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American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL

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Jackie Taylor
Jackie Taylor

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American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
6American Heart Association. life is why" ADVANCED CARDIOVASCULAR LIFE SUPPORT ii;-"ii*i"*q*.m ".e* ."iiiii i o:iills,,*.-".e;s.rc6*'r,6 P-, 6".r'd lMcged&ftsuPlfudMdd PROVIOEB MANUAL
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ontents Pan I lnbodrrcdon co.m o..otdon rE oo., Co.@ Frlrlo!'brb5 ed ArpaEtb, Ef,G mlhh lntdFrllato ld c* Aos FrnrnB &.r. ACLS c'lus .nd Pn@togy Kmrt.dg6 ACtS PB,fir M&ud Po.L{ R.l@@ Cad3 PM A€pMia Cref!, F.qiffi ,br &r...dt, CorE CdrPe.l ACIS PEld..M. rd,ah6.v&tbn bt-dC4r@.Uhs@rt odhy Alsssn, B.vr.r. ard TdEldmr &dE 2 2 5 a P.rt 2 gllltaln ol Ca.. t3 13 17 17 c.dr9P.!*ffia, al,udtdlot Au.l[y lmrlv dr rn Rdsclalron $slm. Pl!l)**,.nd O]tcom. A sysldB Apgwh A.rchrtrrkh! €nd f..db6.k Adn Cddt t Syaeq,,. S@ts 'O. th. Pns." 4ft A.tEriM or EMS HGpibl-B@.d ConF..drs
R.gind@t.n or St k c* Cmmunily @d Prolslon l Edu4lbn Po8,-adthc,,6iCa. Targolod T.mpdtu6 M.n.!mml Her.dynMic and ennhid Oplih zslion lmm€d* . Cdmary B€fldtsM Wu! PCI N€uEloq'c Ce and Foonclidllon eldtdt, hd.narrr^h, at t l*tu It€ N.€d lor Tffi cddiac arur Ied. (|.-HordLl) AEpid R60ore slds tlbli$ed Studi* lmplm.nralioi oI a tLpld H6po^* sFl6m P.n 3 Encdrv. Hlah-Pcrloirn.nce Tctm DttrtErlca $ 13 ,9 r9 b ?2 25 B0&6 d lr, lrt<t4 a*, lt',t,r. ol . Eah-t|*lodr,Er,r. l*n Fole or rrE 'I6m tsr,t EI'ME, ot El'..tN t$9h-ffiti,,gr tM Oyrarrc. whar b Communical. 5 25 26 6 2S 31 Fdn a Th. StI3t m.tlc lppro.ch 3:t ,rr. Sl6lsirtb lppn dr OveMew ol rhs SwrnEIic Aa@ch Ovdiew ot th€ BLS AesMr flD P,iM, Ae,gdit Osvis or rhe Pnmry A@,Mi t r. Seo.r*y Asd,l,,l Ov*l6w ol llE Sddta.y r."-.tdt 3 at
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I S Whva 6Armrlctt Hoart Aaadadon.
lntrcduction Ccurr. Da.cdp$on .t!d Ooal llE L,'d'o.d crlto@ra. Ul. sreo.r Acr$ Pia/n . cda a .lan!.€d fr, n€dl.ap.oi.,'s},Edih.t,lddp.dcp.|..0ErEl.g'enoloniopirre nary dd 6 otE.n dB&I, dElard- IrE4n did.clb i,firlro. rtd drlv! pddpnb. h .[nJ!r6d c!s, .b&na },1l oh.d thdr rt lh ]n trs kosrrtdr lld Itrr46 on ol Edio,urddll} .rur, ]mo€dLl€ pd<,nu. e.l. Br. ahrrnrit, 3t!rc. d !qr. cd!@ lridM6 lacs] n* !.6r ot oE acls Pro d.. caa E to imp.or dtu r.{ .d'n ,.n-tt ot sdir: orBr .rld o$, €rdi.adra!, .d!F.B IB)gn -.jy 6.9iEr !d tr..'dr6 Cculr Obl.dn!. t F. .,rc...*i dna&noi ol 'la ijae 3il&il! ,&ld h. ,al. to . Apdy nE Bet [,{. sr4r.rl lBls), &n@y,..d setdtv Agsdiqar L. . $.t rndh d.Ir.td o, adi Pafirn! ! F.rio6 prfpr F sh.qdr'ry BLs, ftd'! rdtzno €dy dl6r Mp'Ms sd hEsEdn! dt &tn ld d6rEr dsflnilhw (]Eo) u5 . F€.o{.k 'tsd,adyat d . M..rr d,, nE!.!(En o{ 'r.9iituY ,16r . tle6 rt ,esnilio ,rd nEr.o.itn ol Acs. ,rcrri,E .cpr.!rd. diFciib. . ois srv,u!.[bn .rn n ^rrtd 6l **A imtdk{ .ps!9ne dEp6tt 'i . F*.!.@ kdyamllhu &d ta.rvsfrvhniE ud nv eh ir ddr* 'Ed d oi1dlcaEl*lglalbnonc@. .r,.'lon..,ym6.!@t.,bEd}dyom'uEdudryotynm'atharsyan,,tl h.r&Id'l:ldi*detlrh.&t.dm . ri.@ch€dEad . P..tm dt nsEoErn ol €d- lrd ftlrdrrdid ol rEldh. d tu Ir ol cn. trddn, tnr.drra PGr . Ev,ld. 6u*haliE .ltft dutinq , .!rdl.o a4ar $6u$ di.uou. -s.sd n enpm-q re,u* tcpF, ouhv @nrqrs s. p.'r-r! phFio.et: lt.m,,|ddis.mEdhl..db*llolh.t4n . tro(,.r.i-tu ffil.lt d - t Edb.. d.e..d. t't'FFldnrct t' . R.e9,larErr{$.1t5.Mi6o@Jll3nF.id'm
o Cou6e Dcrign Course PrEr€quisites and Preparation ww'fu.n'or9/eccatdenir
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o ACLS Ptovider llenua, Abbreviarions
o Advanced Cardiovascular Life Support
Opiimizalioo ol ACLS C.,1ttc.l C.orrc.pt' M'nimi,e Intemphons in Compressrons Closing lhe Gaps Ataiay Aset dent, ,lentl.tlon.l Sci.n@
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o Taxonomy of Systems of Care: SPSO Slrucllre Process Syslem Outcome C o ntin! ous O Gtit thpmwn E nt htoqt.L.r Catabataton Meas!'eapht Ben.hna r.o. Fedbact
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3{ctlonlng Pneudoc lor OPA. dd l{PA! Lk nr rdlslns Fduion! whn !.hs e OPA d NPA: ! a*.ys d€ck 3podffiw ElpiErkrm immal.i. y .t, ni.rt on ol ofis an oPA or .licpftlj@eab#e]..d.qft3l'npcnl6'lsuEddidalo@ ds3,pl.oli,l.de@ tl'dllffieumv.'l.bl.,@m@GlofEr sktoniig is M .snr6 Mpoft nr oI maitulnng a p.ild!, .y. PBidoG $eu sr$on dai6 c.@ o1 bo$ @rrue .Pmabl€sctd&Y6&rylota$lbddynolqfuadeqd.afu 0 nm H! b qd-dt ddy. e capabl6 ot proud'no M .id!w or s.ars M 40 umn ai Ihoadorh. d.l'sy tob€.nd av*umoln@ rh 30omH0 wh6lhefubescl'mp.ddfun$d0 . dicr tE nouit or sucrbi loEo 16 u$ in ch dm .nd rnlubalod palisb. Ao$ &ft iexibb sd nord 6ucl'6'no @th€6 s .vrrabr€ so, &r/D& €rErffi nBy b. us.d h th. roJf' tr ,e s.( nsrlu. c!fr'h d rvlL h len lU El tub. d..p Mjming. Ag/d er,,.rrt les, Y k u4 e @d ro ffi ,E epha,ynr rhe e b.td rd luo1]oniig}ick*l.l'oN5i!p.nicuhbm.td dt n "rgH 'A&]6ioiollhinffi,rmlh.odpfurynx&tn3$pha,y .P.iionrr{'nhfrr,Elghm'ng ' sd6i0 rhd4h e n pla,.my l€. !PA)roGtub&( oldEo.@x'naFftd*]t'cl.ftMlef' r iron.r..tlv.lJcddre ollhr@prf,ry@ p.tdE,rlnI
o .App]ysucionbyMcudnqlhe'd E I lsdi,fur'Pa'ho!]d.ordc!.d Motrt.tthe patlentshott nte pulse, oxy1c. srrnoan. andclhrcrt rpttca?1ce dutinq sutt.mq t btadycatdta drvctopr axygen satu.ro" tttt or chnicat.1pp.r. t e.tetenarates tthxn4r sEnanng at an(r A rrt'stet hBhltaw Lrqe. I Providing Ventilation With an Advanced Airway
ril. @ d ffibn4 ror rlnr tp6 or 6dY'd.r*aF l,fuih h rho !rt- oredM ot tH rrv@ b bleid ,r dp. omE b4i. lcls PB/ider cd*. lo b. pFided in tl* E or ad!..... de.y d416, yd m6r hm ld.quaL in'rrd ld+ rnc r.d ono.rn! .rponm, Psvrdd *rb im.n .dvso.d aldly0 hd parllcDn. F I q*d ol COI ro d*um..l irld mlni,mD @mplioaliMt r^ ,r. mua, ,!! will pr&rE MtltiiE widr s.dE 'o.d.k!ty in d8e&n l.n.C..l_ r'o rdbrhn wir' clEi MpME. b,ry,|a.dH lb b.t114.d ne* dtu.y E5 dfld.i*zr dE 6tt b EI hrt/Dlre,l 4n F** .aMrb5 E dtur,, h i! @irhle b 6 nE l.ly'sd nur ir*ay E , tI4!€ l.5Ertr6.tu aiftzy nst.odmrn . €!E ad or,.ip..anc.d p,Dre.i drd ,.tun t r,Pd rBtt d .Y ht tu r 56 tE slffi llhrE& tmh-i3s/...errt{ l, lm i"lb@tan 6 rr, dv.nt 96 o, tE lrrno..l iub. e gimid lo rh( ol r,t. @phac..r-tadE l lub.l howr, tE I'yE d rub€ E nm oonpd atd la Mplb.r.d b ild. n aft@ prd6so.ak t r.r.d ln ,E @ oI rh. layic-l h.a. m3v .tsds h ! , .rrndlir b b6snEr vdid. 6 EI ina.lih lg .,My rolqdmrn h dn* d our.:p...xid rlvdrr. rr4rd Fran *f$t ttu ww Lopr.r..Frtci.., iE sDrDloar-h.ll..l lub. B s .d!.n €d s,rsn .ll,nsirv. ro Er mrba o. Tnn dlie pi.vrd6 ad.qd€ FiLlrrl dnrE d. r. e Er rub. rl 6 aepLbb ro @ $. ad{@-tdE rt4..e.n r!}E b, Er tub. kr m., tr@aes-n h t_ dr& .tr* Oiy p.olrd..s .rpd,. 'd *I,, 6 d rrro,id rta dp'Ls'arttdEr E s6 $€ Lryn!€.r rriut toi .dio m lt sru<hd vr.6.i1. lrd.h.rtoq/cr.txt .9 hl m@ iiftlrulhi on fli! p'!..d@ I s€ ,s sri.rt [&6.]i. iffi,hdnd!r'G6ib!0 fi . 6@reorl-r..lE.r I(.{o.
o Fltcaullona lor Tiaulna P-licnL a b.fr eflEry or rE bs srD. i.. p'ro.n'ne Er nnlb.tid € offi h6€ b rrn't&a rh. AcLs s.rts w trtry ein wirr s6 r.c.d6. r Prupm ir inru!.tron by esb .g s. nr4q,y .qdpnnl ' P4tom Er dubaion i* lh6 srudmr whbs .) ! rhfar6 cu{ or culrs on rho lub.. . alllch nEv ridbnb!!. . Confim @d pb6jr by phFEr oiffrdim sd . d!fi.nanon et Cdtl@ ,&.rem c.!.Eo€phy b lg,.rh-(,.d lin adllon io dinial e. nd) a tu rci,!r'-r. nll,'.d o, @.fimng a$ Mirniq @rer dsd o, e Er [b.. lldn'@ Fwdds nEy d!x.l d6ld* tts ,.v,dfr dpnqlphy ! rcl &obl,e O.ty d@iflin eturid* shetd Nt m Ett ntun i@. |a se rlE E 'd.telr@r lnrubali.. e.ton n ih. sllrdd i/.brb (rN.ndtdt/...n d.rrl re I'rc inr(E @ o hu ,.o.€dE Ul6 of C.i@id P!.!rlr! . cico'd pleuB in nmgre$ @r ods mry on r $m. ltl.6!e or Dddioi io lh. i 4 a/ tor 6D tiol fd gei ( ns,,tldio1 dr.! b.9 hek 4n'r.nol. r()shd. tr wF Arcvid ns aesr.d 6 arhn ror par.nE {t$ kewi or suspet d c*Fl dpri. vftd E@srv. h..d 6nd Mk mdms n pardswrh u*bl. @,.d sp ercolumn m euB 'Ewrbt€ inju.y ro rh. lpin.l d d wds 3 mimr 3d.dr cold 'nir/. AppErrnndy 2% or paii,E win dud ldm ru'&9hloo!ul,.!ph.l'n'ao'ngnth.EDhaal!pf.ll4uyftbE*6hpl.d ilBpdf,dhe.hddl.cdh|u'y'AgIredd-yp.tMgfimultoi'h@ injry B. pdtey d/ijoc if . Fr6l rs tuspd.d (pjd 3pft ,ipry Elmpra @ pdigns *rE ha€ bm invorv€d ,n . rygh. lr€€d mdd v6hEr€ cdl6M. haw r.rhn iim a hsilnl 4 e nluEd wrrite di,1.c F. ow rh6o pEaur oN it tou ,{p . orn rheai ay by urtis5l6w rhcr,nnounsd6res6, sd@ rudrint.!. vs dbn e Eis rk. e , h€d rh+nt,fr 'm'p!1'tg l,n,Du.,c-ddrfu',.ffi.1 l.dl.. o'mffil'- sslac*ddEs@ygnpbd.lifu.y I sp,Gr 'mmdi.ar6n d&rE m hdptu dui@ n.@e
Acute Comnary Syndrom€s Case Tn€ rcLs allrdd m61 hd. lh. baic knowlsds€ ro ese .id eblta par {ft *]lh ACS Prr'."b ,, drE cas. h.E s/grr sd stmptdB ot acs, Lctudhs pastble 4 4. 4 wil u& rh. ACS Asdfim a rho eu'd. ro c lnical sid.gy ACs @ io ol.Fry p6ln8 ldo 1 ot 3 EcC ..r- .!ffi. a.n dh difllM rtrLqi6 ot i:rc ald m.n ctu n&.ir nE 3 EcG d 4m @ sr*.qM *dd s4odr^g d'{dE d. iiidy, sI s.sd d.rGs 3!t {Frig erFi4 aild Md'aodt qn niar EcG. Tt6. e dnined i. rErCS ,Jsdihm, bd sr€]d *in rm'BritE 6p€ii!6n .fd.oG r! r. rs or ths dB K.y 6mpon.nE o, rhie @. .rc . rdsntfcalion, Mmml ,nd uas !ln't,lffitol@]bl.Acs ! Etr8lEs*l d st Eotfus ol dE o.!dn wfr ACS/SIEM ii,,Ird,m. rot reE Suddal @d?r de$ $d r'@l@. Bldydhidh6 @ @ 6 ltr i:Eh.tu Prdtd?r *1rr u'&rBr!.d ro *nEForo ts nry$m M s FlrrEd r.. inm.dE . .idprs ar dsfibdndiM .^d .dmhisr.don or drus d .rocr,icar $(apy tor s)nBom.i. Aihoush i 2- ead EcG 'il&pl!t{]on ! b€rdd tE sop. ol tu rCLs PiDMdt c.ue, !m ACLS p.lvdqs *llrtus i2-Lod Ecc Edino JdE Fd $m.lhis .ag llm. d6 nE idsnifdiM .nd man€orE r ol pdid *{h sTEMr ort'. lt rca atlg re@y ,'d ll!.ljd @.06 ffiE io &016 6pd, 'n $E ndd ol Acs. AcLs ,Mnd imp.rlanr dti06 llr€ Aclsi tt vds coe pr6..ls onry bao kD*l.asE rEEing d .diy rEtrEd and b€ p.iodt ol "pB 6FgIB on, dri.r or lcMmrc pri, and tsrmdr or ..ny r,+thEaldrn! @mpra!- rbnr. R€FriGton @y nvorv. t,r. us or llblinorirc lh.Epy n dMa'Y oLqEpiy wth PCr (lo, brroon angioprary/slf'rhgl wh u$d 4 ln. n[r.r reprl6M $ar.qy lq sTIMr, PCl a cdrod pnm,y Fl, .brt .nd nhd rrcmbo ..d ddd.E rlE d14! @ . Fb'ircMrc hs@y {os'.w) Addltodsg*tde&Nrcli.lohMtr,pya,n*{db.fus.di.llE . ^dffiim diphGpiab (Aoa dasoni:tu lcrood.s,lr p.4,{d lies6rd) . Anororftin{onwn .l .n4m. {AcE) inhib ss ! NMG-coA reducrE5€ 'nhrbi@ lsrdin tEdpy) . Gryoos.cn lb,4l16 inirbtors
o Goals lor ACS Patients found.d.El F,Ej. oHcA F6sponse S advan.e di oi orrha,e.e,vnq hosp rr
Eady prrq$ ro.mdon a&nifidr D|lc- ro.tn thll Pl.qu. ruplur./thrombs. SIEMI D t{stE.aqs FGolutlon/ra.bL.nd I C Unstabb argins D Micrc€mboli c E
o ld/r. cdnrEt srtdffi x!odnm-2o!s uprh. i-...rb&fcouBs6fuffi f,eiaglltf lce Tha louta Corcnrry qrdr!.tra. Atecdth 1}E A@!. c@uy Sy lrE ru0qir6 lF'98 4 qiitc rr &d .n od ,ls .o.d d€r. rr, . edinr p.Ebg ,,$ ?ir9i6 rllE€0s ., lcs, tu ars Bp.''daindEd{l+.6{iEl.lffi6b.!htrr..dd.sffi&d .clim. IlEg kElud. lrins orr9€n. api*l hib.ci/*rn, .nd DdpnrE ( i..d.d. ud o fii^g h[h 12 ldd tcc (si,lp 21. Eed d rh. EcG lndi{.i $. Elirs pdids my cMpr€i' a irbanotn $-.!y dr*k*r rn noll'y th. lGrtB ED or . p6rrrid
aMl-srEu "rf,n .pp.or do lstsp 3). lr M-ol-hGpibl pBid.B e unabl. ro .mCar. llB i,'idal n f6 botq€ t5 p.ddr! di!!r rr f'€ hcoilal u. ED povidr *.!rd impre sr$6€quor ,uhd leB oi tE pari€nt ! nnvd at dr. h4pi.r. €o pdsnn r lhourd Ev e th. or-or-h6pirar r 2-tsad Ec,c [ *inabh. I nor p.dmsd, ac{u si(on o, th. 12,hadECGlnqrdbeadon .ho006rr.ro6n r,2€lh.12redECca!@GE ddqdia p.lldn! do i ol3 o@!e a..dding 16 e.rylR o, rh. sr sald (nE p@6 o, r€t blndrs ble,r dmk 0tBB) d tr. i 2 r{d Ec€. TEtrndr lwlM- . Lk anr$i.ddeisr Acs Th. ACS C& wn iocr. M rh6 oany Ep.rtlio o, ri. SrrMr pdbd, .mph$Utis hiriil cs ed oold rd@ rd E@tulron tE@e nf acs ^llorh [!E 20) s.vn6 s@.r srid€riE rq appY b $. dd rE€E . pdi€nll bd.d d syspim d tE 12ri.d EcG H@[hc@ p€Mn€r ori.. obrr]. qr.l cadr.. h.,*.E (c(-MB. odr4 lEp.nr6) n m6r prird! rhar srbw .dd[irRr ddronr Tm rmFdanr pdnb for sIEMr n€sd decson ro .dmrnisr€r flbrlioldc il*Eoy or pslom d d0iorric mmry aishsBphy snh ffi.ry i'ljMrim {.nqioor..t/.tsrhs) 'n srEMrpdr.nt3. ,Ca flg.tllrt n abr..,'d rno sbr6 6 rh. dle hn 0!'d. @t .nd tEt6': LsqBtrv' or'&1.tria (sr€p ' , arn h..pbl rdnvd noimdrd (9.o e) t rmm.ar.i' ED .wr rd ffil ls!4 3, . crarrf.ns ot pah3 &ddinq b sr-!.!nd e4$ lsier6 s s .nd l1) ' STEMIIST@ 5 t'@h 3J ldrntl0c.Uon ol Cha.l Dl.corrilott SugoGiUY. ol l3chdnla Ydxd]djdkwho*lododlydddiM,.n'{eefuoldmi.c''d.rdFd{, &rd rrgd.d .rdudron ol &ay p3t€n1 $w hiu l atsltu 4496r pdsbro acs dadnh 1}' paM nEy prqiE t'B disqirdt ,l@ 4 p.Be s igNlE ds Srnpbms &!sdi$oIACS m.yats imle . ulwbrdbb Dc$6. rull,B. { rasrr{ !€€ar mitu6 luMry lr@ ftr a ro* mind6l . CB d!{i.n 3p.B.d.,O b h srB*k, ,'€c*. @ t bod' ffi, d r* . chd d@riod sp..id.'s do ,*
o STEMI Charn ot Su iv.L I EMS Assessment, Carer and Hospital Prep.ration
ft.vu6 lhoud bo ief ilE wn[ tf, *rim indrc.tons, caurim $d rEffi or .rdo EMs p.!vld... stdud adminl.td drrm r in. p.t d i!: dysp6ic, b hy?ormiJ, h6 06r* d96 ot td riir@, ha e dslJ oryle dlr.tir r8. tu so96. d $ts oxyld sna!.. E hkff p,!v{,.G ,s.& tffi. oxysr d*&y ro , dhEivdy fsrr.r.d orri.rEgro6i^ {rE roi s% r sd, aGe il5 u!.n E ha d b-i *bnah.d ]n ,'morrc pl|rnE win !6per.d & c6tu Acs, @'doB nEy @ sido. w thh.rdhg lupprffi.7y 6xy! nBapy rn trrdo parisrts Asphk (A.etlsalictat. Aci.l) A d4 o{ l8a b 325 ms or 6-rnN@&d .spsi c.te mnEdrd€ lnd lB.-iobr inr*nbn ol thmbore ar r@ducroi by (hbtrs Cdda cl/ddrylde (cox t) tr.r.r6i. e m or s. lrrlEFd rn erid prt.'p.ni3 n tEnlr. roMir. Ina 6pidln,'lhllbaEod@@i',y@du,msdot''elM€d.hdFl' don{y md .ft, ib,imMrc ih.Epy. Hish i6p.!ddys6.1 ie.5 s[ ri'd r. muimiD drhr oxygs 66rio. r]d, ,r M, rlrr.r orrlo ffi T'i' w]l hca srrorr oryrd d.rvry (c.,6. drbl, x rld dyld oonir$ trB cad& dnpd E rim[€d. rh6 !rM-h or]gd rlE py dc nor rf nE pdrtti h& id e*s ..prb 3nd hE do hi{ory ol rw 6prdn a[r!r/ aid m di- d.(s ol lEnr Gr d€edino, sN rh€ p6r6r &ptl. 1160 io 325 hr) b clEn h nE hiud ndE ol s Acs. rsm a .bo.rt d bd.i rrH .rt*.d ,B *rb *.n6,.d, pertar- My ll 6oBr*r ,6 bal 0i6 r.k€ ErJ dphi 3'J0r6ito.E (r0o Ds) id !.rraE si,I nffi, Mtiis, d.rir p€9irc urq dE@, d dn* disrds or rh. lppe 6r f.d Mrcgty$k (Clycqyl t kltete) Nitboly.dn .ftdlvdy Ed@a i&h6lc .lEr dLco'n n. a'd ha bs.fd.r Far'.dy' 'wic .lhcts. rh. physrro!'c .ltd8 or niu& c.4 r.ddim . Lv dtd ,rgri €nrlar- t lFv) e,iL.d ftdsh P.r'rld ,6i, Gis e ,6H 1 dinsud ,ir,rslrEn bbbr ld 3r.Ey -tul .,!ry 3 ro 5 nhLr6 tor ono.ln! lynptoms I i k pqnitld by DodLd enrD] &.d no oont lndLrrro.B di.r H. nce Drovidds may 6xat rhs d@ iric. (rot or 3 d@l Admrnrdr nrtlohdrn o6ly ir rh. p.i-r 'ffiiF h-iody@i.ally d'br.: s8P b si€ale fs 9o hm Hs - tu bM ,ri 30 nm r'{g b.r.* b.!.rrt€ 0, kmrn) ald oE halrn. ! 50 ro 1o(Vmin, Nibogtqin €. €dhro. -d r'..dsb b.6.d dfio5ly r dd.n n p.lirB rltn i..d.(ud. d,1c!rr pEro.d. T}e 3nu!t.B h.ruds . hLrtd rill lll nd iV lil.rcdn. tw rnlmllon may complhaL e rnidor wall Ml. v(y d.Pd.d o Fv rl ^0 9i.su6 to mrn r.ri c!.r* e$', .nd bb.n saM. r Rv 'nr'did cfu b. tur.d d, pr.ed$ nd e Etm h sm.Ebj.g niillB b p.td 6 f'lri' sTEMr. rl tlv irrft- rirn ! dnld by nlnl{tu F!d.di.r r.d d dini.a f,6'n9. by r .rpdsE d prov'dr nin {Dd. ,'d oihd lEdrdor! (mdrrx'€} d vd@{.pLtiE dru93 {didB) m (d.Lnh.!.n a w.rr. . lt!.t 8r.., t .dyqrd., d r.drya'dl r'6id u* or .koolyc.n. h pdr.nL wnn hrld.i6id lsBP r* rhu so mm Ho), m .d brady..rdh 116r aEn sryih), . Bdn ,l.nh.d..ir.. mra.b. q, Avold trE R ol ,*Etrr*in ir ir rs M' pd.d&klM'hddEp.Mhaid(o,l(h.8'l-ffi'6ldihh@iu . Ih66 .Oifr e OrE rry 6.d i0 dEd. drr. furil.o ' h .c6 ol Frmn,y lr}!.rb!i.6 &n h 'sbhds win ^ih€ ,Ey
o c !. rf .p ale ieq mo@r nel ior che e wlh.ador n lSrE Ct alc.l conapa. Parn Fohel wilh Nilroglycerid Use oi Nonsleroidar Antnidlammatory Oruqs
l2.Ln t zCtD EMS @!'k slukl obrrn r i2-r€id EcG Th€ AlrA ,enn ndt d oi hcpir.r u,ar od sl{rhu EMS sFl€ro Th. Ara @mnErd. outrm !s ol 12-Lad out{l-hdplral Eco. ld F dtE *1h doE .nd .ynortu oi pdlbh E s& $. slulhni v,bo.,r. ('w]fddycrtxld) ttr a smd€ lmm.dlrt. ED Ar!.i.mcnt and t .ttn.rll F€evar mr,fids or rh. c0 slds rh€ rm b @i '61 a,t ,9..d. EpdtusM rh.6py ,th fb.mrync d Pcr d both whrch nEy 6dG. md.liy and hin'm'.€ myG. lt SIEM| L idtrrii.d oi tr r2-r.a cco, .Mpr.r. . frbrr- ndtrh ch..t]h .pBlpn n, ri. hEh-pslm € r6.m shourd q p.iionradb.r@mvrr) da!c6rhopdsl th. I2-lead ECe ktnet ih Ftstre 22) is at tha centq of the d*is@ palhwal k lhe milagfieat ot i*henjc chest dt*ofrlon and is the onb n@4s ol i<ledtryina sfEMl dmsdmdl@6mch6ldff,od'sigMsd !ymp16s or h.an t6 uc .ad e h'story dsk racb6 rd rcs, aid hisldical l3aru6 lhlr may p.Erud€ rhs @ or rLb rcras Forrhe pdis w n1 srEMr $€ ooars oi mp€duio @ lo orw ibdnot{G withh 30 mrdss o, md or p€nom Pcr virhin eo minuiB ol t. i.ou'kml*ML6.t&!tcc
o F{@ 2a effi ho* ro ,1u@ SIenEr dMin ,lr l'fr 10 ttu A.Byn€nr an r€birrlnd or rf, @i'n ii nE fiin r 0 'xr6. !ru,& indrd. . chek vti.r.Ed lrn.v.ru.r. oxylH erlraron, . Tak a b.iel re6.d hr3r.?y a.d prlom . ay!r.3r *!nidim. . cmpbr6 rh. fb,rndlnc dekrin fd dEk ror enroMEnldB ir radidngd . o6i.f a b56d ent,r. ro d.r4 rrfiiar .'di* Edr( r.v€ts, .ler!t6, .r, . oar.. nd lfu r..$h dEd rfay [* nB 3) mrin- je dE Fd..i! evd h tu rq. nri' ,eb mt d.r!v r5.ndylk r!*,y 16 SrEMr d &rv.roi . dE pcr ,'Jor.: IlE EU[s or c.dr.c mri(@, .h6t I Ey, -d r.bdlhry 6tudks 3no!E not d.rry rEo*tus on *'€Epy unl€s cri^tc.lty @65ay, .9, .u3p.chn &dic di@noi din'4.!dfuyb.cG*kDdinpdxddh 6danii: rYp. cts dMid: . ory!6 ir hr!.Mic (or x rE rhs $96) d no6 or hi b{B . (hitu (es, moDhim t dEorig defilo.t d m €!pon$ to nlttul Beru$ $e .!€6 m.y h&. bs !i@ oui or ho.pli.r, admintErs inii, or &ppt.- tur,y d6 6 .drc€r€d lse h drr&io ot re dtuo6 in rl p.ai@ r&!.i, EMs a$s,6, c&, .'n H6Bbr PEp6'!t n.)
