The Luce Foundation's Asia Program pursues two interrelated goals. One is fostering cultural and intellectual exchange between the United States and the countries of. SAINT FRANCIS NAMES CHIEF FINANCIAL OFFICER John N. Giamalis To Fill Position. We offer a full range of services and technology that support the health of our community, including quality medical care and holistic approaches to heal.
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ACLS Protocols. ACLS. Algorithms. This page was created. Some of the original info came. However, current information is available at.
Home- Amb- Card- Crit- Neuro- OB- Orth- Pain- Ped- Reg- Tran- Vasc- Misc. Primary Survey Assess responsiveness (speak loudly, gently shake patient if. Call for help/crash cart if unresponsive. ABCD's (sorry, can't get a much better mnemonic than that .. If pulseless, begin chest compressions at. Consider precordial thump with. Interposed. abdominal compression CPR may be more effective if trained.
Class. 2b)Defibrillation Attach monitor, determine rhythm. If VF or pulseless VT. Confirm airway placement (exam.
ETCO2, and Sp. O2). Remember, no metabolism/circulation = no. ETCO2. Circulation Evaluate rhythm, pulse.
Provider of House Officer, a medical billing software program. Heart Start CPR offers CPR classes in the San Francisco bay area including ACLS classes in San Mateo, Alameda and San Ramon. Heart Start CPR also offers PALS classes.
If pulseless continue CPR, obtain. IV access, give rhythm- appropriate medications (see. PIV preferred initially vs. Boy, This 'Ere's Awful! He's Dead. Marshall. If. patient had > 1. Back to Top of Page.
Bradycardia. Primary Survey. Secondary Survey assess need for airway, oxygen, IV, monitor, fluids. ECG, Hx, P/E. Consider DDx If AV block: 2nd degree (type 2) or 3rd degree: standby TCP, prepare. Do NOT give lidocaine. If serious signs or symptoms, treat even though . Normal EF Rate control: Ca- blocker or beta- blocker.
Cardiovert: If onset < 4. DC cardioversion OR with. If onset > 4. 8 hours: avoid drugs that may cardiovert. Either: Delayed Cardioversion: anticoagulate adequately x 3. Early Cardioversion: iv heparin, then TEE, then cardioversion within.
Anticoagulate if not contraindicated, if A fib > 4. Category 2. EF< 4. CHF Rate control: digoxin, diltizaem, amiodarone (avoid if onset of AF >. Anticoagulate, if A fib > 4. Category 3. Management 1. ECG, clinical exam Vagal stimulation, adenosine. Consider esophageal lead Treat according to specific rhythm: Back to Tachycardias.
Back to Top of Page. PSVTEF normal Ca- blocker> beta- blocker> digoxin> DC Cardioversion.
Consider procainamide, sotalol, amiodarone. If unstable proceed to cardioversion. EF < 4. 0%, CHF No Cardioversion. If unstable proceed to cardioversion. Back to Tachycardias. Back to Top of Page.
MATEF normal: Ca- blocker, beta- blocker, amiodarone. EF < 4. 0%, CHF: amiodarone, diltiazem Note: no cardioversion. Back to Tachycardias. Back to Top of Page. Junctional. EF normal: amiodarone, beta- blocker, Ca- blocker. EF < 4. 0%, CHF: amiodarone Notes rare, most commonly misdiagnosed PSVT.
If unable to make Dx, treat according to EF: EF normal: DC cardioversion. EF < 4. 0%, CHF: DC cardioversion.
Note: no lidocaine and bretylium in protocol. Back to Tachycardias. Back to Top of Page. Stable VT May proceed directly to cardioversion If not, treat according to morphology: Monomorphic VT EF normal: one of the following: procainamide (2a), sotalol (2a) OR amiodarone (2b), lidocaine (2b) EF poor amiodarone 1. OR lidocaine 0. 5- 0. Synchromized cardioversion Polymorphic VT Baseline QT Normal Possible ischemia (treat) or electrolyte (esp.
Treatment options: magnesium, overdrive pacing. Back to Tachycardias. Back to Top of Page. Cardioversion For tachycardia with serious signs and symptoms. Generally. not needed for HR< 1. If HR> 1. 50, prepare for immediate cardioversion.
