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American

Heart
Association

ADVANCED CARDIOUASCULAR
LIFE SUPPORT

PROVIDER MANUAL
6 American
Heart
Association.
life is why"

ADVANCED CARDIOVASCULAR
LIFE SUPPORT

PROVIOEB MANUAL

ii;-"ii*i"*q*.m ".e* 6".r'd


."iiiii i o:iills,,*.-".e;s.rc6*'r,6 P-,

lMcged&ftsuPlfudMdd
IrE^,Ed6Hd.Asiafunmdll.$6lollowingp.oob
l.rtI, ddllUt6 b,E d.Elop.d ol,]b maua]
Mi.nad W. Dddm. MD; kmndh Ndm, MB, Lpl
xdhdltu sn!, Mq s].M c B@*i MD, MHs.i
Jull C,idq PnDi Mry F@ Uarru*i, FN, MSN: n'e
a, N€dbr, FN, PhD, rNs sdrb Johns pnmD, acpsi
\tsnu M8m, Dj 3s Msr6, BNr P
MiiEr shr&i MDr D.vrd s.tuy, Mol

E n.vie.reto$6MssdihJ;o;;;il1;;1ri,ffi;:l*rnt
To lind eJr abdn &y updabs or cotr ctions to tn6 tsxt v,3 matro@r'h@ror!'

Tota.e. th6 studei I&bera iq rhis c.ue, so ro wwiE t oqr'.ccmrd*r and 6fl1€r thrs code:
ontents
Pan I
lnbodrrcdon
co.m o..otdon rE oo.,

2
Co.@ Frlrlo!'brb5 ed ArpaEtb, 2

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ACtS PB,fir M&ud


5
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PM A€pMia Cref!,
F.qiffi ,br &r...dt, CorE CdrPe.l
ACIS PEld..M. rd,ah6.v&tbn a
bt-dC4r@.Uhs@rt
odhy Alsssn, B.vr.r. ard TdEldmr &dE
P.rt 2
gllltaln ol Ca.. t3

c.dr9P.!*ffia, al,udtdlot 13
Au.l[y lmrlv
dr rn Rdsclalron $slm. Pl!l)**,.nd O]tcom.
A sysldB Apgwh

A.rchrtrrkh! €nd f..db6.k


17

Adn Cddt t Syaeq,,. 17


S@ts 'O. th. Pns." \4ft A.tEriM or EMS

HGpibl-B@.d ConF..drs
$
R.gind@t.n St k c*
or
Cmmunily @d Prolslon l Edu4lbn
13

Po8,-adthc,,6iCa. ,9
T.mpdtu6 M.n.!mml
Targolod r9
Her.dynMic and \ennhid Oplih zslion
lmm€d* . Cdmary B€fldtsM Wu! PCI

N€uEloq'c Ce and Foonclidllon


eldtdt, hd.narrr^h, at t l*tu b
It€ N.€d lor Tffi
cddiac arur Ied. (|.-HordLl)
AEpid R60ore slds
tlbli$ed Studi* ?2
lmplm.nralioi oI a tLpld H6po^* sFl6m
P.n 3
Encdrv. Hlah-Pcrloirn.nce Tctm DttrtErlca 25

B0&6 d lr, lrt<t4 a*, lt',t,r. ol . Eah-t|*lodr,Er,r. l*n 5


Fole or rrE 'I6m tsr,t 25
26

EI'ME, ot El'..tN t$9h-ffiti,,gr tM Oyrarrc. 6


whar b Communical. 2S
31

Fdn a
Th. StI3t m.tlc lppro.ch 3:t

,rr. Sl6lsirtb lppn dr 3


OveMew ol rhs SwrnEIic Aa@ch

Ovdiew ot th€ BLS AesMr


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Osvis or rhe Pnmry A@,Mi
t r. Seo.r*y Asd,l,,l
Ov*l6w ol llE Sddta.y r."-.tdt
tl,din.*ig utd lt*O lktd.,Yig C4..
CdrdllG ad MorEeEMi

caldbc Md Pur0on ry cadfiore


DruS O'€dGB or Toxic E&oec
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ft. CLt G.... 'fi]
O!.ri,.,at Ct lK'

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kkniicd..t ol FeptElo.y Prlblm3 by S#ily
B€.d..rdy DislB
Bo3pLdrory FaluE
Rrplr.ldy Arcl
,r. AIs /l..E
'.rn rho Pan.nr
Aesd ed tka$$
vdnibto ,id Pube ciEdi
,rEF'i,rry .@'nt 6
Ajd€y M.na€Effit in F..Pli.lory Am*

tttnq.n$ ol R.'Ptuoq And

d*AsqrdaaAAt,r
Mal.ian o4!€n saluai,m

Oeatol,c,t*q
CmM C.EolAtrY Ot lM-to
BadcAl ay oP.n n0 T&hnlqu6
ArMy iltr.g.ml
P'ardir, g..b ltn&i.rbr .lt
Bad. Atuay skllls
S.O.Md v.i lr.to
B& Atwrt ,4nb.,. qodsfieal At*4 61
51

