V

' rhythm

Dellb x 1 Antiarrhythmic

I before or aHor shock)

Amiodarone. Lidocaine, or Mg

Atropine tor asysioto or slow PEA rate

MEDICATIONS

epinephrine img IV (10 ml of 1:10.000 solution)

or 2 mg ETT q3-5 min vasopressin 40 U IV to replace r'or 2"*epi dose amiodarone. 300mg I VP ± 150 mg I VP in 3-5 min lidocaine 1.0-1.5 mgfcg IVP (-100 mg) then 0.5-0.75 mg/Kg (-50 mg) q5-10 min. max 3 mg/Kg atropine 1 mg IV q3-5 min x 3 magnesium 1 -2 g IV for TdP

Treatment of reversible causes of PEA & asystole

Hypovolemia: volume infusion Hypoxia: oxygenate Hydrogen ions (acidosis): NaHCO, Hypokalemia: KCI

Hyperkalemia: Ca. NaHCOs. insulirVglc Hyoglycemia: glucose Hypothermia: warming

Toxins/Tablets: med-specific Tamponade: pericardiocentesis Tension PTX: needle decompression Thrombosis (ACS): PCI (or lysis). IABP Thrombosis (PE): lysis, thrombectomy Trauma (hypovol, t ICP) per ATLS

(Adapted from ACLS 2005 Guidelines. Ore 200S:112(Suppl l):IV-58)

Figure 10-2 ACIS ochytírda algorithm

Tachycardia r/o sinus tach Synch cardioversion

or unstatfe - hypolenwon ot other tfe shock. a MS. ctost pan defibrillation for PMVT

IV Access. 0?,12-lead ECG. focused H & P (or reversible causes

ORS <120 msec

ORS ¿120 msec narrow complex

wide complex regular

vagal maneuvers irregular

AF. AFI. or MAT Control rate w/ diltiazem or metoprolol does not convert

Likely AVNRTor AVRT Rx recurrence w/ adenosine or long-acting AV nodal agent such as diltiazem or metoprolol

Possbly AFL. ATAC. NPJT Control rate w/ diltiazem or metoprolol regular irregular

VT or ? WCT amlodarone or procainamide or lidocaine & prepare for synch cardioversion

SVT w/ aber. adenosine

AF w/ aber Control rate w/ diltiazem or metoprolol

procainamide. or ibutilide avoid adenosine, digoxin. CCB & ¡iB

PMVT (nl QT) treat ischemia amlodarone or lidocaine & prepare for defibrillation

Torsadas (T QT) correct abnl lytes & other precip. Mg 2 g IV overdrive pacing or Isoproterenol ? lidocaine

CARDIOVERSION

Ancillary equipment 0?sat monitor suction device IV line intubation equipment

Premedicate call anesthesia service midazolam 1 -5 mg fentanyl 100-300 pg titrate to effect

Synchronised çgrdiQvgrsiQn 100. 200. 300. 360 J

or biphasic equivalent

MEDICATIONS

adenosine 6 mg rapid IVP then 20 cc NS bolus.

12 mg IVP q2 min x 2 if needed amlodarone 150 mg IV over 10 min diltiazem 15-20 mg IV over 2 min. 20-25 mg 15 min later if needed. 5-15 mg/h

Ibutilide: 1 mg over 10 min. repeat x 1 if needed lidocaine 1-1.5 mg'kg IVP. repeat in 5-10 min metoprolol 5 mg IV q5 min x 3 procainamide 17 rngtog at 50 mg/min (avoid if EFl) verapamil 2.5-5 mg IV over 2 min. 5-10 mg 15-30 min later if needed

(Adapted from ACLS 2005 Guidelines. Ore 2005:112(Suppl l):IV-67)

Figure 10-3 ACIS bndytarda algorithms

Bradycardia

(HR <60 bpm and inadequate for clinical condition)

ABCs. IV Access. Oj,12-lead ECG, focused H&P for reversible causes r

(eg. hypotension or other s/s shock. A MS. chest pain)

prep tor transcutaneous pacing use w/o delay for Type II 2" AVB or 3° AVB

atropine 0.5 mg IV

q3-5min. max 3 mg transcutaneous pacing dopamine 2-10 pg/kg/min, or epinephrine 2 10 pg/min while awaiting pacer or if pacer ineffective transvenous pacing

(Adapted from ACLS 2005 Guidelines. Ore 2005:112(Suppl l):IV-67)

Acute Pulmonary Edoma. Hypotension, or Shock 1

ABCs. IV Access. O,, 12-lead ECG. locus«) HSP. CXR

What is the nature ot the problem?

Fluids and/or blood What Is BP? Go to tachycardia or

Consider vasopressors (after empiric 250-500 cc NS bradycardia algorithm

Fluids and/or blood What Is BP? Go to tachycardia or

Consider vasopressors (after empiric 250-500 cc NS bradycardia algorithm

II in pulmonary edema, consider:

Furosemide 0.5-1 mg/Kg IV Morphine 2-4 mg IV Oxygennonlnvaslve vent, intub.

further interventions based on etiology

(Adapted from ACLS 2005 Guidelines)

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