ACLS Cardiac Arrest

October 26, 7:07 AMSF Medical School Life ExaminerAkpene Gbegnon

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It is recommended that medical students pass an ACLS course before graduating. If  they don't get a chance to do so in medical school, there is always the beginning of internship. Here is a little review on the topic of cardiac arrest.

Causes of cardiac arrest that are potential reversible
5 H's and 5 T's
Hypovolemia
Hypoxia
Hydrogen ion - acidosis
Hyper/Hypokalemia, other metabolic
Hypothermia

Tablets (drug OD, accidents)
Tamponade, cardiac
Tension pneumothorax
Thrombosis, coronary (ACS)
Thrombosis, pulmonary embolism

WHAT TO DO ON CARDIAC ARREST
1. No movement or response
2. Basic Life Support (BLS) algorithm
a. Phone 911 or Emergency #
b. Get AED or send second person to do this
c. Open airway, check breathing
d. If not breathing, give 2 breaths that make chest rise

IF INPATIENT ..
- attempt to place, confirm, secure airway
- attempt and verify IV access
e. If no response, check pulse

f. Do you DEFINITELY feel a pulse within 10 seconds?

DEFINITE PULSE:
a. Give 1 breath every 5 seconds
b. Recheck pulse every 2 minutes

NO PULSE: 
a. Give cycles of 30 COMPRESSIONS and 2 BREATHS until AED/defibrillator arrives, ALS takes over, or victim starts to move.

(During the compressions, push hard and fast (100/min) and release completely); minimize interruptions in compressions.

3. Attach defibrillator/monitor/AED:
- check electrode/paddle positions and contact

4. Check rhythm

SHOCKABLE RHYTHM- outside hospital
- Give 1 shock
- Resume CPR immediately for 5 cycles

SHOCKABLE - INPATIENT
- VF/VT
- Attempt defibrillation X 3 as necessary
- Then CPR X 1 minute
- Consider buffers, antiarrhythmics, pacing
- Search for and correct reversible causes
- If VF/VT refractory to initial shocks:
   - Epinephrine 1mg IV, every 3 to 5 minutes
   - or Vasopressin 40U IV, single dose, 1 time only

OTHER RHYTHM - outside hospital
- Non VF/VT
- Resume CPR immediately for 5 cycles (up to 3 minutes)
- Epinephrine 1mg IV, every 3 to 5 minutes
- Consider buffers, antiarrhythmics, pacing
- Search for and correct reversible causes
- Check rhythm every 5 cycles
- Continue until ALS providers take over or victim starts to move

OTHER RHYTHM - INPATIENT

source:
- the washington manual internship survival guide, p.2
- http://www.starcpr.com/blsalgorithm.pdf
hypothermia treatment protocol for cardiac arrest
hospitalist handbook p. 81
conditions associated with cardiac arrest p. 290 HH