This document summarizes an ACLS update and review presentation. It describes a case of a 62-year-old man admitted with back pain who became unresponsive after being given Haldol. His vitals showed bradycardia and hypotension. He received biphasic shocks and regained a pulse but did not follow commands. The presentation reviewed changes to BLS protocols, including performing chest compressions before breaths for lone rescuers and a compression rate of at least 100/min. It also discussed treatment for pulseless arrest, synchronized cardioversion, and amiodarone dosing. The importance of therapeutic hypothermia for unresponsive post-cardiac arrest patients was emphasized.
Advanced Cardiovascular Life Support (ACLS).pptxRebilHeiru2
discusses the basic and Advanced Life support according to the AHA guidelines.
ACLS, BLS, defibrillation and Advanced medications at Adama Hospital medical college ICU
Advanced Cardiovascular Life Support (ACLS).pptxRebilHeiru2
discusses the basic and Advanced Life support according to the AHA guidelines.
ACLS, BLS, defibrillation and Advanced medications at Adama Hospital medical college ICU
Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Adult Basic Life Support
Demonstration of how to give basic life support to anyone acutely injured or ill. Cardiac support, Advanced Trauma Life Support,
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Adult Basic Life Support
Demonstration of how to give basic life support to anyone acutely injured or ill. Cardiac support, Advanced Trauma Life Support,
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
A brief overview of defibrillator,its physical principles, types, its indications & contraindications and maintenance policy.this powerpoint is primarily intended for anaesthesiologists and other health care providers working in critical care centres.
Saludos! de parte del Ceipem (Centro de Entrenamiento e instrucción para profesionales en Emergencias Médicas), nuestra misión es brindar al profesional de la salud en un ambiente de simulación( Laboratorio de Simulación ), la oportunidad de adquirir habilidades y destrezas, desarrollar competencias individuales y/o grupales ante emergencias médicas, en los ámbitos pre e intra hospitalarios, contamos con el mejor Staff de profesionales para facilitar su aprendizaje. Cualquier información no dude en consultarnos, 0212 7314967/4063 /info@ceipem.org/ www.ceipem.org y si quieres ver fotos, videos y nuestras actividades ingresa por FACEBOOK en ceipem fundación y estarás en línea directa con nuestra comunidad de alumnos y docentes.
This presentation describes the emergency department management of sinus tachycardia, supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular ectopic
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Case
62 yo man with met CRPC with diffuse bone
metastases s/p multiple radiation treatments with
refractory pain
Admitted with back pain for r/o spinal cord
compression
Could not tolerate MRI CT instead without
obvious compression
Given steroids with PPI, DVT ppx
Home methadone continued during admission for
pain control, lexapro for depression, albuterol prn
for SOB (former smoker, ? Mild COPD)
3. Morning Sign Out
Overnight, patient again failed to tolerate MRI
despite pre-medication with ativan and
methadone PCA
Was agitated and aggressive, but afebrile with
other VSS, haldol x 1 given in MRI suite
8. Biphasic unsynchronized shock (ie defibrillation)
delivered at 200J
Next step?
ROSC obtained during next rhythm check
Still not following commands
10. BLS
No more “look, listen, and feel.”
Continued emphasis has been placed on high-
quality CPR
chest compressions of adequate rate and depth
allowing complete chest recoil after each
compression
minimizing interruptions in compressions
avoiding excessive ventilation
11. BLS
There has been a change in the recommended
sequence for the lone rescuer to initiate chest
compressions before giving rescue breaths (C-A-B
rather than A-B-C). The lone rescuer should begin
CPR with 30 compressions rather than 2
ventilations to reduce delay to first compression.
Compression rate should be at least 100/min
(rather than “approximately” 100/min).
Compression depth for adults has been changed
from the range of 1 to 2 inches to at least 2 inches
(5 cm).
13. AED
Shock First vs CPR First
1-Shock Protocol vs 3-Shock Sequence (no
stacking)
Defibrillation Waveforms and Energy Levels
(Biphasic > Monophasic)
Synchronized Cardioversion
Afib: Biphasic 120-200J
Aflutter Biphasic 100 J
If first attempt fails, increase dose incrementally
14. Synchronized Cardioversion
Unstable SVT
Unstable atrial fibrillation
Unstable atrial flutter
Unstable monomorphic (regular) VT
Synchronization avoids shock delivery during the
relative refractory period of the cardiac cycle
when a shock could produce VF
15. Synchronized vs Unsynchronized
If there is any doubt whether monomorphic or
polymorphic VT is present in the unstable
patient, do not delay shock delivery to perform
detailed rhythm analysis: provide high-energy
unsynchronized shocks (ie, defibrillation doses).
