthcare Provider Adult Cardiac Arrest Algorithm —2015 Update ‘By in te nal scenarios eergeney response system o: backup is activated, ‘and AED and etergency eaupment ae Fetroved or someone i ratoring thomRespiratory Arrest Case This case reviews appropriate assessment, intervention, and management options for the unconscious, unresponsive adult patient in respiratory arrest. Respirations are completely absent or clearly inadequate to maintain effective oxygenation and/or ventilation. A pulse if present. The BLS Assessment and the Primary and Secondary Assessments are used even the though the patient is in respiratory distress, not cardiac arrest. The interventions for this case include: A Maintain Oxygen Saturation 1. Give oxygen to patients wih ACS or respiratory distress 2. Titrate oxygen to maintain saturation equal to or greater than 94% 3. For respiratory or cardiac arrest, strive for 100% saturation Opening the Airway 1. Head tittchin lift 2. Jaw thrust without head extension in suspected cervical trauma Providing Basic Ventilation Head tilt-chin lit Jaw thrust without head extension in suspected cervical trauma Mouth to mouth ventilation Mouth to nose ventilation Mouth to barrier device ventilation (pocket mask) Bag mask ventilation sing Basic Airway Adjuncts OPA...used in unconscious patients only. Fits over the tongue and holds it and soft hypopharynx structures away from posterior wall of pharynx 2. NPA...provides conduit for airflow between nares and pharynx 3. Frequent evaluation and suctioning of the airway may be necessary Suetioning 1. Suction airway if there is blood, vomit, or copious secretions 2. Rigid catheter...for thick particulate matter in oropharynx 3. Soft catheter... for thin secretions in oropharynx or nasopharynx Ventilation with Advanced Ainway LMA Laryngeal tube Esophageal-racheal tube Endotracheal tube Ventizations Rates: a. During CPR...30:2 b. For Cardiac Arrest with AA in place...Once every 6 seconds c. For Respiratory Arrest with AA in place... Once every 5-8 seconds = Comsens eensAcute Coronary Syndromes Case In this case, you must have the basic knowledge to assess and stabilize patients with ACS. For this case, patients will have signs and symptoms of ACS, including possible AMI. You will use the ACS Algorithm in working the case. The initial 12-lead ECG is used in all ACS cases to classify patients into 1 of 3 ECG categories with different aspects of care and management. These include: ST-segment elevation suggesting current injury, ST-segment depression suggesting ischemia, and normal ECG. For this case you will need to review the following rhythms: °F “vr © Bradycardia You will also need to be familiar with the following drugs including actions and dosage: Oxygen Aspirin Nitroglycerin Morphine Fibrinolytic therapy Heparin (UFH, LVMH) For this case, you should know how to identify the signs associated with chest discomfort that are suggestive of possible ACS. These include: © Retrostemal chest discomfort © Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest lasting for several minutes © Chest discomfort that spread to the shoulders, neck, one or both arms, or jaw © Chest discomfort that spreads into the back or between the shoulder blades = Chest discomfort with light-headedness, dizziness, fainting, sweating, nausea, or vomiting ‘Unexplained shortness of breath which may occur with or without chest discomfort itis critical to identify patients with STEMI and triage for early reperfusion therapy. This therapy reduces mortality and saves heart muscle. STEMI is characterized by ST- segment elevation in 2 or more contiguous leads or a new LBBB. Fibrin specific agents are effective in achieving normal flow in about 50% of patients receiving the drugs Coronary intervention with stent placement (Primary PCI) is used as an aitemative to fibrinolytics. This is the treatment of choice for the management of STEM! when it can be performed effectively when <90 minutes has elapsed from first medical contact. 