acls update

1. ACLS UPDATE 2005 American Heart Association (AHA) Guidelines

3. CPR Emphasize High-Quality CPR 5 Cycles Or Approximately 2 Minutes Rotate Compressors Every 2 Minutes With Rhythm Checks Most Important Thing In CPR � COMPRESSIONS! Chest Compressions Rescue Breaths With Effective Chest Compressions Ensure Adequate Chest Compression Depth Allow Chest Wall Recoil Organize Care To Minimize Interruptions

4. ADVANCED AIRWAY ET Placement Insertion Of Advanced Airway May Not Be High Priority May Be Deferred Several Minutes Into Resuscitation Limited To Providers With Adequate Training Limited To Providers Who Practice/Perform Intubations Confirmation Requires Both: Clinical Assessment CO2 Detector Or Esophageal Device Advance Airway Inserted/Secured Deliver Continuous Chest Compressions (100/min) Deliver 8-10 Rescue Breaths/Min (1 Breath Every 6-8 Secs)

5. DEFIBRILLATION Treatment For Pulseless Arrest (VF Or VT) Immediate D-fib For Sudden Witnessed Collapse One Shock Immediately Followed By 5 Cycles Of CPR, Then Pulse Check Initial Shock Dosing Adult Monophasic Manual D-fib: 360J Adult Biphasic Manual D-fib: Truncated Exponential Waveform: 150-200J Rectilinear Biphasic Waveform: 120J Unknown Biphasic Waveform: Default Dose 200J Second & Subsequent Attempts -- Same Dose Or Higher

6. ORGANIZE CARE DURING ACLS Therapies Designed Around 5 Cycles (2 Min) Of CPR CPR Resumed Immediately After Shock Pulse/Rhythm Check NOT Performed Immediately After Shock Minimize Chest Compression Interruptions After Completion Of 5 Cycles (Or 2 Min) Of CPR May: Interrupt For Rhythm Checks & Shock Delivery Interrupt When Necessary To �Clear� Patient Resume Immediately After Shock Delivery Resume Immediately After Rhythm Check Minimize Time Between Compressions & Shock Delivery Provide Compressions While Charging Defibrillator

7. ORGANIZE CARE DURING ACLS Drug Delivery Timing Less Important Than Minimization Of Chest Compressions IV/Intraosseous (IO) Route Preferred To Endotracheal Tube (ET) Delivery Should NOT Interrupt CPR Cycles If 3rd Rescuer Available, Prepare Doses In Advance Administer ASAP After Rhythm Checks During D-Fib Charging Following Shock Delivery

8. MEDICATION UPDATES Drug Administration May Be Ordered Prior To Rhythm Recognition Vasopressor During Cardiac Arrest Administer When IV/IO Access Established Typically Given After 1st Or 2nd Shock If VF/Pulseless VT Persists After 1st Or 2nd Shock May Give Epinephrine Every 3 - 5 Minutes Single Dose Of Vasopressin May Replace Either 1st Or 2nd Epinephrine Dose

9. MEDICATION UPDATES Antiarrhythmics During VF/VT Cardiac Arrest Amiodarone Preferred To Lidocaine; Either Is Acceptable Consider For: Persistent Pulseless VF/VT Vasopressor Dose Already Administered Treatment Of Asystole & PEA Epinephrine Still Recommended Every 3-5 Min Atropine Still Considered For Asystole Or Slow PEA One Dose Vasopressin May Be Substituted For 1st Or 2nd Epinephrine Dose

10. MEDICATION UPDATES Treatment Of Symptomatic Bradycardia While Preparing For Transcutaneous Pacing: Consider Atropine 0.5 mg IV Up To 3 Doses If Atropine Ineffective Consider Epinephrine Infusion (2 �10 ug/min) Consider Dopamine Infusion (2 � 10 ug/kg/min) Treatment Of Tachycardia Summarized Into A Single Algorithm Unstable: Immediate Synchronized Cardioversion Still Recommended Stable: 12-lead To Determine Narrow Or Wide Complex Algorithm Designed For In-Hospital Use/Expert Consultation No Changes To Actual Medications And/Or Doses

11. POST RESUSCITATION Post Resuscitation Stabilization Support Of Myocardial Function Maintain Strict Glucose Control Hypothermia Unconscious Adult Whose Initial Rhythm Was VF Out-of-Hospital Consider Inducing -- Cool To 32-34 Degrees Celsius For 12-24 Hrs May Also Be Beneficial For Non-VF Arrest In- & Out-of-Hospital Improved Survival & Neurological Outcomes

12. RESOURCE Web Site: http://www.americanheart.org/presenter.jhtml?identifier Download Currents In Emergency Cardiovascular Care, Winter 2005-06, Vol 16, # 4