T..t'rihr. ot Ot'A hsrlro 51

Batc ettyNln* Nt,lPltrytDal ALtq 59


Ieh.'qE ol NPA ln*rlio.
55
55
Solr s Rigid C€thd6
Oropharyns@l Su6limin9 P@oduE
Eidol@h.al Tubo Sdidi.q Ptuedu6
hu*rine VdtMoi Wtd, Artay s
^.,rdtd
ttat4
Vo.ll'rarM
Layio.al Mah Afray
Lryng..l Tubg
E$pn {oal T.&tEal rubo
Endot&tEr Tub6 5a

Petdo,R lq 1tuM Pdd6b 5A

/rqd. CcDmfl qzdborrr.. C.- te


Fhytr'ms ld acs
Druss hi ACS 59

@.k,b.tCSF d..rb a
Pari.pryioro!ry ol acs 60

,tlentgihg AC* th. h!r. Cotdbry Stn&qtu ,ltui.hn @


O!B@ ot $e Aradi,lB 62
rmp.dE l corcdfirrms 53
appiication ol lh. Acs algdithm 63

lctdttra.ddt a, C& Dir,/tdsl4E rdr6oar.dre& d,


SA^. 6nd cond'l @s
$an'no wrh o.Elcn
E rS i.!riu4 C.rq.drt apriarA?ef,'oi
Monro' .id s{ppoar AaCa
Adm'nEls 0rr!6 -d h4s
ott6h. 12,Lsd EcG 67
hn&lutt EO A@,t.n, tBti.4l
'IlE Fi6! l0 Minut6
6€
PaiE.r cffd T.etlM

CLdy M A.@nlnr b gr-S.!mrO.iado, o


crsfy lnro 3 G,oup6 B6.d on sr-s.gm.t oovl.lon
gtEtar e
Elny R6PatUon rrnpy
70
U* ol Filrircidjc lrrrEpy
AdiumUw letnqtr
?,
Pot nri.r Arrnlhmiru wnh srrDk6
Drugp L. St!k6
lpp!.dr ,o stDrr c.r.
G@L of Srok. C@ 75
cdriel TliE Pdiod.
Appflc.dio. ot tE si!p&i.d srrro lrlcdi0rd
,d.idlt6don ots&l,a! orft..ibb S_t!&. 7A
w' ing StgE std Syirrffi
&livar. Eils sysrd rdfod'aLry
SrDk A..@ner Ter!
C.idc., Ar9 &rsr,'. rd,a.tb,t ct

cnticrl EMS a!d6m.nl3 Md ,allMt a1

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lnmd.b G.d,l Alrgssn.nd Sirr$tsl d a2

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B.gin srEk P.rhway 90


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Ms[d ld ConlolLabdE ol Stdo rn nb.ieidc Irepy s0
M.dlEdn h nm clndld.td
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s3
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asFor./Ps F{hrsd.)

lFPllcriq ol th. ,drn c4bc M aeqtu* w f Prt uq s


Mhlm.l lnr€ruptlon ol Chdr Comp@bn. 95
DiB 1 sldk
Pul,oe oI Dctu ndion
Pn.clpl€ ol E rry D.0biirldrrd
9A
ihyll,n cn€d( s9
serr-Aaheiw Pads
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E ld
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Flu'd Adnini$.iion
LE

v&.01*,s U.d Lbi"s Crn hc A,Ern

@rnnc&ab

lr.onsilm surtrr.

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tu,ror,dat cfr (q whtus vft8.tutPEA)
Erts.poE r Msh"e Oxyleralid
lrtu,,,t d it EI A* W rttfr.PeAl t@
U[E@nd Us ln C.di* ArE l
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D.chrM Poinr Rh)4hm ch&k


Admrl]llr Ep'^.phd€
t{ddrodrbL Rityttn
0.dd6 I,oi.( snodabl. Ftry'hm 113

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csrE a,'r'/h ,.t .cla cu
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rppr!.dr ao ,.!6to,.
Paliftts Wilh DMA Odm 115
Arlddc 6 o Ed Pon'r 115

tt5
r15
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It rnih@rioo en CdEtoi o{ Un lalilc Cra

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admhht\r Epinrprrim
D&rirn Poinr: Rhyhm chek 113
NmlEkrt,. Fnj^nn 116

Arysolo and PEA T.renqtl S.q@


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ForiE Shoc* idhidEtElio. tld Rdntrsrd.d

tqdh.l*o R.ruxllrttoe Efiot,,


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Tmidtns our-ottkr.{ftd a6ratrai$ Eilo.r6
ouhrim or F@it6ri€ Enoi. 1i3
&yBrol6: An A€od Fh)4hm? 113
Etical Cssidd.lidr.
T Ep..i ol P.naE h CrdE ArBt
ttu
Fhjnhms d Br.dyrrdt
On]!6 lor 8.ldy.rdi. 12',1

D@&Jtbn ol drdy6d. tzt


122
SymdlMt A.ad,erdlr 12
slen! and EmpioG 12
nat tt tr Brrd'r-nbt 7,Ir. @ r./'o,ran ,a
Ovwi ol rh. ACdIolm 1A
Wl dth.NpnaeAea*n
rddt,[.. iir. o, B@/6dir

AE SlgN o, Sympl@s Csuod by Badrcardin?