tlt Ll, C.*rata. C!ffiy AF.r6r.. Oxygen, Aspirin, Nii..l6s, and Opiaros Ctassity Patient3 According to ST.S€gmenl Deyiation Ct.sllt lnto 3 O@op, l.r.d on Si-S.rr.ra .tand. ass( prieib nio r oirhe r ro o{rq chi add I ona ,nrodsr on lr'oPon,nl may STEMI fhe mAnstay ol teafient to' SrEMt E eartr Gpe||u'.n .hFtapv achreve.l Mth ptn ary PCIartihn otYhcs-
o FeFico.lhd.D}lolSrEMspenl hea4hu<.|Feiioner.h€'nel.t,edusonlhe lFcor tromd,raiods.noi.adnomd.craioniodtuglorPcrr rh6se4n.lor iqaibmol,l.c[.cknlappro/ak nElo|dll'ioii'lhecJ!oIacl! .Fd'Il:,,hssoalolFodoollc lilblroyssslhedgdele!€n a pc rac q.e!ardr6s! or doray The heprci6r.{jl.pedusof,n.alsgyov,ionnolyrC ry afier rhrno nr.s n pal eds who ma! hale eor s( ed pro! dea tpedo,mnq no/e rhan 7s pcrs Fr leart 3 sk sd pc rac ry ip.dorn
|r.ICLS Crsa tq.t Corcn rys]t<fo,n. Pr n.1 PCr may a so be ofred ro p.i ard . nra{r onl n a surpods rhe traisrer oi [and rc ower monarl! liei FC!Gi be cortaid.arom r. r ioncs aid s .dcared Alblro}lCaqeilol €eralo. qffirerrhan 2 mm irl2 mV |.asetrasihef5lf'bl.ol,1:lsedtde!bU1is ,tctharapyaleasroows slsaso€a$nabaloq!g,blno}1]cSlo ..,.,".,,..."..""'.-'",".,-"" arnasprnmoFhneandlbltro,l
sllMl Ihe assnt s. blorry d scus!.d b.row u$ 6r bNar rud 6, P2Y ! rnhibrtoq D b@kots..id orycop6l6n rrtl/rrra.hrb16w nor b. @v6*€d Us ortEelodh k E .nd a d.r.ir.d kn*r.d!. or Ih. lp.dtum o, 'n9know]..o€o'tErofuhsoicllnlcalld'13 H.9r'n 's ..unftry qi6 6 .n aapd rd Fq ,rn ibnmryrE h.r.ry wih ribi'i.le'fc 4ds 1nPA. Bropre. r.i&r.prel [ 6.r!o hdd.d h dh, sp*ilc hishnsk r d nbir6rFi, ed p@phruE r@ vs* r'Mh. emb.r's Floirs *irr pEroi96d b.d 6r &1d h.d L @ Emd@ri! Ml n rlu @ rhe druss ,!u m6r b6 r i@ w'th d6n9 sh.dore ltr lp.ofrc cl'n'c.t M.!i6 the inapqop al6 dosing ahd fronionnq ol l6pon t6apy ha c6us6d ** hnedebtul dgdling d naiot hqnoohaCo in S7EMI prtimte P@vi.@s @ng hopsh 'toed to XN* tha hdicetbft, dosiaq, a.d us l. rhe spernc.4CS calogo.iss. fhe dosaC, uso, end.lLdl@ h* b@n dditod lfrh !s. in clihical ,i,att Spaili. patlohts nar EquiE doe n@dilicali@. an th. ECC lledb@k tor woghf-blsed dosrrg guid.],G. tntwals ol adninistztion, ert zdj6t- 6enl ol low-tute)laLw.rght h€pa.n b td.l tuNtic., so6 tho acctatla gddelh* t@ dotailod dt*@ion ,D 5p6rfic 4t69di.., ttapatin (UntQctioo.tod d Lo*.naohcul -Waiohl i.lldo'et3.cn.ddr6n'l.n RMre e oi e n(rcttFi € mr 'tu.n.d a.! h& d hei ehM 16 eli'tur y mdE Mar'ry n slrMr N ndDrtdn 6 ,ndi€rd d ud w'd.ry ri r*h.f,€ 3r11dffi h tr prcrdr.d oyr ros.ar o rd!.dh! roG bea* 4 e b. fuabd 'n ap.tdw'hpotmia!|yund.bl.nJn..,ls .[Ere o, iv nr€rr*n n sllMr e . rl.Lv6r c 6l'nu,E crdd &@nvl 6y..oors to &dhqld d sp.sy d.crrdin . Pulmnry q,€nd comprd'ng sTEMr r rtlda3tr cmpio'in! srEMt TElmnlo@3ugnqlvn]n@l@niealolb6 lnFofrnr s rd*rr..hr ri r xa sBP oer.r rhrn so mm 8! . L'h[ dDp 'i SsP lo 30 mh Hs bde bexn.'ihyp.n6w.DdM. t umll dED h saP b r0* or lqr in r umli dEp h aBP 1o 30 hm Hc b.t * bunN h tuDrItrEls Ddqn
Acute Stroke Case rh. idstf.ad.n ,td irlr lM.c.'En ol pltAtu *$ &ri. lrdc ! sf5 ,r *oa. ora rcLS FBt!' 116 4@6 ptttd,t. ol Mrr-tu t'd d an iatuBrd asp* d lrrtd h-lr6pnt ai! rrDr, @ orrr rEp,Lrd eub dok @ roc'e d r tr.pE r.knni*lon &'d 6shrt or po €d uhh d6k ! R.pE n 3p.n lwillr p@n!d nolfl{toi) liJ a ladlity c.p.lr. ol rB'dlng el. li+cphal @t srok 4E hdlds i,t. t ,.brr'ty io €prary r,€Lnr pdhnr dlqlbll y ls fh.rrdrric th..r4 r ramh*llEtd ol rbndric tl@ ro +@Fial crrddd6, *u' lkbrrlt ol Bxdoqi: mldrcd &P*!ab. rlhn!.1iiM . Cdik arb.i ol R t{trB .rddr. lro drdd@la th'roy .l.ilidh.6l,l.|trco.fi@l,ldr{!dn.ffi*,nloa!t6l.6iiil.v€ll.!l€ nE Eld t E 'd s..L - iEEE d.d by tE MNo6, *r"d' 16 ll@mcxr.d llElr*o6dro.t d.rrdoi ol *do F.ri,ft.IB B!€ls d goae,El(' b. drb".d ld.t lcl 30!t ol o'.!.tu *rrr *!i. !n!*. ,r''i''ltml.. lll,' rE EcG do6 nor rat Blsriy d, .6idn.c 6 omplrsd rm.gr$ny pI m. No ettdr6b. s lp.cirE is nDl., bu{ rh. Ec6 mr E {lly otlddr4 .r . lxd aMl d drtyhmiE sud, & dnLr flbn{.llon a . {@ oI e mbdh .tE*. Maiy Fdor. *{h tuk may d..M$aro {rhr$nl.r, but It tf, p.r6nr is hmody.e 41y d.br., mo.r atrfu1hmilB srl mt rcqoLr. lEnlm. . Inm . qdr6 .slMd 16 lemmnd edh. mm[o.rns dudr€ rh. f6l 2,1 hoE ol e.rurtoi in pa8* w]f' &ulo eh.n'c srEk io ddd al',qr ,rariLranon &t pd.nll.lly M+$@L.hg amymmiis Dtt g, lor *oL. rhic d$ iisr6 te di4.: . ^!Fo€d i..ndrirc {ri 6P l
o F.or.W.i.l F.ca. Majo.lypes ot Slroke heb.aiA{houq[6r,dlolsn'ore.JI.sm@, Approach to Strote Care 3a/n
,r,. iClS c.3* l@r. strL Fdddanool F.cb Siroke Chain ol Suruival Thestokecn3iorsur a lFsue25)&scrbddbyrheANA3:orheAne.caistok ,[ Fddndrdd.l F.da. The a D's ot Slroke Ca.e . orus/Devic€: Foriof. o, erdovasct ar rie6py C@k o, Slroke Ca.e
o The N NDS has esrab shed oftcari. rrospla rme goars ror a$essmenr ad m.nage 4. n raron or rfu ioryr c I h erapy n apprcs are pai etrb 11hos6 wihour c onra'ndra The Natioflal lnstituie of Nourological DisordeB and Strcke Crili@l fim. Peio.k ave a tme depende benef r ror r br norrl c rheiapy a[onol/y,&io}1|clheEpybegiswlhilr6onslof hm.dld€ndElogi..$smd lftlpBt {on or th. CT e.n adhindranon or iib noDric rEEpy, Admini*aliono,fibddy{crtl.B,y, tm.rllomon$lol3ympbn. rin.d foh onser or rymdoms
ldil S.4.cld Ah*. llaprt rn C'-ll-F-* o o h-ll.d#** baera.b.drbca5(rr.h- *.-Ha'*|.-{.r$.*t.* bi-l*r-r.d-I+ '...hdg.,d'd,JFih
o ala..M.a,.llsotig'.ld.dlo@ ldontlfic.tion ol Slgn3 of Porslble Strok. . ldd'fdtr or 3En3 Md rynproro o1 p6!lt . nEr. ad acr,dion oi -dgfty . cdicd EMs as6hsirE ed adpns (s'op 2) d jabi zarE. lst.p 3) . rnh€d ar€ nercrds'c aeMd by tE *oro 16 or d€sisne l$op a) r cr gtr, Mdn'a!. d io hslBhase (srap 5) . Fdr.orir thmpy 61 3nttirEdir. ir cdidor. lSrG 6, 3. ,nd 10) . c:.ld sde l)e (sr.pr r d 12) 'lh6 s'EB .nd symolms ol r slioro may b. subto. ft.y ftruds lfl ry.rt' r r6rrrE p@ue sre Fts . Pd'd'ns hqh piuny d6p.ich i rNrdd os bFidna?. ,i tdevta cPR skr13 d o$r .uD@n vo @ th. aHA Eommonds rha! .l EMS p.lsd b€ tr4n a io 6..sn ze shk. b, ude . naroioljc d,Lrroi iod Mh a b6 circiM, ftor'6o[d sde s..h lcpss) ITabrc 5t d r€s, 6!4ELt d @ sd6 ol tE b.dy .Trubbsp6d].Edd.llbdrE . tlz'n63 0r ro$ o, b.r€no. or coo.dinat$ ddd FHid egns - rrndds oI sdc clJdry h.n or aI 3r'.i<o paiffi e div' EMS pov@ rhe srd od @r .rfiJst ldd or m.ipsfty tanspon ro nE hoss r.L ]}rs adv hss or Et s rscpd 'ndtne th. f.ltowh! . EMs peeind can rd.nro and respd a srEt6 lal d ro a hosp i. epabt. or pbv'd nq acds srrck. ce and nolt ih6 hsp[.r .r th. patisrs impondino .r var day € cdicd e 'n lr.ry rDahdn or pd.nlic Citinndri Prctaspital Strcke Scale 1n. CPss dsi{6 3r6lc m rh. b6h or 3 physicat 1nd'ieu: . Fac'ar dmp thdv. in. p.r ftr mLr6 or ty i. sho* r6lh) r Amdfrlhavarhs$.nrcos.!6aodhordb.rh&mour w h d6, up) . Abiomar s@ch thdv. rh. p.risnr say, .you can Mch u oid d@ n& rhk l
sy 6ino ih. cPSs, m.dlcd pren €l . 4allats rhe pdid in r€s $d 1 min'n6. rh. p.se or 1 fndinq on n* cPSs h4 a 3s.itiv t or s9% &d . spsirEary ot 8s*i *tEn uEd bv DEncdEl Nvd*. wfi dadard raliing ln nFtc E ognnb., pdeEdc d@nsr'Elod a scirNity of 61% io 66% t6 Bq 't rE pali.'lls win s1bk6. An, @iving lr.lilng li !s ol . 31rcr. rV ior idslrtins parionls wid' shlo indsdsd b Itl. a Th. cxdnm! lt t€pltd 3t b aeh t*hl d.o9: tiarc t'€ palid slw ,{md-bdh 5id6 of ra6 mv€ €quar, lrr .tltt Pdrr .lr$ .F rd .!d,nd botl am dEttt dr, *ttl ,dB uo ior 10 *dtd. {rh@ 2!) taond-bdnrftlll4lh.m db<dl,@do i.rlMnd @!.. ir*t , 1d' B piq'do. d,it nw b. Abstn F@md*@r,md m m dni. &u. dped mt nx ,'!.6tr1.oG+Hawp.nsl *y, '!!u @1 rffih old do! m Nml-Pa$.d @t cod wods sirh Alllomd-paried stuB wods, t€ !r. wdg *o]ds, or E unabre rd sp.a* [nreeor [ .!y 1 ol tiii 3 rio6 ls drmd, tts ptadlv or a tt!&. L 7296. T} tffi ol al3 rhdte6 hdlcd. fd t E gob.frv ol.rr.,5 b oBt.f- 3516. MdrrMlrm t(. an BU, PsEkrliA, Llu I s.otl T, Brcd€'i.k J. cincin^afi PEiDsp br stuk. sar6: rcpodu.ibirry .id v.rEit. /4ft Fd,s ^r.d 1esei3314):373_37s rv6 p*_
o
:.?;r:---i.g Crilical EfS ALcairrsnt3 and icllons Pespib EMspmv]dmmunminmn6!}6 .,dbeg.nlh.oisoiolgymplma.d parifir .nvar ii rha ED sfftnic arrcke ft6py on be poided only n th8 arpop.i:n8 ruMns hosrihr ED, so r m ]n rh6 fi6rd 6t d.rays (and may p'denr) d€rin'r'E $eapy Crrllc.t EfS Pdrom . 6pid od-d rEpibl .ih*. .'Md (Ct65, s{poon $. AaG {n p6v do $ppl€modary oxyqEn ro hypomic {eg, oxy$n satudiod bs dr& e4%) srrck b tm zm. r rh€ Parbd wai6 rrm s sp *t$ symploms of Ln+.it rrE pdld't .apidly ind cm8idd tiiS. b . tur. 6b., supp..r c@d@rlm.ry rxc!6 doilis lreleo't H pe,ibr€, brrng 6 {1rnB, tdiry Mb.r1 or ca.llwr w n lh. p€ridb cMfim tmo,onido,nEk synprm.. ftovdeoHiva]ndmdimloldaEeisqhosp]b' cirino tnrEpdt ch{k bk d gll@ rpDl@lr d rEdic.l Ihe pari6it wllrr *u16 stoke is * r s aiB.y obstldion, hypdd ialron, d (atdy) Mrclm c p! mona.y €d8m. fto 6mbi narlon of poor polnqon d hypoxmE wirr exacebate ad .ri.nd i{hemic brain inlurv. aid r6b€tras*ai.d wihwG B.lhoutn,+ospiizldn.h6pll.lmdicalp366ndshdldp.oidssuppftnbry oxyqsn b hypdnic (8, ox),s.n duErtr s rhe e4%) sto*s parients d D.lretu In Bcnriry siqrc .s or stoke lstep t)
o Fn$.tun 1 F.cb Skoke CenteE and Stioke Units on6plo,dulnsou|oihosptaha$olSlrcke nromar m ro the EMs sy$em and the commun'ry e$urcesio*leyadmnGlelibnoy{csole.do L^qd€ntlyi9souc6soln6u.oldg'csxpedse I br no[r cs or ef,dovascu r rturapy ar rhar rac' ry qELlyoJlewhenpaieshosplaz In-Hospilal, lmmedi.le General Assessment and Stabiliration fhe goal ol the strcke teafr, emergency physician, ot othet erpeds shootd be ro assess rhe patient w,th suspected strcke within 10 ninutes af anivat h the Eo: 'tine is brain" (Step 3). PEvi& $pprmenlary orys€n b hypdflc 1oo. drre-
tt aCUl*aarLll* troipny M hYp.!rrsr', skr. scae lN Hss) o(. sm ar r@l .xpdb&donpd.lm'ndpmimob oda an Bmdadr cr *ao or rhe b lmm.diale ]{eurologic ^.3.s!ment by Stmke TGam ot Deslgn.c obdi B 12 ead EcG, wh,.h ay iden y a emr or onq.ins AMr d a$rhmias lBe. ardd abrirr.riM) .r a cau* dr mb6rc dofus&u''ali'6i'ms9{,d t,+lhrcdmngdy1lm'amldlo p&culadynlrel*.lh.nud'.!€|lboFtdl6k|.dy 6 c3rly ebbr6. rdmd or ionr'ia-rhErd'n! &myrf,nE (b.rdy@dE vr. a"d armMnfl , IAvl mnducrtr bL.k) oo not tNat th. cf w to obtdn uN tco. The goat tbr neutotoEc assessnent is wnhn 25 ntnutes at the patients atuvat h the ED: "tine 1s brain" lstep 4).
o Cf Scan: Hamordraga or xo HamoEhaga ass rhe pdEnr ntudrogic ddus by usino m or rh. 'Ie advanosd srrcrc ed6 l{ational Institur.. of lt a[h Sirol(e Sc.L Ite NlHss ls 15 nc b assa 0E EpqEv. !f!*6pslid . llrb is a valldaled @su€ ol 3lDk6 *vdty basod m a d6lailed EologD .rdinat6. a dorail€d discu*bn is b6yond lh6 $op€ ol lh6 AcLs Povids ctue. r rt a cT scan s nor @di y av.irsblo, dabirts 3nd pbmprry irangt* lh. patsr loaiacillyw]lhth6capabiy .DonolgMas'lmh€pam'(rlP^ fhe CI scan shootl he conDlelad sithin 25 inns ol lhe ralist s dnvel h the ED a.d shoold be redd wlho 45 hi nes lreh EO etual: iN is CJ p.,n!ro.. CT {Eiosraetry n nasdii lE* l@'m:g''gffioIpd*6hlGF:ted3l,<,G6hdldb.pl!frpuydgD.Er'd bv . .iirtd.n .k rod in ndDm.d4 inkp.eralo. oaraniq te 3rud* 6terd nol drray iniriahon 01 ru n PA n diorb o p6rhds. ft. pE*nc. ol h6mdrn4. vaB3 rc h.m o|h{e d6im'n* tho en st@3 In llaal]rHr lRou6 20A d Bl Yes, HemonlEge ls P6st I hmoda!. s ior.d m h€ cT s the paiqn R mr a cd'd'dar. rq rlbnrclrE. cone t . n&6log'sr ( ntumtu'ssn considd tdt& ld appDpd6r. c.tr (9€? 4 ssd oI tE pdtrl *llt d. Jlrc{. rs b6 pqlor .h.s . llroks. A.s€ss@.r are 'nclLdG 'dqniryr.s dhd 3tudu'ar abnsnaliriG rhar iLY b. cpsBbb rd rh. ptu's .ynptm d iEl oe.en cftr.dad.. lo fbndnE k py.IIErd'.r ll@,161cT !., BtE nd 'nip...rn ler ld. pa d,iU' d. No, Hnoihago ls Not tu$ont ntEcTsasllffim&i(k or h.nuh!s. d rc s'gn or o$*.hdnEtiry (.s, r|ry ll]h s!!r€), dE pat d rEy b. . ardidd. rr fib.i.dyrc r6.py tsr6r6 5 sd 3) lr h€mo6.!. k nor pEsr on rhs '^trar cT e6 &t th. p.ii.d b nor . endi&ro rd tb.noMi6 rtr orhfl @ois 6dd, oM.€ &prin (st4 9) srlE 4cialy or orllv drt pd1m'ns a s*6rosne m l* b.bw) Arhoroh.!plm i! d. itu.tu inr.. rerbnmrsE rh. pd d mud h e b sdy 3*db* b.rd. Gpi,tn 6 9,s d.iy. olhw s, us. rh. .uo@irq rdn
7t ict s c,€,l@l. sai*,a h-
o Fibrinolytic Therapy FibriDofilc fher.Dy haqe,lhspanenlmaybea.and'ddelol,blno,lc ar e bi t and 6k ,rar r car on sfapdympmvnqlo,adnoma'ibmo|tCs . s qni, canl h.ad aauma or prior sr . Eevatdbr@dprcsd4(sydoic>1s5 mm|sordiasrol,c>rlommNql
7n lcLs c.t!r ra,r. StEr. bilo6 or d d dor xa nh'btuB vrh ebvarad sonsirive 6b.rarory 1* G4h as aPrr. rNF, plal.rol @uii, and €cr: rr or apprcpdft tuclor xa et vity asaF) . siood q ucoss con6l61's <50 mddl 12.7 mmo!/L) r cI d ondGr€s murliobar inladim thyp.ddsiiy >"{ cercblar h6m6pheE) .pal6smayEeElbrno,lclhaapydspe rcke symproms 1cb* ns sp.nbneorsy) 6c1 hemoihase (wth n pev ous 21 davs) lwrhin pcvio$ 3 monlhs) r a..hEkrd 'ncluds emo us F smic srrcke. fiMd Arwasa suid€Li6 Evsiotrs ph}.]od*lh{pe'tgi4uiedokeGE 4 dtoaquars c 1+ ' '@rea (rl iPA iinued r NF 13 >r 7 0r Pr is ereialed by ocal labdalorv $adads mbr .@ min d pbr; ot mr I d Asuliad.Uqsi$no)dcshalep E p'eenr iTatr e 6) ft e maior comp.atoi or rv dPAto nqe rrom m no ro malol Aiq'cdema and taB sr
o r $ no,1c theEpy lstep 3). d scuss rhe rsks and Iamiy i avanab e lsiop ]ot Aner rh s ds.csoi. f eropdc6d wrhrbnno}1crherapy qv.lheparenr Da not addtnislet anticaagulants or antelatetet tteatmqt tot 24 haos allet adnrntslntian ol nPA, ,prcal until a lollow-ub Cf scan at 21 haub shaws na lnta.Gnial hehonhage. 2e r a lEcAss 3 lEuropean coopsd !e Atub sroke srdylr thd sp{r m y am bd N|NDS or EcAss.3 e qrb q crietra fiabs 7),s . save6 sroke (NiHss s.ore >25)
,n tCtS c...*Idi 8tr*. Endovascular Therapy subsbnialne{hqhqlalyevdenc Aswhiblno}tClherap}'Flenlsm .arci d adeB or Ddin! MCAIMr) caneral Stroke Care
o E€dln Strote Pathway anmi patenG ro a srrcke un t 1'r ala abldlror c a€rur o bsenal'on lst p 1II m. ud iq ftntavasc u a, voru me les apprcxmate y 75 ro 1 00 Hy06qycema s6sc'dedwrhro n rsimenr o, hyo6arycem a n orheorG y s ucose r.ve s q€al€.rhar r35 mEdL an.genena in nPA 1a par enr se srb3 ror rbrf,ornc h r* ror Acda B.p.dusjon rheBpr .NG'npreN5mg/hltdeUpby,.5mqAse.y515mflUbsmaimum15mg/h: . cnh6' aetrr thydEraz n8 marapl ai, olc) may b. consdedd when arpopiaro
rr-*rrr ol uod, s., drtg.n & lf acl--ritlFtlddratl . ltoiE M r.. Ey 15 tr*xll-b.2 lE- nsr rrE dr.t iFA o:pv. n! dy 3D nl'rn6 ld 6 hqr., .ld ,- Ey ,ur lr 16 hq-. r, rr&Ic br.od Ee l&2lo m l! rdEl.lc l,b6d EEft 1&1m m Hc . t-a&l 10 fi N ioxoEd by dr*Ifu lv ffir$n 2{ n!r'r*r d . ltr.sSti lv 5 nE,l ftn tp t d..rt<, dl. r by 2.5 nl,,t Ey 5.15 mkpt+ lrbio.d FBe nor 6itdhd ddl6t h blooi EB6 >lao mm rh, Mddd !dBdfudy'84fr{ldBlhi,dd.l*E d*i,rddhld,l.!i!ED,fu I! @..odffir or drdi rt,?qLndo. h pdltdts d und€rlo.e ca€rnao lnnc ddijillg.M''yp.6h.E!..nl,BB 24 ho,!.n.dErolst!*.. u isd.f,nEde*ad*b,Ean 6l oir!.tE ,rdld hyp..kEi. 6 r,l sing ol @r! tui,; .hlo € rcr *dr d6l!lr.d lcla rtb: Ld.r or Er{r.n6 o. pddr' $lE rM fr&rt rlrlEM d o$d m.dr.rl indicdjc {o. aos@16 !€.LE n d uod rxeE 3}erd i. M.d t @n'i9rv (Bi:.d ftm rE P.eoB ourddh.).r
o Catdiac Arrest VFlPulseless vT Case Nreds vT s.r 6 cnidoy lu^doqswl b tu f6r 3n@k ewhg€aoppdunylodm',€.fi{- 16hghp€j,orurcol@mbeilvo6*n'bpcilmhqlhssssdand&lon skL s. Duiiq rhe BLs ars@nr r. nflboE ril p€rrom coniitr h si.quEriy Pdmary asesmtrr. mrudr.! ftyihm @osniis lshdkzbte ldus rci.h@kab.l d.n. 1 o) &cs, and advanc.n areays TIE sl]@s or aiy '6u$rars mri 6 b!'[ s. sr..no be oi h'gn-q@r'ry CpR d d.fbi1]aion*henrcqu'dbylh6p.trIsEcG,tryirm,roimFvsc@,l,ad.6mci asss ,E Fdmanc6 or eh 3y3r6n cmpo.st o''t *lEn podm.@ 6 &dua'd 6 patciFfu 'n a sFlm gt,d'v€ly 'nlffi lo 'mprove ca rhs @4 ol qudiry fudtnffqf,eo, .s}<mfuevaBionol,&*ia .sbalelcEnodslosdfudili€d&Ir.ff.i.g anorhs chaEcroisr c or h th,qu.hy siud'* dnondare rhar he rh.ac poudm 'nrmpi mmpEsss ru @ on.^ and rd ltu !ons. in $mo ca*. epsnd ng 25 chesr cm@ssio" rmb, iCCF) s im *+en dsr .ompEsois ,€ p6.lom3d. ccF srEu d bs as hEh N p6'b.r ar r@! fiOSc dd sun'varro h€et, dr*h.rg.. odtymqtvffid66va,da.MlolBeldioErlglr]@aIdMdft i{ee€d(,111@n1€&B.rclqdmg suryryar b tussllr dL-h&g. . 11 is mpglail to sMru h,maio^ .nong dl nrs ii lhs sys6 ol c&, 'rc]Ud]h! .na mmpaEd inina ty ro pdor D.rtoM.. d 0 r.grdris .an i'citihb hE b€ichm.,kns .fion.
rt ,/tc[s qr.G C..d.c ,^rt vFlPt/E',.', W reFs$r}bdedlyaeslolmpo€ms'ids Ihsca*ivoiveslhaseEcGfi,lljms ' vF lexampre 'n F su€ 30) Managing vFlPulseles3 VTI The Adult cardiac Ariest Algorithm rhe Ad! r cad ac Ared A eor rhm lF que 3rl s rhe mosl 'mpodanr aqorrhm ro knos r Ashocrlbredrthm(vF/pursessslrndspravedonthe.fi sdeorrhe3rsorrhn . A ronshockab e hllhn 1ay or3/PEA) d spraved on he rqhr s de o1 $e a sorrhm Al€sr asorrhm lFqurc 3rl Fapdt*t
o estheSequen.eolacllonsloperlomllhehtlhms ,t l*" "t t* ,t *l
aracr"nq rhe manua derrbnlatoi and dervemq the 16r shock lsteps I rhrclqh 4) ini .l lnaeflptid nued DF.r 3i AED lor rhe sromrc modelrMn pctalonuh}lhmanayssandshoc r€ d.r oi l"diaslo . ') pfssu'e mnu s r qhi at'ar rdealon ( d asto c "l p€ssuG Du ms rr,..4c4t cdr: c.rdrc /an *t lFthrt,&,iw Application of the Adull Cardiac ArrE3t Atgorithm: VFlpW pathway ( )
o FMd.ddDl F.cb Besume CPF While Manual Delibrillalor ls Charging lderbnrraioi and Fosc) Tlrus, i s reaenab e kabeh}lhmand'nlaliglhecha'!nqsequence lfi,rhmaBysscompaedwlhaulomatCmone hlrhmanaySsaid B4ha,.&l'bnalo6U*avar]etyol d eneay dose (es n drdosorr20lo200J).Mmy h.arih,lhma.sU6aIel'nihe6usctaloi /nnEdiare,y a4e, rae "no, | 4suDe CpA. D4g,rnrig rtn cnes, -onpres- a.r v ry terri or sponransus dyihmt rrrar urrmare y €su is n a perrusnq hrlhh lFoscl l'eb[onho?sveianyspMlan4ushllhmsIypi or adeqGr psriuson. rhe pa' ed iesds cFH (bes n n'.s {ir chesr .ompEs onst ro. se resumhqhqla]lycPR,b{'nnfq*
The inh.l lrod conaAs ro Mbl lalion rs @ ol rh€ md lmp.tur dereminft or $divar ftom B-dr ad. E ry dafbrirrsiim rs qricar rd p.rr6nrs wih sulds cadLc ' A .ommn iniial dryrhm in d-ol-hosoirrl witner.a 3udd.n caEiac msr k VF. Pu sl€* w @idrv d61dioEk5 io VE rvb VF s p@l( te h@n qui$ 6nd ' Er€ddoar def'b'irbrio. E rhe md dfidiE My 1o rmt w (do'lvsy ol a sdr( b . Ih6 p6b.bi rt or acstu d6ibr raion d{lEes quicldy d4 dtu. ' vF.,6Lrmais !o a.rdo e ( iol t@red In. &nbr (l.nbrjrars @@q rhe hisher dr€ ffi val raL. wn.n vI'b p@i1. cPB En lo lr'. h6an and b@o bd .annd di'w{y csre d oE.nr.d ,ny$m. rne lkofih@d oI @bin! a p€itudio ,6y6m B oplLmted wih imhsdl w mai0l6 ot lhe nt'al Er6t (Fhue 33). Fd e!€ry mnuie frlal pass b.s*n cokp66 dd d.fbrilraiion, he chre or su ival msr decllE by 7% b 1096 Pd minuie rm bysbnder cPq is p,.vid€d.r whn br.land@ p€tu cPR, t'e dedim i:: moc oEdual dd .vdas6 3% ro 4% pd minur€.r" cPR p6/irn€d dt €n doubrdr or alprd tly cdsr AED p'.sms l!@ in nkol h@d ol dny cP€ d allnpr€d darbilr.- t6. Ihis h.h6 3nodd rk t e bei*ffi c.ll.p$ and .r.fib.irarim rbr a srcab. numba ol paliqb witr add6n eJde mer Eoo d50 ta Ift (min) F''$.BdGhr'@dlwdfu I I ! I ! I I I I I I I I I I I I I I I I I I I I I I I I I I I I I r r!l I I I r I I I
o Clearing lor Delibdllalion To 6isu 6 etety dur nq d6r b rrato n. a ways announce rtu shdk war^'ng s1ai6 th6 b.rorc der e nq each shock (his enr're sequoic shoud rak6 srhan 5 €onds): !e,ylhaInooie€sumadcoalaclwi$theFlienl neG! de fes @onm6nd thal hea i.h.sr.omp6ssof,slrhercby mp.ovnq.hat.omp6sonrtuton). usordfi€rcnl I3*examp6oioptmzngccFaidhgh.quaily Mulir€$u.r CmrdiMt d CPR ".$
7he ,Cl.s Cr* Crrdb. t r*t VFlPutuLs Yf Ihe pause rn chesl comFressionsta check the thythm should not exceed usaq.ondrcrremaEr.slsa petnbrt dtrrq nhn andt.E art r at .lihe.h,ihm.re.leleasanom . i rh. firrh'n.,e.k €r*s a sho.kabe ihn q!e I 3ho.k 3id resume cPF mme lmn)etllately aftet the shock rcsumeCPR, beginningwnh chest camptes' si.n. Gtve 2 hhutes .f CPR rruu!E.b'onpna !tu 6[adrerelq. Fn 2.,1!J Odden*E I
o co^duclafi,llrmcheckaltel2mn lntenuption in cohptessons ta canduct a.htrhn analysis shoLld nar r r 3 ioish..iab . 'nyihm s p€s and the lhnhm s oQantred a rem mamber . rftiehnhmcheckrcleasanonshmkabehnhmaidrharc.ioFrs.,oroG6d . rr rhe hnhm check relea s a shockabre hllhm €s!m6 ch6sr comp€ssons {,nd! q (srep 3r ne bam eader 6 rcspon. bre fo' 'v.n aiiadihm,c druss.. h6r beiorc or afis ths a.kngoniheefiectolantarh,thmr o'ad,lhmicdrugbullpossessAeie. ant symp3rhei c ad on (c ass I efi€d) ore d he man 6r,eds or prc onqed amr or rhe cad'ac acron p.reir a l.ras n dfscl) .Lidoc.im110],5mg/kq]vnoif L do.a ne suppresses auiofrarot o 6 po ares load i€ doss 1 ro 2 q rv/ro d uled ,n romLlaq D.w. noma sahe) e ven
tt lcls C1*'Crt!.canrrt lf/Ptr!.,'l' W sequen.eo]cPRrh,ihfr.h€kss Aduh Cardia. Aresl Ctcslar Algo.ilhm- codr,.rl,,..drh, ftftk*rr.icn.,.a.4.,
,oernes u.6ko snaua telu.c ,hssald ,o4etuloa puopv 10 nts.a uatsnpaa tueuqaa) &66ns la96 6m6 ll srus red pareqn o rns sr:uer€d rsoros^qd F@,EA {lrpr,66 pu m Eqr azu rdo 1se an6 rtlwnb Hdc roluoa oslugtEdp€leqn|uU]^qd']6.JdEr
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o Ex fteatnent o, YFtDw Routes ol Access Ior Drug! unnq cpRwrhRosc n s .apnog.aph y rac,ns ar a Gio s ghuy ta*er than I00hin bui a€ nor v s i.€as6 n Pnco. iv sbre rud 8frer ihe ioudh vefrtcar hq io searer rhan 50 nn Hq, ss rhan 30'c less rhan e F) tlhn].druglher4ynhypolhemtp.0snlsn.a.da. o.sare hyporhemal3o.c ro 3,1,c 136"F 10 e3 2,F}. slancPFatomp{dejbr ftitanes.cdsssnotng6gld onloibono}irlheGpynpatenbwlhAcs
tt /rc[scrlB'cr,ti.cl'*!vFlPuLlslf Endoaddr..l Rolae Ftuid A.lnini.tr.aion rhe studenl webele lM.head.ors/€ccsruddr) ne s tpcd v tsi.Ed wdh nomd * ie or actared I
o . Epnephrie r ms v/ o i€pa! elery 3 10 5 m nubo Antiarrhythmic AEents Renenbea lollaw each dase given by penpheral injectian wnh a 2A-nL flush ol lv flud and elevate the extredt, abave the level al the heai lat l aiso has tr 3dr.n6,q. and p adrei. lihmcoio.q$andnqandwdespGadfamady d b,,s bm erircat n cdd ac are{. Prc! dqs br0miulederu!5loamaxmumol3mg/kq
fh. ACLS cM cardLE An.t: Whtutd vt o.ma s nus h,nhi, !hei vFrpr se ess w car iFCI , !olnq ro0 rtscA pate s rie lse or .;craihdriF,m's. '.
o anrason6i nihe bEn sp na cord a^d Gl ih an op o d assoc ated resusc ralv€ en.4eicy at a dose or 2 ms N r 01mq M,V opioid-Associared Lite-ThEaienirg Emergency {Adulr) Algorithm- a*ess and acrivar6, evn9bpbeFyo.aeh@ffiy Adhirislor n.l6rcm. MqBpdaig4nn!6 Sltmullt .nd @*$, conliru. CPR and use AED a3 300n as ir isavail.bte.
