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ACLS Pharmacology dr shabeel pn
Objectives ,[object Object],[object Object],[object Object],[object Object]
 
Drug Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drug Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drug Classifications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Oxygen ,[object Object],[object Object],[object Object],[object Object],[object Object],Universal Algorithm
Oxygen ,[object Object],Universal Algorithm up to 100% 15 lpm Bag Mask 35 to 60% 6 to 10 lpm Partial Rebreather Mask 24 to 40% 4 to 8 lpm Venturi Mask 24 to 44% 1 to 6 lpm Nasal Prongs Oxygen % Flow Rate Device
Oxygen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Universal Algorithm
VF / Pulseless VT Case 3
VF / Pulseless VT  ,[object Object],[object Object],[object Object],Resume attempts to defibrillate 1 x 360 J (or equivalent  biphasic ) within 30 to 60 seconds Consider antiarrhythmics: ,[object Object],[object Object],[object Object],[object Object],Resume attempts to defibrillate
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Epinephrine ,[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Vasopressin ,[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Vasopressin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Vasopressin ,[object Object],[object Object],[object Object],VF / Pulseless VT
Amiodarone ,[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Amiodarone  ,[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Amiodarone ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Lidocaine ,[object Object],[object Object],[object Object],VF / Pulseless VT
Magnesium Sulfate ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Magnesium Sulfate ,[object Object],[object Object],VF / Pulseless VT
Magnesium Sulfate ,[object Object],[object Object],[object Object],VF / Pulseless VT
Procainamide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Procainamide ,[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Procainamide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],VF / Pulseless VT
Procainamide ,[object Object],[object Object],[object Object],VF / Pulseless VT
PEA Case 4
PEA Atropine  1 mg IV (if PEA rate is  slow ), repeat every 3 to 5 minutes as needed, to a total dose of 0.04 mg/kg ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Review for most frequent causes Epinephrine  1 mg IV push, repeat every 3 to 5 minutes
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pulseless Electrical Activity
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],Pulseless Electrical Activity
Epinephrine ,[object Object],[object Object],[object Object],[object Object],Pulseless Electrical Activity
Atropine Sulfate ,[object Object],[object Object],[object Object],[object Object],Pulseless Electrical Activity
Atropine Sulfate ,[object Object],[object Object],[object Object],[object Object],[object Object],Pulseless Electrical Activity
Atropine Sulfate ,[object Object],[object Object],[object Object],Pulseless Electrical Activity
Asystole Case 5
Asystole Transcutaneous pacing: If considered, perform immediately Epinephrine   1 mg IV push, repeat every 3 to 5 minutes Atropine  1 mg IV, repeat every 3 to 5 minutes up to a total of 0.04 mg/kg Asystole persists Withhold or cease resuscitation efforts? ,[object Object],[object Object],[object Object]
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Asystole: The Silent Heart Algorithm
Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],Asystole: The Silent Heart Algorithm
Epinephrine ,[object Object],[object Object],[object Object],[object Object],Asystole: The Silent Heart Algorithm
Atropine Sulfate ,[object Object],[object Object],[object Object],Asystole: The Silent Heart Algorithm
Atropine Sulfate ,[object Object],[object Object],[object Object],[object Object],[object Object],Asystole: The Silent Heart Algorithm
Atropine Sulfate ,[object Object],[object Object],Asystole: The Silent Heart Algorithm
Other Cardiac Arrest Drugs
Calcium Chloride ,[object Object],[object Object],[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Calcium Chloride ,[object Object],[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Calcium Chloride ,[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Sodium Bicarbonate ,[object Object],[object Object],[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Sodium Bicarbonate ,[object Object],[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Sodium Bicarbonate ,[object Object],[object Object],[object Object],Other Cardiac Arrest Drugs
Acute Coronary Syndromes Case 6
 
