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ACLS ALGORITHMS

ACLS ALGORITHMS. Acute Pulmonary Edema / Hypotension / Shock Algorithm. Clinical signs of hypoperfusion, congestive heart failure, acute pulmonary edema Assess ABC’s Assess vitals Secure airway Review history Administer O 2 Perform physical exam Start IV 12 lead ECG, chest x-ray

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ACLS ALGORITHMS

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  1. ACLSALGORITHMS

  2. Acute Pulmonary Edema / Hypotension / Shock Algorithm Clinical signs of hypoperfusion, congestive heart failure, acute pulmonary edema Assess ABC’s Assess vitals Secure airway Review history Administer O2 Perform physical exam Start IV 12 lead ECG, chest x-ray Attach monitor, pulse oximetry and B/P Cuff Figure 8 What is the nature of the problem? Volume problem Includes PVR problems Pump Problem Rate Problem What is the BP ? • Administer • Fluids • Blood transfusions • Cause-specific interventions • Consider vasopressors Too Slow Go to Fig 5 Too Fast Go to Fig 6 Systolic BP < 70 Signs of shock Systolic BP 70 - 100 mmHg Signs of shock Systolic BP 70 - 100 mmHg No Signs of shock Systolic BP > 100 mmHg

  3. Bradycardia Algorithm(Patient is not in Cardiac Arrest) Assess ABC’s Assess vitals Secure airway Review history Administer O2 Perform physical exam Start IV 12 lead ECG, chest x-ray Attach monitor, pulse oximetry and B/P Cuff Figure 5 Bradycardia, either absolute (<60 BPM) or relative Serious signs and symptoms?a,b Yes No Type II second-degree AV heart block or Third-degree AV heart Block?e • Intervention sequence • Atropine0.5 - 1.0 mcg,d (I and IIa) • TCP, if available (I) • Dopamine5 - 20 mcg/kg/min (IIb) • Epinephrine 1 - 10 mcg/min (IIb) • Norepinephrine 0.5 –30 mcg/min (IIb) No Yes Observe • Prepare for transvenous pacer • Use TCP as a bridge device

  4. Tachycardia Algorithm (Patient is not in Cardiac Arrest) Assess ABC’s Assess vitals Secure airway Review history Administer O2 Perform physical exam Start IV 12 lead ECG, chest x-ray Attach monitor, pulse oximetry and B/P Cuff Figure 6 • If ventricular rate > 150 BPM • Prepare for cardioversion • May give brief trial of Rx • Immediate cardioversion is seldom • needed for heart rates < 150 BPM Yes Unstable, with serious signs or symptoms?a No Atrial Fibrillation Atrial Flutter Ventricular Tachycardia (VT) Paroxysmal Supraventricular Tachycardia (PSVT) Wide-complex tachycardia of uncertain type

  5. Pulseless Electrical Activity (PEA) Algorithm(Electromechanical Dissociation [EMD]) Figure 3 Includes Electromechanical dissociation (EMD) Postdefibrillation idioventricular rhythms Pseudo - EMD Bradyasystolic rhythms Idioventricular rhythms Ventricular escape rhythms • Continue CPR / Intubate at once / Obtain IV Access • Assess blood flow using Doppler ultrasound, endtidal CO2, • echocardiography, or arterial line Consider possible causes Hypovolemia (volume infusion) Drug overdoses - tricyclics, digitalis Hypoxia (ventilation) Beta-blockers, calcium channel blockers Cardiac tamponade (pericardiocentesis) Hyperkalemia Tension Pneumothorax Acidosis Hypothermia ( see hypothermia algorithm) Massive acute myocardial infarction Massive pulmonary embolism (surgery, lysine) Massive acute MI (go to Fig 9) Epinephrine 1 mg IV push,a,c repeat q 3 - 5 min • If absolute bradycardia (< 60 BPM) or relative bradycardia • give atropine 1 mg IV • Repeat q 3 -5 min to a total of 0.03 - 0.04 mg/kg

  6. Asystole Treatment Algorithm • Continue CPR • Intubate at once • Obtain IV Access • Confirm asystole in more than 1 lead Consider possible causes Hypoxia Pre-existing acidosis Hyperkalemia Drug Overdose Hypokalemia Hypothermia Consider immediate transcutaneous pacing (TCP)a Figure 4 • Epinephrine 1mg IV push,b,c • repeat q 3 - 5 min • Atropine1 mg IV push • repeat q 3 - 5 min up to a total • of 0.03 - 0.04 mg/kgd,e Consider termination of efforts

  7. Figure 2 Ventricular Fibrillation (VF)& Pulseless Ventricular Tachycardia (VT) • ABCs • Perform CPR until defibrillator Arrives • VF/VT present on defibrillator Defibrillate up to 3 times if needed for persistent VF/VT 200 J, 200 - 300 J, 360 J Rhythm after the first 3 shocks? b VF/VT ROSC PEA Go to Fig 3 Asystole Go to Fig 4

  8. Figure 2 VF & Pulseless VT • Continue CPR • Intubate / IV Access Epinephrine c,d 1 mg/IV 2 mg/ETT q 3 - 5 min Defibrillate 360 J within 30 - 60 sec Administer Rx Class IIa probable benefit f, g Defibrillate 360 J, 30 - 60 sec after Rx

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