16. Treatment?
With a pulse
Adult stable monomorphic VT responds well to
monophasic or biphasic waveform cardioversion (synchronized)
shocks at initial energies of 100 J. If there is no response to the
first shock, it may be reasonable to increase the dose in a stepwise
fashion.
18. Treatment?
SBP 150
SBP 70
Unstable polymorphic ventricular tachycardia is treated with
unsynchronized shocks (defibrillation). Defibrillation is used
because synchronization is not possible.
20. With initiation of CPR, cardiac output is the major determinant of
CO2 delivery to the lungs
100% sensitivity and 100% specificity in identifying correct
endotracheal tube placement.
26. High Quality CPR
Maintain 30:2 ratio until advanced airway
Minimize interruptions in CPR
De-emphasis on Devices, Drugs, and Distractions
Allow complete chest recoil after each
compression
Rate of at least 100 compressions/min
27. Medications
Atropine is no longer part of pulseless arrest
algorithm
Central line ideal, however should not delay time
to CPR or meds
IO if two failed attempts at IV
ETT?
28. What medications can be absorbed
through the trachea?
Lidocaine
Epinephrine
Atropine
Naloxone
Vasopressin
29. Post Cardiac-Arrest Care
Hypothermia protocol
Taper Fi02 to keep Sa02 > 94%
Identify and treat ACS and other reversible
causes
Anticipate, treat, and prevent multiple organ
dysfunction. This includes avoiding excessive
ventilation and hyperoxia.
Transport/transfer to an appropriate hospital or
critical care unit with a comprehensive post–
cardiac arrest treatment system of care
32. Mega-code
A 40 year old man arrives at the ER accompanied by his
family. He is complaining of palpitations after working
outside for several hours. The assessment is as follows:
SKIN: pale, warm and dry
CVS: Strong peripheral pulses and a BP of 125/80
CNS: Fully intact
RESP: RR is 22, no resp. distress, lungs CTA
An EKG is obtained
33.
34. What is the next appropriate intervention?
A – Adenosine 6 mg IVP through closest line to the heart
followed by 20 ml NS push
B – Attempt vagal maneuvers
C – Perform synchronized cardioversion
D – Give epinephrine 1 mg IVP
35. What is the next appropriate intervention?
A – Adenosine 6 mg IVP through closest line to the heart
followed by 20 ml NS push
B – Attempt vagal maneuvers
C – Perform synchronized cardioversion
D – Give epinephrine 1 mg IVP
Lim SH et al. Comparison of treatment of supraventricular tachycardia by Valsalva
maneuver and carotid sinus massage. Ann Emerg Med 1998 Jan 31 30 35
36. You have performed vagal maneuvers and there is no
change in the patient’s heart rate and rhythm. What is your
next step?
A - Give adenosine 6mg rapid IV push. If no
conversion, give 12mg rapid IV push
B - Give adenosine 12mg rapid IV push. If no
conversion, give another 12mg rapid IV push
C - Give Amiodarone 150mg over 10 minutes.
May repeat as needed
D - Continue to attempt vagal manuvers until the
patient converts to a regular sinus rhythm
37. You have performed vagal maneuvers and there is no
change in the patients heart rate and rhythm. What is your
next step?
A - Give adenosine 6mg rapid IV push. If no
conversion, give 12mg rapid IV push
B - Give adenosine 12mg rapid IV push. If no
conversion, give another 12mg rapid IV push
C - Give Amiodarone 150mg over 10 minutes.
May repeat as needed
D - Continue to attempt vagal manuvers until the
patient converts to a regular sinus rhythm
38. You give 6mg Adenosine rapid IV push with no effect. 12mg
Adenosine rapid IV push is then given. The patient develops
severe ongoing chest pain and his vital signs are: HR
220, BP (not obtainable), and weak pulse. Your next step
should be.
A – Immediate defibrillation
B – Give 2nd dose of adenosine rapid IVP
C – Perform immediate synchronized
cardioversion
D – Perform precordial thump
39. You give 6mg Adenosine rapid IV push with no effect. 12mg
Adenosine rapid IV push is then given. The patient develops
severe ongoing chest pain and his vital signs are: HR
220, BP (not obtainable), and weak pulse. Your next step
should be.