ErtrecorFoG.l CPR (for YFlPukele.. VU^.yrtole/PEll Efelpffir cPF (Ecm) dds ro v dur'g@'!acaM,includingdm'porcdrumblamoxyg€Gtma.dcadbpumnary byoas IhN r4hn qu6,equitE a3 Ir'e ue ol ECPR,Ey alrow Fdidm add bd time t lreai 6mbr6 mdsiyins c sot €di* ad (eg, ede .@,y aiory @.rusin, PE, Efr-*rory vi prcid'n hyp.homra, caldit iiluly, fly@dditb. 6d ohylpanr]4 Cmgdive h@r iai6e dtr]g idoxb3t onl ( Wr b b.E e dMrry m ddr 16 .,€nce Biesd rd rhe 2015 arra Guicer,"6 updare to, cPJ? ,rd Ecc eoq8ls a b6^.ir lo sNval and hwabl. n6u6 o9 c o cg16limcPRnpd6bwlhEfrdoqd&esl h ernru8 rn.E Ecln ..n b. Eordry .nddrcnr.d, pDrrda m.y e..d. t u$ tu ,i,I porJrn.rr, 'Mrbb eu$ or edLc rrct utro h{ rc! o$ond.d ro init'l dlldio r cPn. Ultr.sound (for YF,/Fulsele3. yT/Ary.tolc/PEAI uneund may b€ appr.d to parianls ftcoiv ns cPF ro he p ffi m)nadbL anrtuul- lly*'d|oh6lp]dollypoteduy'sl m6dalr..l.dby|hoi.4,'neUseolU[6ound mq pal.rns dpd 4.ins card,e adiui.r ro dandad paiifir *aruar on
o Cardiac An€st Pulsele5s Electdcal Activity Case Description of PEA qDrp or h}1hms rhar are oEanzad or semro'n:tr zad AnyoQanzed,lr'ihmwi[oa.!sssdefLnedasPEAEveisnusfryihmwlhoula eessh,rhfrslhlld.3icldedbydelntonncLude sed he lem ./..rrcre.hanG, dsso.Eron IEMDI *t..actvt!onlhe.ad]acnonlorbutacke
Managing PEA: The Adult Cardiac Arrest AlEorithm flp ACIs C,*s Ca.dia. Aru',. Puts.t s Etecni@l Adtulty The pause in CPR ta cohduct a thtlhn check should nat erceed iotqalzedlnJiifrorlhemJrdorb,.lo.]serha ..ndi.i 6 PE4 rsiep 3t chen ror iFqre39l beq nn .rry ri s1.. I0 LFsure 3sl rhe .fl sd-a or rhe 3qo, pln rhe rnhr sde or he aqo hr 1 perods 12 m iuresior !i nrerqr.d h lrh q$ rr cFB ehe.r ve cPF 3.d r. ded! rd:o lhe Ei P.thwey o, Adninistet dtugs dunng CPR- Do nat stap CPR ta a.ln)nislet dtDgs , ,o ere.ti.il ..1 ,l], 5 pr.5.d 13sy
o adull cardEc Ar€sl abonthm-2015 upd.te t t l I; 't*"
?1,./16[A C.r.- C rirc/lrrrrl t tN E dd *t itherhythmch{k€v6alsashockabah}1hm.€sumecPR*lhch6lcomple. ded saqueice oicFF hrlhmchecks md povde6shoulddGmplbdsllya Common Underlying Causes of PEA
o Cardiac Arrest Asystole Case Approach to Asystole nietupls cPR ror 10 seconds or ress ror a drthm therhJrhn.,ihano,[o,]s?sys'o/echoslcom c Aresl A sor rhm lF sure 3l @rAlsorrhml belr nn'nq { th step i 0 E ,nette.nre ot he aast ts Gtse q hwan at hish pedat@c. tdn n nhe6 nrsl Rhyrhh. lq Asyraole lsowPalem'naiiqibradyasystolclh,thm Asy3loesamid]a.arcSlfi}lhma . Noi another,hylhm l8s fne vn m
,he ,CLS C8sa Cad,ic ,,Et Alyrlbb Foon rali@rl Faclt Asystole and Technical Problens iranaging Asystole i,lhmCarda.lUdoihasdm-nsndAAil.. .hnhr.r 3 pa:e1 rr a ! i vF or p! Adult Caruliac Aftaa r rhe I qir :i da or i[e arqorlhm 1slaps s thEuq[ .n]al],1hmhn{.arPul
o Application of the Adult Cadiac Arrest Algorilhm: Asystole Pathway mteniohe nredenronsou nod i rtuaqorrhm b dmitmdcorstmmdsyhs €6e r r,€s rcsus.1al€elionslobepdeilay wheyo!periormarhlthmche.kYo!nlerp.eilhedyihmonihemonlorasasysloe . r no e/shcara.rydr 6 prese"r lasrsro et so r,ack ro slep j0orrl Con ime., Asyraole son as rv/ o ac.ess s a€itrbrs. srve ep nephr ne Adninistet drugs dunhq CPR. Oo not stop CPR ta addhister dtugs. chtklherh'ihmafle.2mnul€solcPF lnteauption af .hest conpressions to conduct a rhyihm chqk shoutd not beh/hm,ftparetode ler 3 sho.( 1.6um ns rapprcp,are) Rerer ro the reri s de or ih6 a soBrhm Trre draqra^r i F€ure 391rhe cad.. &rcsr Arqorrhm) slmmalzes rhe €.onmended sequen.eolcPRfilihm.he.k.a
rc" xoa s&rd Bldqn .a dtrl.d tEb e lo ,w b.mfi 116 .nsnd€d rcP h. Bvllo' ra ,B Ali dG 'Ei l@r'd dts @ ol TcP lo. pe6 s& aevd!- d*. .d A.r,lih. tto.t lie b rc nldrB M tumllrN lo "d.nb.rlhrd avtioL B b@fi.lal lh m lttv dr g@p lh.t E Cv.d dro.l€ had o hrn iowrd w@ odl]fu crd rh. impqtts o, f,*rfnirm liimwion ol ch6l Ms6ro., lhm b rc lGllioatd r, inrdtopl.g .fi.! .ompEslonBtodoriwadEkiop.ll€,tlwhha,!lol€. Taarrilnrtllc iaa{acltadlr. lfloal, I n . urcr.d *tEnu rho ,@s b fm vf d .!ytlor.. 4 hiri.l frspr al d.ft rlb m.y b. ffit a. Fl€ vF dy b. t! ran ol . prordE€d .tct r! $E nr' fE b-' dr ., dd.rttg r,.ib.$s.., b Frrf, cPn b.rd d.ft.i't'm a md.., EMs svno r!d6r 4-io.. iEy 6E L arpkEtng ! pr.r@l $d *s Eils 6p4tdi3 L qofi cpF *r- EEiE rs d.iir{.Er ol ldfir' h,rd by B,ls pdsra to b. h vf tb,,',|,'tu'{ I hdnh.m p6v]ds dnor Epldly lddriry u udqyig {)M sd tE pd dn &6 nor EF.d io lrE Brs $d Acls Ero]MiMt, lsmh.uon ol Blr BEitsiv. .t ont ,E d.olon ro !.mimb @*r * .lldE EE wrr' h hrdig C'v:tb h rt ho6ph, dtd b b€.d o insid.6t . ol @y tEr6, inddrlg r lmrr. c.ir.D.. b ct fi . Itu tfi €rr.p!. io fi.n dsfar-td sniripr . Adp6o io 6u*r.ll6 llrl;6@c , Eafc.:L.ha 10dn ,dtnt,3o,cPe Nft ol ,p lEcl6 dds r in cdbinatd i. clery p.odLtv. or our.omc HMs oE tfudih ol G@irad* 6ftd b s mp..ld t.fu 4sod.d wfi pd arcom ft. dl@ n[l fE p.lidn *fl ui6 b ,r6.dEl dEdll! -d b. Bd.lndv i:i.cr . s@ nE BeHid dspr *r5 vor d.rt_ niE Brtr r hdn d.o6 ol (furv tn4 tE pdl.n n[ d EFlId b ffi a€rs atn nlr"ht tz o&.,!ng'pl.'I cdfiM qr{r-tr..9tur ,eitaris .{d! dn m ol ,E ldl*tE rcu6: ! Fdd.rio ot .n.dvs, sr.nLndt clrcur.li@ .nd wtratM t T@r, or o@ lo a s.rk .6r.,!6ev m.dlc.r ''el.gomr ! IlE q.!.G ot .dl'rl6 cnt .ra lndtnho rru66ibh !.'rh 6d'Mruois,tusllsddd'ltM . ffibr riasd. d b-aE cd . A v.Id DN B d& i P.BItsd .(''lallEi6h.fud..l..tElc*i'dr.,!El,i,yp'irn'.dd,eol
o pGanenh* remra les srbm-qson I cy {atral,hende.diqlhe 'orroe{oid 1yk,h.an.o4llssusciblion]
7I',,!P,'. ol N.nE Eni!.tur madclr rr3rdE aliai$ andE nd nqdEn Id p@o$l b r:rtF.l 6€y p.trrt $ ddl& 4id !d lo a l!.!nd 6b 6 ED. T@!.rl!r@ tltt .orliu i{ cf,R blrdf.d hr-EnidB @']bbl. h ,E Eo 6n I b. !.rloirEd ln $. olr or-lldpilrl sdit &d nty ff tldlcd.d fo. 6p.qd dt@ttd@ fq e'dbgrM.rv byFda. d .rn&dPo@l ctrlbrioi ior p.lx.n3 vrdt !.@ ttypotEtub). AndoHcasd,tao6c,r.ftpdrn Fdhrn ro s !ppr.9dd€ hGplrd {.ln . |)@ pdEn 16 pGr-o.die add Iql,rdllsys..n ct 6. fd lndird.. eon! 6@rv kr.Midr midoq. c& 6nd rs .fd trvponEhb l@p'd h' h_ha.plttr p6*an!E 4n6r pdl€sl lo s.m,!!.&ie clrdel @ 6lt dFabh al ptblrtuE @_ @ndes !.rr-drdt& ar!.i @.
o Bradycardia Case .add thead Ere ess rhatr 50/m it. sus paoiq arcP) rype lw4ckd{h'Mobr ) .irrierypeoibo.iprcsediFsure.rl conp6reAVbo.r ss€neraryrhenosr mpor ."0,""",""q,,u,..-
rh.ACISc.*W - IE= TEF=- UE- IE- E=t h=
o Description of Bradycardia S,srs and SrDpaoDs Anyhylhdd$rderlvhaheanr.l S,sis aid symproms duo 1o th6 dow hd Gre cehelemb€dym,dndgchmg€ablywth nd phys ca erm mrm b dentry $e ssis md rdta rc alen tescap6) rrcqueni orematlre venr.urar
Li.tftra Sr.dr.;.dL: Tlr. Lrdtlc.ls. Ieorl{t tt nrr.r, B!rq{. wfi r Pt*. agdt (Fac aa ediE nE rr.p b E. rr rn riluaqd ol t ldrn rEnis *'/$ tlcloiE c hrldrsr.*lor prb.. rr?iri&r d otr .holltm b.gi6 *i!l tE rr-t16.dio. ol b. dl/.td. (9Q oi tlr tri a!. B 16 !a sonlh. tu n6 hdrd. n drE .r!l ol th. ats r€4n !n !f, ftrEy a6rE( srdr c r4r..lt .rald..r ttd .ha, nE!.gmrn, sivhc ory!$ il hdd(! nEro.iig n' tdnm ftd $rr qgE, .ddbrrta rv @! .rd oai*tE. 12 Lsd Ecc, &55 61O ?. h !I diiirdrd d.C.E i voJ !.rr_ mrE n dE o.En ,6 !4E d rynplffi d po. priE6. rd ir ts & casd by 'Ilrldn y d..b,r p.rn hd. JrEiUm i'rh d.enimU..t ol.d.e.r.Itt h.r.li tr ot n ha .6qrro !dn6rh, !q .6-rE .d lMh( (9.p ,1, n tu Flbil hr p.d pdnrd6.l yrr .dmhrr.. d!d4 (s!.p q. r dEclE B ht rli,t, arlp.it i4 IcP d 6Erd.r dooriltu q .9dr$nu rfilio. {sr.p g, I Ld€La, yo] pt 90 t0 te_ vt@ p&nrc, sdr l' .nd tld @nrM^! ca&, ,t dl .rr.i .du!t d..r Th! ht*md..qllm ln lhe alsodnn E d.l€rd..d 5y t leny d tF. p8i?nl oddllL.. Yd tr6y 6.d lo Inpl€rn*, tunlpL lic.qrlldE .Lrut.e6lv. rl .*dr* ,r.l dlrloD., ao to ta cad& &.d abodltf. Artfi lr@. r{lth. AiL Abqdi.n r-E!f-n**.6dq! E---F- ,F.chds.dF!.tureash
o lppllcatlon o, the Bradycrrdla Alaorithrn Prhn q ,,!.ar,,.n Ne{. pdl@ th6 rhm,y assmd, in 16[10 tE rorb*i{ nlh€ce'ydhaeapalEnplsd4ms,el@so'U.dr,dl6,Yo!cdld''t bm a drin€d h n* B..dy.!d6 ,'l!dnlh At $. 9e tru, 's e sd"E is r'd ldns tBbr. cdbln'rE la.rm. rdsiry*iEoxtub.adE ds6 tPl!s'byd€fllfu'i€.hddolc,ls5o/nh llnad@El.iofEBM!Brdful'i:d@l''€lt6] A!.El lraihinC a n .dd:llF dy!- rn cu ol riy!.mi.t Mirdy!- Moniior br@d pbsu€ md rr.d €re:obrain lid.€vl.w. 12-r.6d ECGI cndlcl . p6bhn-r..!s€d ht.t ry $d prryr,r..l .*it.xkni {hh t rd tt.l po.rlbr. Mfibdns ,&tdr. S,,rpllrrc..dD, sr.p 3 p@mpG yo! 1o cids i, ttu qrE or tynprm3 oI poor E .rlCon aE os.a by t &. 'k "snG'!*r€ d srnpdE? t &. rh. e'sN aad s:ynp|m dtu lo ru 3b* lE n dl.? Ldldadllg.igGdsylrEbco,nEb..dttgd.: . synprms lee. dr6 difflon. srtu or b€dr, dn s.d bv€r c, cdee n*, waks. {a!s6. &h]r€d€dB @6, pBrtuop6 ( 5yn@p.l . ssnr loe. hyFr€ns, 6.Edi€ h€.n talw, MrErar adntu ed b h ssnoic $.'srmp6" a d dE l. rE n dlc,le Fe .ep1q rry!.rmie 's Grnh., C.r..pt habEd}s'd.sca6in0ihsp.isnl!oymplm Ad.q!.| hrntdorr? . rr rh partrr h& .d.qid. p..r!'&n ob.ea qid mon6 isr.p 1) .lilh.p.islhep@rF'n,'&,,girdlosl.p5
ttEaar.ra Sesuerc. ,t€raDeDt Scquercr: (chmnotop'c o, hean Eie do*) rrl. rots Crla A.dlE & Avodrsynqoianopiatrlype Nrh rcP or D ad'eneG'c srppod as reniporzin tema p.. iq or D adreneQ c qils .n ror pa1 ents 'nfu$oi 1e dopamae. epiep$nel s No knowi vasop,essor 1ep nsPhnne) oi a D b ockar or carc um .Mrne b o gVe'ely3lo5inndestoalo'3doseol00rme] kq tmar num tora dos6or3ms) Ar
o ,Erarrcrt S.{rercer be perromed by acLS prcv de6. dncar3nd m*han ca €dure. Becarse han Eh a dyiam[slabtyG!ean:ges.said.odatlesfol ro d.nrt and corccr thecau*.r rhe rr4dycad a ne reatmenr and I s 3iso .efie*!616q. fcons'stenr .!pi!ro) beq n an lnfuson or dop3n Fou.lda,rond F.ct Sedation and Pacinq ranxsry and mus.e coftad o1 ! llc.lD.rt Seqlcrc.: a 'hoqh 0 adeners c lson ns w ih srancas s!.h as ovedose !rh a ts b ol2lo]omcghnandttalelolatenlEFoiF doses (qr$ler 1han r0 mcqk Erm
Transcutaneous Pacinq E ,r'D. dr ,,rb retAH. rr@r4sml ,Ir tc(s Cr....' 8,.O,!.,rt EPb-um.L-1.&." Erdmde@F,m Ecaolur€ s obseaed lsabry m3q,n)
o 4...., E..pon a ao ,nare bGdlcxd,a deDendenr vc r.urar hnhms lalf,][dsomeliA.3g]^/vAlfraym.UilhF
rha ACtSCq* rE@ SbDb rd Uit!.ta Yachycadia: Stable and lJnstable rhs.ase aloleslrres. EcG rFrtims 1eampes i Fsue.3r . neenrry sup6!eitr.u3,la.rl.ad a 1s41 r r :! =- :='i:=. -=f. I
o I The Approach to Unslable Tachycardia Tachya,rhm''tachycard'a. sFplomalicbchyarh,lhmi.
un r.ue tsdts}dr. .rle glu lF6 h€ui d. ls io. l..r Lr rh. D.rids d]hlc.r d'd- .yntpdEoaue!l.@l(r'dobgg$. . aari,, & n.lrhd ddb d4rr b,n!6dirnb @ @e lteidwy.d.,q @@ry b.h€hra Md rrrtoMio. , rh Educid br..d 0o* ro vi.r oEe . adrE /ditcir€r$ frd @lrLri6 b.rE t!.tlm an Eltrds q nE Enid6 riErHrE '!d@ rdd q,sur Sirn .nd Unilbb laolry.adia L.& lo sdds :r9o! {rd rymplffi trn iictud. . aaidv rbrd rEda di6 . r.d'di. .h.d dh.drr.n ,. tt. r., & r. r|apE Bogiird t'd ri. prt nl Esir,rt errysr,i,trrd. d .E 6l.bE 2 Rapid eo{.i(on fdrh.drft,t tyrlotoase@l$dbyn diy. dla ,E 2 r.y. ro m&o.d or tsffi ri,l uBbn6 rdlFd. e d hu 4*5, Mt tu,t $!at tdrr*dt a Fauq tzraf dt{ciotatrdrect6.tl rtt Ob,. t ',rttu. t E *, d qt ? tdnl*a P,,t dd d,,Eda r.no n satc,,4'l..,d,ya,dt Thrs (krihr.lon M b. dnb![. Mn] .rprL r406t lh.t *ra a h*n ,ar. L ld da rs{y in, n k unnk.ry thd rynloron. ol lndlbrny d6.d FiB, 3, tE t*hr cara ri6 nt! E hp*rd trtioL. lftrbn- A rs. El. tEt r tu 150h,' a 8dt n iEper.o.in6 '!.p..'e ro drysliric tu (.s, l&r( d.rr/ddtr) d drlr S.r.rr0 aG id. b. p.*E 4 .6.a8 ol .as6 *d rrrFio.D ttc ld iLr l.diy. Fdqrd p.M sEn ! indrdod F.pld lddn[l.. d of synplomnb l! lrr{&dh $n hdp }o d.lthltu ,nd,w y@ $drd 9r*r. rd IRredlsr. cfdbBlim. Fd .md.: . Iirc Ecry€d*. b . drY!&lo0k Gp@ to roolE l&io.e, dr.i - Ltq a* D' d l!@l+13d*r' rhd c,* rh. ld ld. an'odEey,n,rry+ oldE.r 'i@6. 'n En d€. rh@ ' d'dv . hsh d.(r! .' svfp.mh lft xd @6nol@sl ractoB li lhce ding' sh6 lehvcrdla w0 ml dpoid ro csd.- ! h p.n d dth t d'@n[ b *e (.. m *i,6.rc td.d b t{ l!.,ry6@, r.tdt'nEyft,l.rr'@,t'd.,Ibg.ftdEn,E{Epdqdldim . Atu rf,turrllcdll s!dr.6. hd 6L or .p9dinf,i.lv ,5dnin lloE Ec n5v v.d obthrr-. D@, a"ldl iLtu d $i. r lM d 3cM .vr6lc d'!€4. . At le c,.d..the 1s0nd, rlmrr@. e onar asn ud cqdirydim I did GqudepdidnE(sbb ' [ni patin b 3dEl, 'lrr h& u.{rryis cdiar&u, d.@. tndm3 mv b.B*nallMld& Ye md h@ *flsn .!.drov.oo^ i3 .d 4bd, how to pilp.E rh. ptlisr lor lt ([rbd- i,o spFopill6 trdds), [n twb.*Lh It d.rbdll.b/rsrd io o9!tb 6
o Managing Unstable Tachycardia: The Tachycardia Algorithfi lfe ra[/]rrd aAqortho 1r qr r. 1r tu.Norr.l F* Serious or Sionnacant Symoloms
Adu[ techyc..ri! With. tuh. Algrlthm bGaIl.t''E!q&L E-a5-h- bl*fuUrdE&6.b^]Fn se ..t6Mr &ld mD'osdr ol rhl. Fdon rr b. suld.d L,v tE Llryh! kry q'r€.dG FEi6d ln nE ftdrrt rdaalasldm: 'A,..rrrrd E.d6&..tr? tboEpd,nn..k-d.bh? . r. 6. oRs nmw or wide? t b h.nnh 'reurr 6 i,.eurd . 6 rE ofis llmmdph- r p.lyndDaa? t- ffi t, t* qo..[..6 dreti*Eb d spiwle n 0. rs*diry,d.fu.lq Irfufulrfl'h feh,fufud ,@@{iiirk)o*5ffi .tdrdMdiot.&
o Application ol the Tachycatdia Algorithm to the Un.table Patient ^,lprca.l.len .t lor thc |tn.t.rUnE Ceu.. Crrdc.l Corrc.pb Unstable Par€nrs C.o.lDg Stgnl,,catn Slgn. or Srmqtohs? lidsho.ks!,'n!dbbeduebJi].hyJf[h}ihn3
,?E ACIS C{|G Lcn BE i.r StzbL an ! Ura'l6l. freatment Based on Type ol Tachycardia ryrhris Mosr rde.ompex lbroad pu:e ( rh equ unlori !de.omp 3t w l-'no . Arhrhm as !r, a poymonh. oFS appeadi.a l,!o]|mophr. .41 nd as ro's.'jes n.hroizaron I1h. D:lerl has p.r,r,phr.14: Detetuine the widlh ol thc oEs codPle, rhP udrh ctif6 oFs.rnrer s e
o CeidioYersion Synchrt'ni.e.t Shock mth Sy'chr!dianon rdicaldaidwhalt/peolshockloadmislel €hen po tri or rhe fi wav4 wh.n rh s opr oo Lrhe syac opr.n) s eisased rheo r 3 shock dur nq cad6. repo ar zaiotr tsp.Eented on lre slrface Ecc as rhe r wavet a Dsrod or vur.erab r./ n uhr.h a shock ca. pG
WEh ta Use Unsynchbn|ad Sh@ks Uns,*hEnizedhgh.saEyshmks . For a @r ed who h pu se 6ss sm!!&rdpyroTi !4 r.r 'dtrn1ade3!n 'ordro'r4 ,rir$n rhe rhsddicar isk). mmgdialo v atempr d6i bd ar on. se d rh. @lgy dos6 le lhe sr€clfc tpe or dnhm .Mono.ha,oadrov.Eon:Delivd .siphascedove6ion:Ddiver sub€&uolshockdoseasn.eded C.'dlN€6 oi ol drlal fluter and svT senda v cqu € s ensrgv A' nitial onearv doe ,o*,r"i rr,,,.aa'"o"a,r* **. tt qlnchtlnlzed C.]dlovcrtlon ?cchnlquc lhq ta Use Synchtunizad Sh@*s . uchbr6 arla ib aron .I.]nsbb.@uemonomorphclac l1doichoedenapalientha3lsymplmstc ;;r"b;,;^i,., sw. w -,h p, vo rs rEaturt oI lunct onar rehv'dia or ectop c -,,,,r-"r"r',"*,*4.u"*,s6s*eyhmshavsdaltomatclocusais'nq *-",',r,"**."-**lv* ;,;;;;;i;; "";.,,^.';"".av aci*rv ircEe rhe Gr6 or rhs t*hva.qrrvihmia ", ^;^"""d ""."*. '- ., .* " ;,";, ^d, ^",,".
