2010 ACLS

2010
BLS

CAB
5 cm( , ), 4 cm(
)
100/min


CPR

 ACLS
Chain of survival -
(Integrated multidisciplinary post resuscitation care)
endo
LMA, ETC, laryngral tube ET or BVM
, cricoid pressure
, ,wide QRS tachycardia adenosine
, bradycardia, atropine ,
( TCP )
PEA/asystole , atropine
CPR
end-tidal CO2 (<10mmHg )
(<20mmHg ) (<30% )

 ACLS
ROSC PETCO2 ( 40mmHg)
ROSC ACLS
ROSC SaO2 94%

Af- 200( ), 120-200( )

,
VT amiodarone
Procainamide, amiodarone, sotalol
Lidocaine

PSVT

 ACS
STEMI ACS

PCI
SaO2 94%

NSTEMI
EMT EKG, aspirin, morphine,
(class I)

 ACS

PCI
ACS 24 -blocker
STEMI PCI
prasugrel
clopidogrel
NSTEMI or STEMI 12 PCI


IV tPA

3
3-4.5 IV tPA 2010

SaO2<94%

50 mg/dL rt-PA
> 185 mg/dL insulin
class I
class I

10-12/min
PaCO240-45 ETCO235-40mmHg
VF Class I
144-180 mg/dL


ST ACS
PCI
EEG (class I)


AED

AED
10J/kg

ACLS
CPR
( ) 100/MIN
5

(

CPR CAB ABC

2010 BLS

Important Issues in ACLS

Good quality-
- primary ABCD, secondary ABCD,
O2/IV/monitor, vital sign, rate/volume/pump
- IV/IO better than endo
-

CPR vs. DC shock ?

- Mega code

Primary ABCD(CABD)
-
- 119 AED
C- circulation,
A- airway,
B- breathing,
D- defibrillation,

Secondary ABCD
A-
B-
C- IV/IO, EKG, drugs
D- DD ( ), 5H5T

Laryngeal Mask Airway

(LMA )
The LMA is an adjunctive airway that
consists of a tube with a cuffed mask-like
projection at distal end.

Esophageal-Tracheal
Combitube
(ETC )
A = esophageal obturator; ventilation into trachea through side openings = B

C = tracheal tube; ventilation through open end if proximal end inserted in trachea

Distal End

D = pharyngeal cuff; inflated through catheter = E

F = esophageal cuff; inflated through catheter = G
H = teeth marker; blindly insert Combitube until marker is at level of teeth

Proximal End

B
F

ETC

A
H

D
A = esophageal obturator; ventilation into trachea
through side openings = B
D = pharyngeal cuff (inflated)
F = inflated esophageal/tracheal cuff
H = teeth markers; insert until marker lines at
level of teeth

LMA

LMA
LMA is in position, a clear, secure airway is present.

End-tidal colorimetric CO2 indicators

Esophageal Detector Device

( )

 (AED)
Automated External Defibrillator
--> PAD ( Public Access Defibrillator)


Vf/pulseless VT
S-5C(iv, monitor)-K
S-5C(endo, epi 1 mg/3-5min or vaso 40 U)-K
S-2m(amiodarone 300 mg)-K
S-2m(epi 1 mg)-K
S-2m(amiodarone 150 mg)-K
S-2m(epi 1 mg)-K

CPR


Asystole
5C (epi/3-5m or vaso 40 unit)-K
5C (endo-epi/ 1 mg or vaso 40 unit)-K
2m (epi 1 mg)-K

PEA

(5H5T)

 unstable
Unstable ( ) >150/min

- cardioversion ( )
Sedation ( )
Synchronize ( )
Dosage( )

AF or SVT- 50~100J
Af: 120-200J( ) or 200J( )
VT: 100J( ) ( VT)

PSVT Adenosine

 -stable

adenosine 6 , 12, 12 mg
PSVT cal block
(diltiazem or verapamil, beta block
AF, AT, JT

Af or MAT

 -stable

QRS adenosine 6mg, amiodarone 150 mg,

cardioversion (100 J)
VT
procainamide20-50/min, amiodarone
150,
sotalol 100mg
lidocaine
(Af with BBB, WPW, VT, torsades)
Af with BBB
WPW amiodarone, ,
(adenosine, digoxin, verapamil, diltia, beta B)
Recurrence poly VT
Torsade MgSO4(1-2 g for 5-20 min)





Atropine 0.5 mg/3-5 min( , AMI,
QRS AVB )
Dopamin(2-10 ug/kg/min) Epinephrine(210ug/min) or TCP
CV for TVP

 (pacemaker)

Bradycardia
Torsade de points
Cardiac arrest- ?

TCP
Intravenous pacemaker

Mega Code
team leader
mega code

: BLS (
) CPR

Close loop communication

Mega Code

( IV
)
team leader
Close loop communication order- -
Constructive intervention, mutual respect

Mega Code

Amiodarone

CPR
ROSC
SaO294%
(debriefing)

ACLS class
ACLS

Airway LMA, endo

BLS AED

ACLS class
AED





(
)

BUDDHIST TZU CHI GENERAL HOSPITAL

Since 1986

42