7Acute Coronary Syndromes Algorithm —2015 Update, ST deposi o dynamo Netra. noraagnoste changes in wave sete; borg ‘St sogmanton T wave sheplcovs or storia Lom /mtormectat-rsk ACS agr-rsk nor-sT-tevaton ACS (usre-acs)Acute Stroke Case For this case you will be using the Suspected Stroke Algorithm. This case will cover the principals of both out-of-hospital and in-hospital acute stroke care. Out-of- hospital care will focus on: rapid identification and assessment of patients with stroke and rapid transport with pre-arrival notification to a facility capable of providing acute stroke care. in-hospital care will focus on: ability to rapidly determine patient eligibility for fibrinolytic therapy, administration of fibrinolytic therapy to appropriate candidates, with availability of neurologic medical supervision within targeted times, consideration of new treatment options such as endovascular therapy, and initiation of the stroke pathway and patient admission to a stroke unit if available. For this case you will need to be familiar with the following drugs including actions and dosage: Approved fibrinolytic agent (rtPA) Glucose (D50) Labetalol Nicardipine Enalaprilat Aspirin Nitroprusside There are two major types of stroke: * Ischemic stroke which is caused by an occlusion of an artery to a region of the brain. This accounts for 87% of all strokes * Hemorthagic stroke which is caused by a blood vessel in the brain rupturing. This accounts for the remaining 13% of all strokes The 8 D’s of Stroke Care highlight the major steps in the diagnosis and treatment of stroke: Detection-rapid recognition of stroke symptoms Dispatch-early activation and dispatch of EMS Delivery-rapid EMS identification, management, and transport Door-appropriate triage to stroke center Data-rapid triage, evaluation, and management in the ED Decision-stroke expertise and therapy selection Drug /Device-fbrinolytic therapy or endovascular therapy Disposition-rapid admission to the stroke unit or critical care unitThe signs and symptoms of a stroke may be subtle and can include: ‘Sudden weakness or numbness of the face, arm, or leg on one side of the body Sudden confusion Trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking Dizziness or loss of balance or coordination Sudden severe headache with no known cause Patients experiencing an acute ischemic stroke have a time-dependent benefit for fibrinolytic therapy of 3 hours from the time of onset of symptoms. Patients exhibiting symptoms of an acute ischemic stroke should receive a CT scan without contrast within 25 minutes of arrival in the ED with immediate interpretation Suspected Stroke Algorithm: Goals for Management of Stroke Silage a, 10Cardiac Arrest: VF/Pulseless VT Case This case focuses on the assessment and actions used for a cardiac arrest that is due to VF or pulseless VT that is unresponsive to the first shock. You will be using the Cardiac Arrest Algorithm which is the most important one to know for adult resuscitation. This algorithm outlines all assessment and management steps for the pulseless patient who does not initially respond to BLS interventions, including the frst shock from an AED. The algorithm consists of two pathways for a cardiac arrest: * Ashockable rhythm-VF/pulseless VT-on the lett side of the algorithm * Anon-shockable rhythm (asystole/PEA-on the lef side of the algorithm During the course, you will have the opportunity to demonstrate effective high performance team behaviors while performing the assessment and action skills. To do this effectively, you must be proficient in performing the steps outlined on the left side of the algorithm, This case will also give you the opportunity to use the Immediate Post-Cardiac Arrest Algorithm after ROSC. For this case, you will need to review the following rhythms: VF Vv ECG artifact that looks liked VF New left Bundle branch block You will also need to be familiar with the following drugs including actions and