D..ldd Pdfr d.q@!o Pituli@?
IlEllIM s.q@ sl,rrEy
Ianrlnr s€quq@; Atopitu '125

ll4lne $qu6nc.: P&r.o 123


TE'ml S€qu*.: Epmphinq Dopsitu 126

ltu,e6P.doe 127
1?7

Ars B*p..r$ ro I6tBn 123


36dy..tnh mh Esp. Fhlahm 124
St .dby Pacins 124

tlcrtF da: 8r.Or. -rd rrdl.lr. l,


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lruls t( UErabL r*hya'di,
,?'r /lpprodr to urlr.Db tdl@rd. lgt
130
r30
P.irtopnysbqy ol trr6r.br. T*nyE di.
SigB sd Synplns 13i
Fapid Rsosnflio. lr lh. K.y 10 Manag.h.nl
131
lndic.liffi ro. Cad@q.iM
,rdqta |&'i'il. llfivcdr,4 fti rW r,ts'ro,n ta
r32

Md ol dD rH/ttI E,.ttrvitrr, ro &. ar,.r.Db P.t,..t

A@s &p.opnab@ lor cllnioal c.ndlilo.


6€rn[y {id TEI lh€ und.rlyi.g c.$.
oeilad Polit l! lh€ P**'M L.tvarnvlhmia
C&tns ssnir@t SigE r symr{oft?
Pridm lf,rn di.r. s!ft:lldi2€d cad'o61o.
Dd.him th6 !\ridn ot $. OHS Cqnobx 135

ta
un$ncrmized 6 sy*hmE€d sn6l.
pd€rnd Pmt*ntt w[h srrctroid@
eE !y Dos for c6dlcerCo 137

$zErnqib.d C.ftlolnr&r L.,' 0r,. ts,

139
RhrrfiG ,q s6L Tdryalda
oruo. lq SLble I*rrlerdia

rpprladr ro srrb,€ ,adD/l.fi[r ,a9

odid. io O.L.nl Cl&ift5rid


rrn gdreS_i.6b trcrrr.El,a tl'.lrd,,Ei,.,hd B

w.tb, ot lh. tl.,l,atb /ltdid*D b dp $.oa P.6..t

Parrdr Agse*trdn
BLs sl(' rcLS Asns'ls
DeM Point si!b& d Lr,Erau.
lv aec 12-1..d EcG
and 141
D€.dd Fbll*: Nrrcw or wid. 112
wd+Cdi9L, T*htsrdB 142
flaM ORS, R€uIt Rltt s
r*hyc.dr. Aoofthm: Adsnc.d M@gffil Sr.p.
h .d.nHa.r{..aEiC-Cr ltt
ffit/nm ld PGr-crdiac arcd c{6
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ovM 6r PGr r:- c.
c,a Ad
r,.r,rat, fr.r-Crt e rr.d C.E t r tu r-
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AM1 ot or nD,eb W ,,D.t Ci &dfi,n t4
oprimE \&rriErs .rn orygduto
T6ri xypol6si6 (SBP LN 1lEn s nm Hs)
SItMr b P,gr q lltgn S{.rici.^ oi AMr
cr,d,y Fr€p..tutd
Fdbehg Comn€r'd3
Trld.d Tmpmtud MM.lmdn 151
ada(.d cdical cm r52
Pd-crdiE Ard Mmrdm. Th..., 152
fDD.rdh t35
tdD CW dtd L,,daA S-blto. Cii.ctlrr. 157

ACIISPhafifi.dqy Aum.ty t* lnt


,rssearE &rflrr.ry lr6b t13
115

hrd.r trc

l{ot 06 Ldlc.ton Doaaa


ED.rr...y .tnhv:{r @ ir a dyMrc &ire. Adv.i.e in Mmd .nd dn€ sapr6 (xur dpElr.
F.ad6 +dld @ tr. ffis
iolrowllr! to chek ior cni.€* in l&mmH&d dle lndldroE, .nd odElr6l
cdiN: *r ECc Handhok. Milahl€ s .ods.r ppbnanry tut rr.r, a.d rh. pek a. hd E dud l.{or.1.lr..
!t'.d Ir dh &i9 an n!dh! da,ie
Al tEt4@n As6lm k riflleode lo *Oer6.i horc ol ilr! r6M mme,Ils Tnars
lhtn
r^frymwiBdebenerl].lnardtr@heaordlllls isr$r!l!relmnmm idIoex.?otral
ran i0 llE ar 0l bdngin! rca$iErir si{tre lD rilFrh@uot qsu're panBnn'p wlh y@ o.ry lhrcoqh
@r c6lrued .olbtF6lM ad d€d@lM 6i re r! y mal6 z dfedrce zid ew I

Llnl fierel a @r d [e dl hedd drsm a]d slrdke. ire Ane,u$ tuan l6sc al oo w r be thfre @!nq
w lh }!! 1o maka a hsllh er rmqs li,e posib e ld weryoie

UhbtlirtsaekbGimollre A!4rr€yerDowed! alMrlotEqBlMol"tyksntuEa


bo lreaihy rrea( and m id I a]$ e&raB sty w do f,tul*e do Llwvn9rc Eery day
'n
I fuou0houl |!Ur studenl ma@] y.tr w l i nd domal on thal .orelals w,rat ]or e eamnq nhs

