SPM200 Skills Lab 7 Notes

(Updated: 1/5/2011)
Skill Lab #7: Abnormal !" #nterpretation and $reatment
Origins of the ACLS Approach:
A!LS trainin% ori%inated in Nebraska in t&e earl' 1(70)s* #ts p+rpose ,as to brin% order and or%ani-ation to t&e treatment o.
/ardia/ arrest*
Primary Survey: (CA!
0o/+s on t&e basi/ !P1 and de.ibrillation
Cir/+lation: %i2e /&est /ompressions (30 /ompressions 4 rate o. 100/min)
Air,a': open t&e air,a'
reat&in%: pro2ide positi2e4press+re 2entilation (2 breat&s)
A5/5e.ibrillation: A11#6S (VF/pulseless VT)
1. !&e/k t&e patient .or responsi2eness and presen/e/absen/e o. normal breat&in% or %aspin%*
2. !all .or &elp*
3. !&e/k t&e p+lse .or no more t&an 10 se/onds*
4. "i2e 30 /ompressions* (2 inches; > 100/min.)
5. 7pen t&e air,a' and %i2e 2 breat&s* (Over 1 second)
. 1es+me /ompressions*
$&e 2 basi/ A!LS skills are t&e abilit' to per.orm !P1 and operate an A5 (A+tomated 8ternal 5e.ibrillator)* $&ere are 7
ad2an/ed A!LS skills:
1* !are o. t&e air,a'*
2* 1e/o%nition o. r&'t&m
3* le/tri/al t&erap' #: de.ibrillation
9* le/tri/al t&erap' ##: /ardio2ersion
5* le/tri/al t&erap' ###: trans/+taneo+s pa/in%
:* #6 a//ess to /ir/+lation
7* Sele/tion o. appropriate res+s/itation medi/ation
"e#ications:
$rug $ose %oute &reatment
Adenosine :412 m%
#6 p+s& ,it& saline
.l+s&; < 5 min*
S6$
5iltia-em
0*25 m%/k% = 20 m%
t&en 0*35 m%/k% = 25 m%
#6
Stable; narro,4/omple8
ta/&'/ardias; A0 or S6$
pinep&rine 1 m% #6 <345 min As'stole; >rad'; PA ? 60
Atropine 0*5 = 1 m% to 0*09m%/k% (e*%* 3 m%) #6 >rad'
Amiodarone
300 m% 8 1 dose
150 m% (2
nd
dose)
#6 bol+s 60; 6$
Pro/ainamide
20 m% to 50 m%/min +ntil
arr&'t&mia s+ppressed
#6 Pre4e8/ited A0; $a/&'
Lido/aine
1 to 1*5 m%/k% bol+s
0*5 to 0*75 m%/k% e2er' 5 mins
(Ma8 3 m%/k%)
P+s&
@ A410 min
#n.+se 149 m%/min
Bemod'nami/all' stable
monomorp&i/ 6$
6asopressin 90 #U
#6 p+s&
1 dose onl'
As'stole; PA; 6$/60
'( Atrial )lutter
1
SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
%ate: Bas man' atrial /ontra/tions .or one 2entri/+lar /ontra/tion* Atrial rate is 2504350 beats/min+te* 6entri/+lar is +s+all'
bet,een :04100 beats/min+te* #. t&e 2entri/+lar rate is 150; 2:1 /ond+/tan/eC 2 atrial /ontra/tions to 1 2entri/+lar /ontra/tion*
%hythm: >ot& atrial and 2entri/+lar patters are re%+lar; b+t t&e' don)t mat/& in rate*
P*%S& +nformation: Bas P ,a2e (sa,4toot&ed or .l+tter ,a2es); @1S /omple8; b+t t&e $ ,a2e is not seen be/a+se it is
/o2ered b' t&e man' P ,a2es*
$ifferential $iagnosis: A/+te !oronar' S'ndrome; !ardiome%al'; !oronar' Arter' 5isease
Signs , Symptoms: S7>; palpitation ? !&est Pain (!P)
&reatment: S'n/&rono+s 5! s&o/k; di%italis; <+inidine; propranolol; diltia-em
-( Atrial )ibrillation
%ate: Atrial Pattern is like a <+i2erin% line = 900 beats/min+te* 6entri/+lar pattern is present and /an be normal or .aster t&an
normal*
%hythm: >ot& are atrial r&'t&m and t&e 2entri/+lar r&'t&ms are irre%+lar*
P*.%S& +nformation: $&ere is no a/t+al P ,a2e; b+t rat&er a .ine ,a2' line* @1S /omple8 is present* $&e $ ,a2e is not
e2ident*
2
SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
$ifferential $iagnosis: (P+%A&/S4 P+lmonar' disease; +s/&emia; %&e+mati/ &eart disease; Anemia; atrial m'8oma;
&&'roto8iosis; /t&anol; Sepsis) /ardia/ 2al2e disorder; &'pertensi2e /ardio2as/+lar disease; /ardiom'opat&'; M#; t&'roto8i/osis;
!7P5; /onstri/ti2e peri/arditis; !B0; /ertain dr+%s*
Signs , Symptoms: S7>; palpitation ? !&est Pain (!P)
&reatment: Pre/ipitatin% /a+se; +se o. p&arma/olo%i/al a%ents .or /ardio2ersion or ele/tri/al s'n/&roni-ed /ardio2ersion is
/ommon to /on2ert a r&'t&m to S1* Ablation /an be done in t&e le/tro4P&'siolo%' (P) lab to interr+pt t&e aberrant .o/i; as a
/+re .or A .ib* !"#e $on#rol% 5i%o8in; >eta blo/kers* &n#i"rrh'#hmics% !or2ert; !ardi-em; Pro/ainimide; @+inidine;