dosage: Oxygen Epinephrine Norepinephrine Amiodarone Lidocaine Magnesium sulfate Dopamine Other medications, depending on the cause of the VT/pulseless VT arrest a1Adult Cardiac Arrest Algorithm—2015 Update + thro signs of ium of spontaneous Grculaton OSC, goto 10 ort + FRESE. go Post-Cariac Aost Cre clement oo * Push ed a eas: inches BerD and hat 00-120rma) trl alow comets csstrocl + Tins ntomptore + adore vein. 2 rates crater aid + ro scranced arn, Sz compression vention io, + hte wave STR ome Hy atone * ta pres COR aes rstaeaso phase foe) pacar cada He, femetorrrove CPt ‘ual = oe + Bighasic: Vantactrer ‘eeoneerdatin 29 tal ooo 159200 aren, Second and eboney dove ‘healbe squid ae Sees ay be stn. + Manephas: 500 + EpinepbeneIVIO dase: ‘ing evy #5 mnie + Ariosirone WO dese Fr one 300 maak Sart toe m3 * Undatvalirbaton o ‘oregte arora sey + Wateom ecproyaphy c ‘aprmety b cowimnars tremor aba pnsrest + Oro aves away mice, the Boa otary 6 cane NOtzahin wah conbuoue het camomcnons eat) 1 Risa Hood aie 1 Abe ste erase in Pree, typealy torn + Spouses posse ome with rarer $ Them, putronary + Thombs, ceonatyOpiod toxicity is associated with CNS and respiratory depression that can progress to respiratory and cardiac arrest. For patients with known or suspected opiod overdose who are in respiratory arrest, healthcare providers should give naloxone as soon as it is available. Below you will find the opiod overdose algorithm. While this was designed for lay rescuers, ACLS providers wil follow the ACLS systematic approach, which includes the pulse check. Qpioid-Associated Life-Threatening Emergency (Adult) Algorithm—New 2015 Continue CPR and use AED. ‘as soon as itis available. “CPR technique based on rescuor's love of training, 13Adult Immediate Post-Cardiac Arrest Care Algorithm—2015 Update i Ventiationiaxygeraton: ‘Avoid oxcessive ventation. Sia at 19 breathsimin and tire to tanjat Pet00, of 36-40 mm Ha, ‘When feasible, trae Fo, to minimum recessaryte achiowe Spo, 204% WV bolus: Approximately 12 noamal saline or lnctated Fingers Epinephrew IV infusion: 04-05 mog/kg per minute fn 70k acu: 7-35 nog per minuta) Dopamine v infusion: 5:10 moghy por minute Norepinephrine IV infusion: 04-05 moafkg pe minute fn 70hg adut: 7-38 mag perminute) + Hypovclerria + Hypoxia * Hydrogen ion (acicosis) * Hypo/yparkaienia + Hypothermia * Torsion pneumothorax * Tamponade, cardiac 8 + Toxins ( } * Thrombosis, puimenary Advanced critical care | «Thrombosis, earenary 2015 Ameen Hae Arceition [Prensa eel 14Pulseless Electrical Activity Case This case will focus on the assessment and management of a cardiac arrest patient with PEA. Any organized rhythm without a pulse is defined as PEA To manage the case, you must be proficient in performing the steps on the right side of the Adult Cardiac Arrest Algorithm. Correction of an underiying cause of PEA is critical to patient outcome. For this case, you will need to review the following rhythms: Rate...to0 fast or too slow Width of QRS compiexes....too wide versus too narrow Idioventricular rhythms Ventricular escape rhythms Post defibrilation idioventricular rhythms. Sinus rhythm You will also need to be familiar with the following drugs including actions and dosage’ © Epinephrine * Other medications depending on the cause of the PEA arrest PEA is associated with many conditions. The history and physical exam will help identify the causes of PEA that could be reversed by appropriate treatment. Common Causes of PEA Hs Ts Hypovolemia ‘Tension pneumothorax Hypoxia ‘Tamponade (cardiac) Hydrogen ion (acidosis) Toxins Hypo/hyper kalemia ‘Thrombosis (pulmonary) Hypothermia ‘Thrombosis (coronary) Hypovolemia and Hypoxia are the most common underlying causes of PEA. 15+ Path ort atin Bony sna gon er) fae arin cha + Wimosinatenetn Fea me gm ‘enon Seat tenet tine OF wos + bind ean Mirman os Bes Hoi ‘Rormenator ital ETRE nnn, Seeger, eae ‘Geomay ocoetane + Hone * Eo 19 ee fete, type sn Ha) + Som tied are + thro sions tur of ( cotosor7 | eee essen, “Ee 16Adult Immediate Post-Cardiac Arrest Care Algorithm—2015 Update 1 Pres Return of spontaneous circulation OSC) re Ventlatlonveaygonation: é void cessive vero Stata ‘0 beatisininand tate 0 taget Petco, of 35-0 nna When ease tide Fi, ‘p minum nacuasayto achiow Spo, 294% Males: Appoomatey 1.2L namalsaine ot claled Fingars Epinephrine IV infusion: 05.0.Smoghg par minut {n 7g adult 7.25 meq er mise) Depanine IV inusion: S510 meghg pr maute Norepinephrine infusion: 01-0.5moykg por int {n70ig aut 7.95 meq per minde) Pac * Hypovlamia + Hypoxa + Hydlogon ian fics] + Tamponage, cardiac + Toxns + Thrones, pulmonary + Themboss, coroner ©2015 Ameena Hae Aceten 7Asystole Case This case will focus on the assessment and management of a patient in cardiac arrest. The patient does not have a pulse and the rhythm on the monitor is asystole. To manage the case, you must be proficient in performing the steps on the right side of the ‘Adult Cardiac Arrest Algorithm. It is critical for you to identify and correct any underlying causes. Be prepared to terminate efforts as appropriate. For this case, you will need to review the following rhythms: * Asystole * Slow PEA terminating in a bradyasystolic rhythm Youwill also need to be familiar with the following drugs including actions and dosage: © Epinephrine * Other medications, depending on the catse of the asystole arrest Ault Candie Ares Algovithn 2046 Update 18,Bradycardia Case This case will focus on the assessment and management of a patient with symptomatic bradycardia, defined as a heart rate <60/minute. You will manage the case using the Bradycardia Algorithm. There are several key points to managing bradycardia. They include: * Differentiating between signs and symptoms that are caused by the slow rate versus those that are unrelated Correctly diagnosing the presence and type of AV block Using atropine as the drug intervention of first choice = Deciding when to initiate transcutaneous pacing (TCP) including the technique and cautions for using TCP ® Deciding when to start an epinephrine or dopamine drip to maintain heart rate and blood pressure * Knowing when to call for expert consultation about complicated rhythm interpretation, drugs, or management decisions For this case, you will need to review the following rhythms: Sinus bradycardia First-degree AV block Second degree AV block... Type | (Wenckebach/Mobitz |) Second degree AV block... Type Il (Mobitz I!) Third degree AV block Youwill also need to be familiar with the following drugs including actions and dosage: © Atropine © Dopamine IV infusion © Epinephrine IV infusion ‘Symptoms of bradycardia include: chest discomfort or pain, shortness of breath, decreased level of consciousness, weakness, fatigue, lightheadedness, dizziness, and syncope, Signs of bradycardia include: hypotension, orthostatic hypotension, diaphoresis, pulmonary congestion on exam or x-ray, congestive heart failure, pulmonary edema, and bradycardia related PVC’s or VT. Ifindicated, conscious patients should be given sedation before initiating TCP IF time and patients’ condition permit. 19Adult Bradycardia With a Pulse Algorithm Doses/Detalls Atropine IV dose: Fst dose: 0.5 mg tous, Ropeat every 3-5 minutes Maximum: 3 mg. Dopamine IV infusion: sta infusion rate is 2.20 mogikg per minute. Terate to patient response: taper slowly. Epinephrine IV infusion: 2-10 mog per minute irdusion. Titate to pationt response. (©2019 maroon Heart Aseciton 20Unstable Tachycardia Case This case will focus on the assessment and management of an unstable patient with a rapidheart rate. You will classify the tachycardia and start appropriate interventions using the Tachycardia with a Pulse Algorithm. A tachyarthythmia is defined as a heart rate > 100/minute. There are several potential causes and the tachycardia can be symptomatic or asymptomatic, The key to managing a patient with any tachycardia is to determine if they have a pulse. If pulses are present, determine