BLS n ACLS

with Dr Shah

BLS
1. Response
2. Breathing (<10s) - shallow n agony -> Activate BLS
    i. Call first - in cardiac event
    ii. Call fast - Paeds, drowning
    (CPR first then call for help)
3. Check pulse - for healthcare provider
4. CAB for 30:2 for 5 cycles
5. Check pulse

With AED (Automated External Defibrillator) -> ACLS

ACLS - Involving health providers
Pulse arrest
i. Asystole/ PEA
ii. VF
iii. Pulseless VT

1. Response
2. Check pulse
3. Start CPR
    i. Monitor
    ii. IV line

Chaotic pattern -> VF

Pads:
1. Right parasternal
2. Apex

1. I clear
2. You clear
3. Everybody clear
4. Bagging clear
5. Look at the monitor for spontaneous reverted rhythm

SHOCK @ 200J Biphasic
Or 360J Monophasic

Continue CPR for 2 minutes regardless of the rhythm
IV Adrenaline 1mg - every 3-5 min

* ROSC - Return of spontaneous circulation -> Post resuscitation care

If no ROSC
Repeat - if needed shock
+ IV Amiodarone 300mg

Assess 5H n 5T
Hypoxia - ETT
Hypovolemia - IVD
Hydrogen ion (Acidosis) - HCO3
Hypothermia Possibilities
Hypo/Hyperkalemia - ABG, to correct

Tension Pneumothorax - paracentesis
CardiacTamponade
Pulmonary Thromboemboli
Cardiac Thromboemboli
Toxins 

* Total Amiodarone - 2.2g/day

Post resuscitation care
1. Breathing
2. BP
3. CBD
4. ABG
5. CXR
6. Ryle's tube insertion

Flat line protocol1. Check leads
2. Increase amplitude
3. Lead select I, II, III

Case Senario
Complaint: Palpitation
ECG: VT

Symptomatic1. Chest pain
2. SOB
3. Altered mental status
4. APO
5. Hypertension
6. Sepsis

-> electrical cardioversion
i. Explain to patient
ii. Fentanyl n Midazolam
iii. 50-100J
iv. Sync
v. Cardiovert
vi. Check rhythm
vii. Check breathing

Elderly with AFCover with Heparin

Asymptomatic1. Adenosine 6mg, 12mg, 12mg
i. 3 way
ii. Large bore over cubital region
iii. Together with 10cc NS fast
iv. Hold the arm up

2. Betablocker
3. CCB
4. Digoxin
5. Amiodarone

AFi. Onset -> CVA?
<48H - rhythm control
>48H - do not control rhythm!! Rate control?

Rate controli. Elderly
ii. Digoxin
iii. Amiodarone - contraindicated for hypo/ hyperthyroidism

Rhythm controli. Young
ii. Warfarin for 2 weeks
iii. Transesophageal cardioversion - elective

AsymptomaticMonomorphic VT - Adenosine
* only in Monomorphic
Amiodarone 150mg over 10 min then infusion

Symptomatic Monomorphic VTi. Sync
ii. 100J
iii. Check rhythm
iv. Check pulse
v. Check breathing

BradycardiaSymptomatic
Atropine 0.5mg
Mobitz II n complete block -> high block - resistent to Atropine

Transcutaneous pacemaker
i. On
ii. Mode:
    a. Fix
    b. Demand - use this!!
iii. Set rate 70
iv. Energy level - increase till electrical capture -> mechanical capture -> secure

BP = cardiac output x TPR
CO = stroke volume x heart rate

Or use
Dopamine 2-10mcg/kg/H
Adrenaline 2-10

Adrenaline - b1 n a1

Dopamine Mcg/kg/min
BW x 3 = 50cc
1ml/H = 1 mcg/kg/min

Dopamine mcg/min
3mg/50cc
1ml/H = 1mcg/min

Asymptomatic
Usually 2° to medication - review medications

New Beginnings

Life on Purpose for Women by J.M. Farro

Forget the former things;

  do not dwell on the past.

See, I am doing a new thing!

  Now it springs up; do you not perceive it?

I am making a way in the desert

  and streams in the wasteland.  

Isaiah 43:18-19

Two years ago my older son, Joseph, moved out of our home. Coping with his absence alone would have been difficult enough, but around the same time of his departure, my younger son, John, graduated from high school. John was going to remain at home and attend a local college, and I was grateful for that. But his high school graduation would mark the end of my family' involvement with the Bible club my older son started 5 years earlier. During those years my life had been filled with countless club-related tasks, including driving teens home from weekly meetings, helping my sons put together Bible lessons, holding parties in my home for the kids, and organizing frequent concert trips. Once it was all over my life began to seem empty, purposeless, and meaningless. Feelings of being unneeded and unwanted overwhelmed me, and I didn't know how to stop the downward spiral I found myself in.

During this time I cried out to the Lord in desperation and despair. It was then that He showed me the verse in Isaiah 43. He revealed to me that He wanted to do a 'new thing' in my life, but first I had to 'forget the former things' and 'not dwell on the past.' God's awesome new plans for me would not unfold until I stopped feeling sorry for myself and let go of all the negative emotions associated with my profound sense of loss. I had to determine to put the past behind me and believe that God has wonderful plans ahead for me, or I would never 'perceive' the 'new thing' He wanted to do in my life. It wasn't easy for me. I kept thinking about all the special times I had shared with my sons over the past 20 years, as well as all the wonderful experiences I had had through my involvement with the Bible club. There were times I doubted that I would ever recover from my sense of loss. But as i prayed and depended upon God's grace to heal me and to help me let go of the past, the Lord began to unfold the 'new thing' He had planned for me.

Today my life is filled with more purpose and meaning than I ever dreamed possible, and I shudder to think of all the blessings I would have missed out on if I hadn't cooperated with God for my deliverance. If you are feeling today that your life is empty, meaningless, or purposeless because of your past experiences or a sense of loss, please know that God has awesome plans for your life. He says, "For I know the plans I have for you - plans to prosper you and not to harm you, plans to give you hope and a future." (Jeremiah 29:11) It doesn't matter how old you are or what your background is - God is able to fill your life with new purpose and meaning. Start asking Him to do something new and wonderful in your life. Trust Him to begin revealing the 'new thing' He has planned for you as you determine to let go of what lies behind and reach out for what lies ahead. Remember that endings pave the way for new beginnings. Today, be encouraged by the precious promise from God: "Arise (from the depression and prostration in which circumstances have kept you - rise to a new life)! Shine (be radiant with the glory of the Lord), for your light has come, and the glory of the Lord has risen upon you!" (Isaiah 60:1)

Prayer
Lord, I ask that You give me a new awareness of the awesome plans You have for my life. Help me to stop dwelling on the past, and to let go of all regrets, sorrow, and bitterness. Fill my life with new purpose and meaning, and use me to make a difference in people's lives for Your glory. Thank You for a new beginning and a fresh start!

* Take some time today to reflect on your dreams, and write down your top 3 goals. Keep them in a place where you can refer to them often - in your Bible or nightstand. Pray about them, and begin to take steps toward them as the Lord leads you.

What a timely reminder, as I prepare for the new beginning, I'm assured that He will give me peace that surpass all understanding and that eventhough the future is uncertain, He know what is best for me and He will lead me through. Thank You Lord for Your faithfulness.