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ACLS Review 2009

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

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  1. ACLS Review 2009 Emory Family Medicine

  2. Phone first ABCs 30:2 cycles 100/min 1 ½ - 2 inches Check rhythm after 5 cycles Adult CPR

  3. 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

  4. 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

  5. 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

  6. 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?

  7. 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

  8. 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

  9. 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?

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. Tachycardia

  16. Name that rhythm Normal Sinus Rhythm

  17. Sinus Tachycardia

  18. Junctional Tachycardia

  19. Multifocal Atrial Tachycardia

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