Sebenernya sih belum sempet ikut ACLS. Cuma pernah baca ini di e-book.. seru aja mnemonic nya.. siapa tau jadi lebih gampang ingetnya… soalnya kasus2 ACLS kan kasus darurat. Nggak ada salahnya dong belajar duluan sebelum ikut kursus resminya, biar nanti kalo ikut, tinggal mendalami.. ^ ^

ini adalah algoritma ACLS 2004 yang dibuat sama dr. Antonio Arnal (Caracas, Venezuela)

    Asystole


    Asystole ….. Check me in another lead,

    then let’s have a cup of TEA.”

    A

    Intervention

    Comments/Dose

    T

    Transcutaneous Pacing (TCP)

    Only effective with early implementation along with appropriate interventions and medications.

    NOTE: Not effective with prolonged down time.

    E

    Epinephrine

    1 mg IV q3-5 min.

    A

    Atropine

    1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

    Consider termination of efforts if asystole persists despite appropriate interventions.

    Asystole may be discovered during the primary ABCD survey after attaching a monitor, or it may develop in a previously monitored patient. In either case, it is essential that asystole be confirmed in another lead with properly functioning equipment. If the patient is in true asystole and is a candidate for resuscitation, then proceed with the secondary ABCD survey.

    Ventricular Fibrillation (VF)/

    Pulseless Ventricular Tachycardia (PVT)

    The following mnemonic directs AHA accepted

    actions after the primary survey ABC’s


    Please Shock-Shock-Shock, EVerybody Shock,

    And Let’s Make Patients Better

    Chant

    Intervention

    Note

    Please

    Precordial Thump

    May be performed immediately after determining pulselessness in a witnessed arrest with no defibrillator immediately available. Check pulse after thump.

    Shock

    200J*

    If VF or VT is shown on monitor, shock immediately, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm.

    Shock

    200-300J*

    If VF or VT persists on monitor, shock immediately, do not check pulse, do not continue CPR, do not lift paddles from chest after shocking, simultaneously charge at next energy level and evaluate rhythm.

    Shock

    360J*

    If VF or VT persists, shock immediately.

    Implement the secondary ABCD survey. Do not continue with this algorithm if an intervention results in the return of spontaneous circulation.

    NOTE: When giving med’s, do so in a drug-shock-drug-shock sequence. Continue CPR while giving meds, and shock within 30-60 seconds. Evaluate the rhythm and check for a pulse in the period immediately after shocking.

    Everybody

    Epinephrine

    1 mg IV q3-5 min.

    or

    eVerybody

    Vasopressin

    40 U IV, one time dose.(wait 10-20 minutes before starting epi)

    If VF/PVT persists, “CONSIDER” antiarrhythmics and sodium bicarb.

    CAUTION: Using more than one antiarrhythmic may result in pro-arrhythmic drug-drug interactions.

    And

    Amiodarone (First Choice)

    300mg IV push. May repeat once at 150mg in 3-5 min. (max. cumulative dose: 2.2g IV/24hrs.)

    Let’s

    Lidocaine

    1.0-1.5 mg/kg IV. May repeat in 3-5 min. (max. loading dose: 3 mg/kg)

    Make

    Magnesium Sulfate

    1-2 g IV (2 min. push) for suspected hypomagnesemia or torsades de pointes.

    Patients

    Procainamide

    20 mg/min, or 100 mg IV q 5 min. for refractory VF. (max. loading dose: 17 mg/kg)

    Consider buffers

    Better

    Bicarbonate

    1 mEq/kg IV for preexisting hyperkalemia, bicarb-responsive acidosis, some drug overdoses, protracted code (intubated), or return of spontaneous circulation after long code with effective ventilation

    Bradycardia


    All Trained Dogs Eat Iams

    (The sequence reflects interventions for increasingly severe bradycardia)

    Algrth

    Intervention

    Comments/Dose

    All

    Atropine

    0.5-1.0 mg IV push q 3-5 min. (max. dose 0.03-0.04 mg/kg)

    Trained

    TCP

    Use Transcutaneous Pacing (TCP) immediately with severely symptomatic patients.

