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ACLS Update

ACLS Update. 2015 guidelines. Review 2015 ACLS changes Review ACLS Algorithms Review Stroke Management Review ACS Management Review ROSC Discuss Special Considerations. Objectives. ACLS Changes. All of the BLS changes incorporated into ACLS (with emphasis on chest compressions)

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ACLS Update

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  1. ACLS Update 2015 guidelines

  2. Review 2015 ACLS changes Review ACLS Algorithms Review Stroke Management Review ACS Management Review ROSC Discuss Special Considerations Objectives

  3. ACLS Changes • All of the BLS changes incorporated into ACLS (with emphasis on chest compressions) • Emphasis on team approach • Continuous Quality Improvement for Resuscitation Programs • Introduction of Nalaxone in suspected opioid overdose • Introduction of Intralipid in suspected toxin overdose • Removal of Vasopressin in algorithms

  4. ROSC changes

  5. BLS ALGORITHMS

  6. Monitoring during CPR • End-tidal C02-prolonged low value (10mmHg) in intubated patients suggests ROSC unlikely-try to improve compressions • Coronary Perfusion Pressure-with art line, use diastolic pressure as surrogate-if value less than 20 mmHg, improve compressions • Central Venous 02 Sats-if SCV02 is less than 30%, improve compressions

  7. ACLS (V.fib/V.tach/PEA/Asystole)

  8. ACLS - Bradycardia

  9. ACLS - Tachycardia

  10. ACLS - Stroke

  11. ACLS - ACS

  12. ACLS - ROSC

  13. Special Circumstances

  14. ideally, drugs delivered IV with no access, options are:-IO-endotracheal (2-2.5x the IV dose)-IM/intranasal (Naloxone)-transdermal (nitro paste in ACS) No IV Access

  15. ODs, toxic exposures • These circumstances may lead to vasodilation and myocardial dysfunction • approach to poisoned patient should be aggressive as toxic effects may progress rapidly and may be of limited duration • here, myocardial dysfunction and arrhythmias may be reversible • interventions are meant to “but time” and reverse ill effects

  16. Prolonged CPR Extracorporeal CPR Intra-aortic bolloon pump Dialysis Intralipid Specific Antidotes Pacing Correction of severe electrolyte disturbances Some specific interventions

  17. Ultrasound Use • may help assess myocardial contractility • may help assess lung function/pathology • may assess for cardiac tamponade • unclear whether important clinical outcomes are affected by routine use of US • Use can be considered by experienced users if the resuscitation is not interrupted

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