Download ACLS, CPR, And PALS - Jones, Shirley PDF

TitleACLS, CPR, And PALS - Jones, Shirley
File Size3.7 MB
Total Pages230
Table of Contents
                            Contacts • Phone/E-Mail
Title Page
Copyright
Tab 1: ECG
Tab 2: CPR
Tab 3: ACLS
Tab 4: PALS
Tab 5: Emergency Medications
Tab 6: Emergency Medical Skills
Tab 7: Megacode
Tab 8: Tools
Index
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Document Text Contents
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Page 115

109

PALS

Ventricular Fibrillation (VF) or Pulseless Ventricular
Tachycardia (VT)

Clinical Presentation
■ Unresponsive state
■ No respirations or only agonal respirations
■ No pulse

Management
1. Establish unresponsiveness:

■ No respirations or only agonal respirations and no pulse.
2. Call for help.
3. C–A–B: Compressions, airway, breathing:

■ Begin CPR, starting with compressions.
■ Provide oxygen.

4. Defi brillation
■ Attach AED or manual monitor-defi brillator as soon as available

without interrupting compressions. Use pediatric pads or paddles if
available and indicated.
• When device is attached, stop CPR and assess rhythm.
• AED: If shock is advised, defi brillate following AED prompts.
• Manual monitor-defi brillator: Defi brillate at 2 J/kg using a biphasic or

monophasic defi brillator.
5. Immediately resume CPR, beginning with compressions.

■ Provide 5 cycles (2 min) of uninterrupted CPR.
■ During CPR, establish IV or IO access.
■ Prepare vasopressor dose (epinephrine).

6. Defi brillation
■ Stop CPR.
■ Assess rhythm.
■ If the rhythm remains shockable, follow AED prompts or defi brillate at

4 J/kg.
7. Immediately resume CPR, beginning with compressions.

■ Provide 5 cycles (2 min) of uninterrupted CPR.
■ Insert an advanced airway (ET) if basic airway management is

inadequate.
• Confi rm correct tube placement without interrupting CPR.
• After correct placement is confi rmed, deliver uninterrupted chest

compressions at a rate of at least 100/min and deliver 8–10 breaths/
min at a rate of 1 breath every 6–8 sec.

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110

PALS

8. Drugs
� Administer epinephrine 0.01 mg/kg.

• Give 0.1 mL/kg of 1:10,000 IV/IO.
• Follow with 20 mL IV fl ush.
• Repeat every 3–5 min as needed.

� If no IV/IO access is available and the patient has an ET in place, stop
compressions and inject 0.1 mg/kg (0.1 mL/kg of 1:1,000) epinephrine
directly into ET followed by a 5-mL saline fl ush. Follow ET drug
administration with ventilations to disperse drug into small airways for
absorption into pulmonary vasculature and resume compressions.

9. Continue CPR; check the rhythm every 2 min.
10. Defi brillation

� If the rhythm remains shockable, follow AED prompts or defi brillate at
4 J/kg.

� May increase energy with subsequent shocks, if needed, to a
maximum of 10 J/kg or adult maximum energy dose.

11. Immediately resume CPR, check rhythm every 2 min.
12. Drugs

� Consider antiarrhythmic drugs for shock-refractory VF or pulseless VT.
• Administer amiodarone 5 mg/kg IV/IO, or lidocaine 1 mg/kg IV/IO if

amiodarone is not available.
• May repeat amiodarone 5 mg/kg IV/IO up to 2 times for shock-

refractory VF or VT to a maximum of 15 mg/kg.
� If the arrhythmia is torsade de pointes, consider magnesium sulfate

25–50 mg/kg IV/IO (maximum dose 2 g) bolus.
13. During CPR, consider and treat potentially reversible causes (Hs and Ts):

� Hypokalemia/hyperkalemia � Trauma (hypovolemia, increased ICP)
� Hypovolemia � Tension pneumothorax
� Hypoxia or ventilation problems � Tamponade (cardiac)
� Hypoglycemia � Toxins
� Hypothermia � Thrombosis (pulmonary or
� Hydrogen ion (acidosis) coronary)

14. If rhythm changes to asystole or PEA, follow algorithm for asystole or
PEA.

15. If rhythm converts to a stable ECG rhythm with ROSC:
� Monitor and reevaluate the patient.
� Arrange for transport to a critical care unit. The patient will need a

comprehensive care plan. (See the Immediate Post–Cardiac Arrest Care
algorithm.)

♥ Clinical Tip: In infants and young children, cardiac arrest is more likely
caused by progressive respiratory failure, or shock leading to an asphyxial
arrest, than by cardiac disease. Early recognition and management of impend-
ing respiratory failure may prevent cardiac arrest.

