Advance Cardiac Life Support I (ACLS)
Clement Arthur S. Torio, MD Department of Anesthesiology Core Concepts The Brain Cardio-Pulmonary-Cerebral Resuscitation The Patient Basic Life Support (BLS) Time The Cause Postresuscitation Care The Chain of Survival Expected Deaths and Futile Resuscitations The Chain of Survival Early Access Early CPR Early Defibrillation Early ACLS Cardiopulmonary Emergencies Acute Coronary Syndromes Stroke Acute Coronary Syndrome (ACS) Nation’s single leading cause of death Approximately 52% of deaths from AMI occur OUT of the st hospital (within the 1 4 hours after the onset of symptoms) Classic symptoms Chest discomfort SOB Sweating
Ospital ng Maynila Medical Center Acads Session 04/04/09 (riz and blue)
Nausea Lightheadedness Atypical symptoms more common in the elderly, women, and diabetic patients Spectrum covers: ST elevation MI (STEMI) Non-ST elevation MI (NSTEMI) Unstable angina ACS is the proximate cause of sudden cardiac death in most adult patients Primary Goals of Therapy Reduction of myocardial necrosis in patients with ongoing infarction. Prevention of major adverse cardiac events (death, nonfatal MI and need for urgent revascularization). Rapid defibrillation when ventricular fibrillation (VF) occurs. Most important conditions other than ACS that may cause chest pain or discomfort Aortic dissection Acute pericarditis with effusion and tamponade Acute myocarditis Spontaneous pneumothorax Pulmonary embolism Esophageal rupture
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Therapy Morphine 2 – 4 mg IV Oxygen Nitroglycerine SL Aspirin 160 – 325 mg PO chew Fibrinolytic therapy Streptokinase – 1.5 MU in D5W 90 cc x 1 hr Premedication with Hydrocortisone 100 mg IV and Diphenhydramine 50 mg IV Tissue plasminogen activator tPA – 15 mg IV bolus 0.75/kg over next 30 mins (not to exceed 50 mg) 0.5 mg/kg over next 60 mins (not to exceed 35 mg) Heparin Bolus dose of 60 U/kg followed by infusion at a rate of 12 U/kg per hour (a maximum of 4,000 U/kg and infusion of 1,000 U/ hr for patients weighing < 70 kgs) An APTT of 50 to 70 secs is considered optimal. If there are signs of shock, fibrinolytic therapy is contraindicated PCI is the treatment of choice
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Acute Stroke Stroke – disruption in blood supply to a region of the brain that causes neurological impairment. Category: Ischemic – blood vessel supplying the brain is occluded; 85% of all strokes Hemorrhagic – rupture of a cerebral artery 7 “D” of Stroke Management Detection Dispatch Delivery Door Data Decision Drug
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