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INTRO TO ACLS

INTRO TO ACLS. Department of Emergency Medicine University of Manitoba Zoe Oliver, Cheryl ffrench, Shai Harel, Hareishun Shanmuganathan, Katie Sullivan. Approach to the first three minutes of a code Primer on the rest…. OBJECTIVES. Part 1: He Looks Dead.

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INTRO TO ACLS

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  1. INTRO TO ACLS Department of Emergency Medicine University of Manitoba Zoe Oliver, Cheryl ffrench, Shai Harel, Hareishun Shanmuganathan, Katie Sullivan

  2. Approach to the first three minutes of a code Primer on the rest…. OBJECTIVES

  3. Part 1: He Looks Dead Katie is a third year medical student on her Ortho rotation. She is pre-rounding on her patients in the morning. Pitfall: • Started CPR before checking responsiveness

  4. Checking Responsiveness • Voice (get close) • Pain (noxious central stimulus) • Sternal Rub • Upper Orbit Pressure • Trapezius Pinch

  5. Part 2 – He Is Dead Katie is a third year medical student on her Ortho rotation. She is pre-rounding on her patients in the morning. Pitfall: • Didn’t call for help

  6. Calling for help • Check which room you’re in • Go into hallway and look for nurse • Get someone to check the code status No one there? • Go to phone and dial ‘55’ for an emergency line • Code Blue vs. Medical 25 vs. Code 88

  7. Part 3 – How was your Weekend? Katie and Shai are third year med students pre-rounding on their Ortho rotation. They enter a four bed room together. Katie’s patient, “doesn’t look right”. Pitfall: • Didn’t activate BLS

  8. Activating the BLS Primary Survey A B C (D)

  9. BLS Primary Survey • Airway • Breathing • Circulation • Defibrillation • Simple interventions

  10. Part 4 – He’s Not Perking Up Katie and Shai decide to activate BLS. Pitfall: • Didn’t open airway • Gave inadequate breaths • Radial pulse check

  11. Airway Primary

  12. Breathing Primary • Give 2 breaths • NO response? 1 breath / 5 seconds and CPR

  13. Primary Circulation • No more than 5-10 seconds • NOT peripheral pulse • Start CPR • CPR board • Recheck pulse every 2 minutes • Ensure IV/IO access

  14. Part 5: The Team Will be Here Soon • Previous scenario continues • Ward resident Hareishun runs into the room… Pitfall: • Too many CPR interruptions

  15. CPR • CPR board • 100 compressions/minute • 30:2 breaths • Hard and fast

  16. Parts 1-5: The Replay

  17. RECAP

  18. Who’s on the code team? • Code team leader • More doctors if they happen to be around • Nurses • Record keeper, someone to give meds • RT • Orderly • CPR

  19. How does the code team work? • Code team leader: • Makes it clear who is in charge • Call for quiet if there’s too much noise • Stands at pt’s side, hand on pulse (femoral) • If possible, delegate tasks to others • Closed-loop communication • Maintain sense of ‘big picture’

  20. What the team leader will ask you…. • Patient name, age, reason for admission • Past medical history • CODE STATUS • Time of arrest, events leading up

  21. What next? • Repeat the BLS Primary Survey • Can now do ‘D’ A B C D

  22. Defibrillation • At casino: • No pulse • power-on AED and follow voice prompts • Apply pads • Administer shock as directed • In hospital: will not have AED immediately available

  23. D: Rhythm Recognition • Once you know the rhythm, you can follow the algorithm • Today: Non-Perfusing Rhythms

  24. Non-Perfusing Rhythms

  25. What are VF and VT? • These two rhythms are treated in the same way (if pulseless) • Both represent the ventricle trying to pump blood in a disorganized way • Usually due to myocardial ischemia (for whatever cause)

  26. VF and VT

  27. Examples

  28. Examples

  29. Examples

  30. Examples

  31. Defibrillators 101

  32. Defibrillators 101 • Gel pads • Select energy (200J) • No Sync • Charge • Clear everyone • Shock

  33. Putting it together • You’ve found an unresponsive patient • Called a code • Did as much of the BLS primary survey as you could • Code team has arrived and repeated the primary survey, including defibrillation if needed

  34. First three minutes… Simple interventions

  35. Approach to the first three minutes of a code Primer on the rest…. OBJECTIVES

  36. Incorporating ACLS Simple interventions Advanced interventions

  37. Now: ACLS Secondary Survey • Airway • Breathing • Circulation • Differential • Advanced interventions

  38. ACLS Secondary Survey: Airway • Is the airway patent? • Is an advanced airway indicated? Laryngeal Mask Airway (LMA) Endotracheal Tube (ETT)

  39. ACLS Secondary Survey: Breathing • Is the airway in the right place? • Is the tube secure? • Are we monitoring O2 and CO2?

  40. ACLS Secondary Survey: Circulation • What is/was the rhythm? • Is there IV access? • Is fluid needed? • Are drugs needed?

  41. ACLS Secondary Survey: Differential • Why did the patient arrest? • Is there a reversible cause for the arrest?

  42. Part 6:Dream Team Code

  43. PEA and Asystole

  44. PEA • Organized • No pulse • Fast or slow

  45. PEA

  46. PEA

  47. Asystole • Final rhythm • Depleted myocardium • Check two leads

  48. PEA and Asystole: Treatment • Epinephrine • Atropine for slow PEA/asystole • CPR • Fix the fixable • Hypovolemia: Bolus NS • Hypoxia: O2 • Hyperkalemia: ABG (for K+), Bicarbonate, Calcium Cl, • Acidosis, TCA OD: Bicarbonate • Pneumothorax/tamponade: Needle • MI/PE: Thrombolytics

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