o Fo os rhese neps ro pedorm syn.h Modry the srepsto.your E E E E rui oi rhe derr 3lo.lmonophas. or b'phas c) Atrach mon ror eads to rrre pat enr t overroihe enshourder')3idoisurcprcperdspayorrhepal,e.lslhnhn Poslron adhsNe ereclrode (condu.lo4 pads on rhe palionr. r s .haqed lsee,Fouidatona facrs: aron I rhe vFiPursesswcase) P.rymorphic w {i@urar roh -
,Srrl@ Ili. d 6nd asteat -d nErrs.nar ot . lsb prtEnl (b, m xI@ s,gF Ebb'tolt *hlcddi4wttt.tpb h.&t6lt. Pln ! eldr hoin l.t.r oBt!.tr{ l ro/min h.s . r.dt'trhnir' d llchrsdr. h frh @, * w]lr e tE l,G bd'r arn ..d6.rrr-rrrDariEdsrsdrr.not $diGr.dtqdL6.r.rrqdnqn !D tffi a!..rh s'u ndy.xda 6 ,nEr .rrryr dtyJoscic, d6dlqrrs 6 dp6rs io . drlp.mb. . rErr. vorD d . @r'drF [d ,lqrli n 're ii crrre ooBI l.s, dr, nyD@r6'&'l Tlgll6 rnvol!* i(h.fr!.dbn ..d 6n l,.i ol Ye tun b. .bb b de}ly tn ryD. ol r..h/.{dk ($,1& d n.,e: '.orrd d iDquk4 I'd i,'d.nd{ rr.nFd. k{rvanG - adii- ii f: ra.hrEtdr a&situ. r turlori lnfiid sBr .(l nrr'.o.rrrt . I!.r ilcol' n!,BdrFh nytrm GrclB lidr d!/..d.) *th vosd mrus dd ad.ndi. lrn. lnriri d@ d i4.t Fu *ln lMnd lrE p.lr.ni ntd tn3p.n dorrd'.4.n dsrt*r n,E p.rE bdr6 q**rly ui!r&, yfl r{ piloei, tnm.di d dtd.hsibn dt dr d.rrdrsti!.d crromb.r dd6qE a h,E trEral. ,fllrlhrrr 6r tt !r. ,rdi,c,, . D trt.tLl,. tlcltc.r t hb d rildB nb ldod,ro dirC s€rtEr ilrt m.Lo u.d r. E rrd. !1dc*r..nd r.d6ri6 d'r'it! dcrid dla rcd. rre .s.n1s @ ml dd.d l. t6 AcLs Prcvi&. c.uE. lrt oaa{i tc AabL lLdrrc.ld. l*nycrrdLr 4 b. cMllr.d h $!qd war! br&d 6 th. dpp4le. ol ih. ocs dal.i nen d4 .rd *h.trr flq ,. e€ol.l or lr.q]e r i!tuoFs Erdd (5/D bd!@dk (of,s 16r t6 0.12 so . !i[d.-oRs drda t <rry.3di3. (ofis 0.12 ryn d asd ! 8.ci.dd d imcL!,, i&DqdL. - tn9!1. Jl!@-cffpLr udyad4 N dlb.blv atilr llb,llbrion r. th! c , ! !r.bh b.ltltsdL 6la. b 6 ddrbn ln wndl t pdf,n '6 I A her rn€ !Er.r tu 10O in . No rJg i.d .i(rr. d lrnipidr. .!x=d bv fl tE@.d rdt . r, dr.r&{ crdl& a-tkd srEd t,r.l OdE l* }r 4'rBr
o Found.do,tal F.cb Unde.srandinq Sinus Tachycardia iranaging Stable Tachycardia: The Tachycardia Atgorithm
lrDllc.Uon ol th. T.ch!rc.dL llgodrhnr to lh. 3t bl. H.nt rl . rrd,yc.rd6 .id a plr(e d pet pdd ..!s6n a.d m.r'6!mt 3r.p5 luid.d by oi Bts A€dBn .nd b nlrEy rn s@.!(,a'y a!a*d DdsmE rfuE Jid !ryhprohs s ,9 m pr6.nt sd ll rhm .ymprom aM sltG e du€ ro dl d!/erfa nii' *lll drld yo b EilE dr sh.i' lstrp6 . tu4' 4 d @r!6E 6eo 4 di6 ot rh6 arloi m. ! ll e0nii@n &re d 3)rr'r'lqB m de ro rf, irdll&adq tE rF t dlyaldb 6 6r!br, tld lnndkE @dbvtao it in.r..td ls nE usr*. rtdryqti. . h t! odisn .,.t€r@ ar6.as v[ .l€li€ ,Eyr.lEd2€d h€lrtsrv $..k l.Lf- bdllaliM .E!r) and ,orxrx lh. cadE Ardr r&stntm r { tF !€ii6i h|s rorrBrrc W lrEl tf n rhm sVf t n.bliE hioh{Elv dEyidMmd dEdc t€, d.fbdidLn dEg, rn ihr. ce, tE prtrfir B strb, .rn y& wrl lM.ee eordh! io th. dabl€ *l6i or lE T*rry6dhrrlo..inm (F'sn r'4. ^ p.air ld.ffiello oI tn nvtm (.s dtv SVl, alddflund) dY nd e P.sbb d I1!' tm h uB cu, a pdLnr ,rs !&ar. rehls7dra ,nrh . prr$. cddud rtu n'p6 '!t]"d n fE I*ll@di. r$didm b ddlre t 'd rMtc. th. p.li-t $., 1 dn ls ye b ** $€ pnidnt .qd!.. Ivpkirr, a rrtttr "t $8'id tlEn l50/min d Er b d6 ro t.drr@nvd as oow ne gn6 dtY@e ,rd.rt L...arlr3tl !l! rnd lclt r rd..nlry d ter Bdtba ..6 ll ryf,plN ,irdsl. ss..d b sraP 3. rtu'!, E @Eba *irr E46 d 3Yni@ilt e 6 lid o{ tu bdrv"d' ('9 r'vrE' i-.J" *u""*.,"a "4.s. !'l.s o' 'hdr' Ed'd'c cid dkdn'dr d rxir. ". o s+ . rp-r.- -''"a,o ryrchE d *o*r *tu u4'da [ $. p.tr.r( B .llbrq !o b 9.P 5. , rtu tu m dNtds '.5d* l. mffi'{E"Fpbsffibtt ;;i",t,..**;"-.-",*.,n.hvhmdd@d'6hl'i drrom' *.i* , -* .r * ""..a, "*","a 06@ ' t2_r"d FcG ($* 'vdL!'rr d ilr,"-, *o " *i-"" I *,ins . n* 0a€ no o'12 *ono d *rd' (0' '2 edd u*rs rir sts, Pim.rv. ,td s4dd,, ^sE lis ro cuid' vu acp'o'dr a€lolr' riE parb md do lhe lollo*rns s @.*44 ! Lodr rr, *r! ot i'r@.r.d wr ol bi-olilro d h/!'n! 6 dddh'ncd r Grw oxygi lMild orYq, {t .rlo.. t srppo'l ,E .My dnho, an .@dl.'. r l]M^ - ECC k, iddli, tf, lhvmmi dEk br.'d p'*ud 1r.l-d E@
o rcd by wharhq [ra oFs a trdp lsre! 6] or i3troN FNr.t ,,oo.l F.ab Tcalins tachycardia Dtugs to Avoad in pari€nts Wfth lza r.id.i.-.! rt-. reAr.4 h,rn5
fi. ACLS C@ f.cht@rM S,rrb dl,ffib oiq i isvr) vasa m..e!ve6 aone 1v. sa !a maneller or ca,oi d s ius ma$asa)w, oush a a aae ie!. ant6ub rarl ve n over 1 secoad ilermnaleappmrmaley90%ofienlryatrhtlh, bockeG iverapam mddt em)orIrbbdss llherhlrh'ndoesnolconvedwh. what to Avoid with Av Nodal Blocking Agents channe brockar o/ D bo.ke6 bec
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL
American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL

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American Heart Association ADVANCED CARDIOUASCULAR LIFE SUPPORT PROVIDER MANUAL

  • 2. 6American Heart Association. life is why" ADVANCED CARDIOVASCULAR LIFE SUPPORT ii;-"ii*i"*q*.m ".e* ."iiiii i o:iills,,*.-".e;s.rc6*'r,6 P-, 6".r'd lMcged&ftsuPlfudMdd PROVIOEB MANUAL
  • 3. IrE^,Ed6Hd.Asiafunmdll.$6lollowingp.oob l.r tI, ddllUt6 b,E d.Elop.d ol,]b maua] Mi.nad W. Dddm. MD; kmndh Ndm, MB, Lpl xdhdltu sn!, Mq s].M c B@*i MD, MHs.i Jull C,idq PnDi Mry F@ Uarru*i, FN, MSN: n'e a, N€dbr, FN, PhD, rNs sdrb Johns pnmD, acpsi tsnu M8m, Dj 3s Msr6, BNr P MiiEr shr&i MDr D.vrd s.tuy, Mol E To lind eJr abdn &y updabs or cotr ctions to tn6 tsxt v,3 n.vie.reto$6MssdihJ;o;;;il1;;1ri,ffi;:l*rnt matro@r'h@ror!' Tota.e. th6 studei I&bera iq rhis c.ue, so ro wwiE t oqr'.ccmrd*r and 6fl1€r thrs code:
  • 4. ontents Pan I lnbodrrcdon co.m o..otdon rE oo., Co.@ Frlrlo!'brb5 ed ArpaEtb, Ef,G mlhh lntdFrllato ld c* Aos FrnrnB &.r. ACLS c'lus .nd Pn@togy Kmrt.dg6 ACtS PB,fir M&ud Po.L{ R.l@@ Cad3 PM A€pMia Cref!, F.qiffi ,br &r...dt, CorE CdrPe.l ACIS PEld..M. rd,ah6.v&tbn bt-dC4r@.Uhs@rt odhy Alsssn, B.vr.r. ard TdEldmr &dE 2 2 5 a P.rt 2 gllltaln ol Ca.. t3 13 17 17 c.dr9P.!*ffia, al,udtdlot Au.l[y lmrlv dr rn Rdsclalron $slm. Pl!l)**,.nd O]tcom. A sysldB Apgwh A.rchrtrrkh! €nd f..db6.k Adn Cddt t Syaeq,,. S@ts 'O. th. Pns." 4ft A.tEriM or EMS HGpibl-B@.d ConF..drs
  • 5. R.gind@t.n or St k c* Cmmunily @d Prolslon l Edu4lbn Po8,-adthc,,6iCa. Targolod T.mpdtu6 M.n.!mml Her.dynMic and ennhid Oplih zslion lmm€d* . Cdmary B€fldtsM Wu! PCI N€uEloq'c Ce and Foonclidllon eldtdt, hd.narrr^h, at t l*tu It€ N.€d lor Tffi cddiac arur Ied. (|.-HordLl) AEpid R60ore slds tlbli$ed Studi* lmplm.nralioi oI a tLpld H6po^* sFl6m P.n 3 Encdrv. Hlah-Pcrloirn.nce Tctm DttrtErlca $ 13 ,9 r9 b ?2 25 B0&6 d lr, lrt<t4 a*, lt',t,r. ol . Eah-t|*lodr,Er,r. l*n Fole or rrE 'I6m tsr,t EI'ME, ot El'..tN t$9h-ffiti,,gr tM Oyrarrc. whar b Communical. 5 25 26 6 2S 31 Fdn a Th. StI3t m.tlc lppro.ch 3:t ,rr. Sl6lsirtb lppn dr OveMew ol rhs SwrnEIic Aa@ch Ovdiew ot th€ BLS AesMr flD P,iM, Ae,gdit Osvis or rhe Pnmry A@,Mi t r. Seo.r*y Asd,l,,l Ov*l6w ol llE Sddta.y r."-.tdt 3 at
  • 6. tl,din.*ig utd lt*O lktd.,Yig C4.. CdrdllG ad MorEeEMi caldbc Md Pur0on ry cadfiore DruS O'€dGB or Toxic E&oec 'fi] F.n 3 ft. CLt G.... O!.ri,.,at Ct Mtu t ,t .., C{ Nmal 6nd ,b.o,n l B6lhrns kkniicd..t ol FeptElo.y Prlblm3 by S#ily B€.d..rdy DislB Bo3pLdrory FaluE Rrplr.ldy Arcl ,r. AIs /l..E '.rn Aesd ed tka$$ rho Pan.nr vdnibto ,id Pube ciEdi ,rEF'i,rry .@'nt Ajd€y M.na€Effit in F..Pli.lory Am* tttnq.n$ ol R.'Ptuoq And d*AsqrdaaAAt,r Mal.ian o4!€n saluai,m Oeatol,c,t*q CmM C.EolAtrY Ot lM-to BadcAl ay oP.n n0 T&hnlqu6 ArMy iltr.g.ml P'ardir, g..b ltn&i.rbr Bad. Atuay skllls S.O.Md v.i lr.to B& Atwrt ,4nb.,. qodsfieal At*4 T..t'rihr. ot Ot'A hsrlro Batc ettyNln* Nt,lPltrytDal ALtq lK' 6 .lt 61 51 51 59
  • 7. Ieh.'qE ol NPA ln*rlio. Solr s Rigid C€thd6 Oropharyns@l Su6limin9 P@oduE Eidol@h.al Tubo Sdidi.q Ptuedu6 hu*rine VdtMoi Wtd, ^.,rdtd Artay Vo.ll'rarM ttat4 Layio.al Mah Afray Lryng..l Tubg E$pn {oal T.&tEal rubo Endot&tEr Tub6 Petdo,R lq 1tuM Pdd6b /rqd. CcDmfl qzdborrr.. C.- Fhytr'ms ld acs Druss hi ACS @.k,b.tCSF d..rb Pari.pryioro!ry ol acs ,tlentgihg AC* th. h!r. Cotdbry Stn&qtu ,ltui.hn O!B@ ot $e Aradi,lB rmp.dE l corcdfirrms appiication ol lh. Acs algdithm lctdttra.ddt a, C& Dir,/tdsl4E rdr6oar.dre& SA^. 6nd cond'l @s $an'no wrh o.Elcn E rS i.!riu4 C.rq.drt apriarA?ef,'oi Mon ro' .id s{ppoar AaCa Adm'nEls 0rr!6 -d h4s ott6h. 12,Lsd EcG hn&lutt EO A@,t.n, tBti.4l 'IlE Fi6! l0 Minut6 PaiE.r cffd T.etlM CLdy M A.@nlnr b gr-S.!mrO.iado, crsfy lnro 3 G,oup6 B6.d on sr-s.gm.t oovl.lon 55 55 s 5a 5A te 59 a 60 @ 62 53 63 d, 67 6€ o
  • 8. gtEtar Elny R6PatUon rrnpy U* ol Filrircidjc lrrrEpy AdiumUw letnqtr Pot nri.r Arrnlhmiru wnh srrDk6 Drugp L. St!k6 lpp!.dr ,o stDrr c.r. G@L of Srok. C@ cdriel TliE Pdiod. Appflc.dio. ot tE si!p&i.d srrro lrlcdi0rd ,d.idlt6don ots&l,a! orft..ibb S_t!&. w' ing StgE std Syirrffi &livar. Eils sysrd rdfod'aLry SrDk A..@ner Ter! C.idc., Ar9 &rsr,'. rd,a.tb,t cnticrl EMS a!d6m.nl3 Md ,allMt ttslroribl , n d.i,O.rird^rsmarrd$.at lro.r lnmd.b G.d,l Alrgssn.nd Sirr$tsl d ,r,n dri.,ll rrbCcrEE a .'stla. t..ln do..tE E3r!$!h Symp16 On.€i Nl@rogrc EoiBlbn ClSe,La'Errn raq$ot@. odis6 P6int Hqdrn o. d lio Htufia0. FHlot rtc ,laA, Ewrul lor FlMnolyd. Ihd!!l/ P.nrnid Adw Eie1, P.$rn l.. csdda.ld Fit*in lylb lhEoy €tt id.d V nPA Wlndw 3 b ,1,5 ll@B e 70 ?, 75 7A ct a1 4 a2 &t a a
  • 9. En(t{cl!&rllBqj, lnlE.an6.ialdPA ll€dEn]el cbr omptd!€ldt R.rrhtn SFIMS ot C@ O.rr.d$or. C.rl B.gin srEk P.rhway Mon lor Bl@d Gll,e Ms[d ld ConlolLabdE ol Stdo rn nb.ieidc Irepy Hyp.arffibn M.dlEdn h nm clndld.td C.,lb lrn a Whda 9f C- s.mhMxirE Md Fadb&k Rhylhfrs fe vFFur..r*6 vT otuo. ld vF/5]ursc.s w lrdt tio, wPtda w:11,. &tt ct<&tai-/l al@.rnn WpW (tln Std.) asFor./Ps F{hrsd.) lFPllcriq ol th. ,drn c4bc M aeqtu* w f Prt uq Mhlm.l lnr€ruptlon ol Chdr Comp@bn. DiB 1 sldk Pul,oe oI Dctu ndion Pn.clpl€ ol E rry D.0biirldrrd ihyll,n cn€d( serr-Aaheiw Pads Srrk E ld vepcls Fhyrhm oEr Shek and &liarrnyrhmia CadL. An€d Tc.tMt S.qum* Ptrrrogi: Monnd,,r{ Cn i.O CPF Tcalr.r'r ol wpvT h HypothMia Ao.rra. orLcE ,o. O.rrlE lnr'mus Ro'x. & a0 90 9o s0 s0 a. al s3 s 95 9A s9
  • 10. Flu'd Adnini$.iion v&.01*,s U.d Lbi"s Crn hc A,Ern @rnnc&ab lr.onsilm surtrr. Bep'trdo.y c 6.rdi* A,6d Ad6in€d wnn op6il odr,@ tu,ror,dat cfr (q whtus vft8.tutPEA) Erts.poE r Msh"e Oxyleralid lrtu,,,t d it EI A* W rttfr.PeAl U[E@nd Us ln C.di* ArE l Cr{.G ari.n Arb.r- !.c*., /lcii,f Cr BMhIB iO. PEA WldPa Hbbncal P66o6crive NNet'4 PFl* flE Nt C.rlec M Alodfthd Iltr PEA PathwEy ot lh6 CE dl6. A,i*i Abpittm D.chrM Poinr Rh)4hm ch&k Admrl]llr Ep'^.phd€ t{ddrodrbL Rityttn 0.dd6 I,oi.( snodabl. Ftry'hm asyibr. md PEA T,6hEr S.qM@s Baffi@t6 Md c6En . or t rd.,ttE c{@ csrE a,'r'/h ,.t .cla cu Fhythm ror Asyliol€ Eruqs ,.. &Flot rppr!.dr ao ,.!6to,. LE t@ ,10 ,to T11 113
  • 11. Paliftts Wilh DMA Odm Arlddc 6 o Ed Pon'r Ad![ cad!. aEr Ahqfihm It rnih@rioo en CdEtoi o{ Un lalilc Cra admhhtr Epinrprrim D&rirn Poinr: Rhyhm chek NmlEkrt,. Fnj^nn Arysolo and PEA T.renqtl S.q@ TCP it'l R6m.nn d ForiE Shoc* idhidEtElio. tld Rdntrsrd.d 115 115 tt5 r15 116 113 116 1i3 113 ttu 12',1 tzt 122 12 12 ,a 1A tqdh.l*o R.ruxllrttoe Efiot,, TmiEUng ln.Soqital R..eitdw Efiort! Tmidtns our-ottkr.{ftd a6ratrai$ Eilo.r6 ouhrim or F@it6ri€ Enoi. &yBrol6: An A€od Fh)4hm? Etical Cssidd.lidr. T Ep..i ol P.naE h CrdE ArBt Fhjnhms d Br.dyrrdt On]!6 lor 8.ldy.rdi. D@&Jtbn ol drdy6d. SymdlMt A.ad,erdlr slen! and EmpioG nat tt tr Brrd'r-nbt 7,Ir. @ r./'o,ran Ovwi ol rh. ACdIolm Wl dth.NpnaeAea*n rddt,[.. iir. o, B@/6dir AE SlgN o, Sympl@s Csuod by Badrcardin? D..ldd Pdfr d.q@!o Pituli@? IlEllIM s.q@ sl,rrEy
  • 12. Ianrlnr s€quq@; Atopitu ll4lne $qu6nc.: P&r.o TE'ml S€qu*.: Epmphinq Dopsitu '125 123 126 127 1?7 123 124 124 l, i2s lgt 130 r30 13i 131 ta r32 ltu,e6P.doe Ars B*p..r$ ro I6tBn 36dy..tnh mh Esp. Fhlahm St .dby Pacins tlcrtF da: 8r.Or. -rd rrdl.lr. ftyrhm ror UrullbL lfthrEri. lruls t( UErabL r*hya'di, ,?'r /lpprodr to urlr.Db tdl@rd. P.irtopnysbqy ol trr6r.br. T*nyE di. SigB sd Synplns Fapid Rsosnflio. lr lh. K.y 10 Manag.h.nl lndic.liffi ro. Cad@q.iM ,rdqta |&'i'il. llfivcdr,4 fti rW r,ts'ro,n Md ol dD rH/ttI E,.ttrvitrr, ro &. ar,.r.Db P.t,..t A@s &p.opnab@ lor cllnioal c.ndlilo. 6€rn[y {id TEI lh€ und.rlyi.g c.$. oeilad Polit l! lh€ P**'M L.tvarnvlhmia C&tns ssnir@t SigE r symr{oft? Pridm lf,rn di.r. s!ft:lldi2€d cad'o61o. Dd.him th6 !ridn ot $. OHS Cqnobx 135 ta un$ncrmized 6 sy*hmE€d sn6l. pd€rnd Pmt*ntt w[h srrctroid@
  • 13. eE !y Dos for c6dlcerCo $zErnqib.d C.ftlolnr&r L.,' 0r,. RhrrfiG ,q s6L Tdryalda oruo. lq SLble I*rrlerdia rpprladr ro srrb,€ ,adD/l.fi[r odid. io O.L.nl Cl&ift5rid 137 ts, 139 ,a9 141 112 142 ltt la5 t4 151 r52 152 rrn gdreS_i.6b trcrrr.El,a tl'.lrd,,Ei,.,hd B w.tb, ot lh. tl.,l,atb /ltdid*D b dp $.oa P.6..t Parrdr Agse*trdn BLs sl(' rcLS Asns'ls DeM Point si!b& d Lr,Erau. lv aec and 12-1..d EcG D€.dd Fbll*: Nrrcw or wid. wd+Cdi9L, T*htsrdB flaM ORS, R€uIt Rltt s r*hyc.dr. Aoofthm: Adsnc.d M@gffil Sr.p. h .d.nHa.r{..aEiC-Cr ffit/nm ld PGr-crdiac arcd c{6 DugB for Posrt.rdi* ArEt crE Muhipl. Syslm App@h lo PoBl-C{de ArBt C@ ovM 6r PGr c. r:- Ad c,a r,.r,rat, fr.r-Crt e rr.d C.E t r tu r- Ca.tuc krqr C*c Nqfrth AM1 ot or nD,eb W ,,D.t Ci &dfi,n oprimE &rriErs .rn orygduto T6ri xypol6si6 (SBP LN 1lEn s nm Hs) SItMr b P,gr q lltgn S{.rici.^ oi AMr cr,d,y Fr€p..tutd Fdbehg Comn€r'd3 Trld.d Tmpmtud MM.lmdn ada(.d cdical cm Pd-crdiE Ard Mmrdm. Th...,
  • 14. fDD.rdh t35 tdD CW dtd L,,daA S-blto. Cii.ctlrr. ACIIS Phafifi.dqy Aum.ty t * ,rssearE &rflrr.ry lr6b 157 lnt t13 115 hrd.r trc ED.rr...y .tnhv:{r @ ir a dyMrc &ire. Adv.i.e in Mmd .nd dn€ sapr6 (xur dpElr. F.ad6 +dld @ tr. iolrowllr! ffis to chek ior cni.€* in l&mmH&d dle lndldroE, .nd odElr6l cdiN: *r ECc Handhok. Milahl€ s .ods.r ppbnanry tut rr.r, a.d rh. pek a. hd E dud l.{or.1.lr.. !t'.d Ir dh &i9 an n!dh! da,ie l{ot 06 Ldlc.ton Doaaa
  • 15.
  • 16. Al tEt4@n lhtn As6lm k riflleode lo *Oer6.i horc ol ilr! r6M mme,Ils Tnars r^frymwiBdebenerl].lnardtr@heaordlllls isr$r!l!relmnmm idIoex.?otral ran i0 llE ar 0l bdngin! rca$iErir si{tre lD rilFrh@uot qsu're panBnn'p wlh y@ o.ry lhrcoqh @r c6lrued .olbtF6lM ad d€d@lM 6i re r! y mal6 z dfedrce zid ew I Llnl fierel a @r d [e dl hedd drsm a]d slrdke. ire Ane,u$ tuan l6sc al oo w r be thfre @!nq w lh }!! 1o maka a hsllh er rmqs li,e posib e ld weryoie UhbtlirtsaekbGimollre A!4rr€yerDowed! alMrlotEqBlMol"tyksntuEa bo lreaihy 'n rrea( and m id I a]$ e&raB sty w do f,tul*e do Llwvn9rc Eery day I fuou0houl |!Ur studenl ma@] y.tr w l i nd domal on thal .orelals w,rat ]or e eamnq nhs . ms ro LIi b vrlrt dd l,! mponaice ol.ardlovascLl sre Ldk lor lie tit hwrykln lshMarrl0h0 d refleniber lrBl {har y4 e eannqroday hA an frpa.1 0n he m slon ol llie Amd .an Hcad Asffialioi ,!e en.olaoe y@ lo d6cMr tou f,|ry and snare 'l wllr ofiss lsk y@ell wrrar are llre rommls peopb aid exporieicBs r w 10? !vh3T hfiqs mejoy wmder. and lrapp ns? Wry am panod n0 wm he AJ1A ro rElo se vsrwhys dd ovasla €e ro@nad Io met Tne answ lo nts qEstus s ,!d tlv, Pe*lllx]@rhebarkolrhsNaqeacharcetu,!rloDandoan( $EAHAS mi$ on and Un h Wiy €mpaiqi C.ndete tis el v! bl lli0 i re lrhrk w h ha wq'd fiar de*r b6 yer $!n Sh&omu I It lit'wh lhe ospe you low and4k$emrcdscmr rre dnlt$.[ltP..tttjlilt {llhLrhf lcrf,$dt a 6Heart t lnstructions Etrtr@8tr8tr
  • 18. lntrcduction Ccurr. Da.cdp$on .t!d Ooal llE L,'d'o.d crlto@ra. Ul. sreo.r Acr$ Pia/n . cda a .lan!.€d fr, n€dl.ap.oi.,'s},Edih.t,lddp.dcp.|..0ErEl.g'enoloniopirre nary dd 6 otE.n dB&I, dElard- IrE4n did.clb i,firlro. rtd drlv! pddpnb. h .[nJ!r6d c!s, .b&na },1l oh.d thdr rt lh ]n trs kosrrtdr lld Itrr46 on ol Edio,urddll} .rur, ]mo€dLl€ pd<,nu. e.l. Br. ahrrnrit, 3t!rc. d !qr. cd!@ lridM6 lacs] n* !.6r ot oE acls Pro d.. caa E to imp.or dtu r.{ .d'n ,.n-tt ot sdir: orBr .rld o$, €rdi.adra!, .d!F.B IB)gn -.jy 6.9iEr !d tr..'dr6 Cculr Obl.dn!. t F. .,rc...*i dna&noi ol 'la ijae 3il&il! ,&ld h. ,al. to . Apdy nE Bet [,{. sr4r.rl lBls), &n@y,..d setdtv Agsdiqar L. . $.t rndh d.Ir.td o, adi Pafirn! ! F.rio6 prfpr F sh.qdr'ry BLs, ftd'! rdtzno €dy dl6r Mp'Ms sd hEsEdn! dt &tn ld d6rEr dsflnilhw (]Eo) u5 . F€.o{.k 'tsd,adyat d . M..rr d,, nE!.!(En o{ 'r.9iituY ,16r . tle6 rt ,esnilio ,rd nEr.o.itn ol Acs. ,rcrri,E .cpr.!rd. diFciib. . ois srv,u!.[bn .rn n ^rrtd 6l **A imtdk{ .ps!9ne dEp6tt 'i . F*.!.@ kdyamllhu &d ta.rvsfrvhniE ud nv eh ir ddr* 'Ed d oi1dlcaEl*lglalbnonc@. .r,.'lon..,ym6.!@t.,bEd}dyom'uEdudryotynm'atharsyan,,tl h.r&Id'l:ldi*detlrh.&t.dm . ri.@ch€dEad . P..tm dt nsEoErn ol €d- lrd ftlrdrrdid ol rEldh. d tu Ir ol cn. trddn, tnr.drra PGr . Ev,ld. 6u*haliE .ltft dutinq , .!rdl.o a4ar $6u$ di.uou. -s.sd n enpm-q re,u* tcpF, ouhv @nrqrs s. p.'r-r! phFio.et: lt.m,,|ddis.mEdhl..db*llolh.t4n . tro(,.r.i-tu ffil.lt d - t Edb.. d.e..d. t't'FFldnrct t' . R.e9,larErr{$.1t5.Mi6o@Jll3nF.id'm
  • 19. o Cou6e Dcrign Course PrEr€quisites and Preparation ww'fu.n'or9/eccatdenir
  • 20. ll.l ttt b Tt idd.t . 01.dm€d lir.3uppdr b nd€ Bts cdlL. Yo! mB pa rh. hEh-qd' [y Bls I4riic sldro. ro mpr6r€ ih. acLs 6ue. i&i6 sE ttr y& @ p!,x..i' n ,, ars dda h.rb,! €tu d,rg th.@ud, E wei tu Hbrr4rariry Bts srdrr. vrrho n {1'd q }E srudor r&&ira Fwrr-trir'....axkd,. FftB iE Hi€rrord,ry Bls sall. 1€5lr's oEddBr b.r!.d in tr &pd'di!. aco',{/4,r,'| loe eat ACIS E Ydr lll ...d ro drglde r1I AcLs P@ sdl-Al..!.Gr. *t'hh 6r..u ECc 'hytrn d6r'f€rd, 6 th. s1lddn i/.brb fmn-tdyEt,..ts ar th. .rld ol lh. ec.rn y.! *lll ,w }o, * .M t €dbd( b r!19 ,u id.nriry '@ .{ shn!$ arE w.dl@. R.nt€dH. sy q.t h yor kwLd!. b.io6 r,tdim tr M. l'lJlno lh. @u6 y.u mBr b. au. lo ]a.rniv {'d tnsP6t tr4nhBddino pE nc.awer edu ng fi€ final I'it $.nd..v.|!lon ti.!on. bb ^cls hq f,r. t dtt Yd ld kw tu dd!6 -n dB u8.d h oE Aos,lgdo'G You w e i..a io hlB tu io @ rdidr du! !d E 60 rrd dd r. en re rh. acts ftM s.{ a.!d'lgi $irr cdn 6 prsln@h{y qlclldB, d rE studdrt !&hciu (tr*rr.n rv-di..'r) ar ln. .rd ol rhs e3.ffinL }!u {lll r*lv. }6u sG .nd h€dbo.k ro h.lp ,d idedity .B .r dcn{th arz w41ru, Fqndbb ev 9.p6 lh vor knovdod9o Tlt b6ic 6r!k '61 8nd pdrrrgl ca..[nm Equhs st]dtu to eogila the r ,&id rb. ilo &n tuflt ' rho€nMl, (Al1 blod( . Pllsal6 dGrrb.l 'c1iv[y PE4 r 6nricur& r*hycrdia (w . vdrai.ll& rb1{5rron (vR
  • 21. o Cor6a lrLr{alr n cocs mardi.r. oonsLrr ol lh..4cls Alyrdrl M.tu r, srudmr vi!b6{. l*Rhddd!/*6trd.n0, 2 Pnkd R.r.|!@ c,n1 and PE.@ ftEpararion Cher(ll3r Th. io m th. rlt dkr! y@ io .ddiridd 3&!i.tui..y ^Cl.' ?twir.' IIE,AC|S Frri,. ^r&aic 6rts dE ba* t drn tid'sn.d h..ll.di€ !d!.{c ioi 6 $€ c@. ltB 'mp..br n€rdiar ind'n6 dE ly4runc 40rDodr to . clde oulmonary sE!*y, .fi.ciE irgi-p€rlolr]@ tM @mmr.lim, ald $. ^ats ca$ $d rroorinm P, Dwl, rtb Mt,/ ,,lar..ttrtdt'! t t M E ttg h -tth tqtt M ed nlna dt*E th. @ Th. m ur E o'!s z.d riro dE rdrowh! F^: ,rr r Prt2 srniBdc@ P.At Eftd. rig$hr-..io Otn 16 F.n a tha Svn halc &F.r.r' Prta r.lo-Bc.- ApFndr T.rtln! Ch..ki.B &1d tohrio slaion OEklnt rOf,SPisrd.a, Brb lCls.|U!., d.-, h.b|ir rd Et*d* &tin y rt tq!, .rd lib ib 2015 S.iE HAtuqtu ol2o15 !d..8 dwro6 h ih.lcrs pro,id.. Srm.EyLUe CdE Glqy r&rd.6.a 5., Enr rn 0i (rh!o.! Fdn&td rndor Pd{6 m* rs, ub,Er! 6 b ro c.dtova6id, p.ct.'9) IE A|IA roqotr '6 s&d..b 6'Erd. d e t! p'ej* sdr Ag.sd told 6 r! Sl{,..n lnr6&i. od prt okgcr6s.6d&.1 loth€irAcrshltwId.]rEP'@s.,.As!..@idbEsddlbl. und.d.nd s€p6 'n klwr.d!€ Equi,ld ro p.ructp.r. ]n &d p6 rh6 {N. Supp .mni!4 !opi6 ie.bd n th. studod r&b!t1. @ ustut hr not M .t ror .uocostur @mprdim ofih. @ue,
  • 22. ft. rCLs Provi.r.7 Marr, conbins Pay Mculeatt lon lo 1iu G .d c.@rr. b6rd har apps ln rh.lcrs Fbvda'Ma Dl. In* c.ut}onersfrpnaszesps.ificnsksaswid.d m 1015 odd.nM boE 6nLli tE @ 2015 Ah GuietuB UNd. tat CPR di EnasdEY cllloveu/.r c,E (Ecq i,nolmtM. Llrc k 9E ur. b |{nY bd6 dsrE $h, hrins EI rne acls sirded lr/Ebs re l'w.hEn orcr'€€dlddr) coiiains rh€ ro owins s.ras*mordd*pp]edalyAdrcos: I
  • 24. nd_aron6 ed! p&kaq€d s {i lh. ACLS PD,ib/ in ymr pekd ior qulck €ia5e !n rh6 io owing Raquiremanta lot Succea3lul CouEe Complc$on .AdUhcard&ArclAlsol]iim r IaAs with druss ed dosse '6m ndm r Adurt hm.diaro Pd-c diac arest cd Algoi$m . Adu r Bdd,ta.dra w[h . Purs Also'idrm .AdUlTa.hycadiavy'lhaPurseA9orthm . aculo c@n y slndlc,Jo.rllrtm . Fr!.noldc ch€ddEl l* SIEMI . Fibndyrl. coitshd@lh.E loi sTEMr ' addr swp-rod sbks Ahonrnn . sh{€ A*sr@r-CtErnarl Prr.?t lst lr. sdh . rkd e dFArbra4t l&h.ni. sLr*. . li/pdr.n hi M.Nomfn h AorL l&hldc Sfok lffi,h{ns!r'.6tuddn) Prsa* plded piepelion 1( sach secri6. @der cde and obrr n Yor mue @mddim . Pdth.AdurHiSh O@iryBLsSkilkI6sl r Pa$ rh. sas-M6k vsriht on ski s T6r, ncludi^g orcphar/rqear aiMav/ mspha,yng@r aieay'r*dim Cadiac d*t remr^s a lead n! .N "*1y"."r."p*.3cfue..keypanol
  • 25. o ACLS Ptovider llenua, Abbreviarions
  • 26.
  • 28. Opiimizalioo ol ACLS C.,1ttc.l C.orrc.pt' M'nimi,e Intemphons in Compressrons Closing lhe Gaps Ataiay Aset dent, ,lentl.tlon.l Sci.n@
  • 29. rM 89 ^ffi JP r6&di H. d d. O.!q d d dopumEy@moodudqn'ho!P'i,cdffld 2.tenfuo'&itrE.6As',J:dbMd n.{*n.2015upd.:r@dlEmlEfu]g]uNen &{rris tuhb 6rrr31lni*+322 ddB!6d.didp}furplEPj6 4EfuPLd!.a^mYdllI1F!4n.ho.,ic c!&tdlr@dlrJrl]@6Fbil]tE dddB ld ,'M ^,d. es r3s{rqr063n06e.
