Cardiac Arrest (ACLS)

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 20 August 2017

⏱️ 9 minutes

🔗️ Recording | iTunes | RSS

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Summary

Hard, fast, unrelenting chest compressions are the core of ACLS!!!

Step 1: Check the Patient’s Pulse

* If the patient does not have a pulse, start CPR* Hard, fast, unrelenting compressions* Intubated patients* Continuous Compressions* Non-intubated adults* 30 compressions then 2 breaths… Repeat* Non-intubated pediatrics* 15 compressions then 2 breaths… Repeat

Step 2: Determine if the Rhythm is Shockable or Non-shockable

* Shockable rhythms* Ventricular Fibrillation (VF)* Ventricular Tachycardia (VT)* Non-shockable rhythms* Pulseless electrical activity (PEA)* Asystole

Step 3: Start a Timer For 2 Minutes

* Do a rhythm/pulse check every 2 minutes

Step 4: Is the Patient in a Shockable Rhythm?

* Repeat/coordinate shocks with every 2-minute pulse check* Give 1mg IV/IO epinephrine every 3-5 minutes* Give amiodarone* 300mg with first dose* 150mg with a repeat dose

Step 5: Is the Patient in a Non-Shockable Rhythm?

* Give epinephrine every 4 minutes (every other cycle)

Quick Facts

* Shockable rhythms (VT/VF) have best prognosis* Frequently related to myocardial infarction* Asystole has the worst prognosis* PEA has mixed prognosis (depends on diagnosis)* Two types (wide and narrow)* “Wide” PEA frequently caused by metabolic abnormalities* Consider bicarb and calcium chloride* “Narrow” PEA frequently caused by shock state* Perform bedside ultrasound in attempt to determine cause* “The H’s and T’s”* Hypoxemia* Hypovolemia* Hydrogen Ions* Hyper/hypokalemia* Tension pneumothorax* Tamponade* Toxins* Thrombosis (MI/PE)

Additional Reading

* When to Stop CPR (EM Clerkship)

Transcript

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0:00.0	Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of
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0:34.1	and you can cancel at any time if you decide it's not right for you.
0:37.7	You can learn more at www.gitfreed.a.i.
0:45.5	Hello, med students. My name is Zach Olson, and thank you for downloading this week's
0:50.6	episode of the EM Clerkship Podcast.
0:56.0	A long-time listener, Lees, wrote in.
0:58.6	Hi, Zach, I have some conflicting info on the management of cardiac arrest when there is
1:04.2	ventricular fibrillation or pulseless ventricular tachycardia.
1:08.7	Do you have a go-to, advanced life support algorithm you could share with me?
1:13.1	I'm wondering when to give epinephrine 1 milligram and when to give amyodorone.
1:19.2	Lease, the quick answer to your question is that I basically stick to ACLS. I'm pretty sure you do
1:23.7	to advanced cardiac life support, but I do really think this is a great question that we should still dive into
1:30.0	because you will see multiple cardiac arrests come in during your clerkships.
1:35.3	And similar to ATLS for trauma, I think it's good to understand ACLS.
1:40.4	So you can keep up with what's going on when these patients come in.
1:44.6	So today, we're going to cover the basic algorithm for patients in cardiac arrest.
1:50.6	And it's based off of the ACLS Advanced Cardiac Life Support algorithm.
	...

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