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ACLS Review 2009. Emory Family Medicine. Phone first ABCs 30:2 cycles 100/min 1 ½ - 2 inches Check rhythm after 5 cycles. Adult CPR. Name this rhythm Ventricular Fibrillation What drugs can you use initially? Epi 1 mg q 3-5 min Vasopressin 40 U x 1 What other drugs can you try?

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acls review 2009

ACLS Review 2009

Emory Family Medicine

adult cpr
Phone first

ABCs

30:2 cycles

100/min

1 ½ - 2 inches

Check rhythm after 5 cycles

Adult CPR
slide3
Name this rhythm
      • Ventricular Fibrillation
  • What drugs can you use initially?
      • Epi 1 mg q 3-5 min
      • Vasopressin 40 U x 1
  • What other drugs can you try?
      • Amiodorone 300 mg once, then 150 mg once, or
      • Lidocaine 1 – 1.5 mg/kg initially, then 0.5 – 0.75 mg/kg to max of 3 mg/kg
      • Mag 1-2 g for torsades
slide4
What should you check with this rhythm?
      • Pulse
  • What is this rhythm?
      • PEA
  • What are the 6 H’s and 5 T’s?
      • Hypoxia, Hypovolemia, Hypo/Hyperkalemia, Hydrogen ions, Hypothermia, Hypoglycemia
      • Toxins, Trauma, Tamponade, Thrombosis, Tension Pneumo
  • What drugs can you use?
      • Epi 1 mg q 3-5 min
      • Vasopressin 40 U x 1
      • Atropine 1 mg for PEA with slow rate
slide5
What is this rhythm?
      • Asystole
  • Do you shock this pt?
      • NO
  • What do you do?
      • CPR, O2, IV, Monitor
      • R/O and fix 6 H’s/ 5 T’s
      • Check DNR status
  • What drugs can you use?
      • Epi 1 mg q 3-5 min
      • Vasopressin 40 U x 1
      • Atropine 1 mg
slide7
Name these rhythms?

1st degree AV Block

2nd degree AV Block Type I

(Mobitz I-Wenkenbach)

2nd degree AV Block Type II

Which rhythm needs TC pacing?

slide8
What does this patient need?

Transcutaneous/transvenous pacing

What drugs can you use?

Atropine 0.5 – 1 mg, to max of 3 mg

Epi 2 - 10 mcg/min

Dopamine 2 - 20 mcg/kg/min

slide10
What is this rhythm?
      • PSVT
  • What can you try first?
      • Vagal manuevers
  • What drug do you use?
      • Adenosine 6 mg IV push
      • Repeat with 12 mg x 2
  • What if patient becomes unstable?
      • Synchronized cardioversion with 50 Joules
slide11
What are these rhythms?
      • A Fib and A flutter
  • What do you need to ask?
      • Is patient stable or unstable?
      • Has rhythm been present for > 48 hrs?
      • Is systolic function impaired < 40%
      • Does pt have WPW?
treatment focus of a fib a flutter
Treatment Focus of A Fib/A Flutter
  • Treat unstable patients with cardioversion
      • 50 - 100 J
  • Rate control
      • Normal LV fx – Ca (Diltiazem) or Beta blocker
      • Impaired LV fx – Digoxin, Amiodarone
  • Rhythm control
      • < 48 hrs – Cardioversion or Amiodarone
      • > 48 hrs – Anticoagulate x 3 wks, then cardiovert, then anticoagulate for 4 more weeks
slide13
What is the rhythm?
      • Wolff-Parkinson-White Syndrome
  • What drugs must you NOT use?
      • Adenosine
      • Ca or Beta Blockers
      • Digoxin
  • What drugs can you use?
      • Amiodarone
      • Flecainide
      • Procainamide
      • Sotalol
      • Propafenone
slide14
What is the rhythm?
      • Monomorphic Ventricular Tachycardia
  • First question to ask?
      • Is pt stable or unstable?
  • What drugs can you use?
      • Amiodarone 150 mg IV over 10 min, to max of 2.2 g/ 24 hrs
      • Lidocaine 0.5 – 0.75 mg/kg IV push
      • Procainamide
      • Sotalol
slide15
What is this rhythm?
      • Polymorphic Ventricular Tachycardia
  • What is your first question?
      • Is pt stable or unstable
  • What drugs can you use?
      • Amiodarone
      • Beta blocker
      • Lidocaine
      • Procainamide
      • Sotalol
slide16
Name the rhythm?
      • Torsades de pointes
  • What can help you determine this?
      • Baseline QT interval prolonged
  • What drugs can you use?
      • Magnesium 1-2 g load
      • Lidocaine
      • Isoproteronol
      • Phenytoin
      • Overdrive pacing
name that rhythm
Name that rhythm

Normal Sinus Rhythm

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