A – Immediate defibrillation
B – Give 2nd dose of adenosine rapid IVP
C – Perform immediate synchronized
cardioversion
D – Perform precordial thump
40. Stable or Unstable SVT?
Shortness of breath
Palpitation feeling in chest
Ongoing chest pain
Dizziness
Rapid breathing
Loss of consciousness
Numbness of body parts
41. Stable or Unstable SVT?
Shortness of breath
Palpitation feeling in chest
Ongoing chest pain
Dizziness
Rapid breathing
Loss of consciousness
Numbness of body parts
Unstable patients with SVT and a pulse are always
treated with cardioversion
42. After synchronized cardioversion is unsuccessful, the pt.
continues to deteriorate. The patient is now unconscious. No
pulse is palpable. Below is what you see on the monitor:
What is your first intervention:
A – Deliver 2 minutes of CPR and then re-assess rhythm
B – Give epinephrine 1 mg IV push and repeat every 3-5 minutes
C – Give one unsynchronized shock (120-200 J)
D – Place an advanced airway
43. After synchronized cardioversion is unsuccessful, the pt.
continues to deteriorate. The patient is now unconscious. No
pulse is palpable. Below is what you see on the monitor:
What is your first intervention:
A – Deliver 2 minutes of CPR and then re-assess rhythm
B – Give epinephrine 1 mg IV push and repeat every 3-5 minutes
C – Give one unsynchronized shock (120-200 J)
D – Place an advanced airway
44. The patient does not respond to the defibrillation
with 120 J. He remains unconscious in ventricular
tachycardia. What is your next intervention?
A – Deliver up to two additional shocks of 200 J
B – Give 1 mg epinephrine IV push and repeat
q3-5 min
C – Give
2 minutes of CPR
D – Check the rhythm and the pulse
45. The patient does not respond to the defibrillation
with 120 J. He remains unconscious in ventricular
tachycardia. What is your next intervention?
A – Deliver up to two additional shocks of 200 J
B – Give 1 mg epinephrine IV push and repeat
q3-5 min
C – Give
2 minutes of CPR
D – Check the rhythm and the pulse
46. After completing 2 minutes of CPR, your rhythm check
indicates a second shock. You shock a second time with 160
J, and the patient's rhythm does not change. You resume
CPR. While completing the cycle of CPR what else should be
done?
A – Epinephrine 1 mg IVP q3-5 min
B – Vasopressin 40 mg IVP to replace first or
second dose of epinephrine
C – Epinephrine 0.5 mg q3-5 min
D – Both A and B
47. After completing 2 minutes of CPR, your rhythm check
indicates a second shock. You shock a second time with 160
J, and the patient's rhythm does not change. You resume
CPR. While completing the cycle of CPR what else should be
done?
A – Epinephrine 1 mg IVP q3-5 min
B – Vasopressin 40 mg IVP to replace first or
second dose of epinephrine
C – Epinephrine 0.5 mg q3-5 min
D – Both A and B
48. You have given the epinephrine or vasopressin and
completed the 5 cycles of CPR. A rhythm check reveals no
change. You attempt at third defibrillation. What will be your
defibrillator setting? (assume biphasic)
A – 160 J
B – 200 J
C – 300 J
D – 360 J
49. You have given the epinephrine or vasopressin and
completed the 5 cycles of CPR. A rhythm check reveals no
change. You attempt at third defibrillation. What will be your
defibrillator setting? (assume biphasic)
A – 160 J
B – 200 J
C – 300 J
D – 360 J
50. The third shock does not change the rhythm and you restart
CPR. You have shocked, you have given vasopressors
(epinephrine and/or vasopressin), you have continued with
effective CPR. What medication should be considered at this
point?
A – Atropine
B – Adenosine
C – Amiodarone
D – Amiloride
51. The third shock does not change the rhythm and you restart
CPR. You have shocked, you have given vasopressors
(epinephrine and/or vasopressin), you have continued with
effective CPR. What medication should be considered at this
point?
A – Atropine
B – Adenosine
C – Amiodarone
D – Amiloride
52. What is the correct dosing for amiodarone in the
Pulseless Arrest Algorithm?
A – 150 mg IV once, if not effective may give one
additional dose of 300 mg IV
B – 200 mg IV once
C – 300 mg IV once, may be repeated with 150
mg IV one additional time
D – Infusion of 300 mg IVPB in one hour
53. What is the correct dosing for amiodarone in the
Pulseless Arrest Algorithm?
A – 150 mg IV once, if not effective may give one
additional dose of 300 mg IV
B – 200 mg IV once
C – 300 mg IV once, may be repeated with 150
mg IV one additional time
D – Infusion of 300 mg IVPB in one hour
54. Amiodarone
Ca Channels
Na Channels
K Channels
Alpha-adrenergic
Beta-Adrenergic
Refractory VF/Pulseless VT
55. In addition to amiodarone, what other antiarrhythmic can you
consider as part of the pulseless arrest algorithm?