    Dogs

    Dopamine

    5-20 µg/kg/min.

    Eat

    Epinephrine

    2-10 µg/min.

    Iams

    Isoproterenol

    2-10 µg/min.

Stable Tachycardia

Think “O-M-I“, (pronounced “oh my“) Oxygen-Monitor-IV, even before you start your primary and secondary ABCD surveys. After the failure of one antiarrhythmic drug, electrical cardioversion is usually the next treatment of choice. If the rate is >150 and/or the patient is unstable with serious signs and symptoms due to the rhythm, prepare for immediate electrical cardioversion.

Note that amiodarone is listed for most of the stable tachycardias. Knowing the exceptions for the use of amiodarone will aid in the implementation of the stable tachycardia algorithms.

Atrial Fibrillation/Flutter

(with/without CHF)


Rate Control diltiazem

Rhythm Conversion ? Nonemergent chemical or DC cardioversion should be avoided, and when indicated, should only be performed by an experienced health care provider after careful evaluation and thromboembolic precautions are taken.

Wolff-Parkinson-White

(with/without CHF)

(avoid adenosine, beta blockers, calcium channel blockers, digoxin)


Rate Control amiodarone

Rhythm Conversion Nonemergent chemical or DC cardioversion should be avoided, and when indicated, should only be performed by an experienced health care provider after careful evaluation and thromboembolic precautions are taken.

Narrow Complex Tachycardias

Vagal maneuvers

Adenosine

Junctional Tachycardia/Ectopic or Multifocal Atrial Tach (with/without CHF)

Amiodarone (no Cardioversion)

Paroximal Supraventricular Tachycardia

No CHF:

Verapamil

DC Cardioversion

Amiodarone

With CHF:

DC Cardioversion

digoxin

amiodarone

diltiazem

Wide-Complex Tachycardia/Unknown Type

(with/without CHF)

(avoid beta blockers, calcium channel blockers, digoxin)

DC Cardioversion or amiodarone

Ventricular Tachycardia

DC Cardioversion or trial of medication

Monomorphic

(with/without CHF)

amiodarone

|

synchronized cardioversion

Polymorphic

Evaluate for electrolyte abnormality or drug toxicity and treat accordingly

/ \

Normal QTI Long QTI

Amiodarone magnesium

cardioversion overdrive pacing

    PEA

    Pulseless Electrical Activity may be discovered during the primary ABCD survey when a monitor is attached to a pulseless patient and a rhythm is shown. As part of the secondary ABCD survey, a doppler should be used to confirm pulselessness.

    Interventions for pulseless electrical activity are guided by the letters P-E-A:

    Algorth

    Comments/Dose

    Problem

    Search for the probable cause and intervene accordingly.

    Epinephrine

    1 mg IV q3-5 min.

    Atropine

    With slow heart rate, 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

    Synchronized Cardioversion

    Synchronized Electrical Cardioversion

    It is essential that ACLS Providers know the indications for synchronized electrical cardioversion and receive proper training on the equipment their institution uses before attempting to perform this intervention.

    The following mnemonic directs preparations for synchronized electrical cardioversion: “Oh Say It Isn’t So

    Mnemonic

    Preparation

    Oh

    O2 saturation monitor

    Say

    Suction equipment

    It

    IV line

    Isn’t

    Intubation equipment

    So

    Sedation and possibly analgesics

    Synchronized Electrical Cardioversion Energy Levels:

    Unless otherwise specified in the table below, successive energy levels are *100J, and up to *200J, *300J, *360J, if needed. If the patient’s condition becomes critical and your equipment will not synchronize, then proceed with immediate unsynchronized shocks.

    Rhythm

    Special Notes:

    Polymorphic V-tach

    Treat polymorphic V-tach like V-fib, i.e., successive unsynchronized shocks at *200J, and up to *200-300J, *360J, if needed.

    PSVT, A-flutter

    start with *50J


    Note: If V-fib develops, immediately defibrillate following the VF algorithm.

    *Or biphasic equivalent