. ms ro LIi b vrlrt dd l,\! mponaice ol.ardlovascLl sre Ldk lor lie


tit hwrykln lshMarrl0h0 d refleniber lrBl {har y4 e eannqroday
hA an frpa.1 0n he m slon ol llie Amd .an Hcad Asffialioi
\,!e en.olaoe y@ lo d6cMr tou f,|ry and snare wllr ofiss lsk y@ell wrrar
'l
are llre rommls peopb aid exporieicBs r w 10? !vh3T hfiqs mejoy wmder.

and lrapp ns? Wry am panod n0 wm he AJ1A ro rElo vsrwhys se


dd ovasla €e ro@nad Io met Tne answ lo nts qEstus s ,!d tlv,

lnstructions
Pe*lllx]@rhebarkolrhsNaqeacharcetu,!rloDandoan( $EAHAS
mi$ on and Un h Wiy €mpaiqi C.ndete tis el v! bl lli0 i re lrhrk
w h ha wq'd fiar de*r b6 yer $!n

Sh&omu I
rre dnlt$.[ltP..tttjlilt
It lit'wh lhe ospe you low and4k$emrcdscmr

{llhLrhf lcrf,$dt a 6 Heart

t Etrtr@8tr8tr
I

S Wh v a

6 Armrlctt
Hoart
Aaadadon.
lntrcduction

Ccurr. Da.cdp$on .t!d Ooal


llE L,'d'o.d crlto@ra. cda a .lan!.€d fr,
Ul. sreo.r Acr$ Pia/n .
n€dl.ap.oi.,'s},Edih.t,lddp.dcp.|..0ErEl.g'enoloniopirre
nary dd 6 otE.n dB&I, dElard- IrE4n did.clb i,firlro. rtd drlv!
pddpnb. h .[nJ!r6d c!s, .b&na },1l oh.d thdr rt lh ]n trs kosrrtdr lld
Itrr46 on ol Edio,urddll} .rur, ]mo€dLl€ pd<,nu. e.l. Br. ahrrnrit,
3t!rc. d !qr. cd!@ lridM6 lacs]
n* !.6r ot oE acls Pro d.. caa E to imp.or dtu r.{ .d'n ,.n-tt ot sdir:
orBr .rld o$, €rdi.adra!, .d!F.B IB)gn -.jy 6.9iEr !d tr..'dr6

Cculr Obl.dn!.
t F. .,rc...*i dna&noi ol ijae 3il&il! ,&ld h. ,al. to
. Apdy nE Bet [,{. sr4r.rl'lalBls), &n@y,..d setdtv Agsdiqar
L. . $.t rndh d.Ir.td o, adi Pafirn!
! F.rio6 prfpr F sh.qdr'ry BLs, ftd'! rdtzno €dy dl6r Mp'Ms sd
hEsEdn! dt &tn ld d6rEr dsflnilhw (]\Eo) u5
. F€.o{.k d
. M..rr d,,'tsd,adyat
nE!.!(En o{ ,16r
'r.9iituY ol Acs. ,rcrri,E .cpr.!rd. diFciib.
. tle6 rt ,esnilio ,rd nEr.o.itn
. ois srv,u!.[bn .rn n 6l **A imtdk{ .ps!9ne dEp6tt
. F*.!.@ kdyamllhu &d ta.rvsfrvhniE ud nv eh ir ddr* 'Ed d'i
^rrtd
oi1dlcaEl*lglalbnonc@.
.r,.'lon..,ym6.!@t.,bEd}dyom'uEdudryotynm'atharsyan,,tl
h.r&Id'l:ldi*detlrh.&t.dm
. ri.@ch€dEad
. P..tm dt nsEoErn ol €d- lrd ftlrdrrdid ol rEldh. d tu
Ir ol cn. trddn, tnr.drra PGr
. Ev,ld. 6u*haliE .ltft dutinq , .!rdl.o a4ar $6u$ di.uou. -s.sd
n enpm-q re,u* tcpF, ouhv @nrqrs s. p.'r-r! phFio.et:
lt.m,,|ddis.mEdhl..db*llolh.t4n
. tro(,.r.i-tu ffil.lt d - t Edb.. d.e..d. t't'FFldnrct t'
. R.e9,larErr{$.1t5.\Mi6o@Jll3nF.id'm
o

Cou6e Dcrign

Course PrEr€quisites and Preparation

ww'fu.n'or9/eccatdenir
ll.l ttt b Tt idd.t . 01.dm€d lir.3uppdr b nd€ Bts cdlL. Yo! mB pa rh. hEh-qd'
[y Bls I4riic sldro. ro mpr6r€ ih. acLs 6ue. i&i6 sE ttr y& @ p!,x..i' n ,,
ars dda h.rb,! €tu d,rg th.@ud,
wei tu Hbrr4rariry Bts srdrr. vrrho n {1'd q }E srudor r&&ira
E Fwrr-trir'....axkd,. FftB iE Hi€rrord,ry Bls sall. 1€5lr's
oEddBr b.r!.d in tr &pd'di!.

aco',{/4,r,'| Tlt b6ic 6r!k 8nd pdrrrgl ca..[nm Equhs st]dtu to eogila the
'61
loe eat ACIS
r ,&id rb. ilo &n tuflt

