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ACLS - Pulse vs. No Pulse, Note: • shock = defibrillate, +CPR is ALWAYS…
ACLS - Pulse vs. No Pulse
Pulse
Arrhythmia?
• sinus tachycardia
• normal sinus rhythm
• sinus bradycardia
NOT Symptomatic
• IVF, O2, monitor
Symptomatic
Stable
you have time
Tx with drugs
Fast and wide (likely vtach): amiodarone
Fast and narrow (likely SVT): adenosine; if it doesn't work then BB or CCB (diltiazem or verapimil)
Slow: Atropine and prepare to pace
Unstable
will die imminently if you do not intervene
• systolic BP < 90
• chest pain, SOB, or altered mental status occurring with onset of arrhythmia
Tx with electricity
FAST = SHOCK (synchronized★ cardioversion)
SLOW = PACE
★
Sync button looks for QRS complex on a T wave and will not drop the charge on a T wave (prevents the R-on-T phenomenon)
No Pulse (code)
Follow this sequence:
2 min CPR
• 1 pulse check
• 1 rhythm check
• 1 shock if indicated
• 1 drug (for which, see below)
2 min CPR
• 1 pulse check
• 1 rhythm check
• 1 shock if indicated
• 1 drug
etc.; the cycle repeats until you stop
In a code, only 2 rhythms you need to worry about:
Vtach/Vfib
• CAN shock this
2 min CPR
Epinephrine, Shock
2 min CPR
Amiodarone, Shock
2 min CPR
Epinephrine, Shock
1 more item...
PEA/Asystole
• PEA is everything else; any rhythm without a pulse other than vtach/vfib)
• CANNOT SHOCK
2 min CPR
Epinephrine, DO NOT SHOCK
2 min CPR
Absent (nothing, keep doing CPR)
2 min CPR
Epinephrine, DO NOT SHOCK
1 more item...
Note:
• shock = defibrillate
+CPR is ALWAYS the right answer
Based on OME Video "ACLS Made Easy"