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ACLS Algorithms 2020

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87 views

ACLS Algorithms 2020

Uploaded by

Alaa Omar
Copyright
© © All Rights Reserved
Available Formats
Download as PDF or read online on Scribd
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7 Adult Cardiac Arrest Algorithm CMe Tac American Heart Association. + Iwnoaceess CPR2 min + Epinephrine every 3-5 min + Consider advanced airway, ceapnography CPR2min + Amiodarone oF lidocaine @ + Ino signs of return of ( Start CPR Gwveoxygen Asystole/PEA | 1 Epinephrine ‘ASAP ‘CPR2 min + WwnOaccess + Epinephrine every 3-5:min Consider advancedairway, CPR2 min + Treatreversible causes: spontaneous circulation (OSC), goto 10 or 1 ROSE, goto Post-Catdae Arrest Care + Consider appropriateness 20-1110 (14) 1SBN97B-1-61669-776- 10720, ‘of continued resuscitation Poshhoealtleast2inches [Semin tet (100-120!) andaliow compete chestrecol + Mima rtertionsin Compressions + Rrodescessve vatlation + Ghangecompressoreveny | 2rmnates, orsooneratques. | + Mine advanced sway 302 + Guntatve waveform capnegrapty STHBeTCO lon ordecresing, reassess CPR ual. | reeommendstion(eg itis | ote 0120-200 Jeitunkaown, | ‘isemmximom vais. Secendand subsequent doses Should be equivalent and higher Gosas may conecored + Monophasie 360) a |. jabeeoseamae | oesraseas Soweto Seen a + Endoacheainubatonersi= | proglatie advanced away « Waretomeapnogrey oan: Ertube plocemert + Once odvancedarwayinplacs, ‘vet broath every Bcaconct {tobreatrami wth contr buschestconpressione Pena Cece) [+ puceandbioodpressure 1 Abroptaustaineaneeaseln ered, ttypaly 240 mg) + Spontanaous ater pressure woes wth iva-rteral Reversible Causes Hypovolemia Hypowa Hyaregenion(acosish | f Hypo-iyperalema 1 hypetnerie 01080r7 || © Fenian pneumomorax * Tampontecaoe 1 Thrombosis. pumoaary 1 Thrombosis coronary crore anecnteateion tensa Bp Adult Post-Cardiac Arrest Care Algorithm CNet Continued Management ‘and Additional Emergent Activities eis Manage airway Early placement of endotracheal tube ‘Manage respiratory parameters ‘Start 10 breaths/min "'$p0,92%-28% Consider for emergent cardiac intervention if + STEMI present + Unstable cardiogenic shock +1™ + Obtainbrain CT American Heart Resuscitationis ongoing during the post-ROSC phase, end many ofthese Activities can occur concurrently. However. if prioritization is necessary follow these steps: + Airway management: Waveform capnography or ceapnometry to confirm and monitor ‘endotracheal tube placement Manage respiratory parameters: Turate Fi, for Spo, 92%-98% start ‘at 10 breaths/min; tate to Paco, of 35-45 mmHg Manage hemodynamic parameters: Administer crystalloid andor vasopressor orinatrope for goal systolic blood pressure >90 mm Hg ormean arterial pressure >65 mmHg Penton cieileuareaciiicd ‘These evaluations should be done ‘concurrently sothat decisions on targeted temperature management (TTM) receive high priority as ‘cardiac interventions, + Emergent carciac intervention: Early evaluation of 12-ead slectrocardiogram (ECG); consider hemodynamics for decision on cardiacintervention + TIME Ifpatientis not folowing commands, start TMas soonas possible: begin at 32-6°C for 24 hours by using cooling device with feedbackloop + Other ertical care management ~ Continuously monitor core tempersture (esophageal rectal. bladder) | ~ Maintain normoxia, normocapnia, euglycemia = Pravide continuous or intermittent tlectroencepnalogram EC) ‘monitoring Provide ut | tective ventilation Hypovolemia | Hypoxia | Hydrogenion acidosis) Hypokalemia/hyperkalemia Hypothermia Tension pneumothorax | Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary | Adult Tachycardia With a Pulse Algorithm Picken rad ‘Assess appropriateness for clinical condition. 21 mi Identify and treat underlying cause + Maintain patent airway:assist breathing as necessary + Oxygen ifhypoxemic} + Cardi ¥ Persistent tachyarrhythmia caus! + Hypotension? + Acutely altered mental status? * Signs of shock? Ischemic chest discomfort? + Acuteheart failure? 