' rho€nMl, (Al1 blod(

. Pllsal6 dGrrb.l PE4


r \6nricur& r*hycrdia'c1iv[y
(w
. vdrai.ll& rb1{5rron (vR
Ydr lll ...d ro drglde r1I AcLs P@ 6r..u
sdl-Al..!.Gr. *t'hh
E ECc
'hytrn ec.rn
ar th. .rld ol lh.
6
d6r'f€rd, th. s1lddn \i/.brb
y.! *lll ,w
}o,
.{ shn!$ arE w.dl@. R.nt€dH. sy
fmn-tdyEt,..ts
* .M t €dbd( b r!19
q.t h yor kwLd!.
,u id.nriry
'@tr M. l'lJlno lh.
b.io6 r,tdim @u6 y.u mBr b. au. lo ]a.rniv {'d tnsP6t
tr4nhBddino pE nc.awer edu ng fi€ final I'it $.nd..v.|!lon ti.!on.

bb hq Yd ld kw tu dd!6 -n dB u8.d h oE Aos,lgdo'G You w e i..a io


^cls hlB tu io @ rdidr du! !d
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@*istd whs r.€ths 6 peor€ d pBn! rh@ r.rsJc mud b. sioihz.d d
&dqmd lo rhs hq lho@ p@id.B p@.ni. F guE 5A $ows how mullps pEvl.,.r
6 tar. 6 hEh'prio.ny r8.k srery 4 l@ lg' !.t to tE Dabn!
'i.h&s
Er/&E,lt llrhNo.i{tat.f.t W

a
IA

iii

I l I
o

r s6k our aid psloh cbany del.€d reka srpDpnft b


UnalktoDdmW
as€i€d Bk bd@ 1r ,s bero{ !r.l o, .@i*e
your

. r*o 6ssim.nB b.yond your d. ol comporsco or

KnonrO laLt Linrrn.is


ElMnrhE&.tal.g,''l1',f,,,[,,{,

Iak. on too many as'qnn6nk a a r

Cbn't t.tv. rt. tu. nL.. \


t

bddmDnsadtug
o

5, nrfrrT f,q and F.!,rrudr q


,:
=a-:j,!;:.

C to sed - L o op C o n n u o t c a t i ons
mm cmruniannq *ih h'gh p.no

dder s srqimdr !o : !ff rumer

jtr n.mbd hedd and ondoBrd rhe m*q6.

.AsEn.nothglaskafrgeryiq

t cr! d* r..p: rnim rh. i.m ra.d tu . lllk b.s6

. GM mm r&*s b a rM mnb
. O v. dnrc. wrthM wltally @nim

r Fo,!.r ro .iom rho r@, hldf and cMig tE dtoo d pq-

s h sh p€dmre rM nidelo^ oi! @ pt

. Eic!u60. r.am mmbere ro speak cba Y


.Bedlh.m..i..|onold,
r oudL6 .i dai ( th. sllshr.rt doutt .xn6

r c @ urcrdi m€se6 md druE

.f..1!fu[db9dM,n@bng.o6
.&lou'Fls*uunagt

^B@t6.€BqaE.

Jq.l Fo6-.ri4t-
'aq/O. ra.$tu$a€ !r*e lF.e.ao.rrliE !
AD4'
-,.srn rd m ml ! u@66. 6!1^lFr'D b ou'|noqr '@
fi v .
ars lo .rcr @Nr@ 4elq ? ur rBods .

ro Eptq Umr aqr Eqr €.uou.d r. ro 6u'u ar Puo{rpre IE ro sselpro.r rduale


8Er6n@ a{ Sunp q* r
a{o
-ro!d'qa''l e e'r o|EUGU $'rbddc |u6q @ a u Eql36or,!A p@ Bro qra fr
!.6de,6lnu. *s ry qru r. p6odug u sl@ M|ud16'q F€q.q1
tlre Systematic Apprcaoh

ir€drn@ p.o,rdorE 6. rynjtrlh .!D..a.h io 4a jd rr!.r aai id erJy I


r tird pdar. td oldlC s, ltr o.d ol nE lllcnFSrll,E txn! ht-EirdE
td . D.L.r h !i.(i&y o od- rin b ro rFr .n Bl!! €ltr.rlF dylidq!
virticr. ,t ddrtrdr dfi Etm d ffi.r Erd.Ca ftri.d6. A. kr!rni<!d. loC o{
,!.{.d.n.raErunot.pfir.rld!dsJ.,Fo€c) I}Eda!6d,ra!d.dLy
,r lirxhtt q/ffi *,r .dE
. PiEy A*lEn A s, c, q rn E
. Sdrd, r€rE l (SAl'f,lE tf. sd ltl

Ilr.t'&GadcfpD.{ci
ddfiiodi..' o, so..r.r, dr e/ffitc.0p6.n 6h@ q nEr EqriE AcLs
tt *.r..(* tordd! !o d.r..htE nE 9diil lad d drr.a(.e. 16 Fr *i!.dr ft ,.uor(
^|!r
. n rr Ddrt rccq. aElchr!
- lb nr a3 AreM 6. u. -tlic dad.lr
- ArdMdd s d.{ or.pp.Dp.d. n !.dtuaLs!86.er.
Ftim 6n s€trd, A.l.4re td m td!.r&!d ddrnbn $d ffil
. t nr pdirn ..ELo!.
U. n 'Otd.
airEy la...rEll ld F, hnc .vacd.(
-
E r..r drbdtr rr_.'b,'r-. silr dr a.*
o
The Systematic Approach