  • 30. Systems of Care CardlopuldonaT, Raauscitadon I $/.a.rr. lrpn ct A stsem b, q6up or,eguhn! dsr* dm'n6 rk iBEih or Mh r.k and rhe cM n ar a*i.]€,3yc*6ni'M,Esy9sd tv6lpodftd!trnlto^h.ddi*dllo*loac@ds,su$i'io^{..6 lunyshqNyep.'@lonIhs|31 At lN lDPtl,r.m.na SyrLDr Proc.t .., cl3ysls5oll]m:lh6s'demlupllanls,hoaffi1 sw.r a csinlJ@quaftv modv.]lhi lcor) 1.9. @pr€.6qupld. 8d@.rtr)and pl@! l'4 oEa^Eions. cu[u6) €ad]ig ro our@n* (.9 psrHt sal.tv. @d'tv *ts'acro4 an efid]v.3F1molcarccomFlsa pdEnr otum6 'n a rrrm*oa o, co lfrourc l)
  • 31. o Taxonomy of Systems of Care: SPSO Slrucllre Process Syslem Outcome C o ntin! ous O Gtit thpmwn E nt htoqt.L.r Catabataton Meas!'eapht Ben.hna r.o. Fedbact
  • 32. *;;wP Medical Emergency Teams and Rapid B€sponse Teams ro€r on (Fqurc 3r {'.are"n30/Joo","op chm@s c; be 6.@n ud bv moii " ""; dd.. o"i* - .4,. a" **d ,av b" p*' bk wo!dyouhavedoneanyjhngdfieevjyoJkneN alnitarrte PetlerTt
  • 33. o alvacorcepinkedthecommuntyloEMsand al one or maiy d fiereni ponb iF sue4) lfuycanpresenlanywheeanyi]me EMS IHCA nlhequal,o'cFFdeve€ddu'igEslscialve ,., "" ," ,,,",,-",.;"' d po*sho.{ pausest .an b Gv ewe onry relrcspe. r!ey whareas oheE lved aion r3r d aroit.sniot be assass.d adelu soc soc
  • 34. d* comp@ion. and cu6r daM.6 olten pidi rib $a &dr ot f.€dbacr( bry us ol a .isid alsoihm in a mann* rhd may nol b€ opim. d BarEr c (oe. o edaomds c nor m6ME d€prh if Ihd€ is 1@ mEh rmrnq, $ lhe da ca wirr EieirEe f6€dbac( to conE i ldnino b.lorc comiino deplh). A[hesh $n6 sottwde la'xomar6d sLsor rhms) and hardy* (.man bekbdrd, duar ad.rmr- 6lm fttorc ma'*m and oltpE) sdd ons cuftnl v exisr, conrinusd d.*ropmml of oplimar a'd wid€ly avaiabl. cPB mdb'in! is a k6y ompoBn 10 i p.otd pslom 6 LriL b WW Hish-Qudlity CPB 13 why Eany re.osnirkr ad cPH 3E cruo.r ftlr su va ftn c.rd ac .resi sy r€minq high_ quariq cPu, y@' h.ve rhe ability Io impEva parHt otums dd ev. moE h6. D.la 3hdrd be sysrfuicall, revFwod and cmp8€d .lornarrv ro prid p€rtm @ 6nd eneroIy b srmlts syslems Exisrlf,! r.oi3l,r6 @n facilirds rhi. bschma*ins efion. r G.rwlhThe G ddin*!'Ba@brion p.oqm io' lHcA simply '@*dno .nd benchmdi ns @ Gn pcitivaLv iniunm dcffi Howa4 oigohs Biaw and intoDrclliim m nNry ro dmrilv ffi lor mpl.v6m.nl, r lmGasd byshd, CPF EP.e da t mp@od cPR p€dom@o . s-rro'1sEd rim ro d.rlbnlraton . c zs and hs lhoee lbkdond edudim 5nd rdn nq Acutc CorDmrt SYndomc. over th6 pa€l 50 yss, $! md€m_M BLS tund.mdids oI €'lv l@snitim and euvali6, €dy cPB, a.d 4iy detiti lives ,ound rh6 wodd. Hmet w6 strl Mvs a lonq mad b ii.ver ir w€ aE ro tuf]ll t'' p<n.nuar oftr€d b.y he cha. ol suru val. s!ru val dispd r 6 p@nled a g€nsEti@ aso apper lo pq!i* FonunatEly, w. cu]mlly po€s lh. kmwledg€ dd ioo s'Epe sdned by n1€ crE n ol sudivar ro addEs manv ol s6s cft sap6 md limdi! dhd cadrNeurd .mpliat ore z Prcwd m4or adv€6..sni& dd{sr dsdn iontdalnv@sd a nlarc1i6, arn $' madlquadeva*ulafuton 3, r@r *d., rGrhrdshs mmplicafons oI Acs, such as venhcurar fibindim (v1')
  • 35. ftompl diagn6B .nd rEatm. on€E lh. oEar.sr pot{lrrr b6.€fr ior riy@ardiar s .aG prcvld$ @osnrze parienls wM potelniar acs 1o . tiaro ovaruafon. .ppoprd. t ag6. .nd m.nag6mm s .xp€dirioGry E pcsib e. r Noliricdion o, the @o'vln{ leirily of a parid s rh pGrbre sI $smed ddalion myd,n ar nrdim rsrEMr atdl") o^ltslodho,renmpglusionlre .coitlnuoc6viswdqudityme.owmml Acul. Stloke ,,{lva|ono,ih6cadi&calhdgiat]onlabqalory Oudiry ssuEn.6, Ea iitu ta€dback, aftd h€[hca6 pdidar .dEri, pmride cporixlon snd6qy Tnehoallhercsyjemhsach'6vad:ignilani]mpoEtrpllsnslrokocm$d]ghde y disparch, p.eh6p(ar .j6rdion ad bao., h6p! ra sroko sydsm deveropftnl, and noke un mnaodmd Nd on y hav. rhe E6 oi appbpritu fbdnoryr c tu6py rcrca6d ov.r dre pasi 5 yom. bd ovsralt sr@k6 e6 h6 also np6v6d, in pd rhrcuqh th. cr*r icdDsqd*6'ldsbke'eombinadiig6D]6- minosfi divard lnF4 r at.! dr. ctu ftke Equi@ Mh appech, as . d.ns y popu ared merrcpo ib c.nr*. r Pat er aducarion ofoft ft msr a6.y,6p,re368; E'3 lmiemddsbcfucidtgflplovamsnlolpdisnt r €MS ep.is6 psGonn.rra red n shke r@s.[im . strok&preparcd hosptbrsrdma-y srEko c.frm .Ao.*lodmkeelpe]seVal€l€
  • 36. Po.!+rrdl.c Arr.d Calt rh. tErr@ s}!m stqk hptut a ffpirBre. trrdftd- m'rld..!r'iEy .rcm of ce 6. @cBbd lllaB ls tE tudn ot pd-cdi* od pdiriil PDsffi shourd iddB ie!ftd k^p...l'i. mn4m.d rn4, honodylma od v.nrllarron opr'midion, immodiars .mn6'y Bpstudoi sltn FddaMu. cmsy kn.r vMlbn (Pcl) idr .rrolbrs pdift ndolo!L ce &d pf.onelleld, md olhd str& P.l*cwt &lro. tudlpat re ci,qrds frosq.n . dd& ar6r h a'y s€ .tcn4..cmpr.tmundonolp*r.pbForos.p,w.ksb.d6pd- drme ,d ryidomo whioh includG pd'r6r b.dn lniwy, p.d.nsl myudjar dystunciid, lrsr-drc r!.tr.mia or ..p.nu.bn Gpons, a.a p{!{ndn &ui. .nd ch@iio pqr*{y rhd mry h.E pr&Fih.d tr ccdiE ,r.d.' Fd-adi* .n6i .nldrft prars a .ig.n rr 6b 'n pdirn mqr.8!. hdh/idud tGA,nl wih s hi$ 'ltq'ey d h.n'g {d* ,d p.rrsG !rE, s r6a&d rikdiho.d ol 6uRivd *rEn be rnbMntoB .6 pdid.d i r ,lrtEa.d funp.rdr,| rh.2015 a]+lcdddi6 upd. t t @ ,r.o.$a."t b. dniieGd ro cod@ tc. r..k Ie '@hsiur cp..e b wtd Mns'&) dx parrB *i r trGsc .n5 Bda. rct, by *l. li'E ..d o6n idns . .@1'n rdrp.6 hr. b.l,en 32'c sd 36'c 13s.6'F 6M 95.2rD ld al r.61 24 hou6. Arnou€h poid*. ota u* 10096 oxnd *hrb pdlmhg th. inrir.r @$ini.., p.o_ Mdr. .tdrd ftn 'n:Fkd oxyla ddit! tE p.d .rte 'd phe b $E br.d r.v.r Equk d r. -ha{ s tui'l o4!- ffi or 9.x q sDdd, wb Ldibr.. In6 hdF to aqd sy polad.r csd@t.n d€er.bd *1r' or}!s rorr.iry. Arcrd 0ic16 v.nulaion ol $€ pElr.n! be@ ot p.rdr6r .dv.e hnodyrumic .liet! whs rnrdhmcr plsrE ft llm3.a dt bc!@ orrdmlE d*@ h orlord aood ne tts F,t.r p,!s 5t @t . dodd. l. addi.l br&d lPacqJ H..nlEe peidd. m.y $tr vd{llaro lfu d lUnin fJdnGrbi. lpdirl pM ot ..nndd €'bs diorBe tPEco?i oi 30 to 10 mm Hg or Psq o, 35 ro 45 mm Hg) mv b€ . E.&do cs unl6 p.tsi l&h pmpl m@ rndrvidu.lir.d ldrm.ii cd* F!eo, Lg.ir nBy b. rol'dsd ld !p.(r6c p'ri*. rd .spk, a hroh{ Pxq nBv b. p..,isrr. i. par.d *ib d. h,rs nn y d htli .,,iv EB6. ur4*. nird hypdrr.E nEh b. @tur 6 a r.npdr, llEe *tld Mjns 6!b.r .dsB bl, hy!@6tlaid 6urd .'H *6Er vedndoi. PEU<,€B lrElE rcL M whd ! p6r.nr! lsri!.'.iu6 L borow ffi.r, laboraro'v vd6 Eporcd ld P@r ml0fr b. hrgh, tE h dud vdu6 H..$mpldi&!llbldMllluid.dfrili!fui]4.r(veli6d[d!pl.zldb s n€€d.d ro optmiz. bL.d BEgn, @de o4!1 d t dnt F.rrlM. IrE 'pt_ .uE or 6s mm Ho d rdsr, B a EMiabl. gdl
  • 37. o ,mmedlaa. Corenary E D.rlu.lon Wth PCI ,4.@loglc C.n .nd Education, lrnplementation, and Team3 fhc ,lce<, aor t .n. naq'r30 ro 1r0mqdL 14r b6 r mmorLI bftau$ or rhe n *sd ' sk of hyposry( d Ca.diac An rl loam.
  • 38. Thetdevanabty]ni.den.gand laureiodenllyaidslab elera.olnteshdedesqidsyslamsiodenlly Medical Energen.y Teans and Fapd Fespo'se TeaDs ...0 *,";..r,,*,;"*. *"* " ;.;;,. p",;,""'."' '"" ;;j;,;;",."",'","".,","" pat enl s bee de rhsse reams qprarLv co's* ol ".^;^-;,."d"-,h b.,, h"" .: " * "- n. """,, "
  • 39. o arie. drdes or MErs or mpd aponse sysrems dllmdmod!lyQl6S rqen.y F.slome mproveie ream (MERII ra rleEn.e i ire compos re prhary odcome lcada. onsesysrems .{u€asqi,canrcutuar.haiqe .nuop!nmdnLfic.{ePgo]-J,apr...,^" r Lrorc! 6dt n!@. o. 6d{ Eastl.. odco.esbdi isdeandoildeh; he .hand ,n i ii, s br h.k*;i .ircrdEo lsi 331sr 13, r&i F66 i;'q ou one5 .ada( itr4 "nd Q;o, ,_";,- .-_. "-*." .=@*,d"";ir,.",,t _.
  • 40. 5rheM(mllBfu6dNs@l€d d Mb sddy crcup r$!. dMhdgm erMd 6r elbbhff.s&''E19lJid Assdh'hr6shbeffiddiErpdkid 'nffi;Hq*d{6b€Jr*@mdi@ sG wisds3Flffido€lpdLynahd6mse LdPddbdryMdds&hEs,sls3ad tusMcouEi l]e 2007;33{11) 3@7 3115 7. wna Fiv. Norao Je tu,. c, d a kltde 6M4ftmegpdmdry,pdhophyiq,d ibd * R*dq E*F" n*,*h,- cd-i k{don turcrdtumAE) Asshdei,@ycddy*e@cfficommdE; cogidloncadopdmi4Pen@d!.aid.d€c€d: b9c@ml6chdGdblry,'d$.shbhid tudtu.x@113pA24a'24. gd!fu!fuI'iyrpddi*.dmodily tu&dDfo 2{ceqr) *v h*;iie4d-sd tuob@ 2oro h15) P4 srq i1.creAe sd 0 v.idyav dd sF@ Dbeuiv d quddh6cmd€ne 6qGd!eddbdd,. 3Fbru d @ JMl. 20r2;o3l9i7@7m G€tu 2m!49214 '174 14 tuadYM @ Btrr AdbBs.d AJd6lfuAledmcoutl6cadhFmoBry Pfu,dv6cddtu. htudm4 sa,{Goup @etE;rdmoi@4 @i4 d s.c$Uldtrdye{hft5Jd.:aEhn hsMzbtfufe{donGum4: h6 Afu@ }d
  • 41. o
  • 42. Part Efrectlye Hlgh-Performanco Team Dymamics Suc.ldrl Brdidoi d-@ .n . rqi6 h.dt r@ pluldr! to ,irrreay 9ddn. ndy d hrmdo.. amE4h . cpsdrd !!6.rd.. rq$nc rom .rr E!di.i. r pd.nl r6ir i, n, ffi .lb co+.., nut .rbmrr rlqh r. dEr.d.lto t .l,irry.h.dn6Fotda6i.clA.r.np*d'/ida.tslis stil. ftlndyq tudqu ol..r.i, qr.dE siccdu oh-F dtub.B.dcrylts'n d sr.tr.rd ney o, elj!.erddl !, !ny.b.k'6ri. rat n6 Bmrr.d6 trd r-n drfln4 tu 3,r tlr. turd.i..ls tE trpctrE drM &lon bc!!{o6 ot .n!&drlif, a.dr.{jd t.r6ia..! id.bn n ot.i-fihat}rrhd E DulrE tha 6uEi ,!u $n lxs e lp!.rnmry io p.*ri]6 tdlo.nh! dnnd d.. 4. 8r5.. id a. L.rrd ol . Crr.r.d l,iCh-p.tu ro. ulrfurdrlg L.m RoL. ai.ar y@ e. rr n-D. c. r-n b(h. drrt. Jdrd6Lr!( yqJ $d*l dFL.rdJrol dr,.rrla lin.lo t . ob.r.ai-r-ra.! ?a .lrq*w h.rp rtr rt.F.r. . $/td &E rll !. Ddlbm- dx . tt*to6rEicn dn Bt d. ffini d a. rd.Ir or. rtrrlp..t irllu lclaa cl {ia L.ad.r ard Lii.l! ot r HrM,nlarEroa lLatr Th. rcb ol ih.n tr l..di ! ,rnlret.d, Jh. Er L.d. t llo.ilor! hdvldd pd6,I1!o d r-n rn it .! ! Modd d4t6t ra.,n b.l!n o. . F6.E oonpitrdrs p.d.llre
  • 43. Ev.ry hoh-!.rrdM8 rM ,t .d6 a r€d.. e dldu ih. dL.E ol rh. s,n& Iii rM r€ldf, ls E o@bbtr nqri'o gft @rdriis i. do,E d tu,iqt'l sm h,E i!,'l way by mmio']n! ud lnt.aBtn9 lndMdu.r p.rhm.M ot Gsn @ b.G. ft6 rc1. ol rh6 tu bsa* i! sin'r., b rhat or .^ eheir. @trdle dl@iig r^divk@l muLLE tul pray dE iBtwc hn 'd..d lrM rw EldnanL cl Ellcctly. Hlgh-P.r{onn.nca Y..ni Dtrrarnlo. ud6 dr.a.ll.{ *..rr.nr r@ b.h.vld arn l..d. hlp rtdb l.. th. rM a,'d otu !6CL hwi,xd 0 dt€bd n llB l@lllrim. l1. r..h bdgshdld*aaEd'..d!!/de rM.trerlwna At 6sr.l6rr.n, $. i4m r*dd M l&lihb.n.lFr, crf4r€,4td pdiG r. p..pdid r, tE n.rr @$irrt@ .{*pr. bqs un6.6Eld sy tEy lM ptlm aLr' r.sks ]n . Bp€.6. w.y, Tne l? 1odtr *buld b€ .br€ lo qphh 6y t 6 6*md to . P6h hdd d rd r. f€ €ntd o, [E ch6r r Els @br..hde!] Wl€lc.i,bgsol5,''qh9..l@l{nlrgn{occofEl.indivinallers'tE lMl*d,nuslifudaf,,ei*.pltl€.{cs. T6 l@bqs mui b. pl!frd.d in ,{iomkl! tE skrrs .dhdiad by tE+ *.r. oi p.di6 rt 6ertdbesl44oltrE @6to..ndd rsl .Ubri ot. . cro.r .bod 6ro dsEnn -rls ' fi!9.Ed ro tuhr $dr rDb dpod,iririB rielEdid'nld]c'Jfu.lkll. . xnowrod€ebro 3boul &e s,6dnnns CbE Fobs.rrd F6spon5ir5 16 Eve'y mombq oi th. r.u snou d know h6 s hd .or. .nd Ep.rcibl]rle. Julr e din&- ..i.rEp.a pl6G n*. u, , jis$w p'de. eh lEn Mb."s Er. b hrr! lrd aih to rh! efiecd. p.rl@ ol *E rs FE@ 5a rdathe 6 rM ro16 l0 @*istd whs r.€ths 6 peor€ d pBn! rh@ r.rsJc mud b. sioihz.d d &dqmd lo rhs hq lho@ p@id.B p@.ni. F guE 5A $ows how mullps pEvl.,.r 6 tar. 6 hEh'prio.ny r8.k srery 4 l@ lg' 'i.h&s !.t to tE Dabn!
  • 45. o r s6k our aid psloh cbany del.€d reka srpDpnft b UnalktoDdmW as€i€d Bk bd@ 1r ,s bero{ your !r.l o, .@i*e KnonrO laLt Linrrn.is . r*o 6ssim.nB b.yond your d. ol comporsco or
  • 46. ElMnrhE&.tal.g,''l1',f,,,[,,{, Cbn't t.tv. t rt.tu. nL.. Iak. on too many as'qnn6nk a a r bddmDnsadtug
  • 47. o 5, nrfrrT f,q and F.!,rrudr q
  • 48. =a-:j,!;:. ,: C to sed - L o op C o n n u o t c a t i ons mm cmruniannq *ih h'gh p.no dder s srqimdr !o : !ff rumer jtr n.mbd hedd and ondoBrd rhe m*q6. .AsEn.nothglaskafrgeryiq t cr! d* r..p: rnim rh. i.m ra.d tu . lllk b.s6 . GM mm r&*s b a rM mnb . O v. dnrc. wrthM wltally @nim r Fo,!.r ro .iom rho r@, hldf and cMig tE dtoo d pq- s h sh p€dmre rM nidelo^ oi! @ pt . Eic!u60. r.am mmbere ro speak cba Y .Bedlh.m..i..|onold, r oudL6 .i dai ( th. sllshr.rt doutt .xn6 r c @ urcrdi m€se6 md druE .f..1!fu[db9dM,n@bng.o6
  • 49. .&lou'Fls*uunagt ^B@t6.€BqaE. Jq.l Fo6-.ri4t- 'aq/O. ra.$tu$a€ !r*e lF.e.ao.rrliE ! AD4' '@ -,.srn rd m ml ! u@66. 6!1^lFr'D b ou'|noqr fi v . ars lo .rcr @Nr@ 4elq ? ur rBods . ro Eptq Umr aqr Eqr €.uou.d r. ro 6u'u ar Puo{rpre IE ro sselpro.r rduale 8Er6n@ a{ Sunp a{o q* r -ro!d'qa''l e e'r o|EUGU $'rbddc |u6q @ a u Eql36or,!A p@ Bro qra fr !.6de,6lnu. *s ry qru r. p6odug u sl@ M|ud16'q F€q.q1
  • 50. tlre Systematic Apprcaoh Ilr.t'&GadcfpD.{ci ir€drn@ p.o,rdorE 6. rynjtrlh .!D..a.h io 4a jd rr!.r aai id erJy I r tird pdar. td oldlC s, ltr o.d ol nE lllcnFSrll,E txn! ht-EirdE td . D.L.r h !i.(i&y o od- rin b ro rFr .n Bl!! €ltr.rlF dylidq! virticr. ,t ddrtrdr dfi Etm d ffi.r Erd.Ca ftri.d6. A. kr!rni<!d. loC o{ ,!.{.d.n.raErunot.pfir.rld!dsJ.,Fo€c) I}Eda!6d,ra!d.dLy ,r lirxhtt q/ffi *,r .dE . PiEy A*lEn A s, c, q rn E . Sdrd, r€rE l (SAl'f,lE tf. sd ltl tt *.r..(* ^|!r ddfiiodi..' o, so..r.r, dr e/ffitc.0p6.n 6h@ q nEr EqriE AcLs tordd! !o d.r..htE nE 9diil lad d drr.a(.e. 16 Fr *i!.dr ft ,.uor( . n rr Ddrt rccq. aElchr! - lb nr a3 AreM 6. u. -tlic dad.lr - ArdMdd s d.{ or.pp.Dp.d. n !.dtuaLs!86.er. Ftim 6n s€trd, A.l.4re td m td!.r&!d ddrnbn $d ffil . t nr pdirn 'Otd. ..ELo!. - U. n airEy la...rEll ld F, hnc .vacd.( E r..r drbdtr rr_.'b,'r-. silr dr a.*
  • 51. o The Systematic Approach The BLS Asses.ment S€condn.y Ass.ssmenl h,lr,i,,Joat, F.cb Sra.ring Cpn When You Are Nor Sure About a Put$
  • 52. G* Ih. srs aesdun b..ts.tc.!cr.dr t6 Br5ln.! y !.r..d rr.dlh6 pr6 vitlr d ,.lb.n. Iih Dlndr .!E -t crE id d, dds.&on- I 6- ,rot rrdd. ,v-..d inimd.ttB rrdr . d'nc.d diry rod.a6, rrr! ldrfiror fir. By d.! tE BLS Ae6f,dt honna. pordi! nEy .drr! € ih.t gsr or aJ0- ponlr4 d rarcing .ih.nv. dyoqtrlro., Bnilidoll sd riEul.tbn h0l Ros6 d ]nltL, to ol ACls Lt6dto.6 P,r..! i9 dr *ioG In ,r ats AeEn ltaln ry hlp.d. ir drn! dEE.r sivd rtd . !.oa mrnrqi. qr6c. ftimb* rs..!.., i''- farbm qpp.Eprirtg ..dor r &s6l cop6 @ mr Enld &flnric. &der gdr. tuy b. p.*d h tn frr 6L! rr.. .i* addd odnkl mr . A pdlri *E 0dr6 @.rry l6rc Io h. h dn*Lc ,r h Ey qirrdiy, rh trudr nr.y h. .p.i rn ln. !,, ha4 d i.d( Ey lm ,l,l qs. GGp. nro srr ftdtl d w..r SdE rxr nEy pa bd*6 C-F b&rq ii, Edly hsar r . !lo* 6b Ilr grp ru, *'d llt. . ,84 em, q oe G..pr!9 h ^d rcnfir brdtllrc. n B a dln o, cad& ,r.t a Fa llm dd.r4 r.td' t tlhrroElry Bts v(,.o 6 n $r..t ua6.li. lm,hdrdr/...sd-r,. Altu4h ,E BIS rlg.fu,t Dqui- rc dvidd .quirE t rE&Ea p..Vdr. 6 reay Ediry erbDh un]!@rprst id ept*- d.d!i<i., &ct e. a.a-@* Ennlnld .h1,16. wr.ne poldeE piB dr pliidl 6 'nd &iM rn. epln. pdr- td to rudnr..,Edr..xffi d crrd dn ierdsLbl. 2 a dvi.* o,tE Brs lsEr., rid Fro'c Trra{h rr ft*n tu *p6 'r..ad ddhg nl sls Ae-rli. A&. $piD.dius th. p.i.'r. dlgD El sr.ry, A .rrrd ffi luv.y .rs-dd b. p.rr.m.d ro d€rmrm n r, l!6d .xki' rot io riod. cPH, sn a . $rd t
  • 53. o lddlll'lheq3,so.h&k*odloin.d smdbn&Lsty wtth the h@rhks .tt*h to nininia dat y in .t @tbn .lio@se.h6cltnlshoclab.tyihm
  • 54. tt $aa.duc,ppl!.dr Cri lc.lC,onc.pb Mininizinglnleruptions ) ( Ou.lity Compressions F@n t ttoEl Fec,, Chesl Comprcssron oepth
  • 55. o Single Healthcare Provido. May Tailo. Fosponse High-Ouality CPR The Primary AssesBment
  • 56. ,rr. n.!r.ib r-r!.dl .klLh.wld0dol@ Nl@frfuha1@ry1 clE3uFr.dnl.ryory*n,hdlnd]cd.d i,o.nor$..d.qu*yo,vdlilano &1d'D.i.rl'byU*ollh.h..dhkhinl'11, moha'yrE6,,fuayqE@phaiyioodaRay . u! .t,vam.d .lmay mi4.md h n..d.d (ss, laryrEaar mdk ,tu., rarnge hb8. 6@haqerlEdEr rube 6nddncher rub.) Hoa]lt,.siaw.6.Ml@lgn.fcb.re6laldn@..dw./pla@@1.dffil1,. ful6polabntdcpa*aenao Ad,dcddMad6llAfuchsabfig3dfuday,dyrEodfuho,d44E- sdl dchaat rh. @ b pldced dh tt uenq effid arNal dd,c$ . conrkr p..p.. inr.s-rdr orcPa rd nn|dbn r co.frm peF d.QlMi or .<nmo.d ddry ddr6. by - OldEiw waErdm €prog.lpny r s.!eD $. d.r€ ro lEvrn dl.bdlmrn ' radrb di*., dffii drh coidNc q.rfttv. ,ur.m c.e..i.rei, ' wbtE.lEcatd* trylh? IEd.nbfufu@@11@d. lh|lhfrol6@p'M? LN lfrid b. @-b@7 hy ( PFco 's 163 rhan 10 mn Hq dnEi ro mproE cPR qua t) - hra-d.nd p6$6 l Erdarm phe ld'6brrl p6sre b r6a han 20 mm Ho, d6pi lo 6A.ve cPF @.tly) . AtL.h motro./c.6h.i[rd r.r .lnryona.. 4 ct.t.o Gi fiirnfi Gg, vs. rrcur& r bJr ar on lvFl. puBaras v6nt cu a, rehymdia lPvrl. 6sy3tor. pu s.h.d ' t6vi.L d.l$dLr..rdrd.sroi . olv. lFlpi& d'u.r b ixmss dnhm and bbod P69o . Gr!. avro nuirr. r Errrd .ch-k9lt@.ndt.nl..b[ . ourclry re3. tor E$drvs.t4 rewl. d c.m.d3ms, a.d pud di.t.n r rhov. cbrhine ro pntom . lrub.l .Emlm60ni roo*1.! td obtr6 .hn.
  • 57. o The liccond.ry Ar3e$menl M6dcar0is Iicrud'do h. rasr doe rak€n) P6r mon.. ri 31ory 16spoc a ry 6h1'^q k rhe.(dnr rissl 'k.ly&sbiyDsH9drsc,aalearcadn@ld d rq se acLS.asos prcvide dorais on Common Underlying Caus8 ol PEA
  • 58. ,tt slalsr,rft I@r!.C, Diagnosing and Treating Underlying Causes Pare.G n .ad a. 3rcsr lvF/pw/as .anqU*ydsllyaSpslCmnd' ot oer arcs1 and cad{o! mo.!4 arcsr oabre 4) .id aod are.oninre 1e PEA) our known purnonary emboLsm (PEl. roui ne t b. no
  • 59. c.dnn dtuq o€'n *s and db 6rroees trEy ]@d ro psipheral vMla, dilalaljm d/or fl'y4adiar dyduicrd wnh Eurlani hyp.t .6ion. fi. ,pp@h b pois.ned p3lisnlt shdrd b. ass@iv6 be $ rhe roxic srers ry pqB r@dly,nd may b. or imned du.alim rn s€e sirualions, nyo.5rd6l dysrurclis sd .lnlrlhmis nry b. mrkm tB .'M or me'y 5p€ ric rrnied hrftn rio6 *1$ m rhins h comlM: tEy bly iim6. r ft.lonssd bariD cPF in 3p*ial 6u$[aiion 3]tudids . l a-aodrc bdM pumpin{ . spodnc dtu! mrrdorB (dEorn mmum F.b. grLeqM. bicaftond€) . Coror on ol sse eleohryb dnulba@ (poErduo dusnerum, ns.hD.r, r, rrr. ,.!.nt .ho* .r9nr ot Rosc, porkrdi'c .'Et qE .lu/d
  • 60. OYaaYle[ ot lrra Cr:ar The ACLS Cases Ir AcLs 3m',r.r6d .6g @.rsisd r. Bi [,E kel.d!.,rd sritk y@.c.d ro 3l@tury panidra. n l* ddts ..d pa ,E M.c.e 3&& 16. Ei$ ce conbiii m loral.! iopics: r De.cdDroB d d.rlnlll... .r k.y cGpb . &F..rid or fE .h.irrf, io rE €E 'IhB pan codains th. lonNlno c.g t A.'n c68ysy1dM6 . radrya,irE lslrt € .rd urEsr.)
  • 61. o Rs3piEtory Arrcst Case R.rolntod D/.t''s ent )n esp)Btary arcst Rspen,s aG canpbtet R..pt6ao., PobL,n. rde.liy is !h? se!e'n or a €sptrir@ chandenzen by abnoma dsptraroq rar.l6s . r^adeqld3 respr3rory enon 13s hypovenr ar on or radypiea) ' Palo .oor ski lnole rhd sotrr3 ca
  • 62. fh. ACIS C@r: E@i'rtutM m6dtdmllyrespGbrylaUeba sts9qf,@bableesqnlarydfulel aid d sodercn .o^1ro of bftalh is les apnea o' sha roq siow 'asp '3r ons) when ,esp, taitue ca1 acctt ||ithott 'prcal slsns .t EspiBtary reve s thypercapn a) a drcp o bLood oxyoeaar on thypoxem a). or both Resp ra1ory a,Er s the Gssaton (a bs.n.e) or breai h nq n tr head nlury For adu ' n Espdory eer arery 500 ro 600 mL 16 to 7 muksl shord sufi ce be prcper y venr 3rd lo make he c a!o'd exc6s vs venl r.i on itoo many b€alrrs or 1@ !a'!e a !o urel drnnq €3p raroq
  • 63. o The BLS A33€i.ment :rheSysemdcAppc.h' Redemberi Assess,,,the, pertom apptopnab action. olb@r.hast.omp.Asons the Primary Asscssment tuotach*rrE! tlba o avo d excess ve venraron lr@ nany breat's per 2Ol5 Ati.r.l,n . Corect Pl.cement or ET Tube
  • 64. llt Aclse'! Wr*irt Management ol Be3piratory A.re3t . Lrs r bas. i ay rdlncb roPA and NPA) ,4.c.rd,rg ro the 20r 5 AHA GLr detnes Updare lor CPfi and ECC, ror paoatsw ha penLs l9 thythat. venrlaltans shatd bc delivercrt ance Avoiding Ercesive Venrilation Giving Supplementery Orygen Opening thc Ai.w.y ,o.l/4c.@fulold4as
  • 66. Providing B.sic Vontil.tion d ue ,E i.v sG! {rou hd q€iln Brg- rtt 1s6p4'd cat, sprermum4 r Modh rrbarls devlce lu sns a pd ket mask) €nr ar on . Baq-m6k vedildion {Fisu,es 1 5 a^d 1 6) duri.scPB 14 sinore h* thcare fiov der shou d !s I avzrldre.) t s 6d6 ir' , tE red md *pe'j3rc6d ton ba! ro nune'ous adlund vav You can atach oth€r .diun.6 ro the t=t *r.s-&reb.F'*wt.