A – Labetalol
B – Lidocaine
C – Digoxin
D - Flecainide
56. In addition to amiodarone, what other anti-arrythmic can
you consider as part of the pulseless arrest algorithm?
A – Labetalol
B – Lidocaine
C – Digoxin
D - Flecainide
57. Great Job! You saved the patient He has been
stabilized and intubated, but does not respond to
verbal commands. He is transported to the hospital's
ICU. Since the patient is not responsive what would be
the most important intervention in the post-cardiac
arrest phase?
A – Monitor waveform capnography
B – Obtain ABG
C – Induce therapeutic hypothermia
D – Monitor oxygen saturation
58. Great Job! You saved the patient He has been
stabilized and intubated, but does not respond to
verbal commands. He is transported to the hospital's
ICU. Since the patient is not responsive what would be
the most important intervention in the post-cardiac
arrest phase?
A – Monitor waveform capnography
B – Obtain ABG
C – Induce therapeutic hypothermia
D – Monitor oxygen saturation
59. Possible Exclusion Criteria
Coma from other cause besides cardiac
(toxins, CNS)
Known bleeding diathesis / ongoing bleeding +/-
recent surgery
Sepsis
Ongoing shock with SBP < 90
Editor's Notes
Patients who do not respond to a total dose of 5 to 10 mg should undergo evaluation for alternative causes of encephalopathy.DDx: opiod intox, NMS, serotonin syndrome less likely (Afebrile), hypoglycemia, COPD exac?
Although no published human or animal evidencedemonstrates that starting CPR with 30 compressionsrather than 2 ventilations leads to improved outcome, chestcompressions provide the blood flow, and studies of out-ofhospitaladult cardiac arrest showed that survival was higherwhen bystanders provided chest compressions rather than nochest compressions.
In most studies, delivery of more compressions during resuscitation is associated with better survival, and delivery of fewer compressions is associated with lower survival.
The total number of compressions delivered during resuscitationis an important determinant of survival from cardiac arrest.The number of compressions delivered is affected by thecompression rate and by the compression fraction (the portionof total CPR time during which compressions are performed)
When any rescuer witnesses an out-of-hospital arrest and an AED is immediately available on-site, the rescuer should start CPR with chest compressions and use the AED as soon as possible. Healthcare providers who treat cardiac arrest in hospitals and other facilities with on-site AEDs or defibrillators should provide immediate CPR and should use the AED/defibrillator as soon as it is available. These recommendations are designed to support early CPR and early defibrillation, particularly when an AED or defibrillator is available within moments of the onset of sudden cardiac arrest. When an out-of-hospital cardiac arrest is not witnessed by EMS personnel, EMS may initiate CPR while checking the rhythm with the AED or on the electrocardiogram (ECG) and preparing for defibrillation. In such instances, 1.to 3 minutes of CPR may be considered before attempted defibrillation. Whenever 2 or more rescuers are present, CPRshould be provided while the defibrillator is retrieved.With in-hospital sudden cardiac arrest, there is insufficient evidence to support or refute CPR before defibrillation.However, in monitored patients, the time from VF to shock delivery should be under 3 minutes, and CPR should beperformed while the defibrillator is readied.When VF is present for more than a few minutes, the myocardium is depleted of oxygen and energy. A brief periodof chest compressions can deliver oxygen and energy to the heart, increasing the likelihood that a shock will both eliminate VF (defibrillation) and be followed by ROSC. Before the publication of the 2005 AHA Guidelines for CPR and ECC, 2 studies suggested the potential benefit of CPR first rather than shock first. In both studies, although 1. to 3 minutes of CPR before shock delivery did not improve overall survival from VF, the CPR-first strategy did improve survival among victims with VF if the EMS call-to-arrival interval was 4 to 5 minutes or longer. However, 2 subsequent randomized controlled trials found that CPR before attempted defibrillation by EMS personnel was not associated with a significant difference in survival to discharge. One retrospective study did find an improved neurologic status at 30 days and at 1 year when immediate CPR was compared with immediate defibrillation in patients with out-of-hospital VF.
Adult stable monomorphic VT responds well tomonophasic or biphasic waveform cardioversion (synchronized)shocks at initial energies of 100 J. If there is no response to thefirst shock, it may be reasonable to increase the dose in a stepwisefashion.Synchronized cardioversion must not be used for treatmentof VF because the device is unlikely to sense a QRS wave,and thus, a shock may not be delivered.When VF is present for more than afew minutes, the myocardium is depleted of oxygen andmetabolic substrates. A brief period of chest compressionscan deliver oxygen and energy substrates and “unload” thevolume-overloaded right ventricle, increasing the likelihoodthat a perfusing rhythm will return after shockdelivery.
