BLS and ACLS

MOVIES

What to do if patient is responsive in BLS assessment

monitor, oxygen, vitals, IV access, ECG, blood sugars

MOVIES

>150 bpm

typical HR in tachyarrhythmia

synchronized cardioversion

What to do if patient has tachyarrhythmia that causes hypotension, acute AMS, signs of shock, ischemic chest discomfort, or acute HF (unstable)

vagal maneuvers;

adenosine;

beta blocker or CCB

What to do if patient has tachyarrhythmia but is stable (no hypotension, acute AMS, signs of shock, ischemic chest discomfort, or acute HF) and has narrow QRS

adenosine (if regular and monomorphic);

antiarrhythmic infusion (procainamide, amiodarone, sotalol)

What to do if patient has tachyarrhythmia but is stable (no hypotension, acute AMS, signs of shock, ischemic chest discomfort, or acute HF) and has wide QRS

6 mg

adenosine dose

rescue breathing;

recheck pulse every 2 minutes;

if no pulse, start CPR

BLS: what to do if patient has pulse but does not have normal breathing

start CPR;

give 1 shock;

resume CPR

BLS: what to do if patient has no pulse and is not breathing/only gasping and their rhythm is shockable

resume CPR

BLS: what to do if patient has no pulse and is not breathing/only gasping and their rhythm is not shockable

1) shock

2) CPR

3) if rhythm is shockable, shock again

4) CPR + epinephrine

5) if rhythm is shockable, shock again

6) CPR + amiodarone or lidocaine

Patient in cardiac arrest: rhythm is shockable (VF/pVT)

1) epinephrine + CPR

2) if rhythm shockable, shock

Patient in cardiac arrest: rhythm is not shockable (asystole/PEA)

1 mg every 3-5 minutes

epinephrine dose in cardiac arrest

1) 300 mg

2) 150 mg

amiodarone dose in cardiac arrest

hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia

tension pneumothorax, tamponade, toxin, thrombosis (cardiac or pulmonary)

reversible causes of cardiac arrest

bradycardia HR

atropine

first line treatment for symptomatic bradycardia (causing hypotension, acute AMS, signs of shock, ischemic chest discomfort, or acute HF)

dopamine or epinephrine

treatment for symptomatic bradycardia if atropine is ineffective

1 mg every 3-5 minutes

atropine dose for symptomatic bradycardia

2-10 mcg/min infusion

epinephrine dose for symptomatic bradycardia

MI/ischemia

drugs (CCBs, beta blockers, digoxin)

hypoxia

electrolyte abnormality (hyperkalemia)

causes of bradycardia

shock

first line therapy for patient in V-fib or pulseless V-tach