Acute Coronary Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Chest pain suggestive of ischemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Memory aid: “MONA” greets all patients (Morphine, Oxygen,  Nitroglycerin, Aspirin) EMS personnel can perform immediate assessment and treat- ment (“MONA”), including initial 12-lead  ECG and review for fibrinolytic therapy indications and contraindications. Assess initial 12-lead ECG
Aspirin ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Aspirin ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Aspirin ,[object Object],[object Object],Acute Coronary Syndromes
Nitroglycerine ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Nitroglycerin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Nitroglycerine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Nitroglycerine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Morphine Sulfate ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Morphine Sulfate ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Morphine Sulfate ,[object Object],[object Object],Acute Coronary Syndromes
Morphine Sulfate ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Acute Coronary Syndromes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST Elevation
Recognition  of AMI  ,[object Object],[object Object],[object Object],[object Object],[object Object],PR baseline ST-segment deviation = 4.5 mm J point plus 0.04 second
ST Elevation Baseline Ischemia —tall or inverted T wave (infarct), ST segment may be depressed (angina) Injury —elevated ST segment, T wave may invert Infarction (Acute) —abnormal Q wave, ST segment may be elevated and T wave may be inverted Infarction (Age Unknown) —abnormal Q wave, ST segment and T wave returned to normal
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Heparin ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Heparin ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Heparin ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Heparin ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Glycoprotein IIb/IIIa Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
PTCA
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Fibrinolytics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
ACE Inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Coronary Syndromes
Bradycardias Case 7
Bradycardia Bradycardia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Primary ABCD Survey Secondary ABCD Survey ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bradycardia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Serious signs or symptoms? Due to bradycardia? Type II second-degree AV block or Third-degree AV block? Observe ,[object Object],[object Object],No Yes Yes No
Atropine Sulfate ,[object Object],[object Object],[object Object],Bradycardias
Atropine Sulfate ,[object Object],[object Object],[object Object],[object Object],Bradycardias
Atropine Sulfate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bradycardias
Dopamine ,[object Object],[object Object],[object Object],Bradycardias
Dopamine ,[object Object],[object Object],[object Object],[object Object],Bradycardias
Dopamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bradycardias
Dopamine ,[object Object],[object Object],[object Object],[object Object],Bradycardias
Epinephrine ,[object Object],[object Object],Bradycardias
Epinephrine ,[object Object],[object Object],[object Object],Bradycardias
Epinephrine ,[object Object],[object Object],[object Object],Bradycardias
Isoproterenol ,[object Object],[object Object],[object Object],[object Object],Bradycardias
Isoproterenol ,[object Object],[object Object],[object Object],Bradycardias
Isoproterenol ,[object Object],[object Object],[object Object],[object Object],Bradycardias
Stable Tachycardias Case 9
Diltiazem ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Diltiazem ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Diltiazem ,[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Verapamil ,[object Object],[object Object],[object Object],Stable Tachycardias
Verapamil ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Verapamil ,[object Object],[object Object],[object Object],Stable Tachycardias
Verapamil ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Adenosine ,[object Object],[object Object],[object Object],Stable Tachycardias
Adenosine ,[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Adenosine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Beta Blockers ,[object Object],[object Object],[object Object],Stable Tachycardias
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Beta Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Digoxin ,[object Object],[object Object],[object Object],Stable Tachycardias
Digoxin ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Digoxin ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Amiodarone ,[object Object],[object Object],[object Object],Stable Tachycardias
Amiodarone  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Amiodarone  ,[object Object],[object Object],[object Object],Stable Tachycardias
Amiodarone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Amiodarone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Lidocaine ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Lidocaine ,[object Object],[object Object],[object Object],Stable Tachycardias
Lidocaine ,[object Object],[object Object],[object Object],Stable Tachycardias
Magnesium Sulfate ,[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Magnesium Sulfate ,[object Object],[object Object],Stable Tachycardias
Magnesium Sulfate ,[object Object],[object Object],[object Object],Stable Tachycardias
Magnesium Sulfate ,[object Object],[object Object],[object Object],Stable Tachycardias
Procainamide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Procainamide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Stable Tachycardias
Procainamide ,[object Object],[object Object],[object Object],Stable Tachycardias
Procainamide ,[object Object],[object Object],[object Object],Stable Tachycardias
Acute  Ischemic Stroke Case 10
Acute  Ischemic Stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Suspected Stroke ,[object Object],[object Object],[object Object],[object Object]
Nitroprusside  ,[object Object],[object Object],Acute Ischemic Stroke
Nitroprusside  ,[object Object],[object Object],[object Object],[object Object],Acute Ischemic Stroke
Nitroprusside  ,[object Object],[object Object],[object Object],Acute Ischemic Stroke
Nitroprusside  ,[object Object],[object Object],[object Object],[object Object],[object Object],Acute Ischemic Stroke
Drugs used in Overdoses
Calcium Chloride ,[object Object],[object Object],Drugs Used in Overdoses
Calcium Chloride ,[object Object],[object Object],Drugs Used in Overdoses
Calcium Chloride ,[object Object],[object Object],[object Object],Drugs Used in Overdoses
Flumazenil ,[object Object],[object Object],Drugs Used in Overdoses
Flumazenil ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Drugs Used in Overdoses
Flumazenil ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Drugs Used in Overdoses
Naloxone Hydrochloride ,[object Object],[object Object],Drugs Used in Overdoses
Naloxone Hydrochloride ,[object Object],[object Object],[object Object],[object Object],Drugs Used in Overdoses
Naloxone Hydrochloride ,[object Object],[object Object],[object Object],[object Object],Drugs Used in Overdoses
Review of Infusions
Dobutamine ,[object Object],[object Object],[object Object],Review of Infusions
Dobutamine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Dobutamine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Dopamine ,[object Object],[object Object],[object Object],Review of Infusions
Dopamine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Review of Infusions
Dopamine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Epinephrine ,[object Object],[object Object],Review of Infusions
Epinephrine ,[object Object],[object Object],[object Object],Review of Infusions
Epinephrine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Norepinephrine ,[object Object],[object Object],[object Object],Review of Infusions
Norepinephrine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Norepinephrine ,[object Object],[object Object],[object Object],[object Object],Review of Infusions
Calculating mg/min ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],=  30 gtts/min =  gtts/min
Calculating mcg/kg/min ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],=  18.75 cc/hr =  cc/hr
Furosemide ,[object Object],[object Object],[object Object],[object Object]
Furosemide ,[object Object],[object Object],[object Object]
Furosemide ,[object Object],[object Object]
Questions? Jeremy Maddux [email_address]
Summary ,[object Object],[object Object],[object Object],[object Object]
Thank You!