Amiodarone
00Anti1coagulate in ne,4onset; si%ni.i/ant risk .or emboli-ation*
2( Sinus ra#ycar#ia
%ate: >ot& t&e atria and 2entri/les are less t&an :0 beats/min+te*
%hythm: 1e%+lar r&'t&m t&ro+%&o+t
P*%S& +nformation: Bas P ,a2e; 71S /omple8; and $ ,a2e present*
$ifferential $iagnosis: 0re<+entl' seen in at&letes; d+rin% sleep; ,it& in/reased intra/ranial press+re; in/rease 2a%al tone
(pain; 2alsal2a; /ord inD+r') ; a.ter an a/+te M# in2ol2in% t&e ri%&t /oronar' arter' (s+pplies blood to t&e SA node);
&'perkalemia; treatment ,it& beta blo/kers; !a
2E
/&annel blo/kers; s'mpat&ol'ti/ dr+%s; di%italis; morp&ine; or demerol*
Signs , Symptoms: p+lse; :0; .ati%+e; li%&t&eadedness; s'n/ope; ma' be ass'mptomati/*
&reatment: $reat +nderl'in% /a+se; &eart rate is maintained ,it& dr+% (atropine) or a pa/emaker i. s'mptomati/*
3( Sinus Arrhythmia
%ate: Atrial and 2entri/+lar /ontra/tion are present and meas+re bet,een :04100 beats/min+te*
%hythm: Sli%&tl' irre%+lar
P*%S& +nformation: Bas P ,a2e; @1S /omple8; and $ ,a2e present*
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
$ifferential $iagnosis: A 2ariation in sin+s r&'t&m t&at +s+all' related to respirator' rate and res+lts .rom in/rease 2a%al tone
in&ibition* $&e &eart rate in/reases ,it& inspiration and de/reases ,it& e8&alation* !ommon in at&letes* A marked 2ariation in
P4P inter2al ma' indi/ate Si/k Sin+s S'ndrome ? Fanderin% Pa/emaker*
Signs , Symptoms: Un/ommon; palpitations or di--iness
&reatment: Unne/essar'
4( Sinus &achycar#ia
%ate: Atrial and 2entri/+lar /ontra/tions are present and t&e rate meas+res 10041:0 beats/min+te*
%hythm: 1e%+lar
P*%S& +nformation: Bas P ,a2e; @1S /omple8; and $ ,a2e present
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
$ifferential $iagnosis: pain; an8iet'; dr+%s (amp&etamines)
Signs , Symptoms: S7>; pain; and an8iet'
&reatment: None; +nless s'mptomati/C treat +nderl'in% disease
:* Asystole (6entri/+lar Standstill)
%ate: No rate obser2able be/a+se t&e atrial pattern ma' be 2isible or not and t&e 2entri/+lar pattern is not present*
%hythm: Atria rate; i. present; is re%+lar* 6entri/+lar rate not s&o,n/2isible*
P*%S& +nformation: P ,a2e o.ten present; @1S /omple8 absent; and no $ ,a2e 2isiable*
"ost )re5uent Causes of Asystole an# P/A (4167s , 4 1&7s!
6'po2olemia &o8ins (75)
6'po8ia &amponade; /ardia/
6'dro%en ion4 (a/idosis) &ension pne+mot&ora8
6'er4/&'pokalemia &&rombosis; /oronar' or p+lmonar'
6'pot&ermia &ra+ma
$ifferential $iagnosis: See abo2e table* !ommonl' in se2erel' diseased &earts* Leads dis/onne/ted*
Signs , Symptoms: 5eat&
&reatment: $rans/+taneo+s pa/in%; pinep&rine and Atropine; re2ersible /onditions asso/iated ,it& as'stole
7( 8entricular &achycar#ia (64ta/&; 6$)
%ate: $&ere is no atrial /ontra/tion 2isible = t&e 2entri/+lar /ontra/tion is present and rapid (1004250 beats/min+te)
%hythm: Atrial r&'t&m is not apparentC 2entri/+lar r&'t&m is +s+all' re%+lar*
P*%S& +nformation: P ,a2e is not 2isible* @1S /omple8 is ,ide and bi-arre* $&e $ ,a2e is present and al,a's pointin% in
t&e opposite dire/tion o. t&e @1S /omple8*
5
SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
$ifferential $iagnosis:
Signs , Symptoms: /&an%e in mental stat+s; !P; S7>; palpitation; p+lse 2s* p+lseless
&reatment: Lido/aine; pro/ainamide; 5! s&o/k; <+inidine
9( 8entricular )ibrillation
%ate: not apparent*
%hythm: rapid and /&aoti/ = looks like an +ne2en line*
P*S%& +nformation: No P ,a2e; No @1S /omple8; and no $ ,a2e*
$ifferential $iagnosis: Lead arti.a/t*
Signs , Symptoms: Le2el o. !ons/io+s (L7!); 5eat&
&reatment: 5! s&o/k
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
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SPM200 Skills Lab 7 Notes
(Updated: 1/5/2011)
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