S€condn.y Ass.ssmenl

The BLS Asses.ment

h,lr,i,,Joat, F.cb Sra.ring Cpn When You Are Nor Sure About a Put$
Ih. srs aesdun b..ts.tc.!cr.dr t6 Br5ln.! y !.r..d rr.dlh6 pr6
vitlr d ,.lb.n. Iih Dlndr .!E id d, dds.&on- I 6- ,rot
rrdd. ,v-..d inimd.ttB rrdr . d'nc.d -t crEd\iry rod.a6, rrr! ldrfiror
fir. By d.! tE BLS Ae6f,dt honna. pordi! nEy .drr! € ih.t gsr or aJ0-
ponlr4 d rarcing .ih.nv. dyoqtrlro., Bnilidoll sd riEul.tbn h0l Ros6 d ]nltL,
to ol ACls Lt6dto.6 P,r..! i9 dr *ioG In ,r ats AeEn ltaln ry
hlp.d. ir drn! dEE.r sivd rtd . !.oa mrnrqi. qr6c.
ftimb* rs..!.., i''- farbm qpp.Eprirtg ..dor

G*
r &s6l cop6 @ mr Enld &flnric. &der gdr. tuy b. p.*d h tn frr 6L!
rr.. .i* addd odnkl mr
t . A pdlri *E 0dr6 @.rry l6rc Io h. h dn*Lc ,r h Ey qirrdiy, rh trudr
nr.y h. .p.i rn ln. !,, ha4 d i.d( Ey lm ,l,l qs. GGp. nro srr
ftdtl d w..r SdE rxr nEy pa bd*6 C-F b&rq ii, Edly hsar r
. !lo* 6b Ilr grp ru, *'d llt. . ,84 em, q oe G..pr!9 h rcnfir
brdtllrc. n B a dln o, cad& ,r.t ^d

Altu4h ,E BIS rlg.fu,t dvidd .quirE t rE&Ea p..Vdr. 6


Dqui- rc
reay Ediry erbDh un]!@rprst id ept*- d.d!i<i., &ct e. a.a-@*
'nd 2&iM
Ennlnld .h1,16. wr.ne poldeE piB dr pliidl 6 rn. epln. pdr-
td to rudnr..,Edr..xffi d crrd dn ierdsLbl. a dvi.* o,tE
Brs lsEr., rid Fro'c Trra{h rr ft*n tu *p6 ddhg nl sls
Ae-rli. A&. $piD.dius th. p.i.'r. dlgD El sr.ry, 'r..ad
A .rrrd ffi luv.y
.rs-dd b. p.rr.m.d ro d€rmrm n r, l!6d .xki' rot io riod. cPH, sn a . $rd

a Fallm dd.r4 r.td' t tlhrroElry


lm,hdrdr/...sd-r,.
Bts v(,.o 6 n $r..t ua6.li.
o

lddlll'lheq3,so.h&k*odloin.d
smdbn&Lsty wtth the h@rhks
.tt*h to nininia dat y in .t @tbn

.lio@se.h6cltnlshoclab.tyihm
tt $aa.duc,ppl!.dr

Cri lc.lC,onc.pb Mininizinglnleruptions

) (

Ou.lity Compressions

F@n t ttoEl Fec,, Chesl Comprcssron oepth


o
Single Healthcare Provido. May Tailo. Fosponse

High-Ouality CPR

The Primary AssesBment


,rr. n.!r.ib r-r!.dl

&1d'D.i.rl'byU*ollh.h..dhkhinl'11,
moha'yrE6,,fuayqE@phaiyioodaRay
. u! .t,vam.d .lmay mi4.md h n..d.d (ss, laryrEaar mdk ,tu., rarnge
hb8. 6@haqerlEdEr rube 6nddncher rub.)
Hoa]lt,.siaw.6.Ml@lgn.fcb.re6laldn@..dw./pla@@1.dffil1,.

.klLh.wld0dol@
Nl@frfuha1@ry1 ful6polabntdcpa*aenao
Ad,dcddMad6llAfuchsabfig3dfuday,dyrEodfuho,d44E-
sdl dchaat rh. @ b pldced dh
tt uenq effid arNal dd,c$
. conrkr p..p.. inr.s-rdr orcPa rd nn|dbn
r co.frm peF d.QlMi or .<nmo.d ddry ddr6. by

- OldEiw waErdm €prog.lpny


r s.!eD $. d.r€ ro lEvrn dl.bdlmrn
' radrb di*., coidNc q.rfttv. ,ur.m c.e..i.rei,
dffii drh
clE3uFr.dnl.ryory*n,hdlnd]cd.d

i,o.nor$..d.qu*yo,vdlilano

hy ( PFco 163 rhan 10 mn Hq dnEi


's
t)
ro mproE cPR qua
wbtE.lEcatd* trylh? - hra-d.nd p6$6 l Erdarm phe ld'6brrl p6sre b r6a han
'IEd.nbfufu@@11@d. 20 mm Ho, d6pi lo 6A.ve cPF @.tly)
. AtL.h motro./c.6h.i[rd r.r .lnryona.. 4 ct.t.o Gi fiirnfi Gg, vs.
rrcur& r bJr ar on lvFl. puBaras v6nt cu a, rehymdia lPvrl. 6sy3tor. pu s.h.d

