sebenernya sih belum sempet ikut ATLS or ACLS. Cuma pernah baca ini di e-book.. seru aja mnemonic nya.. siapa tau jadi lebih gampang ingetnya... secara kasus2 ACLS kan kasus darurat. ga ada salahnya dong belajar duluan sebelum ikut kursus resminya, biar tar kalo ikut, tinggal mendalami.. ^ ^
ini adalah algoritma ACLS 2004 yang dibuat sama dr. Antonio Arnal (Caracas, Venezuela)
Asystole
"Asystole ..... Check me in another lead,
then let's have a cup of TEA."
| A | Intervention | Comments/Dose |
| T | Transcutaneous Pacing (TCP) | Only effective with early implementation along with appropriate interventions and medications. NOTE: Not effective with prolonged down time. |
| E | Epinephrine | 1 mg IV q3-5 min. |
| A | Atropine | 1 mg IV q3-5 min. (max. dose 0.04 mg/kg) |
Consider termination of efforts if asystole persists despite appropriate interventions.
Asystole may be discovered during the primary ABCD survey after attaching a monitor, or it may develop in a previously monitored patient. In either case, it is essential that asystole be confirmed in another lead with properly functioning equipment. If the patient is in true asystole and is a candidate for resuscitation, then proceed with the secondary ABCD survey.
Ventricular Fibrillation (VF)/
Pulseless Ventricular Tachycardia (PVT)
The following mnemonic directs AHA accepted
actions after the primary survey ABC's
Please Shock-Shock-Shock, EVerybody Shock,
And Let's Make Patients Better
| Chant | Intervention | Note |
| Please | Precordial Thump | May be performed immediately after determining pulselessness in a witnessed arrest with no defibrillator immediately available. Check pulse after thump. |
| Shock | 200J* | If VF or VT is shown on monitor, shock immediately, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm. |
| Shock | 200-300J* | If VF or VT persists on monitor, shock immediately, do not check pulse, do not continue CPR, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm. |
| Shock | 360J* | If VF or VT persists, shock immediately. |
Implement the secondary ABCD survey. Do not continue with this algorithm if an intervention results in the return of spontaneous circulation.
NOTE: When giving med's, do so in a drug-shock-drug-shock sequence. Continue CPR while giving meds, and shock within 30-60 seconds. Evaluate the rhythm and check for a pulse in the period immediately after shocking.
| Everybody | Epinephrine | 1 mg IV q3-5 min. |
or
| eVerybody | Vasopressin | 40 U IV, one time dose.(wait 10-20 minutes before starting epi) |
If VF/PVT persists, "CONSIDER" antiarrhythmics and sodium bicarb.
CAUTION: Using more than one antiarrhythmic may result in pro-arrhythmic drug-drug interactions.
| And | Amiodarone (First Choice) | 300mg IV push. May repeat once at 150mg in 3-5 min. (max. cumulative dose: 2.2g IV/24hrs.) |
| Let's | Lidocaine | 1.0-1.5 mg/kg IV. May repeat in 3-5 min. (max. loading dose: 3 mg/kg) |
| Make | Magnesium Sulfate | 1-2 g IV (2 min. push) for suspected hypomagnesemia or torsades de pointes. |
| Patients | Procainamide | 20 mg/min, or 100 mg IV q 5 min. for refractory VF. (max. loading dose: 17 mg/kg) |
Consider buffers
| Better | Bicarbonate | 1 mEq/kg IV for preexisting hyperkalemia, bicarb-responsive acidosis, some drug overdoses, protracted code (intubated), or return of spontaneous circulation after long code with effective ventilation |
Bradycardia
All Trained Dogs Eat Iams
(The sequence reflects interventions for increasingly severe bradycardia)
| Algrth | Intervention | Comments/Dose |
| All | Atropine | 0.5-1.0 mg IV push q 3-5 min. (max. dose 0.03-0.04 mg/kg) |
| Trained | TCP | Use Transcutaneous Pacing (TCP) immediately with severely symptomatic patients. |
| Dogs | Dopamine | 5-20 µg/kg/min. |
| Eat | Epinephrine | 2-10 µg/min. |
| Iams | Isoproterenol | 2-10 µg/min. |
Stable Tachycardia
Think "O-M-I", (pronounced "oh my") Oxygen-Monitor-IV, even before you start your primary and secondary ABCD surveys. After the failure of one antiarrhythmic drug, electrical cardioversion is usually the next treatment of choice. If the rate is >150 and/or the patient is unstable with serious signs and symptoms due to the rhythm, prepare for immediate electrical cardioversion.
