ACLS

1. ACLS
FOR DUMMIES (PARAMEDICS)

2. Algorhythms are your best friend
Does he have
a pulse ?
No
Are you sure?
Transport to
hospital. Treat
as indicated
Yes
Transport to
hospital. Treat
as indicated
Is the patient
talking ?
No
Give oxygen
Transport to
hospital. Treat
as indicated
Yes
Take him to the
hospital. Treat
as indicated.

3. Main Algorhythms
 CPR Algorhythm
 Pulseless Arrest
 Tachycardia with pulse
 Bradycardia
 ROSC

4. CPR Algorhythm (BLS Code)
1. “Hey, hey, are you
okay?”
2. You are 911
3. Jaw thrust or head tilt
chin lift
4. Use an Ambu bag and
at least one basic
airway adjunct
5. ONLY 10 seconds
6. Hard and fast 30:2
7. Turn on your AED /
Monitor
8. Rhythm check
9. Shock
10.Start CPR again

7. Pulseless
Arrest
 Call for assistance if
not already there
 Use Ambu bag
 Attach cardiac monitor
 Check rhythm
 Confirm V-fib or V-
tach

8. Pulseless Arrest  Shock at 200 J
 Resume CPR
 If you did not secure
an airway yet, do it
now.
 Attach Lucas
 Establish IV or IO
access
 Get ready with the
EPI

9. Pulseless Arrest
 Check rhythm
 Shock at 200 J
 Restart CPR
 Give either one:
 EPINEPHRINE 1mg
 VASOPRESSSIN 40
units

10. Pick One

11. Pulseless Arrest
 Rhythm Check
 Shock
 Give an antiarrhythmic:
 LIDOCAINE 1 – 1.5 mg/kg
 AMIODARONE 300 mg
 Mag Sulfate if Torsades

13. Pulseless Arrest
 Package patient
 Initiate transport
 Reconfirm airway
 Continue to give EPINEPHRINE q 3 -5 minutes
 Repeat antiarrhythmics:
 LIDOCAINE (0.5- 0.75 mg / kg ) half first dose
 AMIODARONE (150 mg) half first dose
 If you get a pulse back with one of these drugs, set up
a drip.

14. Pulseless Arrest
 Not shockable
 PEA
 Asystole

15. Pulseless Arrest
 Assure adequate CPR
 Secure Airway
 Establish IV or IO
 Administer medications:
 EPINEPHRINE 1 mg q 3-5 min
 Vasopressin 40 Units (one
time)
 Atropine (Asystole or slow
PEA)

16. Pulseless Arrest
 Recheck rhythm after
5 cycles of cpr
 If shockable, then
shock
 If there is a pulse,
treat as indicated

17. Pulseless Arrest

18. Pulseless Arrest
 If patient is intubated, do continuous
compressions
 Recheck tube placement often
 Document tube placement confirmations

19. Tachycar
dia with
Pulse

20. Is there a pulse?

21. Is he stable or unstable?

22. Tachycardia
 OXYGEN
 ECG
 GOOD SET OF VITALS
 ANY CAUSES?
 Hyperventilation
 Overdose
TREAT THE
PATIENT
NOT THE
MONITOR

23. TACHYCARDIA
 STABLE OR
UNSTABLE
 GO BACK TO
GENERAL
IMPRESSION
 HOW LONG WILL
PATIENT TOLERATE
THE RHYTHM ?
 HOW LONG HAS
THE PATIENT BEEN
IN THIS RHYTHM ?

24. TACHYCARDIA: Unstable
 Establish IV
 Sedate patient if
possible
 Cardioversion:
 Press Sync button
 Press Shock (hold
down until it
discharges)

25. TACHYCARDIA: Stable
 Establish IV
 12 lead ECG
 Identify the
rhythm

27. Tachycardia: Narrow
 SVT
 Vagal Maneuvers
 Adenosine
 6 mg (Rapidly)
 12 mg
 12 mg ? ?
 A-Fib
 Think about
cardizem
 A- Flutter

29. Tachycardia: Narrow
 Transport patient
 Transmit 12 lead
 Call for additional
orders

30. TACHYCARDIA:
Wide complex
• Ventricular Tachycardia
• Amiodarone
• Cardioversion
•Atrial fib with aberrancy
• Think about cardizem
•SVT with aberrancy
• Adenosine

33. TACHYCARDIA
 H’s and T’s
 Look for possible
causes

34. ELECTRICAL CARDIOVERSION
 Not usually needed for HR < 150 bpm
 Check O2 Sats; IV; Intubation equipment
 Premedicate if possible: valium or versed

35. CARDIOVERSION
 V- Tach: start at 100 J
 SVT: start at 50 J

36. BRADYCARDIA

37. BRADYCARDIA
 Less than 60 bpm
 Is patient symptomatic ?
 Some causes of bradycardia
 Healthy, athletic person
 Patient on beta blockers
 Patient on digoxin
 Overdose of narcotics

38. BRADYCARDIA
(SYMPTOMATIC)
 Use atropine while
you are setting up the
pacemaker
 Does not last very
long
 Pace 3rd degree

39. BRADYCARDIA
 Transmit ECG if
available
 Sedate patient if
necessary
 Don’t delay
pacing
 Atropine may not
work for
transplanted
hearts

41. Treatments of these causes
Cause Treatment
 Hypoxia
 Hypvolemia
 Hypothermia
 Hypokalemia
 Hypoglycemia
 Toxins
 Thrombosis
 Trauma
 Cardiac Tamponade
 Tension Pneumothorax
 Hyperkalemia
 Metabolic Acidosis
 Respiratory Acidosis
 Ventilation
 IV Fluids
 Warm Patient
 Restore electolyte imbalance
 Sugar
 Detoxify
 Thrombolysis
 Surgery / bleeding control
 Pericardialcentesis
 Thoracic decompression
 Bicarb
 Bicarb
 Ventilation

42. Amiodarone 3 Ways:
 For VF/Pulseless V-Tach
 V-Tach or wide complex regular
 Maintenance Drip

43. Amiodarone #1: VF or Pulseless
VT
 300 mg
 2 vials of 150 mg

44. Amiodarone #2: V-tach with pulse
 150 mg over 10 minutes
 150 mg in 100 mL spiked with macro is 100
gtt/min

45. Amiodarone #3: Maintenance
 1 mg / min
 100 mg in 100 mL bag spiked with micro drip = 60
gtt/min