  • 67. o L-
  • 68. B.!ic lfiv.y Adiuncta: Orcph..1llrgo.l hv.t' 'I}: OpA 6 6.d 'n p.rhrs who ft at isr b? d.v.roo4 a'84 o63Ms ftln nE baw or tlm tld.d upp€r aiNay nMl* rhis J-rEp.d d*e (Fis,E i7a)ms oa tfulon@.loh.]dsndlholollhy 118 oPA 6 '!.d 'n l],ffie paeG , soc.dG ro op.n rE .my (.9, h..d M- dh lm s 1., rh@r) rai ro rwd€ and @turn a ci@, u?Eoshrrd aB.y t oP,A tlbw Nt b. utad tn a c*@B 6 s,.o,nnfus palb"r b&aus r may stlmurd€ g.gsins ed vhrflne Th! t y a!ffi couqh ard o€g Efl.r rr$,dorcre oPA IiE om n.y b 'd ro r..0 rE a'*ay op.. duirE b.q.n6rt H 'M wn- p6vir. .6 misht ukM ngry p!.h dNn m rh. .hr^. unkins rh. rR:y. ne oPA r .rs u3.d dui.! sucllonlis or tE moulh aid b@r .nd rn intubarod pa[tu ro p6v6nr rM llm b['no and @ ud E t'. Er rub.. cl{r th. m.uin -d l6rFr oi @Erions, hlmd. or rcmri by whg a dgid Dh!@.d MI'd r ! rr o@r!3 ad.c tr,.!F.!r cr Pb,r osa {-rd !l i<h d t lElFsd 17q. wlb nlrbrc. ort! oPA: a,l ffi ol ruEit', rr Q a d iurch.{ h. mrdtr. A ptlclly *..d fd tr.i.d os qd.h a!r.. dgr.r wih tE dori. opc'hg, ln,tolo,^snsIitM']plvenbw,,d!ll.hadp.l.l.aifrl* L tn oPA po. ,r64h $. (r.r siiy id .!p6dt- oE podrld wddu.lrs .Dr.l.niaknotuDr.af, Do.rion{Fi!!E17c).rn oFA o .r.. b. rGt d d . s r{r. ro oE trsrnl fld ,6 tdd rrn' rrds,E lod.Li,!!lu. i L itzr..d.,r h.fi oEd., tue... io cln ,E d.rlo rld [E ldrcD & td !. r..sr b nor h6..bidy nrn d !d iito th. lnryfl dlv tE nl,lo pti.d l*ern t lh. Opl" ar .ltdtr. rrned ir to t'l u. oP lrdcm h *h[. u*E.lqt!6 d+.*ddrrr,dato.bidd$.toio,lsd!G0io L Afi.r G6nbn .l ai oPA, nonte rhe paid. x6.r $e hoad aid lrw posnro.od pop€trv b mrdrn . p.r{r aieay slclion B. A*.r! ol nE Followlltg Wt€n Ullng an OPA . oPAst6r@roor44Fruy&srdrh.r&Fxor@stoumatorh. ay.g.al . oFAr tEr e b sE/, tr ,Med impl.p..t ma, pGh th. t[g of irE tdEE pcrffir, .nd o6dd 6. ai ?y . r@d ho opA i)atur, ro 6void 30ft [su. tauru ro h rrF and E s6 rl6mmbsr io uo be oPA ery 'n rtu un6poN w pdbnl whrr m ruglh o/ 6€0 Ei*v lr
  • 70. B.rlc llruay ldluncts: ll.3oph.nmgeal Alrt.y s OPA 'i patmE *ho ld a lr3s simay mn.qe mr adrumr Th. NPA B a elr tubb€r s prasrE uncuned rub€ lF ruE 1&{) rMi pmutu a ctrdu r ror a drow b3ir6 rh. nc Md rh€ phaiyni. un ko oEr eMays, NPAg my be uk paib,rs (pa .nrs wrh an dd ctugh and gag rcrro, Tho NPA s ndicabd wh6n rns. os'dry 'mFid *fi por phrynga.r rm d 3.1-tn,.!r.r&I'r r Crrr.6 rho oe ckdnfffi ol tf, NPA *ttl th. LE rpdd o, ti n@s. Tn. NPA.nouE ior b. E 1.,!. t'd lt ws iutdmd bLrEhrno d $. n6lif.. sdro rcvld(. u. lh. dhm.td oi u. pali.nll htlb.t lkld B . srld. ro ..i&1.9 ItE Frqr tJz., ! Tlllqr$ ortE NP .hdrd b. tf, td - $. dbl,E fiqn,r dp ol d.pdrn!l@ot dlo6. (tle6 13q. L.tcd. rh J*., q'ih a *ard 3dubb rtur r an€dh.rrc Fir, arr !. -x{ lro,dr t! ,rlr b . pdx. ndo.r F.Fdol b ,r ,arorf.be.Paic.ny&.tnrt .air..soBEyqficoiac), ! s{e, y M. oE ta. r. l-iM. iNdt . .r rh. .neL ol trE n &l p* ! Ar.fipr ph!.@nr $@0n lh. orha i6tl1 b€&s pdlml! h*. dltlr. R*arU.I.lt€qsnlyMslfuinh6.n MUcu3bbod'!m(,dfu$frti*6ol!h.ph' b.@€p.ey ae Awar! ol lh€ Following Wh.n Using 3n l{PA aido,Gabls€dng,wi$pGsb]€&prcllonol mo.ery lo Emov6 brmd e *rd ois lhsdop66!Gwlh&lvsvsllal'm,such4 b.orukdidt6,lkNPAmay. ddvomd]i!d6hougn€@mmmlyb!(d€d b,sr..G@pd]ds. tuma b.c&e o, rtu nsk ot misregM '.ro ft @nl.lB'tyhugha'.ddeddeMp'd.
  • 72. 3{ctlonlng Pneudoc lor OPA. dd l{PA! Lk nr rdlslns Fduion! whn !.hs e OPA d NPA: ! a*.ys d€ck 3podffiw ElpiErkrm immal.i. y .t, ni.rt on ol ofis an oPA or .licpftlj@eab#e]..d.qft3l'npcnl6'lsuEddidalo@ ds3,pl.oli,l.de@ tl'dllffieumv.'l.bl.,@m@GlofEr sktoniig is M .snr6 Mpoft nr oI maitulnng a p.ild!, .y. PBidoG $eu sr$on dai6 c.@ o1 bo$ @rrue .Pmabl€sctd&Y6&rylota$lbddynolqfuadeqd.afu 0 nm H! b qd-dt ddy. e capabl6 ot proud'no M .id!w or s.ars M 40 umn ai Ihoadorh. d.l'sy tob€.nd av*umoln@ rh 30omH0 wh6lhefubescl'mp.ddfun$d0 . dicr tE nouit or sucrbi loEo 16 u$ in ch dm .nd rnlubalod palisb. Ao$ &ft iexibb sd nord 6ucl'6'no @th€6 s .vrrabr€ so, &r/D& €rErffi nBy b. us.d h th. roJf' tr ,e s.( nsrlu. c!fr'h d rvlL h len lU El tub. d..p Mjming. Ag/d er,,.rrt les, Y k u4 e @d ro ffi ,E epha,ynr rhe e b.td rd luo1]oniig}ick*l.l'oN5i!p.nicuhbm.td dt n "rgH 'A&]6ioiollhinffi,rmlh.odpfurynx&tn3$pha,y .P.iionrr{'nhfrr,Elghm'ng ' sd6i0 rhd4h e n pla,.my l€. !PA)roGtub&( oldEo.@x'naFftd*]t'cl.ftMlef' r iron.r..tlv.lJcddre ollhr@prf,ry@ p.tdE,rlnI
  • 73. o .App]ysucionbyMcudnqlhe'd E I lsdi,fur'Pa'ho!]d.ordc!.d Motrt.tthe patlentshott nte pulse, oxy1c. srrnoan. andclhrcrt rpttca?1ce dutinq sutt.mq t btadycatdta drvctopr axygen satu.ro" tttt or chnicat.1pp.r. t e.tetenarates tthxn4r sEnanng at an(r A rrt'stet hBhltaw Lrqe. I Providing Ventilation With an Advanced Airway
  • 74. ril. @ d ffibn4 ror rlnr tp6 or 6dY'd.r*aF l,fuih h rho !rt- oredM ot tH rrv@ b bleid ,r dp. omE b4i. lcls PB/ider cd*. lo b. pFided in tl* E or ad!..... de.y d416, yd m6r hm ld.quaL in'rrd ld+ rnc r.d ono.rn! .rponm, Psvrdd *rb im.n .dvso.d aldly0 hd parllcDn. F I q*d ol COI ro d*um..l irld mlni,mD @mplioaliMt r^ ,r. mua, ,!! will pr&rE MtltiiE widr s.dE 'o.d.k!ty in d8e&n l.n.C..l_ r'o rdbrhn wir' clEi MpME. b,ry,|a.dH lb b.t114.d ne* dtu.y E5 dfld.i*zr dE 6tt b EI hrt/Dlre,l 4n F** .aMrb5 E dtur,, h i! @irhle b 6 nE l.ly'sd nur ir*ay E , tI4!€ l.5Ertr6.tu aiftzy nst.odmrn . €!E ad or,.ip..anc.d p,Dre.i drd ,.tun t r,Pd rBtt d .Y ht tu r 56 tE slffi llhrE& tmh-i3s/...errt{ l, lm i"lb@tan 6 rr, dv.nt 96 o, tE lrrno..l iub. e gimid lo rh( ol r,t. @phac..r-tadE l lub.l howr, tE I'yE d rub€ E nm oonpd atd la Mplb.r.d b ild. n aft@ prd6so.ak t r.r.d ln ,E @ oI rh. layic-l h.a. m3v .tsds h ! , .rrndlir b b6snEr vdid. 6 EI ina.lih lg .,My rolqdmrn h dn* d our.:p...xid rlvdrr. rr4rd Fran *f$t ttu ww Lopr.r..Frtci.., iE sDrDloar-h.ll..l lub. B s .d!.n €d s,rsn .ll,nsirv. ro Er mrba o. Tnn dlie pi.vrd6 ad.qd€ FiLlrrl dnrE d. r. e Er rub. rl 6 aepLbb ro @ $. ad{@-tdE rt4..e.n r!}E b, Er tub. kr m., tr@aes-n h t_ dr& .tr* Oiy p.olrd..s .rpd,. 'd *I,, 6 d rrro,id rta dp'Ls'arttdEr E s6 $€ Lryn!€.r rriut toi .dio m lt sru<hd vr.6.i1. lrd.h.rtoq/cr.txt .9 hl m@ iiftlrulhi on fli! p'!..d@ I s€ ,s sri.rt [&6.]i. iffi,hdnd!r'G6ib!0 fi . 6@reorl-r..lE.r I(.{o.
  • 75. o Fltcaullona lor Tiaulna P-licnL a b.fr eflEry or rE bs srD. i.. p'ro.n'ne Er nnlb.tid € offi h6€ b rrn't&a rh. AcLs s.rts w trtry ein wirr s6 r.c.d6. r Prupm ir inru!.tron by esb .g s. nr4q,y .qdpnnl ' P4tom Er dubaion i* lh6 srudmr whbs .) ! rhfar6 cu{ or culrs on rho lub.. . alllch nEv ridbnb!!. . Confim @d pb6jr by phFEr oiffrdim sd . d!fi.nanon et Cdtl@ ,&.rem c.!.Eo€phy b lg,.rh-(,.d lin adllon io dinial e. nd) a tu rci,!r'-r. nll,'.d o, @.fimng a$ Mirniq @rer dsd o, e Er [b.. lldn'@ Fwdds nEy d!x.l d6ld* tts ,.v,dfr dpnqlphy ! rcl &obl,e O.ty d@iflin eturid* shetd Nt m Ett ntun i@. |a se rlE E 'd.telr@r lnrubali.. e.ton n ih. sllrdd i/.brb (rN.ndtdt/...n d.rrl re I'rc inr(E @ o hu ,.o.€dE Ul6 of C.i@id P!.!rlr! . cico'd pleuB in nmgre$ @r ods mry on r $m. ltl.6!e or Dddioi io lh. i 4 a/ tor 6D tiol fd gei ( ns,,tldio1 dr.! b.9 hek 4n'r.nol. r()shd. tr wF Arcvid ns aesr.d 6 arhn ror par.nE {t$ kewi or suspet d c*Fl dpri. vftd E@srv. h..d 6nd Mk mdms n pardswrh u*bl. @,.d sp ercolumn m euB 'Ewrbt€ inju.y ro rh. lpin.l d d wds 3 mimr 3d.dr cold 'nir/. AppErrnndy 2% or paii,E win dud ldm ru'&9hloo!ul,.!ph.l'n'ao'ngnth.EDhaal!pf.ll4uyftbE*6hpl.d ilBpdf,dhe.hddl.cdh|u'y'AgIredd-yp.tMgfimultoi'h@ injry B. pdtey d/ijoc if . Fr6l rs tuspd.d (pjd 3pft ,ipry Elmpra @ pdigns *rE ha€ bm invorv€d ,n . rygh. lr€€d mdd v6hEr€ cdl6M. haw r.rhn iim a hsilnl 4 e nluEd wrrite di,1.c F. ow rh6o pEaur oN it tou ,{p . orn rheai ay by urtis5l6w rhcr,nnounsd6res6, sd@ rudrint.!. vs dbn e Eis rk. e , h€d rh+nt,fr 'm'p!1'tg l,n,Du.,c-ddrfu',.ffi.1 l.dl.. o'mffil'- sslac*ddEs@ygnpbd.lifu.y I sp,Gr 'mmdi.ar6n d&rE m hdptu dui@ n.@e
  • 76. Acute Comnary Syndrom€s Case Tn€ rcLs allrdd m61 hd. lh. baic knowlsds€ ro ese .id eblta par {ft *]lh ACS Prr'."b ,, drE cas. h.E s/grr sd stmptdB ot acs, Lctudhs pastble 4 4. 4 wil u& rh. ACS Asdfim a rho eu'd. ro c lnical sid.gy ACs @ io ol.Fry p6ln8 ldo 1 ot 3 EcC ..r- .!ffi. a.n dh difllM rtrLqi6 ot i:rc ald m.n ctu n&.ir nE 3 EcG d 4m @ sr*.qM *dd s4odr^g d'{dE d. iiidy, sI s.sd d.rGs 3!t {Frig erFi4 aild Md'aodt qn niar EcG. Tt6. e dnined i. rErCS ,Jsdihm, bd sr€]d *in rm'BritE 6p€ii!6n .fd.oG r! r. rs or ths dB K.y 6mpon.nE o, rhie @. .rc . rdsntfcalion, Mmml ,nd uas !ln't,lffitol@]bl.Acs ! Etr8lEs*l d st Eotfus ol dE o.!dn wfr ACS/SIEM ii,,Ird,m. rot reE Suddal @d?r de$ $d r'@l@. Bldydhidh6 @ @ 6 ltr i:Eh.tu Prdtd?r *1rr u'&rBr!.d ro *nEForo ts nry$m M s FlrrEd r.. inm.dE . .idprs ar dsfibdndiM .^d .dmhisr.don or drus d .rocr,icar $(apy tor s)nBom.i. Aihoush i 2- ead EcG 'il&pl!t{]on ! b€rdd tE sop. ol tu rCLs PiDMdt c.ue, !m ACLS p.lvdqs *llrtus i2-Lod Ecc Edino JdE Fd $m.lhis .ag llm. d6 nE idsnifdiM .nd man€orE r ol pdid *{h sTEMr ort'. lt rca atlg re@y ,'d ll!.ljd @.06 ffiE io &016 6pd, 'n $E ndd ol Acs. AcLs ,Mnd imp.rlanr dti06 llr€ Aclsi tt vds coe pr6..ls onry bao kD*l.asE rEEing d .diy rEtrEd and b€ p.iodt ol "pB 6FgIB on, dri.r or lcMmrc pri, and tsrmdr or ..ny r,+thEaldrn! @mpra!- rbnr. R€FriGton @y nvorv. t,r. us or llblinorirc lh.Epy n dMa'Y oLqEpiy wth PCr (lo, brroon angioprary/slf'rhgl wh u$d 4 ln. n[r.r reprl6M $ar.qy lq sTIMr, PCl a cdrod pnm,y Fl, .brt .nd nhd rrcmbo ..d ddd.E rlE d14! @ . Fb'ircMrc hs@y {os'.w) Addltodsg*tde&Nrcli.lohMtr,pya,n*{db.fus.di.llE . ^dffiim diphGpiab (Aoa dasoni:tu lcrood.s,lr p.4,{d lies6rd) . Anororftin{onwn .l .n4m. {AcE) inhib ss ! NMG-coA reducrE5€ 'nhrbi@ lsrdin tEdpy) . Gryoos.cn lb,4l16 inirbtors
  • 77. o Goals lor ACS Patients found.d.El F,Ej. oHcA F6sponse S advan.e di oi orrha,e.e,vnq hosp rr
  • 78. Eady prrq$ ro.mdon a&nifidr D|lc- ro.tn thll Pl.qu. ruplur./thrombs. SIEMI D t{stE.aqs FGolutlon/ra.bL.nd I C Unstabb argins D Micrc€mboli c E
  • 79. o ld/r. cdnrEt srtdffi x!odnm-2o!s uprh. i-...rb&fcouBs6fuffi f,eiaglltf lce Tha louta Corcnrry qrdr!.tra. Atecdth 1}E A@!. c@uy Sy lrE ru0qir6 lF'98 4 qiitc rr &d .n od ,ls .o.d d€r. rr, . edinr p.Ebg ,,$ ?ir9i6 rllE€0s ., lcs, tu ars Bp.''daindEd{l+.6{iEl.lffi6b.!htrr..dd.sffi&d .clim. IlEg kElud. lrins orr9€n. api*l hib.ci/*rn, .nd DdpnrE ( i..d.d. ud o fii^g h[h 12 ldd tcc (si,lp 21. Eed d rh. EcG lndi{.i $. Elirs pdids my cMpr€i' a irbanotn $-.!y dr*k*r rn noll'y th. lGrtB ED or . p6rrrid
  • 80. aMl-srEu "rf,n .pp.or do lstsp 3). lr M-ol-hGpibl pBid.B e unabl. ro .mCar. llB i,'idal n f6 botq€ t5 p.ddr! di!!r rr f'€ hcoilal u. ED povidr *.!rd impre sr$6€quor ,uhd leB oi tE pari€nt ! nnvd at dr. h4pi.r. €o pdsnn r lhourd Ev e th. or-or-h6pirar r 2-tsad Ec,c [ *inabh. I nor p.dmsd, ac{u si(on o, th. 12,hadECGlnqrdbeadon .ho006rr.ro6n r,2€lh.12redECca!@GE ddqdia p.lldn! do i ol3 o@!e a..dding 16 e.rylR o, rh. sr sald (nE p@6 o, r€t blndrs ble,r dmk 0tBB) d tr. i 2 r{d Ec€. TEtrndr lwlM- . Lk anr$i.ddeisr Acs Th. ACS C& wn iocr. M rh6 oany Ep.rtlio o, ri. SrrMr pdbd, .mph$Utis hiriil cs ed oold rd@ rd E@tulron tE@e nf acs ^llorh [!E 20) s.vn6 s@.r srid€riE rq appY b $. dd rE€E . pdi€nll bd.d d syspim d tE 12ri.d EcG H@[hc@ p€Mn€r ori.. obrr]. qr.l cadr.. h.,*.E (c(-MB. odr4 lEp.nr6) n m6r prird! rhar srbw .dd[irRr ddronr Tm rmFdanr pdnb for sIEMr n€sd decson ro .dmrnisr€r flbrlioldc il*Eoy or pslom d d0iorric mmry aishsBphy snh ffi.ry i'ljMrim {.nqioor..t/.tsrhs) 'n srEMrpdr.nt3. ,Ca flg.tllrt n abr..,'d rno sbr6 6 rh. dle hn 0!'d. @t .nd tEt6': LsqBtrv' or'&1.tria (sr€p ' , arn h..pbl rdnvd noimdrd (9.o e) t rmm.ar.i' ED .wr rd ffil ls!4 3, . crarrf.ns ot pah3 &ddinq b sr-!.!nd e4$ lsier6 s s .nd l1) ' STEMIIST@ 5 t'@h 3J ldrntl0c.Uon ol Cha.l Dl.corrilott SugoGiUY. ol l3chdnla Ydxd]djdkwho*lododlydddiM,.n'{eefuoldmi.c''d.rdFd{, &rd rrgd.d .rdudron ol &ay p3t€n1 $w hiu l atsltu 4496r pdsbro acs dadnh 1}' paM nEy prqiE t'B disqirdt ,l@ 4 p.Be s igNlE ds Srnpbms &!sdi$oIACS m.yats imle . ulwbrdbb Dc$6. rull,B. { rasrr{ !€€ar mitu6 luMry lr@ ftr a ro* mind6l . CB d!{i.n 3p.B.d.,O b h srB*k, ,'€c*. @ t bod' ffi, d r* . chd d@riod sp..id.'s do ,*
  • 81. o STEMI Charn ot Su iv.L I EMS Assessment, Carer and Hospital Prep.ration
  • 82. ft.vu6 lhoud bo ief ilE wn[ tf, *rim indrc.tons, caurim $d rEffi or .rdo EMs p.!vld... stdud adminl.td drrm r in. p.t d i!: dysp6ic, b hy?ormiJ, h6 06r* d96 ot td riir@, ha e dslJ oryle dlr.tir r8. tu so96. d $ts oxyld sna!.. E hkff p,!v{,.G ,s.& tffi. oxysr d*&y ro , dhEivdy fsrr.r.d orri.rEgro6i^ {rE roi s% r sd, aGe il5 u!.n E ha d b-i *bnah.d ]n ,'morrc pl|rnE win !6per.d & c6tu Acs, @'doB nEy @ sido. w thh.rdhg lupprffi.7y 6xy! nBapy rn trrdo parisrts Asphk (A.etlsalictat. Aci.l) A d4 o{ l8a b 325 ms or 6-rnN@&d .spsi c.te mnEdrd€ lnd lB.-iobr inr*nbn ol thmbore ar r@ducroi by (hbtrs Cdda cl/ddrylde (cox t) tr.r.r6i. e m or s. lrrlEFd rn erid prt.'p.ni3 n tEnlr. roMir. Ina 6pidln,'lhllbaEod@@i',y@du,msdot''elM€d.hdFl' don{y md .ft, ib,imMrc ih.Epy. Hish i6p.!ddys6.1 ie.5 s[ ri'd r. muimiD drhr oxygs 66rio. r]d, ,r M, rlrr.r orrlo ffi T'i' w]l hca srrorr oryrd d.rvry (c.,6. drbl, x rld dyld oonir$ trB cad& dnpd E rim[€d. rh6 !rM-h or]gd rlE py dc nor rf nE pdrtti h& id e*s ..prb 3nd hE do hi{ory ol rw 6prdn a[r!r/ aid m di- d.(s ol lEnr Gr d€edino, sN rh€ p6r6r &ptl. 1160 io 325 hr) b clEn h nE hiud ndE ol s Acs. rsm a .bo.rt d bd.i rrH .rt*.d ,B *rb *.n6,.d, pertar- My ll 6oBr*r ,6 bal 0i6 r.k€ ErJ dphi 3'J0r6ito.E (r0o Ds) id !.rraE si,I nffi, Mtiis, d.rir p€9irc urq dE@, d dn* disrds or rh. lppe 6r f.d Mrcgty$k (Clycqyl t kltete) Nitboly.dn .ftdlvdy Ed@a i&h6lc .lEr dLco'n n. a'd ha bs.fd.r Far'.dy' 'wic .lhcts. rh. physrro!'c .ltd8 or niu& c.4 r.ddim . Lv dtd ,rgri €nrlar- t lFv) e,iL.d ftdsh P.r'rld ,6i, Gis e ,6H 1 dinsud ,ir,rslrEn bbbr ld 3r.Ey -tul .,!ry 3 ro 5 nhLr6 tor ono.ln! lynptoms I i k pqnitld by DodLd enrD] &.d no oont lndLrrro.B di.r H. nce Drovidds may 6xat rhs d@ iric. (rot or 3 d@l Admrnrdr nrtlohdrn o6ly ir rh. p.i-r 'ffiiF h-iody@i.ally d'br.: s8P b si€ale fs 9o hm Hs - tu bM ,ri 30 nm r'{g b.r.* b.!.rrt€ 0, kmrn) ald oE halrn. ! 50 ro 1o(Vmin, Nibogtqin €. €dhro. -d r'..dsb b.6.d dfio5ly r dd.n n p.lirB rltn i..d.(ud. d,1c!rr pEro.d. T}e 3nu!t.B h.ruds . hLrtd rill lll nd iV lil.rcdn. tw rnlmllon may complhaL e rnidor wall Ml. v(y d.Pd.d o Fv rl ^0 9i.su6 to mrn r.ri c!.r* e$', .nd bb.n saM. r Rv 'nr'did cfu b. tur.d d, pr.ed$ nd e Etm h sm.Ebj.g niillB b p.td 6 f'lri' sTEMr. rl tlv irrft- rirn ! dnld by nlnl{tu F!d.di.r r.d d dini.a f,6'n9. by r .rpdsE d prov'dr nin {Dd. ,'d oihd lEdrdor! (mdrrx'€} d vd@{.pLtiE dru93 {didB) m (d.Lnh.!.n a w.rr. . lt!.t 8r.., t .dyqrd., d r.drya'dl r'6id u* or .koolyc.n. h pdr.nL wnn hrld.i6id lsBP r* rhu so mm Ho), m .d brady..rdh 116r aEn sryih), . Bdn ,l.nh.d..ir.. mra.b. q, Avold trE R ol ,*Etrr*in ir ir rs M' pd.d&klM'hddEp.Mhaid(o,l(h.8'l-ffi'6ldihh@iu . Ih66 .Oifr e OrE rry 6.d i0 dEd. drr. furil.o ' h .c6 ol Frmn,y lr}!.rb!i.6 &n h 'sbhds win ^ih€ ,Ey
  • 83. o c !. rf .p ale ieq mo@r nel ior che e wlh.ador n lSrE Ct alc.l conapa. Parn Fohel wilh Nilroglycerid Use oi Nonsleroidar Antnidlammatory Oruqs
  • 84. l2.Ln t zCtD EMS @!'k slukl obrrn r i2-r€id EcG Th€ AlrA ,enn ndt d oi hcpir.r u,ar od sl{rhu EMS sFl€ro Th. Ara @mnErd. outrm !s ol 12-Lad out{l-hdplral Eco. ld F dtE *1h doE .nd .ynortu oi pdlbh E s& $. slulhni v,bo.,r. ('w]fddycrtxld) ttr a smd€ lmm.dlrt. ED Ar!.i.mcnt and t .ttn.rll F€evar mr,fids or rh. c0 slds rh€ rm b @i '61 a,t ,9..d. EpdtusM rh.6py ,th fb.mrync d Pcr d both whrch nEy 6dG. md.liy and hin'm'.€ myG. lt SIEM| L idtrrii.d oi tr r2-r.a cco, .Mpr.r. . frbrr- ndtrh ch..t]h .pBlpn n, ri. hEh-pslm € r6.m shourd q p.iionradb.r@mvrr) da!c6rhopdsl th. I2-lead ECe ktnet ih Ftstre 22) is at tha centq of the d*is@ palhwal k lhe milagfieat ot i*henjc chest dt*ofrlon and is the onb n@4s ol i<ledtryina sfEMl dmsdmdl@6mch6ldff,od'sigMsd !ymp16s or h.an t6 uc .ad e h'story dsk racb6 rd rcs, aid hisldical l3aru6 lhlr may p.Erud€ rhs @ or rLb rcras Forrhe pdis w n1 srEMr $€ ooars oi mp€duio @ lo orw ibdnot{G withh 30 mrdss o, md or p€nom Pcr virhin eo minuiB ol t. i.ou'kml*ML6.t&!tcc
  • 85. o F{@ 2a effi ho* ro ,1u@ SIenEr dMin ,lr l'fr 10 ttu A.Byn€nr an r€birrlnd or rf, @i'n ii nE fiin r 0 'xr6. !ru,& indrd. . chek vti.r.Ed lrn.v.ru.r. oxylH erlraron, . Tak a b.iel re6.d hr3r.?y a.d prlom . ay!r.3r *!nidim. . cmpbr6 rh. fb,rndlnc dekrin fd dEk ror enroMEnldB ir radidngd . o6i.f a b56d ent,r. ro d.r4 rrfiiar .'di* Edr( r.v€ts, .ler!t6, .r, . oar.. nd lfu r..$h dEd rfay [* nB 3) mrin- je dE Fd..i! evd h tu rq. nri' ,eb mt d.r!v r5.ndylk r!*,y 16 SrEMr d &rv.roi . dE pcr ,'Jor.: IlE EU[s or c.dr.c mri(@, .h6t I Ey, -d r.bdlhry 6tudks 3no!E not d.rry rEo*tus on *'€Epy unl€s cri^tc.lty @65ay, .9, .u3p.chn &dic di@noi din'4.!dfuyb.cG*kDdinpdxddh 6danii: rYp. cts dMid: . ory!6 ir hr!.Mic (or x rE rhs $96) d no6 or hi b{B . (hitu (es, moDhim t dEorig defilo.t d m €!pon$ to nlttul Beru$ $e .!€6 m.y h&. bs !i@ oui or ho.pli.r, admintErs inii, or &ppt.- tur,y d6 6 .drc€r€d lse h drr&io ot re dtuo6 in rl p.ai@ r&!.i, EMs a$s,6, c&, .'n H6Bbr PEp6'!t n.)