Note that amiodarone is listed for most of the stable tachycardias. Knowing the exceptions for the use of amiodarone will aid in the implementation of the stable tachycardia algorithms.
Atrial Fibrillation/Flutter
(with/without CHF)
Rate Control diltiazem
Rhythm Conversion ? Nonemergent chemical or DC cardioversion should be avoided, and when indicated, should only be performed by an experienced health care provider after careful evaluation and thromboembolic precautions are taken.
Wolff-Parkinson-White
(with/without CHF)
(avoid adenosine, beta blockers, calcium channel blockers, digoxin)
Rate Control amiodarone
Rhythm Conversion Nonemergent chemical or DC cardioversion should be avoided, and when indicated, should only be performed by an experienced health care provider after careful evaluation and thromboembolic precautions are taken.
Narrow Complex Tachycardias
Vagal maneuvers
Adenosine
Junctional Tachycardia/Ectopic or Multifocal Atrial Tach (with/without CHF)
Amiodarone (no Cardioversion)
Paroximal Supraventricular Tachycardia
No CHF:
Verapamil
DC Cardioversion
Amiodarone
With CHF:
DC Cardioversion
digoxin
amiodarone
diltiazem
Wide-Complex Tachycardia/Unknown Type
(with/without CHF)
(avoid beta blockers, calcium channel blockers, digoxin)
DC Cardioversion or amiodarone
Ventricular Tachycardia
DC Cardioversion or trial of medication
Monomorphic
(with/without CHF)
amiodarone
|
synchronized cardioversion
Polymorphic
Evaluate for electrolyte abnormality or drug toxicity and treat accordingly
/ \
Normal QTI Long QTI
Amiodarone magnesium
cardioversion overdrive pacing
PEA
Pulseless Electrical Activity may be discovered during the primary ABCD survey when a monitor is attached to a pulseless patient and a rhythm is shown. As part of the secondary ABCD survey, a doppler should be used to confirm pulselessness.
Interventions for pulseless electrical activity are guided by the letters P-E-A:
| Algorth | Comments/Dose |
| Problem | Search for the probable cause and intervene accordingly. |
| Epinephrine | 1 mg IV q3-5 min. |
| Atropine | With slow heart rate, 1 mg IV q3-5 min. (max. dose 0.04 mg/kg) |
Synchronized Cardioversion
Synchronized Electrical Cardioversion
It is essential that ACLS Providers know the indications for synchronized electrical cardioversion and receive proper training on the equipment their institution uses before attempting to perform this intervention.
The following mnemonic directs preparations for synchronized electrical cardioversion: "Oh Say It Isn't So"
| Mnemonic | Preparation |
| Oh | O2 saturation monitor |
| Say | Suction equipment |
| It | IV line |
| Isn't | Intubation equipment |
| So | Sedation and possibly analgesics |
Synchronized Electrical Cardioversion Energy Levels:
Unless otherwise specified in the table below, successive energy levels are *100J, and up to *200J, *300J, *360J, if needed. If the patient's condition becomes critical and your equipment will not synchronize, then proceed with immediate unsynchronized shocks.
| Rhythm | Special Notes: |
| Polymorphic V-tach | Treat polymorphic V-tach like V-fib, i.e., successive unsynchronized shocks at *200J, and up to *200-300J, *360J, if needed. |
| PSVT, A-flutter | start with *50J |
Note: If V-fib develops, immediately defibrillate following the VF algorithm.
*Or biphasic equivalent
