ACLS Algorith 2004

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