Adult stable monomorphic VT responds well tomonophasic or biphasic waveform cardioversion (synchronized)shocks at initial energies of 100 J. If there is no response to thefirst shock, it may be reasonable to increase the dose in a stepwisefashion.Synchronized cardioversion must not be used for treatmentof VF because the device is unlikely to sense a QRS wave,and thus, a shock may not be delivered.When VF is present for more than afew minutes, the myocardium is depleted of oxygen andmetabolic substrates. A brief period of chest compressionscan deliver oxygen and energy substrates and “unload” thevolume-overloaded right ventricle, increasing the likelihoodthat a perfusing rhythm will return after shockdelivery.
Unstable polymorphic ventricular tachycardia is treated with unsynchronized shocks (defibrillation). Defibrillation is used because synchronization is not possible.Synchronized cardioversion must not be used for treatmentof VF because the device is unlikely to sense a QRS wave,and thus, a shock may not be delivered.
Studies of waveform capnography to verify endotracheal tube position in victims of cardiac arrest have shown 100% sensitivity and 100% specificity in identifying correct endotracheal tube placement.During untreated cardiac arrest CO2 continues to be produced in the body, but there is no CO2 delivery to thelungs. Under these conditions PETCO2 will approach zero with continued ventilation. With initiation of CPR, cardiacoutput is the major determinant of CO2 delivery to the lungs. If ventilation is relatively constant, PETCO2 correlates well with cardiac output during CPR.
Quantitative waveform capnography is recommended for confirmation and monitoring of endotracheal tube placementand CPR quality.
There is no definitiveclinical evidence that early intubation or drug therapy improvesneurologically intact survival to hospital discharge.
If IV or IO access cannot be established, epinephrine,vasopressin, and lidocaine may be administered by theendotracheal route during cardiac arrest (Class IIb, LOE B).The optimal endotracheal dose of most drugs is unknown, buttypically the dose given by the endotracheal route is 2 to 21⁄2times the recommended IV dose.Providers should dilute the recommended dose in 5 to 10 mLof sterile water or normal saline and inject the drug directlyinto the endotracheal tube.256 Studies with epinephrine263 andlidocaine251 showed that dilution with sterile water instead of0.9% saline may achieve better drug absorption.
Since 2005, two nonrandomized studies with concurrentcontrols and other studies using historic controls haveindicated the possible benefit of therapeutic hypothermiaafter in-hospital cardiac arrest and out-of-hospital cardiacarrest with PEA/asystole as the presenting rhythm.As noted above, an oxygen saturation of 100% maycorrespond to a Pao2 anywhere between approximately 80 and500 mm Hg.
Bicarbonate may compromise CPP by reducing systemic vascular resistance.313 It can create extracellular alkalosisthat will shift the oxyhemoglobin saturation curve and inhibit oxygen release. It can produce hypernatremia andtherefore hyperosmolarity. It produces excess CO2, which freely diffuses into myocardial and cerebral cells and mayparadoxically contribute to intracellular acidosis.314 It can exacerbate central venous acidosis and may inactivate simultaneously administered catecholamines.In some special resuscitation situations, such as preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose, bicarbonate can be beneficial
Lim SH et al. Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med 1998 Jan 31 30 35 Conversion rate of up to 28% with nonpharmacologic therapy
Lim SH et al. Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med 1998 Jan 31 30 35 Conversion rate of up to 28% with nonpharmacologic therapy
Adenosine is recommended in the initial diagnosisand treatment of stable, undifferentiated regular, monomorphicwide-complex tachycardia (this is also consistent in ACLS andPALS recommendations). It is important to note that adenosineshould not be used for irregular wide-complex tachycardiasbecause it may cause degeneration of the rhythm to VF.
The heart fills during diastole, and diastole is normally 2/3 the cardiac cycle. A rapid heart rate will significantly reduce the time which the ventricles have to fill. The reduced filling time results in a smaller amount of blood ejected from the heart during systole. The end result is a drop in cardiac output & hypotension.Unstable patients with SVT and a pulse are always treated with cardioversion
The 4 most common types of SVT are A-V Nodal Reentry Tachycardia, A-VReentry Tachycardia, atrial tachycardia and atrial flutter. These rhythmsare regular in nature and have a rate > 150. To distinguish the differencebetween the re-entry tachycardias and the other types really requires a 12lead ECG. The diagnostic criteria to determine that it is a reentranttachycardia is actually quite complex.