  • 86. tlt Ll, C.*rata. C!ffiy AF.r6r.. Oxygen, Aspirin, Nii..l6s, and Opiaros Ctassity Patient3 According to ST.S€gmenl Deyiation Ct.sllt lnto 3 O@op, l.r.d on Si-S.rr.ra .tand. ass( prieib nio r oirhe r ro o{rq chi add I ona ,nrodsr on lr'oPon,nl may STEMI fhe mAnstay ol teafient to' SrEMt E eartr Gpe||u'.n .hFtapv achreve.l Mth ptn ary PCIartihn otYhcs-
  • 87. o FeFico.lhd.D}lolSrEMspenl hea4hu<.|Feiioner.h€'nel.t,edusonlhe lFcor tromd,raiods.noi.adnomd.craioniodtuglorPcrr rh6se4n.lor iqaibmol,l.c[.cknlappro/ak nElo|dll'ioii'lhecJ!oIacl! .Fd'Il:,,hssoalolFodoollc lilblroyssslhedgdele!€n a pc rac q.e!ardr6s! or doray The heprci6r.{jl.pedusof,n.alsgyov,ionnolyrC ry afier rhrno nr.s n pal eds who ma! hale eor s( ed pro! dea tpedo,mnq no/e rhan 7s pcrs Fr leart 3 sk sd pc rac ry ip.dorn
  • 88. |r.ICLS Crsa tq.t Corcn rys]t<fo,n. Pr n.1 PCr may a so be ofred ro p.i ard . nra{r onl n a surpods rhe traisrer oi [and rc ower monarl! liei FC!Gi be cortaid.arom r. r ioncs aid s .dcared Alblro}lCaqeilol €eralo. qffirerrhan 2 mm irl2 mV |.asetrasihef5lf'bl.ol,1:lsedtde!bU1is ,tctharapyaleasroows slsaso€a$nabaloq!g,blno}1]cSlo ..,.,".,,..."..""'.-'",".,-"" arnasprnmoFhneandlbltro,l
  • 89. sllMl Ihe assnt s. blorry d scus!.d b.row u$ 6r bNar rud 6, P2Y ! rnhibrtoq D b@kots..id orycop6l6n rrtl/rrra.hrb16w nor b. @v6*€d Us ortEelodh k E .nd a d.r.ir.d kn*r.d!. or Ih. lp.dtum o, 'n9know]..o€o'tErofuhsoicllnlcalld'13 H.9r'n 's ..unftry qi6 6 .n aapd rd Fq ,rn ibnmryrE h.r.ry wih ribi'i.le'fc 4ds 1nPA. Bropre. r.i&r.prel [ 6.r!o hdd.d h dh, sp*ilc hishnsk r d nbir6rFi, ed p@phruE r@ vs* r'Mh. emb.r's Floirs *irr pEroi96d b.d 6r &1d h.d L @ Emd@ri! Ml n rlu @ rhe druss ,!u m6r b6 r i@ w'th d6n9 sh.dore ltr lp.ofrc cl'n'c.t M.!i6 the inapqop al6 dosing ahd fronionnq ol l6pon t6apy ha c6us6d ** hnedebtul dgdling d naiot hqnoohaCo in S7EMI prtimte P@vi.@s @ng hopsh 'toed to XN* tha hdicetbft, dosiaq, a.d us l. rhe spernc.4CS calogo.iss. fhe dosaC, uso, end.lLdl@ h* b@n dditod lfrh !s. in clihical ,i,att Spaili. patlohts nar EquiE doe n@dilicali@. an th. ECC lledb@k tor woghf-blsed dosrrg guid.],G. tntwals ol adninistztion, ert zdj6t- 6enl ol low-tute)laLw.rght h€pa.n b td.l tuNtic., so6 tho acctatla gddelh* t@ dotailod dt*@ion ,D 5p6rfic 4t69di.., ttapatin (UntQctioo.tod d Lo*.naohcul -Waiohl i.lldo'et3.cn.ddr6n'l.n RMre e oi e n(rcttFi € mr 'tu.n.d a.! h& d hei ehM 16 eli'tur y mdE Mar'ry n slrMr N ndDrtdn 6 ,ndi€rd d ud w'd.ry ri r*h.f,€ 3r11dffi h tr prcrdr.d oyr ros.ar o rd!.dh! roG bea* 4 e b. fuabd 'n ap.tdw'hpotmia!|yund.bl.nJn..,ls .[Ere o, iv nr€rr*n n sllMr e . rl.Lv6r c 6l'nu,E crdd &@nvl 6y..oors to &dhqld d sp.sy d.crrdin . Pulmnry q,€nd comprd'ng sTEMr r rtlda3tr cmpio'in! srEMt TElmnlo@3ugnqlvn]n@l@niealolb6 lnFofrnr s rd*rr..hr ri r xa sBP oer.r rhrn so mm 8! . L'h[ dDp 'i SsP lo 30 mh Hs bde bexn.'ihyp.n6w.DdM. t umll dED h saP b r0* or lqr in r umli dEp h aBP 1o 30 hm Hc b.t * bunN h tuDrItrEls Ddqn
  • 90. Acute Stroke Case rh. idstf.ad.n ,td irlr lM.c.'En ol pltAtu *$ &ri. lrdc ! sf5 ,r *oa. ora rcLS FBt!' 116 4@6 ptttd,t. ol Mrr-tu t'd d an iatuBrd asp* d lrrtd h-lr6pnt ai! rrDr, @ orrr rEp,Lrd eub dok @ roc'e d r tr.pE r.knni*lon &'d 6shrt or po €d uhh d6k ! R.pE n 3p.n lwillr p@n!d nolfl{toi) liJ a ladlity c.p.lr. ol rB'dlng el. li+cphal @t srok 4E hdlds i,t. t ,.brr'ty io €prary r,€Lnr pdhnr dlqlbll y ls fh.rrdrric th..r4 r ramh*llEtd ol rbndric tl@ ro +@Fial crrddd6, *u' lkbrrlt ol Bxdoqi: mldrcd &P*!ab. rlhn!.1iiM . Cdik arb.i ol R t{trB .rddr. lro drdd@la th'roy .l.ilidh.6l,l.|trco.fi@l,ldr{!dn.ffi*,nloa!t6l.6iiil.v€ll.!l€ nE Eld t E 'd s..L - iEEE d.d by tE MNo6, *r"d' 16 ll@mcxr.d llElr*o6dro.t d.rrdoi ol *do F.ri,ft.IB B!€ls d goae,El(' b. drb".d ld.t lcl 30!t ol o'.!.tu *rrr *!i. !n!*. ,r''i''ltml.. lll,' rE EcG do6 nor rat Blsriy d, .6idn.c 6 omplrsd rm.gr$ny pI m. No ettdr6b. s lp.cirE is nDl., bu{ rh. Ec6 mr E {lly otlddr4 .r . lxd aMl d drtyhmiE sud, & dnLr flbn{.llon a . {@ oI e mbdh .tE*. Maiy Fdor. *{h tuk may d..M$aro {rhr$nl.r, but It tf, p.r6nr is hmody.e 41y d.br., mo.r atrfu1hmilB srl mt rcqoLr. lEnlm. . Inm . qdr6 .slMd 16 lemmnd edh. mm[o.rns dudr€ rh. f6l 2,1 hoE ol e.rurtoi in pa8* w]f' &ulo eh.n'c srEk io ddd al',qr ,rariLranon &t pd.nll.lly M+$@L.hg amymmiis Dtt g, lor *oL. rhic d$ iisr6 te di4.: . ^!Fo€d i..ndrirc {ri 6P l
  • 91. o F.or.W.i.l F.ca. Majo.lypes ot Slroke heb.aiA{houq[6r,dlolsn'ore.JI.sm@, Approach to Strote Care 3a/n
  • 92. ,r,. iClS c.3* l@r. strL Fdddanool F.cb Siroke Chain ol Suruival Thestokecn3iorsur a lFsue25)&scrbddbyrheANA3:orheAne.caistok ,[ Fddndrdd.l F.da. The a D's ot Slroke Ca.e . orus/Devic€: Foriof. o, erdovasct ar rie6py C@k o, Slroke Ca.e
  • 93. o The N NDS has esrab shed oftcari. rrospla rme goars ror a$essmenr ad m.nage 4. n raron or rfu ioryr c I h erapy n apprcs are pai etrb 11hos6 wihour c onra'ndra The Natioflal lnstituie of Nourological DisordeB and Strcke Crili@l fim. Peio.k ave a tme depende benef r ror r br norrl c rheiapy a[onol/y,&io}1|clheEpybegiswlhilr6onslof hm.dld€ndElogi..$smd lftlpBt {on or th. CT e.n adhindranon or iib noDric rEEpy, Admini*aliono,fibddy{crtl.B,y, tm.rllomon$lol3ympbn. rin.d foh onser or rymdoms
  • 94. ldil S.4.cld Ah*. llaprt rn C'-ll-F-* o o h-ll.d#** baera.b.drbca5(rr.h- *.-Ha'*|.-{.r$.*t.* bi-l*r-r.d-I+ '...hdg.,d'd,JFih
  • 95. o ala..M.a,.llsotig'.ld.dlo@ ldontlfic.tion ol Slgn3 of Porslble Strok. . ldd'fdtr or 3En3 Md rynproro o1 p6!lt . nEr. ad acr,dion oi -dgfty . cdicd EMs as6hsirE ed adpns (s'op 2) d jabi zarE. lst.p 3) . rnh€d ar€ nercrds'c aeMd by tE *oro 16 or d€sisne l$op a) r cr gtr, Mdn'a!. d io hslBhase (srap 5) . Fdr.orir thmpy 61 3nttirEdir. ir cdidor. lSrG 6, 3. ,nd 10) . c:.ld sde l)e (sr.pr r d 12) 'lh6 s'EB .nd symolms ol r slioro may b. subto. ft.y ftruds lfl ry.rt' r r6rrrE p@ue sre Fts . Pd'd'ns hqh piuny d6p.ich i rNrdd os bFidna?. ,i tdevta cPR skr13 d o$r .uD@n vo @ th. aHA Eommonds rha! .l EMS p.lsd b€ tr4n a io 6..sn ze shk. b, ude . naroioljc d,Lrroi iod Mh a b6 circiM, ftor'6o[d sde s..h lcpss) ITabrc 5t d r€s, 6!4ELt d @ sd6 ol tE b.dy .Trubbsp6d].Edd.llbdrE . tlz'n63 0r ro$ o, b.r€no. or coo.dinat$ ddd FHid egns - rrndds oI sdc clJdry h.n or aI 3r'.i<o paiffi e div' EMS pov@ rhe srd od @r .rfiJst ldd or m.ipsfty tanspon ro nE hoss r.L ]}rs adv hss or Et s rscpd 'ndtne th. f.ltowh! . EMs peeind can rd.nro and respd a srEt6 lal d ro a hosp i. epabt. or pbv'd nq acds srrck. ce and nolt ih6 hsp[.r .r th. patisrs impondino .r var day € cdicd e 'n lr.ry rDahdn or pd.nlic Citinndri Prctaspital Strcke Scale 1n. CPss dsi{6 3r6lc m rh. b6h or 3 physicat 1nd'ieu: . Fac'ar dmp thdv. in. p.r ftr mLr6 or ty i. sho* r6lh) r Amdfrlhavarhs$.nrcos.!6aodhordb.rh&mour w h d6, up) . Abiomar s@ch thdv. rh. p.risnr say, .you can Mch u oid d@ n& rhk l
  • 96. sy 6ino ih. cPSs, m.dlcd pren €l . 4allats rhe pdid in r€s $d 1 min'n6. rh. p.se or 1 fndinq on n* cPSs h4 a 3s.itiv t or s9% &d . spsirEary ot 8s*i *tEn uEd bv DEncdEl Nvd*. wfi dadard raliing ln nFtc E ognnb., pdeEdc d@nsr'Elod a scirNity of 61% io 66% t6 Bq 't rE pali.'lls win s1bk6. An, @iving lr.lilng li !s ol . 31rcr. rV ior idslrtins parionls wid' shlo indsdsd b Itl. a Th. cxdnm! lt t€pltd 3t b aeh t*hl d.o9: tiarc t'€ palid slw ,{md-bdh 5id6 of ra6 mv€ €quar, lrr .tltt Pdrr .lr$ .F rd .!d,nd botl am dEttt dr, *ttl ,dB uo ior 10 *dtd. {rh@ 2!) taond-bdnrftlll4lh.m db<dl,@do i.rlMnd @!.. ir*t , 1d' B piq'do. d,it nw b. Abstn F@md*@r,md m m dni. &u. dped mt nx ,'!.6tr1.oG+Hawp.nsl *y, '!!u @1 rffih old do! m Nml-Pa$.d @t cod wods sirh Alllomd-paried stuB wods, t€ !r. wdg *o]ds, or E unabre rd sp.a* [nreeor [ .!y 1 ol tiii 3 rio6 ls drmd, tts ptadlv or a tt!&. L 7296. T} tffi ol al3 rhdte6 hdlcd. fd t E gob.frv ol.rr.,5 b oBt.f- 3516. MdrrMlrm t(. an BU, PsEkrliA, Llu I s.otl T, Brcd€'i.k J. cincin^afi PEiDsp br stuk. sar6: rcpodu.ibirry .id v.rEit. /4ft Fd,s ^r.d 1esei3314):373_37s rv6 p*_
  • 97. o
  • 98. :.?;r:---i.g Crilical EfS ALcairrsnt3 and icllons Pespib EMspmv]dmmunminmn6!}6 .,dbeg.nlh.oisoiolgymplma.d parifir .nvar ii rha ED sfftnic arrcke ft6py on be poided only n th8 arpop.i:n8 ruMns hosrihr ED, so r m ]n rh6 fi6rd 6t d.rays (and may p'denr) d€rin'r'E $eapy Crrllc.t EfS Pdrom . 6pid od-d rEpibl .ih*. .'Md (Ct65, s{poon $. AaG {n p6v do $ppl€modary oxyqEn ro hypomic {eg, oxy$n satudiod bs dr& e4%) srrck b tm zm. r rh€ Parbd wai6 rrm s sp *t$ symploms of Ln+.it rrE pdld't .apidly ind cm8idd tiiS. b . tur. 6b., supp..r c@d@rlm.ry rxc!6 doilis lreleo't H pe,ibr€, brrng 6 {1rnB, tdiry Mb.r1 or ca.llwr w n lh. p€ridb cMfim tmo,onido,nEk synprm.. ftovdeoHiva]ndmdimloldaEeisqhosp]b' cirino tnrEpdt ch{k bk d gll@ rpDl@lr d rEdic.l Ihe pari6it wllrr *u16 stoke is * r s aiB.y obstldion, hypdd ialron, d (atdy) Mrclm c p! mona.y €d8m. fto 6mbi narlon of poor polnqon d hypoxmE wirr exacebate ad .ri.nd i{hemic brain inlurv. aid r6b€tras*ai.d wihwG B.lhoutn,+ospiizldn.h6pll.lmdicalp366ndshdldp.oidssuppftnbry oxyqsn b hypdnic (8, ox),s.n duErtr s rhe e4%) sto*s parients d D.lretu In Bcnriry siqrc .s or stoke lstep t)
  • 99. o Fn$.tun 1 F.cb Skoke CenteE and Stioke Units on6plo,dulnsou|oihosptaha$olSlrcke nromar m ro the EMs sy$em and the commun'ry e$urcesio*leyadmnGlelibnoy{csole.do L^qd€ntlyi9souc6soln6u.oldg'csxpedse I br no[r cs or ef,dovascu r rturapy ar rhar rac' ry qELlyoJlewhenpaieshosplaz In-Hospilal, lmmedi.le General Assessment and Stabiliration fhe goal ol the strcke teafr, emergency physician, ot othet erpeds shootd be ro assess rhe patient w,th suspected strcke within 10 ninutes af anivat h the Eo: 'tine is brain" (Step 3). PEvi& $pprmenlary orys€n b hypdflc 1oo. drre-
  • 100. tt aCUl*aarLll* troipny M hYp.!rrsr', skr. scae lN Hss) o(. sm ar r@l .xpdb&donpd.lm'ndpmimob oda an Bmdadr cr *ao or rhe b lmm.diale ]{eurologic ^.3.s!ment by Stmke TGam ot Deslgn.c obdi B 12 ead EcG, wh,.h ay iden y a emr or onq.ins AMr d a$rhmias lBe. ardd abrirr.riM) .r a cau* dr mb6rc dofus&u''ali'6i'ms9{,d t,+lhrcdmngdy1lm'amldlo p&culadynlrel*.lh.nud'.!€|lboFtdl6k|.dy 6 c3rly ebbr6. rdmd or ionr'ia-rhErd'n! &myrf,nE (b.rdy@dE vr. a"d armMnfl , IAvl mnducrtr bL.k) oo not tNat th. cf w to obtdn uN tco. The goat tbr neutotoEc assessnent is wnhn 25 ntnutes at the patients atuvat h the ED: "tine 1s brain" lstep 4).
  • 101. o Cf Scan: Hamordraga or xo HamoEhaga ass rhe pdEnr ntudrogic ddus by usino m or rh. 'Ie advanosd srrcrc ed6 l{ational Institur.. of lt a[h Sirol(e Sc.L Ite NlHss ls 15 nc b assa 0E EpqEv. !f!*6pslid . llrb is a valldaled @su€ ol 3lDk6 *vdty basod m a d6lailed EologD .rdinat6. a dorail€d discu*bn is b6yond lh6 $op€ ol lh6 AcLs Povids ctue. r rt a cT scan s nor @di y av.irsblo, dabirts 3nd pbmprry irangt* lh. patsr loaiacillyw]lhth6capabiy .DonolgMas'lmh€pam'(rlP^ fhe CI scan shootl he conDlelad sithin 25 inns ol lhe ralist s dnvel h the ED a.d shoold be redd wlho 45 hi nes lreh EO etual: iN is CJ p.,n!ro.. CT {Eiosraetry n nasdii lE* l@'m:g''gffioIpd*6hlGF:ted3l,<,G6hdldb.pl!frpuydgD.Er'd bv . .iirtd.n .k rod in ndDm.d4 inkp.eralo. oaraniq te 3rud* 6terd nol drray iniriahon 01 ru n PA n diorb o p6rhds. ft. pE*nc. ol h6mdrn4. vaB3 rc h.m o|h{e d6im'n* tho en st@3 In llaal]rHr lRou6 20A d Bl Yes, HemonlEge ls P6st I hmoda!. s ior.d m h€ cT s the paiqn R mr a cd'd'dar. rq rlbnrclrE. cone t . n&6log'sr ( ntumtu'ssn considd tdt& ld appDpd6r. c.tr (9€? 4 ssd oI tE pdtrl *llt d. Jlrc{. rs b6 pqlor .h.s . llroks. A.s€ss@.r are 'nclLdG 'dqniryr.s dhd 3tudu'ar abnsnaliriG rhar iLY b. cpsBbb rd rh. ptu's .ynptm d iEl oe.en cftr.dad.. lo fbndnE k py.IIErd'.r ll@,161cT !., BtE nd 'nip...rn ler ld. pa d,iU' d. No, Hnoihago ls Not tu$ont ntEcTsasllffim&i(k or h.nuh!s. d rc s'gn or o$*.hdnEtiry (.s, r|ry ll]h s!!r€), dE pat d rEy b. . ardidd. rr fib.i.dyrc r6.py tsr6r6 5 sd 3) lr h€mo6.!. k nor pEsr on rhs '^trar cT e6 &t th. p.ii.d b nor . endi&ro rd tb.noMi6 rtr orhfl @ois 6dd, oM.€ &prin (st4 9) srlE 4cialy or orllv drt pd1m'ns a s*6rosne m l* b.bw) Arhoroh.!plm i! d. itu.tu inr.. rerbnmrsE rh. pd d mud h e b sdy 3*db* b.rd. Gpi,tn 6 9,s d.iy. olhw s, us. rh. .uo@irq rdn
  • 102. 7t ict s c,€,l@l. sai*,a h-
  • 103. o Fibrinolytic Therapy FibriDofilc fher.Dy haqe,lhspanenlmaybea.and'ddelol,blno,lc ar e bi t and 6k ,rar r car on sfapdympmvnqlo,adnoma'ibmo|tCs . s qni, canl h.ad aauma or prior sr . Eevatdbr@dprcsd4(sydoic>1s5 mm|sordiasrol,c>rlommNql
  • 104. 7n lcLs c.t!r ra,r. StEr. bilo6 or d d dor xa nh'btuB vrh ebvarad sonsirive 6b.rarory 1* G4h as aPrr. rNF, plal.rol @uii, and €cr: rr or apprcpdft tuclor xa et vity asaF) . siood q ucoss con6l61's <50 mddl 12.7 mmo!/L) r cI d ondGr€s murliobar inladim thyp.ddsiiy >"{ cercblar h6m6pheE) .pal6smayEeElbrno,lclhaapydspe rcke symproms 1cb* ns sp.nbneorsy) 6c1 hemoihase (wth n pev ous 21 davs) lwrhin pcvio$ 3 monlhs) r a..hEkrd 'ncluds emo us F smic srrcke. fiMd Arwasa suid€Li6 Evsiotrs ph}.]od*lh{pe'tgi4uiedokeGE 4 dtoaquars c 1+ ' '@rea (rl iPA iinued r NF 13 >r 7 0r Pr is ereialed by ocal labdalorv $adads mbr .@ min d pbr; ot mr I d Asuliad.Uqsi$no)dcshalep E p'eenr iTatr e 6) ft e maior comp.atoi or rv dPAto nqe rrom m no ro malol Aiq'cdema and taB sr
  • 105. o r $ no,1c theEpy lstep 3). d scuss rhe rsks and Iamiy i avanab e lsiop ]ot Aner rh s ds.csoi. f eropdc6d wrhrbnno}1crherapy qv.lheparenr Da not addtnislet anticaagulants or antelatetet tteatmqt tot 24 haos allet adnrntslntian ol nPA, ,prcal until a lollow-ub Cf scan at 21 haub shaws na lnta.Gnial hehonhage. 2e r a lEcAss 3 lEuropean coopsd !e Atub sroke srdylr thd sp{r m y am bd N|NDS or EcAss.3 e qrb q crietra fiabs 7),s . save6 sroke (NiHss s.ore >25)
  • 106. ,n tCtS c...*Idi 8tr*. Endovascular Therapy subsbnialne{hqhqlalyevdenc Aswhiblno}tClherap}'Flenlsm .arci d adeB or Ddin! MCAIMr) caneral Stroke Care
  • 107. o E€dln Strote Pathway anmi patenG ro a srrcke un t 1'r ala abldlror c a€rur o bsenal'on lst p 1II m. ud iq ftntavasc u a, voru me les apprcxmate y 75 ro 1 00 Hy06qycema s6sc'dedwrhro n rsimenr o, hyo6arycem a n orheorG y s ucose r.ve s q€al€.rhar r35 mEdL an.genena in nPA 1a par enr se srb3 ror rbrf,ornc h r* ror Acda B.p.dusjon rheBpr .NG'npreN5mg/hltdeUpby,.5mqAse.y515mflUbsmaimum15mg/h: . cnh6' aetrr thydEraz n8 marapl ai, olc) may b. consdedd when arpopiaro
  • 108. rr-*rrr ol uod, s., drtg.n & lf acl--ritlFtlddratl . ltoiE M r.. Ey 15 tr*xll-b.2 lE- nsr rrE dr.t iFA o:pv. n! dy 3D nl'rn6 ld 6 hqr., .ld ,- Ey ,ur lr 16 hq-. r, rr&Ic br.od Ee l&2lo m l! rdEl.lc l,b6d EEft 1&1m m Hc . t-a&l 10 fi N ioxoEd by dr*Ifu lv ffir$n 2{ n!r'r*r d . ltr.sSti lv 5 nE,l ftn tp t d..rt<, dl. r by 2.5 nl,,t Ey 5.15 mkpt+ lrbio.d FBe nor 6itdhd ddl6t h blooi EB6 >lao mm rh, Mddd !dBdfudy'84fr{ldBlhi,dd.l*E d*i,rddhld,l.!i!ED,fu I! @..odffir or drdi rt,?qLndo. h pdltdts d und€rlo.e ca€rnao lnnc ddijillg.M''yp.6h.E!..nl,BB 24 ho,!.n.dErolst!*.. u isd.f,nEde*ad*b,Ean 6l oir!.tE ,rdld hyp..kEi. 6 r,l sing ol @r! tui,; .hlo € rcr *dr d6l!lr.d lcla rtb: Ld.r or Er{r.n6 o. pddr' $lE rM fr&rt rlrlEM d o$d m.dr.rl indicdjc {o. aos@16 !€.LE n d uod rxeE 3}erd i. M.d t @n'i9rv (Bi:.d ftm rE P.eoB ourddh.).r
  • 109. o Catdiac Arrest VFlPulseless vT Case Nreds vT s.r 6 cnidoy lu^doqswl b tu f6r 3n@k ewhg€aoppdunylodm',€.fi{- 16hghp€j,orurcol@mbeilvo6*n'bpcilmhqlhssssdand&lon skL s. Duiiq rhe BLs ars@nr r. nflboE ril p€rrom coniitr h si.quEriy Pdmary asesmtrr. mrudr.! ftyihm @osniis lshdkzbte ldus rci.h@kab.l d.n. 1 o) &cs, and advanc.n areays TIE sl]@s or aiy '6u$rars mri 6 b!'[ s. sr..no be oi h'gn-q@r'ry CpR d d.fbi1]aion*henrcqu'dbylh6p.trIsEcG,tryirm,roimFvsc@,l,ad.6mci asss ,E Fdmanc6 or eh 3y3r6n cmpo.st o''t *lEn podm.@ 6 &dua'd 6 patciFfu 'n a sFlm gt,d'v€ly 'nlffi lo 'mprove ca rhs @4 ol qudiry fudtnffqf,eo, .s}<mfuevaBionol,&*ia .sbalelcEnodslosdfudili€d&Ir.ff.i.g anorhs chaEcroisr c or h th,qu.hy siud'* dnondare rhar he rh.ac poudm 'nrmpi mmpEsss ru @ on.^ and rd ltu !ons. in $mo ca*. epsnd ng 25 chesr cm@ssio" rmb, iCCF) s im *+en dsr .ompEsois ,€ p6.lom3d. ccF srEu d bs as hEh N p6'b.r ar r@! fiOSc dd sun'varro h€et, dr*h.rg.. odtymqtvffid66va,da.MlolBeldioErlglr]@aIdMdft i{ee€d(,111@n1€&B.rclqdmg suryryar b tussllr dL-h&g. . 11 is mpglail to sMru h,maio^ .nong dl nrs ii lhs sys6 ol c&, 'rc]Ud]h! .na mmpaEd inina ty ro pdor D.rtoM.. d 0 r.grdris .an i'citihb hE b€ichm.,kns .fion.
  • 110. rt ,/tc[s qr.G C..d.c ,^rt vFlPt/E',.', W reFs$r}bdedlyaeslolmpo€ms'ids Ihsca*ivoiveslhaseEcGfi,lljms ' vF lexampre 'n F su€ 30) Managing vFlPulseles3 VTI The Adult cardiac Ariest Algorithm rhe Ad! r cad ac Ared A eor rhm lF que 3rl s rhe mosl 'mpodanr aqorrhm ro knos r Ashocrlbredrthm(vF/pursessslrndspravedonthe.fi sdeorrhe3rsorrhn . A ronshockab e hllhn 1ay or3/PEA) d spraved on he rqhr s de o1 $e a sorrhm Al€sr asorrhm lFqurc 3rl Fapdt*t
  • 112. aracr"nq rhe manua derrbnlatoi and dervemq the 16r shock lsteps I rhrclqh 4) ini .l lnaeflptid nued DF.r 3i AED lor rhe sromrc modelrMn pctalonuh}lhmanayssandshoc r€ d.r oi l"diaslo . ') pfssu'e mnu s r qhi at'ar rdealon ( d asto c "l p€ssuG Du ms rr,..4c4t cdr: c.rdrc /an *t lFthrt,&,iw Application of the Adull Cardiac ArrE3t Atgorithm: VFlpW pathway ( )
  • 113. o FMd.ddDl F.cb Besume CPF While Manual Delibrillalor ls Charging lderbnrraioi and Fosc) Tlrus, i s reaenab e kabeh}lhmand'nlaliglhecha'!nqsequence lfi,rhmaBysscompaedwlhaulomatCmone hlrhmanaySsaid B4ha,.&l'bnalo6U*avar]etyol d eneay dose (es n drdosorr20lo200J).Mmy h.arih,lhma.sU6aIel'nihe6usctaloi /nnEdiare,y a4e, rae "no, | 4suDe CpA. D4g,rnrig rtn cnes, -onpres- a.r v ry terri or sponransus dyihmt rrrar urrmare y €su is n a perrusnq hrlhh lFoscl l'eb[onho?sveianyspMlan4ushllhmsIypi or adeqGr psriuson. rhe pa' ed iesds cFH (bes n n'.s {ir chesr .ompEs onst ro. se resumhqhqla]lycPR,b{'nnfq*
  • 114. The inh.l lrod conaAs ro Mbl lalion rs @ ol rh€ md lmp.tur dereminft or $divar ftom B-dr ad. E ry dafbrirrsiim rs qricar rd p.rr6nrs wih sulds cadLc ' A .ommn iniial dryrhm in d-ol-hosoirrl witner.a 3udd.n caEiac msr k VF. Pu sl€* w @idrv d61dioEk5 io VE rvb VF s p@l( te h@n qui$ 6nd ' Er€ddoar def'b'irbrio. E rhe md dfidiE My 1o rmt w (do'lvsy ol a sdr( b . Ih6 p6b.bi rt or acstu d6ibr raion d{lEes quicldy d4 dtu. ' vF.,6Lrmais !o a.rdo e ( iol t@red In. &nbr (l.nbrjrars @@q rhe hisher dr€ ffi val raL. wn.n vI'b p@i1. cPB En lo lr'. h6an and b@o bd .annd di'w{y csre d oE.nr.d ,ny$m. rne lkofih@d oI @bin! a p€itudio ,6y6m B oplLmted wih imhsdl w mai0l6 ot lhe nt'al Er6t (Fhue 33). Fd e!€ry mnuie frlal pass b.s*n cokp66 dd d.fbrilraiion, he chre or su ival msr decllE by 7% b 1096 Pd minuie rm bysbnder cPq is p,.vid€d.r whn br.land@ p€tu cPR, t'e dedim i:: moc oEdual dd .vdas6 3% ro 4% pd minur€.r" cPR p6/irn€d dt €n doubrdr or alprd tly cdsr AED p'.sms l!@ in nkol h@d ol dny cP€ d allnpr€d darbilr.- t6. Ihis h.h6 3nodd rk t e bei*ffi c.ll.p$ and .r.fib.irarim rbr a srcab. numba ol paliqb witr add6n eJde mer Eoo d50 ta Ift (min) F''$.BdGhr'@dlwdfu I I ! I ! I I I I I I I I I I I I I I I I I I I I I I I I I I I I I r r!l I I I r I I I
  • 115. o Clearing lor Delibdllalion To 6isu 6 etety dur nq d6r b rrato n. a ways announce rtu shdk war^'ng s1ai6 th6 b.rorc der e nq each shock (his enr're sequoic shoud rak6 srhan 5 €onds): !e,ylhaInooie€sumadcoalaclwi$theFlienl neG! de fes @onm6nd thal hea i.h.sr.omp6ssof,slrhercby mp.ovnq.hat.omp6sonrtuton). usordfi€rcnl I3*examp6oioptmzngccFaidhgh.quaily Mulir€$u.r CmrdiMt d CPR ".$
  • 116. 7he ,Cl.s Cr* Crrdb. t r*t VFlPutuLs Yf Ihe pause rn chesl comFressionsta check the thythm should not exceed usaq.ondrcrremaEr.slsa petnbrt dtrrq nhn andt.E art r at .lihe.h,ihm.re.leleasanom . i rh. firrh'n.,e.k €r*s a sho.kabe ihn q!e I 3ho.k 3id resume cPF mme lmn)etllately aftet the shock rcsumeCPR, beginningwnh chest camptes' si.n. Gtve 2 hhutes .f CPR rruu!E.b'onpna !tu 6[adrerelq. Fn 2.,1!J Odden*E I
  • 117. o co^duclafi,llrmcheckaltel2mn lntenuption in cohptessons ta canduct a.htrhn analysis shoLld nar r r 3 ioish..iab . 'nyihm s p€s and the lhnhm s oQantred a rem mamber . rftiehnhmcheckrcleasanonshmkabehnhmaidrharc.ioFrs.,oroG6d . rr rhe hnhm check relea s a shockabre hllhm €s!m6 ch6sr comp€ssons {,nd! q (srep 3r ne bam eader 6 rcspon. bre fo' 'v.n aiiadihm,c druss.. h6r beiorc or afis ths a.kngoniheefiectolantarh,thmr o'ad,lhmicdrugbullpossessAeie. ant symp3rhei c ad on (c ass I efi€d) ore d he man 6r,eds or prc onqed amr or rhe cad'ac acron p.reir a l.ras n dfscl) .Lidoc.im110],5mg/kq]vnoif L do.a ne suppresses auiofrarot o 6 po ares load i€ doss 1 ro 2 q rv/ro d uled ,n romLlaq D.w. noma sahe) e ven
  • 118. tt lcls C1*'Crt!.canrrt lf/Ptr!.,'l' W sequen.eo]cPRrh,ihfr.h€kss Aduh Cardia. Aresl Ctcslar Algo.ilhm- codr,.rl,,..drh, ftftk*rr.icn.,.a.4.,
  • 119. ,oernes u.6ko snaua telu.c ,hssald ,o4etuloa puopv 10 nts.a uatsnpaa tueuqaa) &66ns la96 6m6 ll srus red pareqn o rns sr:uer€d rsoros^qd F@,EA {lrpr,66 pu m Eqr azu rdo 1se an6 rtlwnb Hdc roluoa oslugtEdp€leqn|uU]^qd']6.JdEr
  • 120. fh. Ac[s CM Cdfr* M WAtMd. Yl
  • 121. o Ex fteatnent o, YFtDw Routes ol Access Ior Drug! unnq cpRwrhRosc n s .apnog.aph y rac,ns ar a Gio s ghuy ta*er than I00hin bui a€ nor v s i.€as6 n Pnco. iv sbre rud 8frer ihe ioudh vefrtcar hq io searer rhan 50 nn Hq, ss rhan 30'c less rhan e F) tlhn].druglher4ynhypolhemtp.0snlsn.a.da. o.sare hyporhemal3o.c ro 3,1,c 136"F 10 e3 2,F}. slancPFatomp{dejbr ftitanes.cdsssnotng6gld onloibono}irlheGpynpatenbwlhAcs
  • 122. tt /rc[scrlB'cr,ti.cl'*!vFlPuLlslf Endoaddr..l Rolae Ftuid A.lnini.tr.aion rhe studenl webele lM.head.ors/€ccsruddr) ne s tpcd v tsi.Ed wdh nomd * ie or actared I
  • 123. o . Epnephrie r ms v/ o i€pa! elery 3 10 5 m nubo Antiarrhythmic AEents Renenbea lollaw each dase given by penpheral injectian wnh a 2A-nL flush ol lv flud and elevate the extredt, abave the level al the heai lat l aiso has tr 3dr.n6,q. and p adrei. lihmcoio.q$andnqandwdespGadfamady d b,,s bm erircat n cdd ac are{. Prc! dqs br0miulederu!5loamaxmumol3mg/kq
  • 124. fh. ACLS cM cardLE An.t: Whtutd vt o.ma s nus h,nhi, !hei vFrpr se ess w car iFCI , !olnq ro0 rtscA pate s rie lse or .;craihdriF,m's. '.
  • 125. o anrason6i nihe bEn sp na cord a^d Gl ih an op o d assoc ated resusc ralv€ en.4eicy at a dose or 2 ms N r 01mq M,V opioid-Associared Lite-ThEaienirg Emergency {Adulr) Algorithm- a*ess and acrivar6, evn9bpbeFyo.aeh@ffiy Adhirislor n.l6rcm. MqBpdaig4nn!6 Sltmullt .nd @*$, conliru. CPR and use AED a3 300n as ir isavail.bte.