May give. brief drug trial. Steps: Prepare emergency equipment Medicate if possible Cardioversion monomorphic VT with pulse, PSVT, A fib, A flutter. J* (Synchronized) may try 5. J first for PSVT or A flutter may use equivalent biphasic (biphasic 7.
J) if machine unable to synchronize and patient critical. VT: use VT/VF algorithm. Back to Tachycardias. Back to Top of Page. PEA The . If present treat agressively). Problem. Search for the probable cause ..
Wide QRS: suggests massive myocardial injury. Wide QRS+Slow: consider drug OD (tricyclics.
Ca- blockers, digoxin) Narrow complex: suggests intact heart; consider. PE, tamponade.. Evaluate rhythm and check for. Epi or vasopressin big drugs (may give. If VF/PVT persists, may move on to. High dose epinephrine is no longer recommended.
Vasopressin. 40 U IVone time dose (wait 5- 1. Preferred first drug? Shock 3. 60. J*Amiodarone (Class 2b)3. IV push. May repeat once at 1.
IV/2. 4hrs. Shock 3. J*Lidocaine (Class. Indeterminate)1. 0- 1.
IV q 3- 5 minmax 3 mg/kg. Shock 3. 60. J*Magnesium Sulfate (Class 2b)1- 2 g IV (over 2 min) for suspected. VT)Shock 3. 60. J*Procainamide . Note: bretylium acceptable but no longer recommended in. ACLSShock 3. 60. J*Bicarbonate. Eq/kg IV for reasons below: Class 1: hyperkalemia. Class 2a. bicarbonate- responsive acidosis, tricyclic OD, to alkinalize.
ODClass 2b: prolonged arrest Not for hypercarbia- related acidosis, nor for routine use in cardiac arrest. Shock 3. 60. J** Or equivalent biphasic shocks (1. J- 1. 50. J- 1. 50. J). It requires less energy to achieve. Lower energy requirements = smaller, lighter. All new ICDs, for example.
Newer defibrillators also monitor impedence, and. Success rates may be higher with. See this. site for details.
Then infuse 1- 4 mg/minmagnesium sulfate: 1- 2g over 5- 6. Side Effects: HTN, torsadevasopressin: 4.
IU x 1 dose only (for pulseless VT/VF) verapamil: 2. Back to Top of Page. Class Definitions: I II. III Indeterminant. Class I Definitely recommended. Definitive, excellent evidence.
Definition Class I interventions are always acceptable, unquestionably. Proven in both efficacy and effectiveness.** Must be used in the intended manner for proper clinical. Required Evidence One or more Level 1 studies are present (with rare. Study results are consistently positive and compelling. Class IIa and IIb Acceptable and useful Definition Both Class IIa and IIb interventions are acceptable, safe.
Must be used in the intended manner for proper clinical. Required Evidence Available evidence, in general, is positive. Level 1 studies are absent, inconsistent, or lack power. Classes IIa and IIb are distinguished by levels of. No evidence of harm. Class IIa Acceptable and useful. Very good evidence provides support.
Definition Class IIa interventions are acceptable, safe, and useful in. Considered interventions of choice.
Required Evidence Generally higher levels of evidence. Results are consistently positive. Class IIb Acceptable and useful.
Fair- to- good evidence provides support Definition Class IIb interventions are acceptable, safe, and useful in. Considered optional or alternative interventions. Required Evidence Generally lower or intermediate levels of evidence. Results are generally but not consistently positive. Class III Not acceptable, not useful, may be harmful Definition Class III interventions are unacceptable, not useful in. Required Evidence Complete lack of positive data from higher levels of. Some studies suggest or confirm harm.
Class Indeterminant Definition A continuing area of research; no recommendation until. Required Evidence Higher- level evidence unavailable; studies in progress.
Lower- level studies, when available, are not compelling.**Efficacy versus effectiveness. Evidence- based. medicine draws sharp distinctions between efficacy and. Drugs and other. interventions may produce a significant level of benefit in tightly.
These trials are a measure of efficacy- -under the. Effectiveness is the.