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ACLS Past, Present & Future

ACLS Past, Present & Future. http://pmh-acls2004.tripod.com. Dr FT Lee A&E, PMH 2004. Do s. Brief review of main points Case presentation Future development. Don’t s. Review of Algorithms. History. Originated in Nebraska in early 1970. History.

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ACLS Past, Present & Future

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  1. ACLSPast, Present & Future http://pmh-acls2004.tripod.com Dr FT Lee A&E, PMH 2004

  2. Do s • Brief review of main points • Case presentation • Future development

  3. Don’t s • Review of Algorithms

  4. History • Originated in Nebraska in early 1970

  5. History • Organised in Hong Kong by Hong Kong Society of Emergency Medicine and surgery since 1991 • Case-based small group teaching since 1994 • A two days workshop with hands on experience

  6. Cardiac arrest? • Breathing 氣 • Beating 血

  7. Pulse check • no more than 10 sec • Start chest compression if you are unsure

  8. Cardiac Arrest • Ventricular fibrillation/ Pulseless Ventricular Tachycardia • Asystole • Pulseless Electrical Activity(PEA)

  9. Early defibrillation • The most frequent initial rhythm in sudden cardiac arrest is VF • Chance of successful defibrillation reduced 10% each minute

  10. Chain of survival

  11. Pulse +ve • Tachycardia 快 • Bradycardia 慢

  12. Tachycardia (P > 100/min) • Wide complex • QRS >0.12 s (3 small squares) • Narrow complex • QRS < 0.12 s

  13. Bradycardia (P< 60/min) • Sinus • Heart Block • 1st, 2nd and 3rd

  14. Pulse +ve STABLE ?

  15. Unstable • Shock • SOB • Severe chest pain • Impaired consciousness

  16. Unstable • Electrical therapy

  17. Stable • Drug

  18. Drugs • Adrenaline/Vasopressin • Amiodarone • 300mg iv bolus in VF/pulseless VT • 150mg ivi over 10 min in stable tachycardia • Maintenance infusion 1mg/min for 8hrs then 0.5mg/min for 16 hours • ATP/Verapamil/Diltiazem • Atropine

  19. Is life so simple?

  20. Case 1 • AE 04026XXX(X) • Mr Au, M/57, • 19:58, 3/2004 • C/O: Chest pain since 18:00 with radiation to neck & back, sweating +ve • PH: HT, Gout

  21. BP: 182/73, P: 99/min reg, RR: 14/min • SaO2: 96% (RA) • Triage as Cat III (20:00) • ECG ordered

  22. Seen at 20:46 (46mins after triage) • Diagnosed as Angina • O2, TNG, Aspirin and Heparin block ordered • Patient disappeared at 20:55, 20:56, 20: 58, 21:00, 21:03. • Reappeared at 21:05

  23. Developed generalized seizure on receiving treatment • Valium 10mg iv given • Seizure stopped

  24. Cardiac monitor

  25. Defibrillation 200J Asystole Adrenaline 1mg VF Defibrillation 300J Asystole Amiodarone 300mg iv bolus Adrenaline 1mg iv SR

  26. Patient semi conscious • Intubated under RSI • Admitted to ICU • Extubated in ICU and discharged from medical ward

  27. Happy Ending Beating Heart with a Thinking Mind

  28. Case 2 • AE04097XXX(X) • Ms Ou F/28, 16:24 10-04 • Tourist from Thailand to China • C/O: Chest discomfort since 14:30 • PH: VSD

  29. P/E: BP: 115/64, P: 119/min, RR:14/min • GCS: 15 • Cat II

  30. Dormicum 5mg iv • Synchronized cardioversion 100J SR • Amiodarone 150mg iv stat 150mg in 100ml over 1 hour

  31. Admitted to CCU • DAMA 2 days after

  32. Case 3 • AE04071XXX(X) • Ms Siu F/82, 09:56, 8-04 • C/O: Increase dizziness in the morning. Fell onto ground for 3 times. • PH: HT, gout

  33. P/E: • BP: 95/50 (R/C 95/60) P:60 reg • Fully conscious • Cat III

  34. Amiodarone 150mg in 100ml D5 ivi over 30mins • Convert back to SR • BP: 107/50, P:82/min

  35. Case 4 • AE01134XXX(X) • Mr Cheng M/17, 17:48, 12-01 • C/O: LOC at 15:00 for 2mins, Left chest pain, sweating, palpitation • PH: good

  36. P/E: • BP: 95/51, P150/min, RR: 22/min, • SaO2: 100% (RA), GCS:15 • Cat II

  37. What next?

  38. Chest drain inserted • 1.4 litre of blood drained • 1 litre of NS given • Admit to surgery

  39. Case 5 • AE04102XXX(X) • Mr Cheng M/75, 18:26, 11-04 • C/O: sudden onset of chest pain and SOB • P/E: In distress, sweating • BP: 106/51, P:71/min, RR: 40/min • SaO2: 87% with O2

  40. CXR: APO • TNG, Aspirin were given

  41. What next? Intubate or TCP?

  42. Intubation was done under RSI • Developed cardiac arrest after Suxamethonium was given • CPR, Atropine and Adrenaline

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