  • 126. ErtrecorFoG.l CPR (for YFlPukele.. VU^.yrtole/PEll Efelpffir cPF (Ecm) dds ro v dur'g@'!acaM,includingdm'porcdrumblamoxyg€Gtma.dcadbpumnary byoas IhN r4hn qu6,equitE a3 Ir'e ue ol ECPR,Ey alrow Fdidm add bd time t lreai 6mbr6 mdsiyins c sot €di* ad (eg, ede .@,y aiory @.rusin, PE, Efr-*rory vi prcid'n hyp.homra, caldit iiluly, fly@dditb. 6d ohylpanr]4 Cmgdive h@r iai6e dtr]g idoxb3t onl ( Wr b b.E e dMrry m ddr 16 .,€nce Biesd rd rhe 2015 arra Guicer,"6 updare to, cPJ? ,rd Ecc eoq8ls a b6^.ir lo sNval and hwabl. n6u6 o9 c o cg16limcPRnpd6bwlhEfrdoqd&esl h ernru8 rn.E Ecln ..n b. Eordry .nddrcnr.d, pDrrda m.y e..d. t u$ tu ,i,I porJrn.rr, 'Mrbb eu$ or edLc rrct utro h{ rc! o$ond.d ro init'l dlldio r cPn. Ultr.sound (for YF,/Fulsele3. yT/Ary.tolc/PEAI uneund may b€ appr.d to parianls ftcoiv ns cPF ro he p ffi m)nadbL anrtuul- lly*'d|oh6lp]dollypoteduy'sl m6dalr..l.dby|hoi.4,'neUseolU[6ound mq pal.rns dpd 4.ins card,e adiui.r ro dandad paiifir *aruar on
  • 127. o Cardiac An€st Pulsele5s Electdcal Activity Case Description of PEA qDrp or h}1hms rhar are oEanzad or semro'n:tr zad AnyoQanzed,lr'ihmwi[oa.!sssdefLnedasPEAEveisnusfryihmwlhoula eessh,rhfrslhlld.3icldedbydelntonncLude sed he lem ./..rrcre.hanG, dsso.Eron IEMDI *t..actvt!onlhe.ad]acnonlorbutacke
  • 128. Managing PEA: The Adult Cardiac Arrest AlEorithm flp ACIs C,*s Ca.dia. Aru',. Puts.t s Etecni@l Adtulty The pause in CPR ta cohduct a thtlhn check should nat erceed iotqalzedlnJiifrorlhemJrdorb,.lo.]serha ..ndi.i 6 PE4 rsiep 3t chen ror iFqre39l beq nn .rry ri s1.. I0 LFsure 3sl rhe .fl sd-a or rhe 3qo, pln rhe rnhr sde or he aqo hr 1 perods 12 m iuresior !i nrerqr.d h lrh q$ rr cFB ehe.r ve cPF 3.d r. ded! rd:o lhe Ei P.thwey o, Adninistet dtugs dunng CPR- Do nat stap CPR ta a.ln)nislet dtDgs , ,o ere.ti.il ..1 ,l], 5 pr.5.d 13sy
  • 129. o adull cardEc Ar€sl abonthm-2015 upd.te t t l I; 't*"
  • 130. ?1,./16[A C.r.- C rirc/lrrrrl t tN E dd *t itherhythmch{k€v6alsashockabah}1hm.€sumecPR*lhch6lcomple. ded saqueice oicFF hrlhmchecks md povde6shoulddGmplbdsllya Common Underlying Causes of PEA
  • 131. o Cardiac Arrest Asystole Case Approach to Asystole nietupls cPR ror 10 seconds or ress ror a drthm therhJrhn.,ihano,[o,]s?sys'o/echoslcom c Aresl A sor rhm lF sure 3l @rAlsorrhml belr nn'nq { th step i 0 E ,nette.nre ot he aast ts Gtse q hwan at hish pedat@c. tdn n nhe6 nrsl Rhyrhh. lq Asyraole lsowPalem'naiiqibradyasystolclh,thm Asy3loesamid]a.arcSlfi}lhma . Noi another,hylhm l8s fne vn m
  • 132. ,he ,CLS C8sa Cad,ic ,,Et Alyrlbb Foon rali@rl Faclt Asystole and Technical Problens iranaging Asystole i,lhmCarda.lUdoihasdm-nsndAAil.. .hnhr.r 3 pa:e1 rr a ! i vF or p! Adult Caruliac Aftaa r rhe I qir :i da or i[e arqorlhm 1slaps s thEuq[ .n]al],1hmhn{.arPul
  • 133. o Application of the Adult Cadiac Arrest Algorilhm: Asystole Pathway mteniohe nredenronsou nod i rtuaqorrhm b dmitmdcorstmmdsyhs €6e r r,€s rcsus.1al€elionslobepdeilay wheyo!periormarhlthmche.kYo!nlerp.eilhedyihmonihemonlorasasysloe . r no e/shcara.rydr 6 prese"r lasrsro et so r,ack ro slep j0orrl Con ime., Asyraole son as rv/ o ac.ess s a€itrbrs. srve ep nephr ne Adninistet drugs dunhq CPR. Oo not stop CPR ta addhister dtugs. chtklherh'ihmafle.2mnul€solcPF lnteauption af .hest conpressions to conduct a rhyihm chqk shoutd not beh/hm,ftparetode ler 3 sho.( 1.6um ns rapprcp,are) Rerer ro the reri s de or ih6 a soBrhm Trre draqra^r i F€ure 391rhe cad.. &rcsr Arqorrhm) slmmalzes rhe €.onmended sequen.eolcPRfilihm.he.k.a
  • 134. rc" xoa s&rd Bldqn .a dtrl.d tEb e lo ,w b.mfi 116 .nsnd€d rcP h. Bvllo' ra ,B Ali dG 'Ei l@r'd dts @ ol TcP lo. pe6 s& aevd!- d*. .d A.r,lih. tto.t lie b rc nldrB M tumllrN lo "d.nb.rlhrd avtioL B b@fi.lal lh m lttv dr g@p lh.t E Cv.d dro.l€ had o hrn iowrd w@ odl]fu crd rh. impqtts o, f,*rfnirm liimwion ol ch6l Ms6ro., lhm b rc lGllioatd r, inrdtopl.g .fi.! .ompEslonBtodoriwadEkiop.ll€,tlwhha,!lol€. Taarrilnrtllc iaa{acltadlr. lfloal, I n . urcr.d *tEnu rho ,@s b fm vf d .!ytlor.. 4 hiri.l frspr al d.ft rlb m.y b. ffit a. Fl€ vF dy b. t! ran ol . prordE€d .tct r! $E nr' fE b-' dr ., dd.rttg r,.ib.$s.., b Frrf, cPn b.rd d.ft.i't'm a md.., EMs svno r!d6r 4-io.. iEy 6E L arpkEtng ! pr.r@l $d *s Eils 6p4tdi3 L qofi cpF *r- EEiE rs d.iir{.Er ol ldfir' h,rd by B,ls pdsra to b. h vf tb,,',|,'tu'{ I hdnh.m p6v]ds dnor Epldly lddriry u udqyig {)M sd tE pd dn &6 nor EF.d io lrE Brs $d Acls Ero]MiMt, lsmh.uon ol Blr BEitsiv. .t ont ,E d.olon ro !.mimb @*r * .lldE EE wrr' h hrdig C'v:tb h rt ho6ph, dtd b b€.d o insid.6t . ol @y tEr6, inddrlg r lmrr. c.ir.D.. b ct fi . Itu tfi €rr.p!. io fi.n dsfar-td sniripr . Adp6o io 6u*r.ll6 llrl;6@c , Eafc.:L.ha 10dn ,dtnt,3o,cPe Nft ol ,p lEcl6 dds r in cdbinatd i. clery p.odLtv. or our.omc HMs oE tfudih ol G@irad* 6ftd b s mp..ld t.fu 4sod.d wfi pd arcom ft. dl@ n[l fE p.lidn *fl ui6 b ,r6.dEl dEdll! -d b. Bd.lndv i:i.cr . s@ nE BeHid dspr *r5 vor d.rt_ niE Brtr r hdn d.o6 ol (furv tn4 tE pdl.n n[ d EFlId b ffi a€rs atn nlr"ht tz o&.,!ng'pl.'I cdfiM qr{r-tr..9tur ,eitaris .{d! dn m ol ,E ldl*tE rcu6: ! Fdd.rio ot .n.dvs, sr.nLndt clrcur.li@ .nd wtratM t T@r, or o@ lo a s.rk .6r.,!6ev m.dlc.r ''el.gomr ! IlE q.!.G ot .dl'rl6 cnt .ra lndtnho rru66ibh !.'rh 6d'Mruois,tusllsddd'ltM . ffibr riasd. d b-aE cd . A v.Id DN B d& i P.BItsd .(''lallEi6h.fud..l..tElc*i'dr.,!El,i,yp'irn'.dd,eol
  • 135. o pGanenh* remra les srbm-qson I cy {atral,hende.diqlhe 'orroe{oid 1yk,h.an.o4llssusciblion]
  • 136. 7I',,!P,'. ol N.nE Eni!.tur madclr rr3rdE aliai$ andE nd nqdEn Id p@o$l b r:rtF.l 6€y p.trrt $ ddl& 4id !d lo a l!.!nd 6b 6 ED. T@!.rl!r@ tltt .orliu i{ cf,R blrdf.d hr-EnidB @']bbl. h ,E Eo 6n I b. !.rloirEd ln $. olr or-lldpilrl sdit &d nty ff tldlcd.d fo. 6p.qd dt@ttd@ fq e'dbgrM.rv byFda. d .rn&dPo@l ctrlbrioi ior p.lx.n3 vrdt !.@ ttypotEtub). AndoHcasd,tao6c,r.ftpdrn Fdhrn ro s !ppr.9dd€ hGplrd {.ln . |)@ pdEn 16 pGr-o.die add Iql,rdllsys..n ct 6. fd lndird.. eon! 6@rv kr.Midr midoq. c& 6nd rs .fd trvponEhb l@p'd h' h_ha.plttr p6*an!E 4n6r pdl€sl lo s.m,!!.&ie clrdel @ 6lt dFabh al ptblrtuE @_ @ndes !.rr-drdt& ar!.i @.
  • 137. o Bradycardia Case .add thead Ere ess rhatr 50/m it. sus paoiq arcP) rype lw4ckd{h'Mobr ) .irrierypeoibo.iprcsediFsure.rl conp6reAVbo.r ss€neraryrhenosr mpor ."0,""",""q,,u,..-
  • 139. o Description of Bradycardia S,srs and SrDpaoDs Anyhylhdd$rderlvhaheanr.l S,sis aid symproms duo 1o th6 dow hd Gre cehelemb€dym,dndgchmg€ablywth nd phys ca erm mrm b dentry $e ssis md rdta rc alen tescap6) rrcqueni orematlre venr.urar
  • 140. Li.tftra Sr.dr.;.dL: Tlr. Lrdtlc.ls. Ieorl{t tt nrr.r, B!rq{. wfi r Pt*. agdt (Fac aa ediE nE rr.p b E. rr rn riluaqd ol t ldrn rEnis *'/$ tlcloiE c hrldrsr.*lor prb.. rr?iri&r d otr .holltm b.gi6 *i!l tE rr-t16.dio. ol b. dl/.td. (9Q oi tlr tri a!. B 16 !a sonlh. tu n6 hdrd. n drE .r!l ol th. ats r€4n !n !f, ftrEy a6rE( srdr c r4r..lt .rald..r ttd .ha, nE!.gmrn, sivhc ory!$ il hdd(! nEro.iig n' tdnm ftd $rr qgE, .ddbrrta rv @! .rd oai*tE. 12 Lsd Ecc, &55 61O ?. h !I diiirdrd d.C.E i voJ !.rr_ mrE n dE o.En ,6 !4E d rynplffi d po. priE6. rd ir ts & casd by 'Ilrldn y d..b,r p.rn hd. JrEiUm i'rh d.enimU..t ol.d.e.r.Itt h.r.li tr ot n ha .6qrro !dn6rh, !q .6-rE .d lMh( (9.p ,1, n tu Flbil hr p.d pdnrd6.l yrr .dmhrr.. d!d4 (s!.p q. r dEclE B ht rli,t, arlp.it i4 IcP d 6Erd.r dooriltu q .9dr$nu rfilio. {sr.p g, I Ld€La, yo] pt 90 t0 te_ vt@ p&nrc, sdr l' .nd tld @nrM^! ca&, ,t dl .rr.i .du!t d..r Th! ht*md..qllm ln lhe alsodnn E d.l€rd..d 5y t leny d tF. p8i?nl oddllL.. Yd tr6y 6.d lo Inpl€rn*, tunlpL lic.qrlldE .Lrut.e6lv. rl .*dr* ,r.l dlrloD., ao to ta cad& &.d abodltf. Artfi lr@. r{lth. AiL Abqdi.n r-E!f-n**.6dq! E---F- ,F.chds.dF!.tureash
  • 141. o lppllcatlon o, the Bradycrrdla Alaorithrn Prhn q ,,!.ar,,.n Ne{. pdl@ th6 rhm,y assmd, in 16[10 tE rorb*i{ nlh€ce'ydhaeapalEnplsd4ms,el@so'U.dr,dl6,Yo!cdld''t bm a drin€d h n* B..dy.!d6 ,'l!dnlh At $. 9e tru, 's e sd"E is r'd ldns tBbr. cdbln'rE la.rm. rdsiry*iEoxtub.adE ds6 tPl!s'byd€fllfu'i€.hddolc,ls5o/nh llnad@El.iofEBM!Brdful'i:d@l''€lt6] A!.El lraihinC a n .dd:llF dy!- rn cu ol riy!.mi.t Mirdy!- Moniior br@d pbsu€ md rr.d €re:obrain lid.€vl.w. 12-r.6d ECGI cndlcl . p6bhn-r..!s€d ht.t ry $d prryr,r..l .*it.xkni {hh t rd tt.l po.rlbr. Mfibdns ,&tdr. S,,rpllrrc..dD, sr.p 3 p@mpG yo! 1o cids i, ttu qrE or tynprm3 oI poor E .rlCon aE os.a by t &. 'k "snG'!*r€ d srnpdE? t &. rh. e'sN aad s:ynp|m dtu lo ru 3b* lE n dl.? Ldldadllg.igGdsylrEbco,nEb..dttgd.: . synprms lee. dr6 difflon. srtu or b€dr, dn s.d bv€r c, cdee n*, waks. {a!s6. &h]r€d€dB @6, pBrtuop6 ( 5yn@p.l . ssnr loe. hyFr€ns, 6.Edi€ h€.n talw, MrErar adntu ed b h ssnoic $.'srmp6" a d dE l. rE n dlc,le Fe .ep1q rry!.rmie 's Grnh., C.r..pt habEd}s'd.sca6in0ihsp.isnl!oymplm Ad.q!.| hrntdorr? . rr rh partrr h& .d.qid. p..r!'&n ob.ea qid mon6 isr.p 1) .lilh.p.islhep@rF'n,'&,,girdlosl.p5
  • 142. ttEaar.ra Sesuerc. ,t€raDeDt Scquercr: (chmnotop'c o, hean Eie do*) rrl. rots Crla A.dlE & Avodrsynqoianopiatrlype Nrh rcP or D ad'eneG'c srppod as reniporzin tema p.. iq or D adreneQ c qils .n ror pa1 ents 'nfu$oi 1e dopamae. epiep$nel s No knowi vasop,essor 1ep nsPhnne) oi a D b ockar or carc um .Mrne b o gVe'ely3lo5inndestoalo'3doseol00rme] kq tmar num tora dos6or3ms) Ar
  • 143. o ,Erarrcrt S.{rercer be perromed by acLS prcv de6. dncar3nd m*han ca €dure. Becarse han Eh a dyiam[slabtyG!ean:ges.said.odatlesfol ro d.nrt and corccr thecau*.r rhe rr4dycad a ne reatmenr and I s 3iso .efie*!616q. fcons'stenr .!pi!ro) beq n an lnfuson or dop3n Fou.lda,rond F.ct Sedation and Pacinq ranxsry and mus.e coftad o1 ! llc.lD.rt Seqlcrc.: a 'hoqh 0 adeners c lson ns w ih srancas s!.h as ovedose !rh a ts b ol2lo]omcghnandttalelolatenlEFoiF doses (qr$ler 1han r0 mcqk Erm
  • 144. Transcutaneous Pacinq E ,r'D. dr ,,rb retAH. rr@r4sml ,Ir tc(s Cr....' 8,.O,!.,rt EPb-um.L-1.&." Erdmde@F,m Ecaolur€ s obseaed lsabry m3q,n)
  • 145. o 4...., E..pon a ao ,nare bGdlcxd,a deDendenr vc r.urar hnhms lalf,][dsomeliA.3g]^/vAlfraym.UilhF
  • 146. rha ACtSCq* rE@ SbDb rd Uit!.ta Yachycadia: Stable and lJnstable rhs.ase aloleslrres. EcG rFrtims 1eampes i Fsue.3r . neenrry sup6!eitr.u3,la.rl.ad a 1s41 r r :! =- :='i:=. -=f. I
  • 147. o I The Approach to Unslable Tachycardia Tachya,rhm''tachycard'a. sFplomalicbchyarh,lhmi.
  • 148. un r.ue tsdts}dr. .rle glu lF6 h€ui d. ls io. l..r Lr rh. D.rids d]hlc.r d'd- .yntpdEoaue!l.@l(r'dobgg$. . aari,, & n.lrhd ddb d4rr b,n!6dirnb @ @e lteidwy.d.,q @@ry b.h€hra Md rrrtoMio. , rh Educid br..d 0o* ro vi.r oEe . adrE /ditcir€r$ frd @lrLri6 b.rE t!.tlm an Eltrds q nE Enid6 riErHrE '!d@ rdd q,sur Sirn .nd Unilbb laolry.adia L.& lo sdds :r9o! {rd rymplffi trn iictud. . aaidv rbrd rEda di6 . r.d'di. .h.d dh.drr.n ,. tt. r., & r. r|apE Bogiird t'd ri. prt nl Esir,rt errysr,i,trrd. d .E 6l.bE 2 Rapid eo{.i(on fdrh.drft,t tyrlotoase@l$dbyn diy. dla ,E 2 r.y. ro m&o.d or tsffi ri,l uBbn6 rdlFd. e d hu 4*5, Mt tu,t $!at tdrr*dt a Fauq tzraf dt{ciotatrdrect6.tl rtt Ob,. t ',rttu. t E *, d qt ? tdnl*a P,,t dd d,,Eda r.no n satc,,4'l..,d,ya,dt Thrs (krihr.lon M b. dnb![. Mn] .rprL r406t lh.t *ra a h*n ,ar. L ld da rs{y in, n k unnk.ry thd rynloron. ol lndlbrny d6.d FiB, 3, tE t*hr cara ri6 nt! E hp*rd trtioL. lftrbn- A rs. El. tEt r tu 150h,' a 8dt n iEper.o.in6 '!.p..'e ro drysliric tu (.s, l&r( d.rr/ddtr) d drlr S.r.rr0 aG id. b. p.*E 4 .6.a8 ol .as6 *d rrrFio.D ttc ld iLr l.diy. Fdqrd p.M sEn ! indrdod F.pld lddn[l.. d of synplomnb l! lrr{&dh $n hdp }o d.lthltu ,nd,w y@ $drd 9r*r. rd IRredlsr. cfdbBlim. Fd .md.: . Iirc Ecry€d*. b . drY!&lo0k Gp@ to roolE l&io.e, dr.i - Ltq a* D' d l!@l+13d*r' rhd c,* rh. ld ld. an'odEey,n,rry+ oldE.r 'i@6. 'n En d€. rh@ ' d'dv . hsh d.(r! .' svfp.mh lft xd @6nol@sl ractoB li lhce ding' sh6 lehvcrdla w0 ml dpoid ro csd.- ! h p.n d dth t d'@n[ b *e (.. m *i,6.rc td.d b t{ l!.,ry6@, r.tdt'nEyft,l.rr'@,t'd.,Ibg.ftdEn,E{Epdqdldim . Atu rf,turrllcdll s!dr.6. hd 6L or .p9dinf,i.lv ,5dnin lloE Ec n5v v.d obthrr-. D@, a"ldl iLtu d $i. r lM d 3cM .vr6lc d'!€4. . At le c,.d..the 1s0nd, rlmrr@. e onar asn ud cqdirydim I did GqudepdidnE(sbb ' [ni patin b 3dEl, 'lrr h& u.{rryis cdiar&u, d.@. tndm3 mv b.B*nallMld& Ye md h@ *flsn .!.drov.oo^ i3 .d 4bd, how to pilp.E rh. ptlisr lor lt ([rbd- i,o spFopill6 trdds), [n twb.*Lh It d.rbdll.b/rsrd io o9!tb 6
  • 149. o Managing Unstable Tachycardia: The Tachycardia Algorithfi lfe ra[/]rrd aAqortho 1r qr r. 1r tu.Norr.l F* Serious or Sionnacant Symoloms
  • 150. Adu[ techyc..ri! With. tuh. Algrlthm bGaIl.t''E!q&L E-a5-h- bl*fuUrdE&6.b^]Fn se ..t6Mr &ld mD'osdr ol rhl. Fdon rr b. suld.d L,v tE Llryh! kry q'r€.dG FEi6d ln nE ftdrrt rdaalasldm: 'A,..rrrrd E.d6&..tr? tboEpd,nn..k-d.bh? . r. 6. oRs nmw or wide? t b h.nnh 'reurr 6 i,.eurd . 6 rE ofis llmmdph- r p.lyndDaa? t- ffi t, t* qo..[..6 dreti*Eb d spiwle n 0. rs*diry,d.fu.lq Irfufulrfl'h feh,fufud ,@@{iiirk)o*5ffi .tdrdMdiot.&
  • 151. o Application ol the Tachycatdia Algorithm to the Un.table Patient ^,lprca.l.len .t lor thc |tn.t.rUnE Ceu.. Crrdc.l Corrc.pb Unstable Par€nrs C.o.lDg Stgnl,,catn Slgn. or Srmqtohs? lidsho.ks!,'n!dbbeduebJi].hyJf[h}ihn3
  • 152. ,?E ACIS C{|G Lcn BE i.r StzbL an ! Ura'l6l. freatment Based on Type ol Tachycardia ryrhris Mosr rde.ompex lbroad pu:e ( rh equ unlori !de.omp 3t w l-'no . Arhrhm as !r, a poymonh. oFS appeadi.a l,!o]|mophr. .41 nd as ro's.'jes n.hroizaron I1h. D:lerl has p.r,r,phr.14: Detetuine the widlh ol thc oEs codPle, rhP udrh ctif6 oFs.rnrer s e
  • 153. o CeidioYersion Synchrt'ni.e.t Shock mth Sy'chr!dianon rdicaldaidwhalt/peolshockloadmislel €hen po tri or rhe fi wav4 wh.n rh s opr oo Lrhe syac opr.n) s eisased rheo r 3 shock dur nq cad6. repo ar zaiotr tsp.Eented on lre slrface Ecc as rhe r wavet a Dsrod or vur.erab r./ n uhr.h a shock ca. pG
  • 154. WEh ta Use Unsynchbn|ad Sh@ks Uns,*hEnizedhgh.saEyshmks . For a @r ed who h pu se 6ss sm!!&rdpyroTi !4 r.r 'dtrn1ade3!n 'ordro'r4 ,rir$n rhe rhsddicar isk). mmgdialo v atempr d6i bd ar on. se d rh. @lgy dos6 le lhe sr€clfc tpe or dnhm .Mono.ha,oadrov.Eon:Delivd .siphascedove6ion:Ddiver sub€&uolshockdoseasn.eded C.'dlN€6 oi ol drlal fluter and svT senda v cqu € s ensrgv A' nitial onearv doe ,o*,r"i rr,,,.aa'"o"a,r* **. tt qlnchtlnlzed C.]dlovcrtlon ?cchnlquc lhq ta Use Synchtunizad Sh@*s . uchbr6 arla ib aron .I.]nsbb.@uemonomorphclac l1doichoedenapalientha3lsymplmstc ;;r"b;,;^i,., sw. w -,h p, vo rs rEaturt oI lunct onar rehv'dia or ectop c -,,,,r-"r"r',"*,*4.u"*,s6s*eyhmshavsdaltomatclocusais'nq *-",',r,"**."-**lv* ;,;;;;;i;; "";.,,^.';"".av aci*rv ircEe rhe Gr6 or rhs t*hva.qrrvihmia ", ^;^"""d ""."*. '- ., .* " ;,";, ^d, ^",,".
  • 155. o Fo os rhese neps ro pedorm syn.h Modry the srepsto.your E E E E rui oi rhe derr 3lo.lmonophas. or b'phas c) Atrach mon ror eads to rrre pat enr t overroihe enshourder')3idoisurcprcperdspayorrhepal,e.lslhnhn Poslron adhsNe ereclrode (condu.lo4 pads on rhe palionr. r s .haqed lsee,Fouidatona facrs: aron I rhe vFiPursesswcase) P.rymorphic w {i@urar roh -
  • 156. ,Srrl@ Ili. d 6nd asteat -d nErrs.nar ot . lsb prtEnl (b, m xI@ s,gF Ebb'tolt *hlcddi4wttt.tpb h.&t6lt. Pln ! eldr hoin l.t.r oBt!.tr{ l ro/min h.s . r.dt'trhnir' d llchrsdr. h frh @, * w]lr e tE l,G bd'r arn ..d6.rrr-rrrDariEdsrsdrr.not $diGr.dtqdL6.r.rrqdnqn !D tffi a!..rh s'u ndy.xda 6 ,nEr .rrryr dtyJoscic, d6dlqrrs 6 dp6rs io . drlp.mb. . rErr. vorD d . @r'drF [d ,lqrli n 're ii crrre ooBI l.s, dr, nyD@r6'&'l Tlgll6 rnvol!* i(h.fr!.dbn ..d 6n l,.i ol Ye tun b. .bb b de}ly tn ryD. ol r..h/.{dk ($,1& d n.,e: '.orrd d iDquk4 I'd i,'d.nd{ rr.nFd. k{rvanG - adii- ii f: ra.hrEtdr a&situ. r turlori lnfiid sBr .(l nrr'.o.rrrt . I!.r ilcol' n!,BdrFh nytrm GrclB lidr d!/..d.) *th vosd mrus dd ad.ndi. lrn. lnriri d@ d i4.t Fu *ln lMnd lrE p.lr.ni ntd tn3p.n dorrd'.4.n dsrt*r n,E p.rE bdr6 q**rly ui!r&, yfl r{ piloei, tnm.di d dtd.hsibn dt dr d.rrdrsti!.d crromb.r dd6qE a h,E trEral. ,fllrlhrrr 6r tt !r. ,rdi,c,, . D trt.tLl,. tlcltc.r t hb d rildB nb ldod,ro dirC s€rtEr ilrt m.Lo u.d r. E rrd. !1dc*r..nd r.d6ri6 d'r'it! dcrid dla rcd. rre .s.n1s @ ml dd.d l. t6 AcLs Prcvi&. c.uE. lrt oaa{i tc AabL lLdrrc.ld. l*nycrrdLr 4 b. cMllr.d h $!qd war! br&d 6 th. dpp4le. ol ih. ocs dal.i nen d4 .rd *h.trr flq ,. e€ol.l or lr.q]e r i!tuoFs Erdd (5/D bd!@dk (of,s 16r t6 0.12 so . !i[d.-oRs drda t <rry.3di3. (ofis 0.12 ryn d asd ! 8.ci.dd d imcL!,, i&DqdL. - tn9!1. Jl!@-cffpLr udyad4 N dlb.blv atilr llb,llbrion r. th! c , ! !r.bh b.ltltsdL 6la. b 6 ddrbn ln wndl t pdf,n '6 I A her rn€ !Er.r tu 10O in . No rJg i.d .i(rr. d lrnipidr. .!x=d bv fl tE@.d rdt . r, dr.r&{ crdl& a-tkd srEd t,r.l OdE l* }r 4'rBr
  • 157. o Found.do,tal F.cb Unde.srandinq Sinus Tachycardia iranaging Stable Tachycardia: The Tachycardia Atgorithm
  • 158. lrDllc.Uon ol th. T.ch!rc.dL llgodrhnr to lh. 3t bl. H.nt rl . rrd,yc.rd6 .id a plr(e d pet pdd ..!s6n a.d m.r'6!mt 3r.p5 luid.d by oi Bts A€dBn .nd b nlrEy rn s@.!(,a'y a!a*d DdsmE rfuE Jid !ryhprohs s ,9 m pr6.nt sd ll rhm .ymprom aM sltG e du€ ro dl d!/erfa nii' *lll drld yo b EilE dr sh.i' lstrp6 . tu4' 4 d @r!6E 6eo 4 di6 ot rh6 arloi m. ! ll e0nii@n &re d 3)rr'r'lqB m de ro rf, irdll&adq tE rF t dlyaldb 6 6r!br, tld lnndkE @dbvtao it in.r..td ls nE usr*. rtdryqti. . h t! odisn .,.t€r@ ar6.as v[ .l€li€ ,Eyr.lEd2€d h€lrtsrv $..k l.Lf- bdllaliM .E!r) and ,orxrx lh. cadE Ardr r&stntm r { tF !€ii6i h|s rorrBrrc W lrEl tf n rhm sVf t n.bliE hioh{Elv dEyidMmd dEdc t€, d.fbdidLn dEg, rn ihr. ce, tE prtrfir B strb, .rn y& wrl lM.ee eordh! io th. dabl€ *l6i or lE T*rry6dhrrlo..inm (F'sn r'4. ^ p.air ld.ffiello oI tn nvtm (.s dtv SVl, alddflund) dY nd e P.sbb d I1!' tm h uB cu, a pdLnr ,rs !&ar. rehls7dra ,nrh . prr$. cddud rtu n'p6 '!t]"d n fE I*ll@di. r$didm b ddlre t 'd rMtc. th. p.li-t $., 1 dn ls ye b ** $€ pnidnt .qd!.. Ivpkirr, a rrtttr "t $8'id tlEn l50/min d Er b d6 ro t.drr@nvd as oow ne gn6 dtY@e ,rd.rt L...arlr3tl !l! rnd lclt r rd..nlry d ter Bdtba ..6 ll ryf,plN ,irdsl. ss..d b sraP 3. rtu'!, E @Eba *irr E46 d 3Yni@ilt e 6 lid o{ tu bdrv"d' ('9 r'vrE' i-.J" *u""*.,"a "4.s. !'l.s o' 'hdr' Ed'd'c cid dkdn'dr d rxir. ". o s+ . rp-r.- -''"a,o ryrchE d *o*r *tu u4'da [ $. p.tr.r( B .llbrq !o b 9.P 5. , rtu tu m dNtds '.5d* l. mffi'{E"Fpbsffibtt ;;i",t,..**;"-.-",*.,n.hvhmdd@d'6hl'i drrom' *.i* , -* .r * ""..a, "*","a 06@ ' t2_r"d FcG ($* 'vdL!'rr d ilr,"-, *o " *i-"" I *,ins . n* 0a€ no o'12 *ono d *rd' (0' '2 edd u*rs rir sts, Pim.rv. ,td s4dd,, ^sE lis ro cuid' vu acp'o'dr a€lolr' riE parb md do lhe lollo*rns s @.*44 ! Lodr rr, *r! ot i'r@.r.d wr ol bi-olilro d h/!'n! 6 dddh'ncd r Grw oxygi lMild orYq, {t .rlo.. t srppo'l ,E .My dnho, an .@dl.'. r l]M^ - ECC k, iddli, tf, lhvmmi dEk br.'d p'*ud 1r.l-d E@
  • 159. o rcd by wharhq [ra oFs a trdp lsre! 6] or i3troN FNr.t ,,oo.l F.ab Tcalins tachycardia Dtugs to Avoad in pari€nts Wfth lza r.id.i.-.! rt-. reAr.4 h,rn5
  • 160. fi. ACLS C@ f.cht@rM S,rrb dl,ffib oiq i isvr) vasa m..e!ve6 aone 1v. sa !a maneller or ca,oi d s ius ma$asa)w, oush a a aae ie!. ant6ub rarl ve n over 1 secoad ilermnaleappmrmaley90%ofienlryatrhtlh, bockeG iverapam mddt em)orIrbbdss llherhlrh'ndoesnolconvedwh. what to Avoid with Av Nodal Blocking Agents channe brockar o/ D bo.ke6 bec