ADVANCE CARDIAC LIVE SUPPORT (ACLS).
Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? Yes ➡ ventricular/ pulseless ventricular tachycardia ➡ schock ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ shock shockable rhythm? No ➡ schock ➡ heart-lung resuscitation for 2 minutes : epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? No ➡ schock ➡ heart-lung resuscitation for 2 minutes : amiodarone/ lidocain and treat reversible causes.
Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? No ➡ asistol/ pulseless electrical activity ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? No ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ rhythm shockable? No ➡ if there is no ROSC sign: repeat heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography or heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ if ROSC : to Post Cardiac Arrest Care.
Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? No ➡ asistol/ pulseless electrical activity ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? Yes ➡ schock.
Quality of heart-lung resuscitation.
- Minimum pressure of 5 cm.
- Speed of 100-120 ×/minute.
- Minimal interruptions during compression.
- Avoid excessive ventilation.
- Change the compressor every 2 minutes or if you are tired.
- If there is no advanced airway, the compression ratio is 30: 2.
Drug dosage.
Epinefrin intravenous/ intraosscous :
- 1 mg every 3-5 minutes.
Amiodarone intravenous/ intraosscous :
- First dose : 300 mg dolus.
- Second dose : 150 mg.
Lidocain intravenous/ intraosscous :
- First dose: 1-1,5 mg/kg.
- Second dose: 0,5-0,75 mg/kg.
Defibrillation energy.
Biphasic : 120-200 J
Monophasic : 360 J
Advanced airway.
- Endotracheal intubation/supraglotic advanced airway.
- Capnography waveform/capnometry for monitoring endotracheal tube placement.
- After the advanced airway is installed, give 10 breaths/ minute (1 every 6 seconds) with continuous chest compression.
Reversible cause.
- Hypovolemia.
- Hypoxia.
- Hydrogen ions (acidosis).
- Hypo/hyperkalemia.
- Hypothermia.
- Tension pneumothorax.
- Heart tamponade.
- Toxin.
- Pulmonary thrombosis.
- Coronary thrombosis.
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