' t6vi.L d.l$dLr..rdrd.sroi


. olv. lFlpi& d'u.r b ixmss dnhm and bbod P69o
. Gr!. avro nuirr. r Errrd
lh|lhfrol6@p'M? .ch-k9lt@.ndt.nl..b[
LN lfrid b. @-b@7

. ourclry re3. tor E$drvs.t4 rewl. d c.m.d3ms, a.d pud di.t.n

r rhov. cbrhine ro pntom . lrub.l .Emlm60ni roo*1.! td obtr6 .hn.


o
The liccond.ry Ar3e$menl

M6dcar0is Iicrud'do h. rasr doe rak€n)


P6r mon.. ri 31ory 16spoc a ry 6h1'^q k rhe.(dnr rissl

'k.ly&sbiyDsH9drsc,aalearcadn@ld

d rq se acLS.asos prcvide dorais on

Common Underlying Caus8 ol PEA


,tt slalsr,rft I@r!.C,

Diagnosing and Treating Underlying Causes


Pare.G n .ad a. 3rcsr lvF/pw/as

.anqU*ydsllyaSpslCmnd'

ot oer arcs1 and cad{o! mo.!4 arcsr oabre 4)

.id aod are.oninre 1e PEA)

our known purnonary emboLsm (PEl. roui ne t b. no


c.dnn dtuq o€'n *s and db 6rroees trEy ]@d ro psipheral vMla, dilalaljm
d/or fl'y4adiar dyduicrd wnh Eurlani hyp.t .6ion. fi. ,pp@h b pois.ned
p3lisnlt shdrd b. ass@iv6 be $ rhe roxic srers ry pqB r@dly,nd may b.
or imned du.alim rn s€e sirualions, nyo.5rd6l dysrurclis sd .lnlrlhmis nry b.
mrkm tB .'M or me'y 5p€ ric rrnied hrftn
rio6 *1$ m rhins h comlM: tEy bly iim6.

r ft.lonssd bariD cPF in 3p*ial 6u$[aiion 3]tudids

.l a-aodrc bdM pumpin{

. spodnc dtu! mrrdorB (dEorn mmum F.b. grLeqM. bicaftond€)

. Coror on ol sse eleohryb dnulba@ (poErduo dusnerum,

ns.hD.r, r, rrr. ,.!.nt .ho* .r9nr ot Rosc, porkrdi'c .'Et qE .lu/d


The ACLS Cases

OYaaYle[ ot lrra Cr:ar


Ir AcLs 3m',r.r6d .6g @.rsisd r. Bi [,E kel.d!.,rd sritk y@.c.d ro
3l@tury panidra. n l* ddts ..d pa ,E M.c.e 3&& 16. Ei$ ce
conbiii m loral.! iopics:

r De.cdDroB d d.rlnlll... .r k.y cGpb

. &F..rid or fE .h.irrf, io rE €E
'IhB pan codains th. lonNlno c.g
t A.'n c68ysy1dM6

. radrya,irE lslrt € .rd urEsr.)


o
Rs3piEtory Arrcst Case

ent )n esp)Btary arcst Rspen,s aG canpbtet

rde.liy is !h? se!e'n or a €sptrir@


R..pt6ao., PobL,n.

R.rolntod D/.t''s chandenzen by abnoma dsptraroq rar.l6s

. r^adeqld3 respr3rory enon 13s hypovenr ar on or radypiea)

' Palo .oor ski lnole rhd sotrr3 ca


fh. ACIS C@r: E@i'rtutM

m6dtdmllyrespGbrylaUeba

sts9qf,@bableesqnlarydfulel

aid d sodercn .o^1ro of bftalh is les apnea o' sha roq siow ons) when ,esp,
'asp '3r
taitue ca1 acctt ||ithott slsns .t EspiBtary
'prcal

reve s thypercapn a) a drcp o bLood oxyoeaar on thypoxem a). or both

Resp ra1ory a,Er s the Gssaton (a bs.n.e) or breai h nq


n tr head nlury For adu n Espdory eer
arery 500 ro 600 mL 16
'
to 7 muksl shord sufi ce

be prcper y venr 3rd lo make he c

a!o'd exc6s vs venl r.i on itoo many b€alrrs or 1@ !a'!e a !o urel drnnq €3p raroq
o
The BLS A33€i.ment

:rheSysemdcAppc.h'

Redemberi Assess,,,the, pertom apptopnab action.

olb@r.hast.omp.Asons

the Primary Asscssment

tuotach*rrE! tlba

o avo d excess ve venraron lr@ nany breat's per

2Ol5 Ati.r.l,n . Corect Pl.cement or ET Tube


llt Aclse'! Wr*irt

Management ol Be3piratory A.re3t

. Lrs r bas. i ay rdlncb roPA and NPA)

,4.c.rd,rg ro the 20r 5 AHA GLr detnes Updare lor CPfi and ECC, ror
paoatsw ha penLs l9 thythat. venrlaltans sha\td bc delivercrt ance