if they are stable or unstable, For this case, you will need to review the following rhythms: Atrial fibrillation Atrial flutter Reentry supraventricular tachycardia (SVT) Monomorphic VT Polymorphic VT Wide-complex tachycardia of a certain type Signs and symptoms for unstable tachycardia include: Hypotension Acutely altered mental status Signs of shock Ischemic chest discomfort Acute heart failure At rates > 150/minute, synchronized cardioversion is often required for the unstable patient. At this rate, the heart is beating so fast that the cardiac output is reduced, which in turn can cause pulmonary edema, coronary ischemia, and reduced blood flow to vital organs. Also, the heart is beating ineffectively so the coordination between the atrium and ventricles, or the ventricles themselves, reduces cardiac output, Synchronized cardioversion is recommended for patients with Unstable SVT Unstable atrial fibrillation Unstable atrial futter Unstable regular Monomorphic tachycardia with pulses 21Energy doses will be adjusted for the specific type of rhythm. For unstable atrial fibrillation * Monophasic cardioversion...deliver and initial 200-J synchronized shock * Biphasic cardioversion....deliver and initial 120-200-J synchronized shock * Whichever is used, increase the energy dose in a stepwise fashion for any subsequent cardioversion attempts. For SVT or atrial flutter: © 50-100-J with either monophasic or biphasic cardioversion For Monomorphic VT with a pulse: * 100-J with either a monophasic or biphasic cardioversion * Increase the energy dose in a stepwise fashion if there is no response to the first shock Stable Tachycardia Caso This case will focus on the assessment and management of a stable patient with a rapid heart rate. You will classify the tachycardia and start appropriate interventions using the Tachycardia with a Pulse Algorithm. The heart rate wil be > 100/minute with no significant signs or symptoms caused by the increased rate, and there is an underlying cardiac electrical abnormality that generates the rhythm, For this case, you will need to review the following rhythms: * Narrow QRS complex (SVT) tachycardias with QRS < 0.12 second in order of frequency: Sinus tachycardia, Atrial fibrilation, Atrial flutter, AV nodal reentry * Wide QRS compiex tachycardias with QRS > 0.12 second: Monomorphic VT, Polymorphic VT, SVT with aberrancy © Regular or irregular tachycardias: Irregular narrow complex tachycardias are probably atrial fibrillation ‘You ill also need to be familiar with the following drug including actions and dosage: © Adenosine NOTE: Sinus tachycardia can be caused by external influences on the heart, such as. fever, anemia, hypotension, blood loss, or exercise. The rate may be slowed by vagal maneuvers. Cardioversion is contraindicated 22Adult Tachycardia With a Pulse Algorithm 1 ‘Synchronized cardonersione Int commended ose: 4 Nano rogue 8-10. + Nano req, 20-200 J biptsicor 20 menopasio + Wide equa 100 + Wide regula: defibiton ‘Adenosine I cose: Fs dose: 6 mg apd W push; fol with NS fush, ‘Seoond dose. 12g rere. mic infusion for ‘Stable Wid-QRS Tachycarcia Prosanatide NV deoe: 20-80 mginin nt ayn ‘suppressed, hypotension ensues, FS duration increases 250%, rrasiun dove 17 mga gen, Neitenenee ino: -4 lin, ‘vod pcorged OT or CHE ‘riodarone W dose: Fist doe 160 mq ever 10min, Ropet 2s naded VT rca Fallow by mainlrarce ison of 4 min for fest 8 hours, ‘Sotalol W dese: 100 mg (1.5 mgyka) over § minutes. ‘od if prolonged CT, ‘ozuisanercan Het iscatin 23ACLS Pharmacology Review Deog Tndications: Desage ‘Adenosine Stable SVT ‘Contraindicated i poisonvarug emg IV/ given Diagnostic maneuver for duced tachycardia or saconder | rapidly over 1-3 stable narrow complexSVT | third degree heart block minutes, ‘ollowed Doos NOT convert arial Transient effects flushing, chest | by 20 ri NS fibnilation, atnal flutter, or VT | pain, bref penods of asystole or —_‘| bolus. then bradycardia elevate extremity Reduce intial