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Acute Coronary Syndromes Pharmacology

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  • 73. ST Elevation Baseline Ischemia —tall or inverted T wave (infarct), ST segment may be depressed (angina) Injury —elevated ST segment, T wave may invert Infarction (Acute) —abnormal Q wave, ST segment may be elevated and T wave may be inverted Infarction (Age Unknown) —abnormal Q wave, ST segment and T wave returned to normal
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  • 193. Questions? Jeremy Maddux [email_address]
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Editor's Notes

  1. Epinephrine (Class Indeterminate) 1 mg IV push every 3 to 5 minutes. If this fails, higher doses of epinephrine (up to 0.2 mg/kg) are acceptable but not recommended (there is growing evidence that it may be harmful). Vasopressin is recommended only for VF/VT; there is no evidence to support its use in asystole or PEA. There is no evidence about The value of repeated vasopressin doses or The best approach after the first single bolus of vasopressin As a Class Indeterminate action, it is acceptable to resume epinephrine 1 mg IV push every 3 to 5 minutes if there was no response in 5 to 10 minutes to a single IV dose of vasopressin. The evidence for this approach is based on rational conjecture. Suggestion to instructors Resist the requests to tell the learners whether you prefer epinephrine or vasopressin. The evidence, as of 2001, makes them equivalent, with vasopressin, as a nonadrenergic agent, associated with fewer adverse side effects. The supply chain from production to widespread distribution throughout all hospitals and the EMS system has been slow to develop.