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