(click for larger images)
In a earlier summary of the 2010 ACLS guidelines, Dr. Demian Szyld succinctly highlighted changes from previous guidelines.
There are 2 flowcharts (above) that the AHA provides. They are conceptually complete, but I had a hard time implementing the steps in real-time.
So, I created my own. Thanks to Dan, who commented in my chat box that I should make an ACLS card.
Update 3/30/12: A reader (@drtompalfi) mentioned adding two other causes for potentially "reversible causes":
- Hypoglycemia
- Trauma
Tips:
- 2 minutes of continuous, uninterrupted CPR is key before rechecking the rhythm.
- Think about giving epinephrine every OTHER time you check the rhythm. This puts it at roughly a q4 minute dosing (recommended q3-5 minutes).
- Don't delay CPR when you recognize a cardiac arrest. That means do this first, and then work on giving oxygen, placing the patient on various monitors, setting up the defibrillator, and establishing IV/IO access. Hence, the C-A-B mnemonic (Circulation before Airway)
- Chest compressions should be "hard and fast" -- Depth of at least 2 inches and ≥ 100 compressions with a target pCO2 on the end-tidal capnography of ≥10 mm Hg.
- Use your mobile phone's timer to help alert you every time when 2 minutes is up.
References
Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S729-67. Review. Erratum in: Circulation. 2011 Feb 15;123(6):e236. Pubmed
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Excellent flowchart! Something else we're teaching that's relatively new (past couple revisions) to the guidelines is immediate CPR after defibrillation. It's a hard habit to break for those who have taken ACLS multiple times.
ReplyDeleteThanks, Michelle!
ReplyDelete@Fred: Good point. I too struggle with NOT checking pulses after each defibrillation That's why I put the SHOCK icon within the CPR boxes. Technically you stop CPR for a second to defibrillate, but then should continue with CPR immediately. The less of a pause in CPR, the better the outcome.
ReplyDeleteBeautifully redone card but I think hypo/hyperkalemia is missing.
ReplyDeleteOh wow! Great catch. Adding "H"ypo/hyperkalemia for the "Treat reversible causes" section. Not sure how that got left out. Thanks!! Will change now.
ReplyDeleteAlso missing is Hypoglycaemia
ReplyDeleteCheers
Tom
P.S. Some people also include another 'T' as in Trauma (head)
@Tom: I agree about hypoglycaemia. It's odd that the AHA didn't include that in their algorithm. It fits very easily in the "H"s and "T"s list, as does Trauma. I'm going to added an editorial note above. I'm just a little hesitant to change on the card itself because it's not actually in the official AHA guidelines. Thanks for the tips.
Delete