20-1110 2014) ‘SON978-1-61659-776-1 ‘Synchronized cardioversion + Consider sedation + Adenosine only a American Heart Association. Doses/Details ‘Synchronized cardioversion: Refer to your specific device's recommended energy level to ‘maximize first shock success. ‘Adenosine IV dose: First dose: 6 mg rapid IV push follow with NS flush. Second dose: 12 mgifrequired. “Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia Procainamide V dose: 20-50 mgimin unt arrhythmia suppressed, hypotension ensues, ‘GRS duration increases >50%, or maximum dose 17 mg/kg given. Maintenance infusion: 1-4 mgimin, Avoid prolonged GT or CHF. ‘Amiodarone IV dose: First dose: 160 mg aver 10 minutes. Repeat as neededif VT recurs, Follow by maintenance infusion of 1 mg/min for first hours. | Sotalottv dost | 100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT. refractory, consider "= Underiying cause + Needtoincrease: Consider rand B 120 ©2020AmericonHeart Assocation PrintedintheUSA Adult Bradycardia Algorithm (eM ie eae tad ;ppropriatenes ( Assessay Identity and treat underlying cause + Maintain patent airway; assist breathing as necessary + Oxygen ifhypoxemic a sentfy rhythm: monitor blood, Persistent bradyarrhythmia causin Hypotension? ‘Acutely sltered mental status? Signs of shock? Ischemic chest discomfort? ‘Acute heart failure? Atropine atropine ineffective: ‘= Transcutaneous pacing a ‘American Heart Association. — | Atropine IV dost | First dose: 1 mg bolus. Repeat every 35 minutes. Maximum: mo, Dopamine IV infusion: | UUsualinfusion rates 5-20 moglkg per minute. Titrate to patient response; taper stowly. Epinephrine IV infusion: 2-10meg per minute infusion. Titrate to patientresponse. Causes: ‘= Myocardial ischemia infarction + Drugsitoxicologic (oa ccalcium-channal blockers, | beta blockers, digoxin) | + Hypoxia Electrolyte abnormality (es, hyperkalemia) ‘©2020AmercanHoart Association Acute Coronary American Heart Syndromes Algorithm Association. even kee eee ts aad EMS assessment and care and hospital preparation + Assess ABCs. Be preparedto provide CPRand defbilation ‘Administer aepicin and consider oxygen. ntogyeeri nc morphine needed ECG. ST levats Concurrent ED/eathiab assessment Immediate ED/eathiab general treatment {eto minutes) 170, sat 00% tartonygent man trate : speeenoe zien | + gn insane oven) 1 Assess Aa: gweoxyoen needed ECG interpretation | STelevationornewor | (( Non-ST-elevation ACS (NSTE-ACS) presumably new LBEE: Determine iskusing validated ‘strongly suspicious foriniury ‘score le TIMior GRACE) ‘ST-elevation MI(STEM) ‘ eo (ST depression or dynamic T-vave (NormaiEeGornonclagnostic | ‘version, transient ST elevation, changes in ST segment or T wave strongly suspicious forischemia Towesisk core ‘andlor high-risk scare | Low-fintormodiate-risk NSTE-ACS | Mignerisk wsTE-acs oe es ‘Troponin elevated or high-risk patont Consider admission to a os Consider early invasive strategy it: EDchest painunitorto xs Refractoryischemic chest discomfort appropritebed for Recurrentpersistont ST deviation Ventricular tachycardia Homodynamicinstabilty s12hours | Adult Suspected Stroke American Heart Algorithm Association, — Eten ke eee ae ras tity signs and symptoms of possible stroke Critical EMS assessments and actions + Assess ABCS; give oxygenifneeded + Initiate stroke protocol + Perform physicalexam SENSO ea aenumnenataithal ED orbrain maging suite" ral and neurologic sssessment by hospital stroke team ‘Activate svoks tam upon EMSnoiicaton rapa for emergent CT scan or MB bran upon aria 1 Stoktaa mest on rv Cardiac Arrest in Pregnancy American Heart In-Hospital ACLS Algorithm Association. EXT eee as ‘Continue BLS/ACLS + High-quality CPR + Deribilation when indicated ora “+ Team planning should be done in ‘allaboration with tha obstetric, neonatal emergency, “anesthesiology, intensive care, ‘nd cardiac arrest services. + Priorities for pregnant women Ineardiac arrest shouldinetude rovision ofhigh-cuality CPR and Felt of aortocaval compression with Iateral uterine cisplacament + The goal of perimortem cesarean

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