Advanced Cardiovascular Life Support: Provider Manual

194 Pages·2011·9.68 MB·English

by  Elizabeth Sinz, Kenneth Navarro, Erik S. Soderberg

A d v a c e d C a r d io v a s c la r
L ife S p p o r t
P R O V I D E R M A n u A L
Editors ACLS Subcommittee 2010-2011
Elizabeth Sinz, MD, Associate Science Editor Clifton W. Callaway, MD, PhD, Chair
Kenneth Navarro, Content Consultant Robert W. Neumar, MD, PhD, Immediate
Past Chair, 2008-2010
Senior Managing Editor Steven Brooks, MD
Erik S. Soderberg, MS Daniel P. Davis, MD
Michael Donnino, MD
Special Contributors Andrea Gabrielli, MD
Clifton W. Callaway, MD, PhD Romergryko Geocadin, MD
Diana M. Cave, RN, MSN Erik Hess, MD, MSc
Heba Costandy, MD, MS Mark S. Link, MD
Mary Fran Hazinski, RN, MSN Bryan McNally, MD, MPH
Theresa Hoadley, RN, PhD, TNS Venu Menon, MD
Robert W. Neumar, MD, PhD Graham Nichol, MD, MPH
Peter D. Panagos, MD Brian O’Neil, MD
Sallie Young, PharmD, BCPS Joseph P. Ornato, MD
Charles W. Otto, MD
Michael Shuster, MD
Scott M. Silvers, MD
Mintu Turakhia, MD, MS
Terry L. Vanden Hoek, MD
Janice L. Zimmerman, MD
© 2011 American Heart Association
ISBN 978-1-61669-010-6
Printed in the United States of America
First American Heart Association Printing May 2011
eBook edition © 2013 American Heart Association. ISBN 978-1-61669-350-3
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ACLS Subcommittee 2009-2010
Robert W. Neumar, MD, PhD, Chair
Laurie J. Morrison, MD, MSc, Immediate
Past Chair, 2006-2008
Steven Brooks, MD
Cli ton W. Callaway, MD, PhD
Daniel P. Davis, MD
Andrea Gabrielli, MD
Romergryko Geocadin, MD
Richard Kerber, MD
Mark S. Link, MD
Bryan McNally, MD, MPH
Graham Nichol, MD, MPH
Brian O’Neil, MD
Joseph P. Ornato, MD
Charles Otto, MD, PhD
Michael Shuster, MD
Scott M. Silvers, MD
Terry L. Vanden Hoek, MD
Acknowledgments
Peter Olu Anderson, MD
Ulrik Christensen, MD
To f nd out about any updates or corrections to this text, visit www.heart.org/cpr, navigate
to the page or this course, and click on “Updates.”
To access the Student Website or this course, go to www.heart.org/eccs tudent and enter
this code: algorithm
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C o n t e n t s
P a r t 1
Co u r s e Ove r vie w 1
Course Description and Goal 1
Course Objectives 1
Course Design 2
Course Prerequisites and Preparation 2
BLS Skills 2
ECG Rhythm Interpretation for Core ACLS Rhythms 3
Basic ACLS Drug and Pharmacology Knowledge 3
Practical Application of ACLS Rhythms and Drugs 3
Effective Resuscitation Team Concepts 3
Course Materials 3
ACLS Provider Manual 4
Student Website 5
Pocket Reference Cards 6
Precourse Preparation Checklist 6
Requirements for Successful Course Completion 7
ACLS Update Course 7
ACLS Provider Manual Abbreviations 7
P a r t 2
Th e S ys t e m a t ic Ap p ro a c h : Th e BLS a n d ACLS S u r ve ys 1 1
Introduction 11
Learning Objectives 11
The Systematic Approach: The BLS and ACLS Surveys 11
Overview of the Systematic Approach 11
The BLS Survey 12
Overview of the BLS Survey 12
The ACLS Survey 14
Overview of the ACLS Survey 14
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C o n t e n t s
P a r t 3
Effe c t ive Re s u s c it a t io n Te a m Dyn a m ic s 1 7
Introduction 17
Learning Objectives 17
Roles of the Team Leader and Team Members 18
Role of the Team Leader 18
Role of the Team Member 18
Elements of Effective Resuscitation Team Dynamics 19
Closed-Loop Communications 19
Clear Messages 19
Clear Roles and Responsibilities 20
Knowing One’s Limitations 21
Knowledge Sharing 22
Constructive Intervention 22
Reevaluation and Summarizing 23
Mutual Respect 23
P a r t 4
S ys t e m s o f Ca re 2 5
Introduction 25
Learning Objectives 25
Cardiopulmonary Resuscitation 25
Quality Improvement in Resuscitation Systems,
Processes, and Outcomes 25
A Systems Approach 26
Measurement 27
Benchmarking and Feedback 27
Change 27
Summary 27
Post–Cardiac Arrest Care 28
Therapeutic Hypothermia 28
Hemodynamic and Ventilation Optimization 28
Immediate Coronary Reperfusion With PCI 28
Glycemic Control 28