dose to 3mg in Wait 1-2 minutes pationts receiving dipyridamole or | 12MG IV following carbamazepine, n heart transplant | same guidelines patients, or f given via a CVL ‘Timiodarone VFipuselass VT Rapid intusion may lead to Cards Arost unresponsive 10 shock hypotension First dose: 300ma ddlivery, CPR, and a Half-life up to 40 days IVAO push vasopressor May proiong QT interval Second dose (it Recurrent, unstable VT needed) 160mg IVAO pus Life-Threatening Armythmias: Max dose: 22g IV ‘over 24 hours Rapid: 150 mg IV ‘over 10 minutes- repeal as needed, Slow 360 mg V over 6 hours ‘Riropine Sulfate ‘Symptorrate Bradycarda | creases myocardial owgen Can be given via ET tube demand AAvcid in hypothermic bradycardia Dose < 0.5 mg may result in mgikg (ital 3 mg) paradoxical slowing of heart cate Dopamine Seconetine drug for Correct hypovolemia W Agni infusion symptomatic bradycordia__| Use with caution in cardiogonic 2 to.20 mogikg por Use for hypotension (SEP | shook wth CHF minute 270-100 mm HG with sis of | May cause tachyarythmia, irate to response Shock excessve vasoconsinicton Epinephrine Cardiac arrest Thoreasing BP and HR may cause | Gardac Arest Can be given va ET tube | Symptorratic bradycardia | myocarcial ischemia, angna,and | 1 mg (1:10000 Severe Hypotension increased myocardial oxygen concentration) Available in 110,000 and | Ananhylaxss demand every 3-5 minutes 11,000 Higher doses may be needed to eat | Follow witha 20, concentrations poisonicrug.incused shock miflush and elevate extremity for 10-20 seconds Higher Dose Up to 02 mg/kg forB-blocker or caicium channel blocker OD Infusion 0.1.0.5 megkg per minute For 70 kg patient 247-35 meg per minute Tirate to effect ET Route 2.2.5 mg diuted in 10@NS Lidocaine: Can be given via ET tube ‘Allemaiive to Amodarone mn cardiac arrest due to VFNT Stable VT with pulse ‘Symptomatic PVG's Prophylactic use in ANI contraindicated Reduce mainienance dose in presence of impaired liver function CNS toxctty: muscle twitching, slurred speech, respiratory arrest, altered LOC, seizures Cada Arest 4-1.5 mglkg VIO Repeat dose at 0.5-0.75 mgkg IVAO every 6-10 minutes toa masirnum of 3 coses (oial of mg) Pertusing Artrythmas 05-0.75 maka IVAO (up to 11.5 mg/kg) Repeat 08.0.75 mgkg IVAO every §-10 minutes toa manirmum of amgka infasion 1-4 mgmiure 60.50 meghkg por minute) Wagnesium Sulfate Tr cardiac arrest only # torsades de pointes or ‘suspected hypomagnesemia Life-thraatening ventricular arttythmias due to digoxin toxicity Decreased blood prossure with rapid infusion Use with caution ifrenal failure is present ‘Cardo Arest with torsades 1-2g diluted 10m DSWINS. over 1-2 minutes IvAo Torsades with a pulso Loading dose 12g mixed in 50- 100 mi diuent ‘over 5-60 minutes Follow with 0.5-1 gr perhour lV trate 0 control torsades 25References 2015 American Heart Association Guidelines Update for CPR and ECC; Supplement to Circulation-Volume 132-Number 18-Supplement 2-November 3, 2015 2016American Heart Association Advanced Cardiovascular Life Support Provider Manual 2016 American Heart Association Basic Life Support Provider Manual 26ACLS PRECOURSE PREPARATION CHECKLIST Please bring this completed form with you to the course To prepare for the course, you must + Complete/pass the ACLS Precourse self-Assessment on the ACLS Student Website ‘© Print your certificate from the Precourse Self-Assessment and bring the certificate with you to class, * Complete a BLS course or be able to perform high-quality BLS, including the use of an AED, according to the 2015 AHA Guidelines Update for CPR and ECC © Understand the 9 ACLS cases © Understand the ACLS algorithms Print Name Check what you have accomplished for your precourse preparation: 0 ACLS Precourse Self-Assessment 0) High-quality BLS competency 0 Seases Algorithms for cases understand the need for significant precourse preparation, and I understand that without adequate precourse preparation I may not successfully complete the ACLS Course Signature Date