ACLS questions

[Speedylifsavr]

I am a little confused about ACLS . Specificaly VF/VT . I understand you now do 2 min of CPR then begin the algorhythm .

So CPR 2 min , Then Defib (If VF/VT) , then immediately resume CPR for 2 min....before difibrillating again right? And in the mean time give the epi . So essentially you will have 2 min between shocks? And 2 min before you would give amiodarone?

Is this correct:sad:

.

 

[stonez]

Basically look at it as every 2 minutes something happens, either shock/give a drug.

So it goes like this:
(unwitnessed arrest)
CPR for 2 minutes
analyse rhythm (if shockable) deliver shock
resume CPR for 2 minutes
analyse rhythm (if shockable) deliver shock
administer adrenaline
resume CPR for 2 minutes
analyse rhythm (if shockable) deliver shock
administer amiodarone/lidocaine (VT/VF)
resume CPR for 2 minutes
analyse rhythm (if shockable) deliver shock

etc

 

[46Young]

If the arrest is witnessed, or good CPR was being performed PTA, then begin your algorithm immediately. Otherwise, give 2 mins CPR first. After the first shock, medication should be given in a "Drug/CPR, Shock, CPR, analyze rhythm" sequence. CPR is only interrupted to analyze the rhythm, to defib, or when an organized thythm with ROSC is achieved. Give meds during each cycle of CPR. Alternate the vasopressor or antidysrhythmic.

 

[46Young]

The intent of doing two minutes of CPR prior to defib in an unwitnessed arrest is to get some coronary perfusion prior.

 

[medic3416]

2005 ACLS concepts go are centered around excellent CPR. The reason CPR is done for 2min before a rhythm check is because you need to build up the intrathoracic pressure in order to increase cardiac output and therefore increasing perfusion to essential organs like the heart and brain. Think of this kind of like the whirlpool effect in a swimming pool, you need to move the water around the pool in an organized way for a while so the water will continue to move on its own when you stop. Short interruptions will make it easier to regain good intrathoracic pressure again, the longer the interruption the longer it takes to build up that pressure again.

Ideally, during the first two minutes a lot should be going on. Combo pads are placed on the chest (right upper and lower left chest or if there is a pacemaker anterior and posterior chest) Establish a good BLS airway and ensure good chest rise, if you have enough extra hands have someone maintain cric pressure and keep suction handy. And establish your first IV or IO and hang NS or LRS and get your code drugs ready. It may seem impossible to you right now to do all this in two minutes but you would be surprised what can happen if you take a logical and systematic approach to every cardiac arrest.

Once you confirm VF/VT defib once at 200J and immediately resume CPR (without a rhythm check) and administer 1.0mg epi or 40.0 units of Vasopressin and get your next drug of choice ready, check to ensure proper CPR is effective by checking femoral pulses with compressions and make sure airway is being maintained; of course all the while thinking about possible causes.

2 min is up again; check rhythm if still VF/VT defib once at 200J and restart CPR (without rhythm check) and administer either 300.0mg of Amiodarone or 100.0mg Lidocaine during CPR and again check for femoral pulses and check airway patency.

Think about your H’s and T’s check and treat as necessary (ie. BS, OD, tension pneumo ect.. I usually check for things I can fix right away first then go through all the rest of the H’s and T’s).

If you have enough time at this point go ahead and intubate but if its going to take too much time wait, remember VF/VT has the most potential to change to either a worse or better rhythm as opposed to asystole which is more likely to remain unchanged.
Also, remember things can change or you could find a treatable cause so you have to be flexible and be prepared to change your treatment plan.

• Important points to remember;
• Be sure to hang a CRI drip of whichever anti-arrhythmic you used last prior to conversion,
• ET intubation takes a back seat in the line of priorities as long as there is a good BLS airway, especially if you have someone to hold cric pressure (if not I personally bump it up a little).
• Limit interruptions of CPR and keep interruptions to an absolute minimum.
• Make sure CPR is being done effectively and redelegate if necessary.

O yea, this should go without saying but just incase; always confirm cardiac arrest yourself before starting or taking over care from someone by checking for a pulse!! Nothing is worse that jumping in at a nursing home where the nurses are freaking out and doing CPR on a living person. :excl:

 

[firemedic1563]

The "events" every two minutes are rhythm check and defib if indicated. This should occur EVERY two minutes. To say drug/shock is true, but may be misleading. The "drug" part of the sequence occures during the two minutes of CPR, do not pause CPR for this.

 

[falcon-18]

I am a little confused about ACLS . Specificaly VF/VT . I understand you now do 2 min of CPR then begin the algorhythm .

So CPR 2 min , Then Defib (If VF/VT) , then immediately resume CPR for 2 min....before difibrillating again right? And in the mean time give the epi . So essentially you will have 2 min between shocks? And 2 min before you would give amiodarone?

Is this correct:sad:

.

cpr...2 mins
check rhythm....shokable give shock ,resume cpr ...
after 2 mins ..check rhythm ....shokable give shock, resume cpr and give epi or vasopressin 40 U

after 2 mins check rhythm ..shokable give shock ,resume cpr ..now give amiodarone...

...after the first shock you will not give medication..only shock and cpr

after the second shock you will give medication

after the third shock you will give antiarrhytmic medication (amiodarone ...etc)

 

[TomB]

The intent of doing two minutes of CPR prior to defib in an unwitnessed arrest is to get some coronary perfusion prior.

True enough, but I would suggest you should be doing 2 minutes of chest compressions (200 compressions) prior to the first shock with witnessed arrest when the down time is > 4 minutes and no CPR has been performed prior to EMS arrival (the majority of witnessed arrests). This is based on the 3-phase model of cardiac arrest. Even if the patient is across the street, by the time the person who witnessed the arrest calls 9-1-1, a dispatcher processes the call, the call is toned out, the responding crew reacts, wheels-up to wheels-down at the curbside of the emergency, arrival to patient's side, and exposing the patient's chest, it's usually at least 4 minutes.

Tom

 

[Melbourne MICA]

2 mins

The main reason for just two minute ongoing cycles of chest compressions then rhythm check is in fact operator fatigue. This was apparent in the ILCOR research that lead to these important changes. Pts faired better (more likley to be both defibbable - course VF - to a rhythm with output or to get ROSC outright) when ECC's were effective.

But theres no stopping unless you get ROSC and only when the check is done each two minutes.

MM