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ACLS Update

ACLS Update

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ACLS Update

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  1. ACLS Update 2015 guidelines

  2. Review 2015 ACLS changes Review ACLS Algorithms Review Stroke Management Review ACS Management Review ROSC Discuss Special Considerations Objectives

  3. ACLS Changes • All of the BLS changes incorporated into ACLS (with emphasis on chest compressions) • Emphasis on team approach • Continuous Quality Improvement for Resuscitation Programs • Introduction of Nalaxone in suspected opioid overdose • Introduction of Intralipid in suspected toxin overdose • Removal of Vasopressin in algorithms

  4. ROSC changes

  5. BLS ALGORITHMS

  6. Monitoring during CPR • End-tidal C02-prolonged low value (10mmHg) in intubated patients suggests ROSC unlikely-try to improve compressions • Coronary Perfusion Pressure-with art line, use diastolic pressure as surrogate-if value less than 20 mmHg, improve compressions • Central Venous 02 Sats-if SCV02 is less than 30%, improve compressions

  7. ACLS (V.fib/V.tach/PEA/Asystole)

  8. ACLS - Bradycardia

  9. ACLS - Tachycardia

  10. ACLS - Stroke

  11. ACLS - ACS

  12. ACLS - ROSC

  13. Special Circumstances

  14. ideally, drugs delivered IV with no access, options are:-IO-endotracheal (2-2.5x the IV dose)-IM/intranasal (Naloxone)-transdermal (nitro paste in ACS) No IV Access

  15. ODs, toxic exposures • These circumstances may lead to vasodilation and myocardial dysfunction • approach to poisoned patient should be aggressive as toxic effects may progress rapidly and may be of limited duration • here, myocardial dysfunction and arrhythmias may be reversible • interventions are meant to “but time” and reverse ill effects

  16. Prolonged CPR Extracorporeal CPR Intra-aortic bolloon pump Dialysis Intralipid Specific Antidotes Pacing Correction of severe electrolyte disturbances Some specific interventions

  17. Ultrasound Use • may help assess myocardial contractility • may help assess lung function/pathology • may assess for cardiac tamponade • unclear whether important clinical outcomes are affected by routine use of US • Use can be considered by experienced users if the resuscitation is not interrupted