Advanced Cardiac Life Support

Cardiac Arrest

Pulseless VT / Vfib Defibrillation, Epinephrine PEA/Asystole Epinephrine Tachydysrhythmias Stable vs Unstable CASH gets JULES CASH = chest pain, altered mental status, shortness of breath, hemodynamic instability / hypotension Bradyarrhythmia ROSC BLS Chest Compressions

Objectives

1. Keep up to date with advanced cardiac life support (ACLS) recommendations (i.e., maintain your knowledge base).
2. Promptly defibrillate a patient with ventricular fibrillation (V fib), or pulseless or symptomatic ventricular tachycardia (V tach).
3. Diagnose serious arrhythmias (V tach, V fib, supraventricular tachycardia, atrial fibrillation, or second- or third-degree heart block), and treat according to ACLS protocols.
4. Suspect and promptly treat reversible causes of arrhythmias (e.g., hyperkalemia, digoxin toxicity, cocaine intoxication) before confirmation of the diagnosis.
5. Ensure adequate ventilation (i.e., with a bag valve mask), and secure the airway in a timely manner.
6. In patients requiring resuscitation, assess their circumstances (e.g., asystole, long code times, poor pre-code prognosis, living wills) to help you decide when to stop. (Avoid inappropriate resuscitation.)
7. In patients with serious medical problems or end-stage disease, discuss code status and end-of-life decisions (e.g., resuscitation, feeding tubes, levels of treatment), and readdress these issues periodically.
8. Attend to family members (e.g., with counselling, presence in the code room) during and after resuscitating a patient.
9. In a pediatric resuscitation, use appropriate resources ( e.g., Broselow tape, the patient’s weight) to determine the correct drug doses and tube sizes.