=> ADVANCED CARDIAC LIFE SUPPORTE

. 4 "efficient and advanced

I
- -

life support
CABI
& circulation

⑧ airway-head-chin lift
~ Out of hospital cardiac arrest
-

obstruction (finger sweeps

> In-hospital cardiac arrest
⑧ breathing ·
house

80 BLS ⑧ Pharmacologic

RISCUE BREATHING
⑧ D-Fib

& cardioversion

chest] by
no rise and fall of assessed

CHAI NOO
⑧ no sound of air heard look , listen and
feel (l(F] 5 sess
,

.
I HOUSE
COOOOO
of SURVIVAL

↓ breathing =
recovery position V Early surveillance/monitoring/prevention
-

giving meds . , BIS , etc .

: CPR =
↓ Early recognition/activation of the code team
pulse one
no compression
-

~ -
call team immediately

GOLDEN HOUR ↓ Immediate HQ CPR

↓ Rapid defibrillation

& BLS
-

OVERVIEW ↓ Advanced IS and post-arrest care

-
Mech. Vent.
MEMBERS
of the cool team

⑧ Team leader-physician direct , the resuscitation effort -

announces drugs before/after
"

-
RN with ACIS certification V until team "prep .
Epi ! Epi Ready ! -
First Epi given !
leader arrives

Cardiac monitor
-foot/head of bed (clearly check) 8 Defibrillator connects to
-

ochest compressor primary RN ; performs survey starts defibrillation

-
-

CAB
-
if no pulse -> activate code (C -

Monitor ECG with team leader

>
-
compress
-
make sure team is cleared before
- extra nurse - > standby
shock
>
-
preps . Crush card

assist-second RN : ventilates BUM

⑧ Airway * Recorder -

begins recording
-

performs HQ [PR -

code time ; compression time med.s time / loc ., amnt .

,

-
can initiate intubation/assist -
the CLOCK used
... clock used
"

ward
"

intubation is the clock

.... PST'
"

Nintubate directly
unless no physician -
announce med .
I confirms intervention

* Medication nurse-handing drugs

-
O participate in other tasks

-
accustomed to crush cards

-
establish IV access (PNSS)
 I
DIRTER RESPONSIBILITIES

Cardiac board

· 100-120 compressions/min . - IV (flush 10 -

20mL/Fast drip

Depth 2 inches for adults Check face IV

3
for Elevation of extremity
=
⑧ color -

=
<2 inches for children sheck pulse -
IV fluids compatible (PNSS)
in-house = check monitor

* Allow full-chest recoil 1. Epinephrine

- all cardiac arrest rhythm
Minimize interruptions
-
vasoconstrictor >
-
4BP -> reach organs

o Switch compressions 92 mins sympathomimetic

-

NO airway =
30 : 2 () chronotropic-heart rate ↑

-
1 breath a 6 sees .
(established (t) inotropic-heart contractility
air way () dromotropic-heart conductivity
1mg/3.5 mins.
·
no max. dis
DOIDLE IMELDDCIATI
-

DIN $
-

Rhythm check 12 mins .

8 A systole 2-2 5 mg/3 5 .

-

mins
ROSC-return of Spontaneous circulation
8 V-tach (pulseless)

&
.

Shockable
. Amiodarone
2

⑧V-Fib .
-

anti-arrhythmic
-
Pulseless v-tach/v-fib .

8 pulseless electrical activity -

give after 3rd shock

-300mg Conce )
!

then 150mg after 2 mins .

R OUTE S =
reverted
not
peripheral ⑧ 2 .

2g/day max dosa

IV
-

·
central (SVc/1vc)-nearer the heart reverted =
drip =
Img/min First Chrs
.

+ D5w/PNsS 0 5 mg/min
.
.
next 18hrs .

Intra-osseous -
Tibia humerus , sternum
,

3 lidocaine
Endotracheal
- anti .

arrhythmic

Adenosine
sub. for amiodarone
Epinephrine
5
1. .

01-1 5 .

mg/kg -
0 5-0.
.

75mg/kg
2
. Amiodarone 6 .
M9S04 to 39 max dose

-
Torsades de
4
. A tropine
pointes
.
3 Lidocaine (V-tach) -
anticholinergic
-

sympathomimetic

4
. A tropine
-

for bradycardia (symptomatic

0 5 .

mg z-5 mins .

83mg max
 I
5 . Adenosine ADIREADY MAINIA GLE MIEIN IT
-anti-arrhythmic -
Wide QRS (should be

tachycardia uniform/regular) -
assist during intubation

Narrow QRS (SUT) -

Flush and elevate

-
BVM w/ compressor 30 : 2 -

intubated I lesess .

06mg >
-

12mg after 1-2 mins . (SUT)

-
count until 30

-very short half-life trauma pt .

(Jaw thrust Maneuver

-
basic (head-tilt , chin lift)

6 .