Neurologic Care and Prognostication 29
Acute Coronary Syndromes 29
Starts “On the Phone” With Activation of EMS 29
EMS Components 29
Hospital-Based Components 29
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Contents
Acute Stroke 30
Regionalization of Stroke Care 30
Community and Professional Education 30
EMS 30
Education, Implementation, and Teams 30
The Need for Teams 30
Cardiac Arrest Teams (In-Hospital) 31
Rapid Response System 31
Medical Emergency Teams and Rapid Response Teams 31
Regional Systems of Emergency Cardiovascular Care 32
Published Studies 32
Implementation of a Rapid Response System 32
P a r t 5
Th e ACLS Ca s e s 3 3
Overview of the Cases 33
Respiratory Arrest Case 34
The BLS Survey 34
The ACLS Survey 36
Management of Respiratory Arrest 38
Giving Supplementary Oxygen 38
Opening the Airway 38
Providing Basic Ventilation 40
Basic Airway Adjuncts: Oropharyngeal Airway 42
Basic Airway Adjuncts: Nasopharyngeal Airway 43
Suctioning 45
Providing Ventilation With an Advanced Airway 47
Precautions for Trauma Patients 49
VF Treated With CPR and AED Case 49
The BLS Survey 50
AED Use in Special Situations 57
VF/Pulseless VT Case 59
Managing VF/Pulseless VT: The Cardiac Arrest Algorithm 60
Application of the Cardiac Arrest Algorithm: VF/VT Pathway 62
Routes of Access for Drugs 69
Vasopressors 70
Antiarrhythmic Agents 71
Immediate Post–Cardiac Arrest Care 72
Application of the Immediate Post–Cardiac Arrest Care Algorithm 73
Pulseless Electrical Activity Case 78
Description of PEA 78
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C o n t e n t s
Managing PEA: The Cardiac Arrest Algorithm 79
Managing PEA: Diagnosing and Treating Underlying Causes 82
Asystole Case 86
Approach to Asystole 86
Managing Asystole 87
Application of the Cardiac Arrest Algorithm: Asystole Pathway 88
Terminating Resuscitative Efforts 89
Acute Coronary Syndromes Case 91
Goals for ACS Patients 92
Managing ACS: The Acute Coronary Syndromes Algorithm 95
Identification of Chest Discomfort Suggestive of Ischemia (Box 1) 96
EMS Assessment, Care, and Hospital Preparation (Box 2) 96
Immediate ED Assessment and Treatment (Box 3) 99
STEMI (Boxes 5 Through 8) 100
Classify Patients According to ST-Segment Deviation
(Boxes 5, 9, and 13) 101
Bradycardia Case 104
Description of Bradycardia 107
Managing Bradycardia: The Bradycardia Algorithm 108
Application of the Bradycardia Algorithm 109
Transcutaneous Pacing 112
Unstable Tachycardia Case 114
The Approach to Unstable Tachycardia 114
Managing Unstable Tachycardia: The Tachycardia Algorithm 116
Application of the Tachycardia Algorithm to the Unstable Patient 118
Cardioversion 120
Synchronized Cardioversion Technique 122
Stable Tachycardia Case 124
Approach to Stable Tachycardia 125
Managing Stable Tachycardia: The Tachycardia Algorithm 126
Application of the Tachycardia Algorithm to the Stable Patient 127
Acute Stroke Case 130
Approach to Stroke Care 132
Identification of Signs of Possible Stroke (Box 1) 135
Critical EMS Assessments and Actions (Box 2) 138
In-Hospital, Immediate General Assessment and Stabilization (Box 3) 139
Immediate Neurologic Assessment by Stroke Team or Designee (Box 4) 140
CT Scan: Hemorrhage or No Hemorrhage (Box 5) 141
Fibrinolytic Therapy 143
General Stroke Care (Boxes 11 and 12) 146
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Contents
Ap p e n d ix 1 4 9
Testing Checklists and Learning Station Checklists 151
2010 AHA Guidelines for CPR and ECC Summary Table 163
ACLS Pharmacology Summary Table 165
Glossary 168
Foundation Index 171
In d e x 1 7 3
No t e o n Me d ic a t io n Do s e s
Emergency cardiovascular care is a dynamic science. Advances in treatment and drug therapies occur rapidly.
Readers should use the following sources to check for changes in recommended doses, indications, and contraindi-
cations: the ECC Handbook, available as optional supplementary material, and the package insert product information
sheet for each drug and medical device.
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