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ACLS (Cardiopulmonary Resuscitation and Advanced Cardiac Life Support)A. Electrocardiographic Asystole (suggested for all levels of training) . We suggest that bedside cardiac ultrasonography may be performed during asystole to guide further resuscitative efforts. Grade 2C Rationale: The American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) and European Resuscitation Council and International Liason Committee on Resuscitation (ILCOR) guidelines emphasize detection and treatment of potentially reversible causes of pulseless cardiac arrest. These are referred to as the six H’s and T’s and include: Hypovolemia, Hypoxia, Hydrogen (acidosis), Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Toxins, Tamponade, Tension Pneumothorax, Thrombosis (coronary or pulmonary), and Trauma. 81, 82 However, prior to detecting potential secondary etiologies and subsequent continuation of a “Pulseless Arrest” algorithm the correct diagnosis that a pulse is indeed absent needs to be made. However, this seemingly simple physical exam finding is often interpreted incorrectly when applied during the emergent evaluation of an unstable patient. 83-85 Bedside echocardiography has been shown to be very useful at detecting whether or not true cardiac contractility is occurring.86, 87 Patients found to be in true cardiac standstill on BCU have a nearly 100% mortality rate.88, 89 The intensivist should use this information if oxygenation and other treatment modalities are optimized as one source in deciding if continued resuscitative efforts are useful. ADDIN EN.CITE <EndNote><Cite><Author>Breitkreutz</Author><Year>2010</Year><RecNum>950</RecNum><record><rec-number>950</rec-number><foreign-keys><key app="EN" db-id="p05fesxr5sea2cera0ap0rvoevtpfz09e9x2">950</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Breitkreutz, R.</author><author>Price, S.</author><author>Steiger, H. V.</author><author>Seeger, F. H.</author><author>Ilper, H.</author><author>Ackermann, H.</author><author>Rudolph, M.</author><author>Uddin, S.</author><author>Weigand, M. A.</author><author>Muller, E.</author><author>Walcher, F.</author></authors></contributors><auth-address>Department of Anaesthesiology, Intensive Care and Pain Therapy University of the Saarland, Medical Faculty, D-66421 Homburg (Saar), Germany. raoul.breitkreutz@</auth-address><titles><title>Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial</title><secondary-title>Resuscitation</secondary-title></titles><periodical><full-title>Resuscitation</full-title></periodical><pages>1527-33</pages><volume>81</volume><number>11</number><edition>2010/08/31</edition><dates><year>2010</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>1873-1570 (Electronic)&#xD;0300-9572 (Linking)</isbn><accession-num>20801576</accession-num><urls><related-urls><url>(10)00416-8 [pii]&#xD;10.1016/j.resuscitation.2010.07.013</electronic-resource-num><language>eng</language></record></Cite></EndNote>90-92 81.Associations AH. Adult Advanced Cardiovascular Life Support:2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association,2010:S737-74182.Stapleton ER. Adult CPR. BLS Healthcare Providers. 2001:75.83.Ochoa FJ, Ramalle-Gomara E, Carpintero JM, et al. Competence of health professionals to check the carotid pulse. Resuscitation, 1998;37(3):173-175.84.Flesche CW, et al. The ability of health professionals to check the carotid pulse. Circulation,. 1994;90:I-288.85.Eberle B, Dick WF, Schneider T, et al. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation, 1996;33(2):107-116.86.Bocka JJ, Overton DT, Hauser A. Electromechanical dissociation in human beings: an echocardiographic evaluation. Ann Emerg Med., 1988;17(5):450-452.87.Paradis NA, Martin GB, Goetting MG, et al. Aortic pressure during human cardiac arrest. Identification of pseudo-electromechanical dissociation. Chest, J1992;101(1):123-128.88.Salen P, Melniker L, Chooljian C, et al. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med., J2005;23(4):459-462.89.Blaivas M, Fox JC. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med., 2001;8(6):654-657.90.Breitkreutz R, Price S, Steiger HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation,2010;81(11):1527-1533.91.Chardoli M, Heidari F, Rabiee H, et al. J.Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest. Traumatol. ,2012;15(5):284-7.92.Hayhurst C, Lebus C, Atkinson PR, et al. An evaluation of echo in life support (ELS): is it feasible? What does it add? Emerg Med J., 2011;28(2):119-21. ................
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