ACLS

นางสาว A อาชีพ นสพ. ขับรถอยู่ พบว่ามีคนนอนกลางถนน ไม่ขยับตัว

• ลงไป check pulse คนไข้

• เช็ค scene safety ก่อนลงไป

• โทร 1669

• ขับรถวนหา AED

คนไข้มาที่ ER หมดสติไม่รู้สึกตัว no pulse

Start CPR and .......

• Adenosine 6 mg IV

• Adrenaline 1 mg via ETT

• Flat line protocol

  • - Check lead

  • - Change lead

  • - Increase amplitude

• Defibrillation 200 J

After CPR 2 min

No pulse

EKG show this

.....

• Resume CPR

• Defibrillation 200 J

• Synchronized cardioversion 100 J

• Amiodarone 300 mg IV

You defib 200 J and resume CPR,

next 2 min, EKG no change, you give defibrillation 200 J

and .......

• Continue CPR with adrenaline 1 mg IV q 3-5 min

• Amiodarone 300 mg IV

• Amiodarone 150 mg IV

• double sequential defibrillation

EKG?

• Ventricular fibrillation

• Atrial fibrillation

• Ventricular tachycardia

• Pace rhythm

BP 70/40, HR 180, chest pain

• Amiodarone 150 mg IV in 10 min

• Synchronize cardioversion start 50 J

• Synchronize cardioversion start 120 J

• Defibrillation 200 J

Agitation, BP 180/100, PR 180

Lung; fine crepitation both

• Amiodarone 150 mg IV in 10 min

• Adenosine 6 mg IV double syringe technique

• Synchronize cardioversion start 120 J

• Propranolol 10 mg oral stat

chest pain, BP 50/40, PR 35, sweating

• Adenosine 6 mg IV double syringe technique

• on external pacemaker

• Atropine 1 mg IV

• Levophed drip

No chest pain, no functional class change, BP 120/70

• Observe

• Atropine 1 mg IV stat

• on pacemaker

• Drip dopamine

High quality CPR?

• Push hard 3 cm depth in adult

• Push fast 100-120 /min

• Ventilate via ETT q 10 sec

• Interruption < 5 sec