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2005 ACLS Guidelines 5.15
2005 ACLS Guidelines 5.15
2005 ACLS Guidelines 5.15
During CPR
1. Airway-breathing-circulation-defibrillator
2. Airway-breathing (advanced)-circulation (access)-differential
diagnosis
3. O2 –IV-monitor-fluid
4. Temp-HR-BP-R
5. Tank (size)-tank (volume)-pump-rate (consider the cause)
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ACLS 2005 GUIDELINES
Comprehensive ECC Algorithm
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ACLS 2005 GUIDELINES
Ventricular Fibrillation/Pulseless VentricularTachycardia
Primary ABCD
Defibrillate one time at 360 or equivalent biphasic
Perform CPR for 2 minutes (5 cycles 30:2)
Reassess patient and rhythm
Defibrillate at 360
Perform CPR for 2 minutes, simultaneously perform a
secondary ABCD and begin medication consideration
Administer a vasoconstrictor (Epinephrine or Vasopressin)
- Epinephrine 1 mg every 3 minutes
o Vasopressin 40 units may replace the first or
second dose of epineprhine
Reassess patient and rhythm
Defibrillate after each 2 minutes of CPR
Consider an antiarrhythmic
- Amiodarone 300 mg, may be repeated in 3-5 minutes
at 150 mg IVP
OR
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ACLS 2005 GUIDELINES
Pulseless Electrical Activity (PEA)
Primary ABCD
Perform CPR for 2 minutes (5 cycles 30:2), simultaneously
perform the Secondary ABCD
Focus on identifying and correcting causes (6 Hs, 5 Ts)
Administer a vasoconstrictor (Epinephrine or Vasopressin)
- Epinephrine 1 mg every 3 minutes
o Vasopressin 40 units may replace the first or
second dose of epineprhine
Atropine 1 mg every 3 minutes, up to a maximum of 3 mg
(if the PEA is less than 60 on the monitor)
Asystole
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ACLS 2005 GUIDELINES
Bradycardia
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ACLS 2005 GUIDELINES
Tachycardia with Pulses
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ACLS 2005 GUIDELINES
Medications
ADENOSINE
- 6 mg, 12, mg, 12 mg RIVP
AMIODARONE
- 300 mg in cardiac arrest, may be repeated in 3-5 minutes at half dose
- 150 mg given over 10 minutes for tachycardias
ASPIRIN
- 81 mg to 324 mg chewable
ATENOLOL
- 5 mg slow IVP over 5 minutes, may be repeated in 10 minutes
ATROPINE
- 0.5 mg for bradycardia, may be repeated in 3-5 minutes to a maximum
dose of 3 mg
- 1 mg for pulseless patients, may be repeated in 3-5 minutes to a
maximum dose of 3 mg
CALCIUM CHLORIDE
- 500 mg to 1g for hyperkalemia and calcium channel blocker overdose
DIGOXIN
- 10 to 15 mcg/kg for impaired hearts
DILTIAZEM
- 15 to 20 mg over 2 minutes, may be repeated at 20 to 25 mg in 15
minutes
DOPAMINE
- 2 to 20 mcg/kg/min
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ACLS 2005 GUIDELINES
Medications
EPINEPHRINE
- 1 mg every three minutes for the arrested patient
- 2 to 10 mcg/min as an infusion for bradycardiac patients
FLECANIDE
- Not for IV use in United States
FUROSEMIDE
- 0.5 to 1 mg/kg
HEPARIN (UFH)
- 60 IU/KG
IBUTILIDE
- 1 mg over 10 minutes for rate control of Afib/Aflutter
LIDOCAINE
- 1 to 1.5 mg/kg in VF/PVT, may be repeated at half dose in 5 minutes
- 1 to 1.5 mg/kg in WCT, may be repeated at half dose in 5 minutes
- Begin at 0.50 to 0.75 mg/kg for patients with WCT and impaired heart
function
- Maximum dose of 3 mg/kg
- Infusion of 1 to 4 mg/min
MAGNESIUM SULFATE
- 1 to 2 g
METOPROLOL
- 5 mg slow IVP, may be repeated every 5 minutes up to 15 mg
maximum
MORPHINE
- 2 to 4 mg increments for pain relief of ACS
NALOXONE
- 0.4 to 2 mg for narcotic overdose
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ACLS 2005 GUIDELINES
Medications
NITROGLYCERIN
- 1 tablet or spray sublingual, may be repeated
NOREPINEPHRINE
- 0.5 to 1 mcg/min to improve BP
PROCAINAMIDE
- 20 to 50 mg/min for perfusing tachycardias
PROPAFENONE
- Not for IV use in the Untied States
SODIUM BICARBONATE
- 1 mEq/kg for metabolic acidosis and/or hyperkalemina
SOTALOL
- Not for IV use in the United States
VASOPRESSIN
- 40 units, one time to replace the first or second dose of epinephrine
VERAPAMIL
- 2.5 to 5 mg IVP over 2 minutes, may double the dose in 15 to 30
minutes
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ACLS 2005 GUIDELINES
Electrical Therapy for Unstable Tachycardias
Cardioversion (synchronized)
- Narrow and Wide Complex Tachycardias with a pulse
o 100, 200, 300 and then 360 joules or equivalent
biphasic
Defibrillation (unsynchronized)
- Ventricular Fibrillation and Pulseless Ventricular
Tachycardia
o Defibrillate at 360 joules or equivalent biphasic
o Repeat after every 2 minutes of CPR, as needed
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