Page 229

223

TOOLS/
INDEX

PALS
algorithms, 108–120
megacode practice scenarios,

165–166, 190–214
primary patient assessment, 88–94
secondary patient assessment, 94–96
systematic approach, 88

Paroxysmal supraventricular
tachycardia (PSVT), 16

Partial rebreathing mask, 152f
Peak expiratory fl ow rate, 96
Pediatric advanced life support. See

PALS
Pericardial tamponade, 107–108
Peripheral cyanosis, 92
Pitressin. See Vasopressin
Polymorphic ventricular tachycardia,

26
PR interval, 3, 4t–5t
Premature ventricular contraction

(PVC), 21–24
ProAir. See Albuterol
Procainamide (Pronestyl), 119, 137
Proventil. See Albuterol
Pulmonary thrombosis, 63–64
Pulse

bradycardia with, 74–75
pediatric, 91
sites for, 41
tachycardia with, 75–79

Pulse oximetry, 153–154
Pulseless electrical activity (PEA)

ACLS for, 70–72
description of, 29
PALS for, 111–112

Pulseless ventricular tachycardia,
68–70, 109–111

Q
Q wave, 3
QRS complex, 4t, 6t

QRS interval, 3, 5t
QT interval, 3, 4t–6t

R
Rapid-response team (RRT), 66
Rescue breathing, 41–43, 42f–43f
Respiratory acidosis, 62
Respiratory arrest and failure,

96–102, 190–194
Respiratory distress, 97, 190–194
Respiratory rates, 90
Resuscitation

cardiopulmonary. See CPR
enhancing of, 65–66
goal of, 65

Resuscitation team, 66, 162–165
Return of spontaneous circulation

(ROSC), 79–80, 119
R-on-T phenomenon, 24

S
S wave, 3
Second-degree AV block, 32–33
Septic shock, 104–105
Shock

anaphylactic, 105–106
cardiogenic, 106–107
defi nition of, 102
distributive, 104–106
hypotensive, 103
hypovolemic, 103–104
neurogenic, 106
obstructive, 107–108
PALS megacode scenario for,

195–199
pathophysiology of, 102–103
septic, 104–105
types of, 103–107

Simple mask, 151f
Sinoatrial node arrhythmias, 11–13
Sinus bradycardia, 12

Page 230

224

TOOLS/
INDEX

Sinus tachycardia, 13
Skin color, 92
Sodium bicarbonate, 137–138
ST segment, 3, 4t, 10, 10f
ST-elevation myocardial infarction,

10, 86
Stridor, 90
Stroke, 81–83
Suction catheter, 150
Suctioning of airway, 150
Supraventricular tachycardia (SVT),

15, 199–203
Synchronized cardioversion, 76–77,

118–119, 146

T
T wave, 3, 4t
Tachycardia

ACLS for, 77–79, 174–190
case studies of, 174–190
defi nition of, 91
multifocal atrial, 14
narrow-complex, 77–78, 115–116
PALS for, 115–119
paroxysmal supraventricular, 16
with pulse, 75–79
sinus, 13
supraventricular, 15
unstable, 75–77
wide-complex, 78–79, 117–119

Tachypnea, 89
Tamponade, cardiac, 64–65, 107–108
Tension pneumothorax, 63, 108
Third-degree AV block, 34
Thrombosis, 63–64
Tonsil tip, 150
Torsade de pointes, 27
Toxins, 65
Transcutaneous pacing (TCP), 74, 147
12-lead ECG, 7, 95

U
U wave, 3, 4t
Unconscious adult

choking in, 54f–55f
CPR in, 44f–47f

Unfractionated heparin, 131–132
Unstable tachycardia, 75–77
Upper airway obstruction,

98–100

V
Vagal maneuvers, 160–161
Valsalva’s maneuver, 160
Vasopressin, 69, 71, 73, 138
Venous blood gas, 95
Ventolin. See Albuterol
Ventricular arrhythmias, 20–30
Ventricular fi brillation (VF)

ACLS for, 67–70
description of, 28
PALS megacode scenario for,

211–214
Ventricular tachycardia (VT)

ACLS for, 68–70
monomorphic, 25, 79
PALS for, 109–111
polymorphic, 26
pulseless, 68–70, 109–111

Venturi mask, 153f
Verapamil, 138–139

W
Wenckebach block, 32
Wheezing, 90
Wide-complex tachycardia, 78–79,

117–119

X
Xylocaine. See Lidocaine

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