M9S04
-
one press is enough to ventilate

pulseless TDP /1-29 dilute TOML D5W) -

BVM connected with supplemental 02 (6-101PM)
bolus
-
advanced airway : intubate

TDP (drip 0 5-1g/hr )

·
ET tube : 7-7 5 .
Fr Carina
pulse
- .
.

-
supraglottic/laryngeal mask airway
DEF1BR11IATION glottis

therapeutic use of electric current in large 1 .

laryngoscope-adult
pediatric
blade
-
5

· Clean/sterile
gloves
amounts in a short period of time ET tube withStylet
.
2

⑧ automated 3 KY Jelly Stethoscope

.

Manual . 70CC
4
syringe .
7 BVM device
lanchoring
Monophasic-1pt -
-another

Biphasic-returns
POST-ARREST CARE

STEPS
.
7 Remove transdermal meds .

/ shave chest hair -optimize recovery/prevent secondary injury

. Turn on
2 machine
-

maintain SpO2 at 94 % -

99 % (First 4h)

.
3 Set energy level (Monophasic -

3605) -
BP systole >
/ 90mmHg-MAP
= =< / =
Commig
4) (t) inotropes
(Biphasic -
1203- 2005 (

T =
(1st 24h) Therapeutic hypothermia
·

Y 34-yearly
paddles 32-36 c
-

4
. place

1
. im clear on 1
I
-

Neuro . US Orientation 3 spheres

-

2- everybody
clear 80 GCS ⑧ PERRLA -
LOS
3 clear
⑧ pain
-

"shock delivered"
-
after ROSC a 30 mins then .

hourly
-

Blood glucose 140-180mg/dl

-

Prevent complications
-Family
I support
 I
INL DIR TIM
1. putting the code in motion

quick assignment of roles

-

team leader positioned opposite to

the recorder

chesk 8 rhythm
2
. Drugs/defibrillation
airway intubation
-

-
ECO

.
3 Winding down

monitoring
-

-maintaining stability
* rhythm check a 2 mins .

5 HS 4 TS
Hypovolemia Tension Pneumothorax

Hypoxia Tamponade
H
+
acidosis/metabolic Toxins/poisoning
Hypothermia Thrombosis

Hyperkalemia/hypokal .
 I
Pulseless V-Tach/V-fib .
Advanced air way
CPR continues chest compression
-
-

Defib 1205 -
I breath every 6 seconds
-
Continue [PR
compressor
-

Rhythm check 2 min .

·
still pulseless V-tach/v-fib 1. Check pulse/breathing
-

Img Epi lVP count 1001 ...

-
shock at 2005 . CODE !
2

-
[PR . Cardiac
3 board

Rhythm check in 1 min . .

4 CPR

v-tach/V-fib . 5 .

Defib . After 5 cycles/2 mins .

-
Shock at 2005
AIRWAY MN .
-
[DR
-

300mg Amiodarone IVP (3rd Shock) 1. Prep airway

150mg after two minutes
-
-
also intubation mats .
If may time

ASYSTOLE
-
[PR 2. BUM-OatTO nd assist

EPi ll0c syringe air ,

-

Tmg lVP
b atts .,
Stethoscope)
Rhythm check 2 min .

Suction PRNATION
-

REMEMBER NURSE
⑧ check carotid pulse before shock/meds . cart and board
1 .

Emergency
⑧ Defib (5th cycle CPR
.
(min . 30secs) . put cardiac
2 board

. IV access
3 patency
PEA to PNSS
.
4
Change/hook
CPR 5 prepares for flushing
⑧ epinephrine . 5Rs
6 "Epi given at elevate arm

DEFIBRILLATOR

1. In-cardiac monitor/defib .

pads
"

2. "Defib charged
.
at 1205 ...
ready to shock
-

put pads on chest

-
"Im clear on 1 , you're clear ,
oh clear ,
"

everybody clear
-
"Shock delivered"
 I
R ECORDER TEAM LEADER
"

1. Records start of code 1 .

"I'll take the role of team leader r... Confirms
.
2 Updates med due "Epi due ,
Second Epidue" , roles

Rhythm check & 2 mins . 2 .

Check Monitor (if V-tach , ALWAYS
. Records EC6
3 Check PULSE
.
4
Records defib . + joules

5 make sure interruptions </ =

10s .

u
6 .
Checks & establishes presence of ROS [ check pulse

.
2 .
g Team leader : "Check for pulse...
We have a pulse , BP
at 90/60"

Recorder : "Rose achieved at

10 : 42 am
"

2 mins .

TO bring :
↓ batteries

↓ scrub shoes

~ Stethoscope
/ gloves
~ Whiteboard marker

~ Small NB
 Record
code started Time

episo given
-
Vtach 120]
-
shock given
"epidue"

epi given
remind rhythm check
(no touch

swap compress
-

say "Shift"
"Standby
ready
"

intubation muna
prepare
·

gloves