Thank you for choosing SureFire CPR! This study guide is ...

[Pages:18]Thank you for choosing SureFire CPR! This study guide is an outline to help you prepare for your upcoming ACLS course. Even though there is a lot of information in this guide, it is important to have your textbook to help you review the material over the next 2 years to keep your skills sharp.

Because the course covers a lot of material in a short amount of time, there is required prestudy material.

In the course you will be expected to evaluate and identify different cardiac emergencies. At the completion of the course, you will act as the team leader to diagnose and treat a variety of cardiac rhythms. Please pay special attention to the BLS review, as it is the foundation for ACLS.

Here is what you need to do before you come to class.

1. Read through this study guide (paying particular attention to anything marked with a "*") 2. Go to and play the 6 Second ECG Game to

practice up on your EKG skills 3. Go to this website: American Heart Association Prestudy Material and enter the password:

compression 4. Watch the ACLS Science Overview Video 5. Watch the CPR/AED Overview Video 6. Watch the Intraosseous Video 7. Watch the ACS Video 8. Watch the Stroke Video 9. Take the Precourse Self-Assessment 10. Print out your results and bring them to class!

We look forward to having you in class. If you need anything at all, please don't hesitate to call us. Remember we also have PALS, BLS, PEARS, EKG, and NRP for your training needs as well. Thanks again!

Take care,

Zack Zarrilli CEO/President SureFire CPR (888) 277-3143

ACLS Assessment

Quality ACLS can only be built upon a foundation of solid BLS skills. There are 2 levels of ACLS care: the BLS survey and the ACLS survey.

The BLS Survey is used if the patient appears to be unconscious. The ACLS Survey is used if the patient is conscious.

BLS Survey:

A. Check responsiveness B. Activate the emergency response system and get an AED C. Circulation

a. Check the carotid pulse b. If no pulse, start CPR c. If a pulse is present, start rescue breathing D. Defibrillation** a. If no pulse, check for a shockable rhythm as soon as the AED arrives

ACLS Survey:

A. Airway a. Make sure the airway is adequate and protected b. Use adjuncts if needed c. Insert advanced airways

B. Breathing a. Provide Oxygen b. Confirm placement of Endotracheal Tube c. Monitor waveform capnography d. Avoid excessive ventilation

C. Circulation a. Establish IV/IO access b. Treat the heart rate and rhythm c. Monitor CPR quality d. Provide defibrillation or Cardioversion if necessary e. Take vital signs (BP, etc.)

D. Differential Diagnosis and Disability a. Determine the reason for the problem b. H's and T's (Seen later in this guide) c. Mental Status d. Glasgow Coma Scale

Study Guide Page 1 ? SureFire CPR 2012

The Heart

Here is a quick review of the anatomy of the heart before we get into our ECG rhythms. First, blood enters the atria of the heart and an electrical impulse is sent out from the SA node. This electrical impulse travels through the atria causing them to contract. When the atria contract, it registers on the EKG as a P wave. Next, the electrical impulse travels to the AV node which sends out an electrical impulse that travels through the Bundle of His, bundle branches, and into the Purkinje fibers of the ventricles. This causes ventricular contraction which registers on the EKG as the QRS complex. Finally, the ventricles rest and repolarize, which is shown on the EKG as a T wave. (In case you were wondering, the atria repolarize also, but it occurs during the QRS complex where you can't see it on the EKG) Narrow QRS complexes originate in the atria (near the AV node) and wide QRS complexes originate in in the ventricles (below the Bundle of His).

Anatomy of the Heart

ECG Breakdown

Study Guide Page 2 ? SureFire CPR 2012

ECG Review and Cardiac Algorithms

Pulseless Rhythms: 1. Ventricular Fibrillation 2. Ventricular Tachycardia

3. Pulseless Electrical Activity 4. Asystole

Ventricular Fibrillation

Coarse VF

Fine VF Description: Ventricular Fibrillation (also known as V-Fib or VF) is the most common rhythm to occur immediately after cardiac arrest. The ventricles quiver and are unable to pump blood to the rest of the body. Survival chances diminish rapidly while in ventricular fibrillation and immediate defibrillation is essential. There are two types of V-Fib: Coarse and Fine. Coarse VF is more easily corrected with defibrillation than fine VF. Fine VF is more likely seen in a patient with a prolonged cardiac arrest. Both types of ventricular fibrillation are treated with defibrillation.

Study Guide Page 3 ? SureFire CPR 2012

Ventricular Tachycardia (No Pulse)

Description: Ventricular Tachycardia (also known as V-Tach or VT) occurs when the ventricular focus takes over control of the heart and fires at a tachycardic rate. The QRS complex is wide because it originates in the ventricles. This rhythm is treated identically as V-Fib when there are no pulses.

