ACLS : some point not to forget

Pr; < 0.12 Sec

QRS: ,0.12 sec

QT<0.460sec

VF:

FIne vs COarse VF, 

Not VF or pulseless VT

PEA: 

electromechanical Dissociation

narrow complex usually caused by condition iutside the heart but Wide complex usually caused by heart

Not VF or pulseless VT

ASystole:

Pwave might me present but no R wave/ ventricular activity

AFT: 

atial rate 220-350

FLutter wave usually occupieause s 1 big box

AF: 

Atrial rate 300-400

Reenterant SVT: 

220-250 rate usually

P waves are not usallly seen  cause fuses with T wave cause of rapid heart arte

So looks like Sinus tachy but rhythm is fast

Ventricular tachyarrythmia:( check for QT prolonging drugs)( Anti muscaranic)

VT> 30 sec----sustained VT, 

<30 sec duration is Unsustained VT---dont req intervention

3 consecutive PVC: means VT

ventricular rate > 120-250

 p wave present but not seen < AV disscoiation>

Torsa de:

QT prolongation--------increase RRP---so increase risk of arrythmia

* difficult to distinguish type 2b AV block from AF

Pediatric Defib dose is 2-4 J/kg

 bBrady:

if symptomatic----- then gv ATropine 0.5mg I V bolus q 3-4 min---------if no response gv TCP or meds like dopa or epi at a rate of 2-10mcg /min-----------id still no response to TCP the  consider TVP

• During CPR : coronary perfusion pressure > 10mmhg--------------but this cant  be done during cpr so Intra arterial relaxation pressure < 20 mmhg 

end tidal co2--< 10 indicates inadequate CPR..

• Chest recoil ------increase increase coronary perfursion pressure
• 100 heart rate improves ROS and Neurological outcome...( proved)
• for uncoscious pt: tidal volume requirement is around > 500-600ml
• half a bag squeeze is adequate to fill the lungs and chest rise
• Excessive ventilation: cause gastric inflation, decrease venous return and decrease survival

ACLS:

• imp to give complete 2 min of CPR
• Amidarone  for refractory VF/VT
• Epinephrie to all card arrrest pt eveyry 3 -5 min
• Atropine No longer used for PEA and pulseless electrivity or Asystole.

Perfusing rythm:

•  regular monomorphic Wide complex Tachy: If source of Tachy is not known then use Adenosine
• If regular  mono narrow complex tachy---use adenosine
• But for irreg wide complex tachy: dont use adenosine ow cause degn of rythm to VT
• Brady cardia:  Atropine for all brady------if ineffective then use either chronotropic agent like epi or dopa= tc pacer

Suchronised Cardioversion:

•  for unstabel Atrial Fibrillation: dose 120-200 j ( biphasic)
• for unstable AFT or SVT: 50-100 j

for monophasic waveform:

Initial dose 200 j then increase in step wise manner

FOR UNstable VT: initial dose is 100j ---if no response increase the dose

post Cardiac arrest carre:

• Therapeutic Hypothermia is the only intervation shown to improve neurologic recovery: gives esp in coatose pt after ROS and VF as a [resenting rhtythm: cool down body to 32- 34'c for 12-24 hrs
• STMI pt hypothermia and PCI

AIRWAY Management:

• CApnography: most reliable indiactor of ETT and eff of chest compression
• Endtidal co2 normally is 40mmhg...if ineffective chest compression then blood flow to lung decrease and co2 diffusion also decrease ---decreasing endtial c02

 Goals of reperfusion treatment:

•  PCI within 90 min of arrival to ED
• fibrinolytic t/t within 30 min of arrival to ED

 STroke:

pt should recive fibrinolytic t/t within 3 hrs of onset of symp or for slelcted pt windows has been increase to 3-4 and half hrs...( bt not approved by FDA yet)