Treatment for Ventricular Fibrillation and Pulseless V-Tach:

1. Defibrillate 2. Perform CPR for 2 minutes 3. Quickly check a rhythm and a pulse 4. If another shock is needed, clear the patient and defibrillate again 5. Repeat this sequence until the rhythm is not shockable

Medication Sequence (Performed Simultaneously with CPR and Defibrillation):

1. Epinephrine 1mg 1:10,000 IV/IO every 3 to 5 minutes a. Vasopressin 40 U may be substituted for the first or second dose of Epi b. A peripheral IV is the preferred method of access for Epi administration during a cardiac arrest**

2. For refractory (persistent) VF: a. Amiodarone 300mg IV/IO (Initial dose)** b. Amiodarone 150mg IV/IO (2nd and Final Dose ? 3 to 5 minutes after the first dose)

Asystole

Description: Asystole is when there is no detectable activity on the ECG. It may follow many rhythms, including VF, PEA, or 3rd Degree Heart Block. Always ensure that all leads are attached to the patient.

Study Guide Page 4 ? SureFire CPR 2012

Pulseless Electrical Activity (PEA)

Description: Pulseless Electrical Activity (PEA) occurs when the heart is beating and has a rhythm, but the patient does not have a pulse. For example: Sinus rhythm without a pulse = PEA**

For all patients without a pulse, CPR is the priority.

Treatment for Asystole and PEA:

1. CPR 2. Epinephrine 1mg of 1:10,000 IV/IO every 3-5 minutes 3. Consider H's and T's to find the root of the problem.

Consider H's and T's (Differential Diagnosis)

? Hypovolemia (most common cause) ? Hypoxia ? Hydrogen ion (acidosis) ? Hypo/hyperkalemia ? Hypoglycemia

? Toxins ? Tamponade, cardiac ? Tension pneumothorax ? Thrombosis, coronary ? Thrombosis, pulmonary

Bradycardic Rhythms:

? Sinus Bradycardia ? 1st Degree AV Block ? 2nd Degree Block (Type I)

? 2nd Degree Block (Type II) ? 3rd Degree Block

Sinus Bradycardia

Description: Sinus bradycardia occurs when the SA node fires at a rate that is too slow for the person's age. For adults, this is less than 60 beats per minute. Many athletes have a resting heart rate of less than 60, so it is important to only treat patients that are symptomatic (fatigue, dizziness, hypotension, altered mental status, etc.)

Study Guide Page 5 ? SureFire CPR 2012

1st Degree AV Block

Description: In a first-degree AV block, everything is normal except for a prolonged PR interval. The interval is longer than .20 seconds (or 5 small boxes on the ECG strip). This conduction delay in the AV node rarely causes any problems.

2nd Degree Block (Type I - Wenckebach)

Description: Second Degree, Type I block occurs at the AV node. The PR interval gets progressively longer until it drops the QRS complex. You can see 2 dropped QRS complexes on the strip above.

2nd Degree Block (Type II - Mobitz)

Description: Second Degree, Type II block occurs below the AV node. The P waves are regular, but QRS complexes are dropped. The electrical impulses fail to pass through the AV node which results in atrial contractions that are not followed by ventricular contractions. This rhythm is more serious than the 2nd Degree Type I, and pacing is usually recommended.

Study Guide Page 6 ? SureFire CPR 2012

3rd Degree Block

Description: 3rd Degree, or Complete Heart Block is characterized by no communication between the SA and AV nodes. P waves and QRS complexes will be completely independent of each other. The ventricles will generate their own electrical signal through an accessory pacemaker in the lower chambers. The location of this "Escape Pacemaker" will determine if the QRS complexes are wide or narrow (Junctional = Narrow QRS, Ventricular = Wide QRS).

Treatment (if symptomatic):

1. Oxygen 2. Atropine .5mg (Repeated every 3-5 minutes to a max dose of 3mg)**

a. Though atropine is now recommended for symptomatic bradycardia, it will probably not work in high degree heart blocks (2nd Degree Type II or 3rd Degree)

3. Prepare for Transcutaneous Pacing (TCP) if needed

As an alternative to TCP, chronotropic drug infusions are also available: ? Dopamine IV infusion (2-10 mcg/kg/min)** ? Epinephrine IV infusion (2-10 mcg/min)

For patients in respiratory failure with rapidly dropping heart rates, assisting with ventilation and simple airway maneuvers are the highest priority.**

Tachycardic Rhythms:

? Sinus Tachycardia ? Supraventricular Tachycardia ? Monomorphic Ventricular

Tachycardia

? Polymorphic Ventricular Tachycardia

? Torsades de Pointes

Sinus Tachycardia

Description: Sinus tachycardia occurs when the SA node fires at a rate that is too fast for the person's age. For adults, this is generally between 101 and 150 beats per minute. In sinus tach, all of the normal components of an ECG are present (P waves, QRS complexes, and T waves). Sinus tachycardia usually starts and stops gradually and is the result of pain or another cause that can be identified (fever, exercise, etc.)

Study Guide Page 7 ? SureFire CPR 2012

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download