Avoiding Ercesive Venrilation

Giving Supplementery Orygen

,o.l/4c.@fulold4as

Opening thc Ai.w.y


o

e
!.ia
s
s
{a
'./
+F,
lii
d ue ,E i.v sG! {rou hd q€iln

Providing B.sic Vontil.tion

1s6p4'd cat, sprermum4

r Modh rrbarls devlce lu sns a pd ket mask) €nr ar on


. Baq-m6k vedildion {Fisu,es 1 5 a^d 6) 1

Brg- rtt

duri.scPB 14 sinore h* thcare fiov der shou d !s


I avzrldre.) t s 6d6 ir' , tE red md *pe'j3rc6d

ton ba! ro nune'ous adlund vav

You can atach oth€r .diun.6 ro the

t=t *r.s-&reb.F'*wt.
o

L-
B.!ic lfiv.y Adiuncta: Orcph..1llrgo.l hv.t'
'I}: OpA 6 6.d p.rhrs who ft
at isr b? d.v.roo4 a'84 o63Ms ftln nE
baw or tlm
'n
tld.d upp€r aiNay nMl* J-rEp.d d*e (Fis,E i7a)ms oa
rhis
tfulon@.loh.]dsndlholollhy

118 oPA6 l],ffie paeG , soc.dG ro op.n rE .my (.9, h..d M-


'!.drh@r)
dh lm s 1., 'n
rai ro rwd€ and @turn a ci@, u?Eoshrrd aB.y t oP,A
tlbw Nt b. utad tn a c*@B 6 s,.o,nnfus palb"r b&aus r may stlmurd€
g.gsins ed vhrflne Th! t y a!ffi
couqh ard o€g Efl.r rr$,dorcre oPA
IiE om n.y b ro r..0 rE a'*ay op.. duirE b.q.n6rt H wn- p6vir.
'd
.6 misht ukM ngry p!.h dNn m rh. .hr^. unkins rh. rR:y. ne 'M
oPA r .rs u3.d
dui.! sucllonlis or tE moulh aid b@r .nd rn intubarod pa[tu ro p6v6nr rM llm
b['no and @ ud E t'. Er rub..

cl{r th. m.uin -d l6rFr oi @Erions, hlmd. or rcmri by whg a dgid


Dh!@.d MI'd r ! rr o@r!3
ad.c tr,.!F.!r cr Pb,r osa {-rd !l i<h d t lElFsd
17q. wlb nlrbrc. ort! oPA: a,l ffi ol ruEit', rr Q a d
iurch.{ h. mrdtr. A ptlclly *..d fd tr.i.d os qd.h a!r..
dgr.r wih tE dori. opc'hg,
ln,tolo,^snsIitM']plvenbw,,d!ll.hadp.l.l.aifrl*
L tn oPA po. ,r64h $. (r.r siiy id .!p6dt- oE podrld
wddu.lrs .Dr.l.niaknotuDr.af, Do.rion{Fi!!E17c).rn
oFA o .r.. b. rGt d d . s r{r. ro oE trsrnl fld ,6 tdd rrn'
rrds,E lod.Li,!!lu. i L itzr..d.,r h.fi oEd., tue...
io cln ,E d.rlo rld [E ldrcD & td !. r..sr b nor h6..bidy
nrn d !d iito th. lnryfl dlv tE nl,lo pti.d l*ern t lh. Opl"
ar .ltdtr. rrned ir to t'l u. oP lrdcm h *h[. u*E.lqt!6
d+.*ddrrr,dato.bidd$.toio,lsd!G0io L

.l ai oPA, nonte rhe paid. x6.r $e


Afi.r G6nbn hoad aid lrw posnro.od pop€trv
b mrdrn . p.r{r aieay slclion

B. A*.r! ol nE Followlltg Wt€n Ullng an OPA


. oPAst6r@roor44Fruy&srdrh.r&Fxor@stoumatorh. ay.g.al
. oFAr tEr e b sE/, tr ,Med impl.p..t ma, pGh th. t[g of irE tdEE
pcrffir,
.nd o6dd 6. ai ?y
. r@d ho opA i)atur, ro 6void 30ft [su. tauru ro h rrF and E s6
rl6mmbsr io uo be oPA ery rtu un6poN w pdbnl whrr m ruglh o/ 6€0 Ei*v lr
'n
o

($ a

ai
B.rlc llruay ldluncts: ll.3oph.nmgeal Alrt.y
s OPA
'i
patmE *ho ld lr3s simay mn.qe
a
mr adrumr Th. NPA B a elr tubb€r sprasrE uncuned rub€ lF ruE 1&{) rMi pmutu
a ctrdu r ror a drow b3ir6 rh. nc Md rh€ phaiyni.
un ko oEr eMays, NPAg my be uk
paib,rs (pa .nrs wrh an dd ctugh and gag rcrro, Tho NPA s ndicabd wh6n rns.

os'dry *fi por phrynga.r rm d


'mFid

3.1-tn,.!r.r&I'r
r Crrr.6 rho oe ckdnfffi ol tf, NPA *ttl th. LE rpdd o, ti
n@s. Tn. NPA.nouE ior b. E 1.,!. t'd lt ws iutdmd bLrEhrno
d $. n6lif.. sdro rcvld(. u. lh. dhm.td oi u. pali.nll htlb.t
lkld B . srld. ro ..i&1.9 ItE Frqr tJz.,
! Tlllqr$ ortE NP .hdrd b. tf, td - $. dbl,E fiqn,r dp ol
d.pdrn!l@ot dlo6. (tle6 13q.
L.tcd. rh J*., q'ih a *ard 3dubb rtur r an€dh.rrc Fir,
arr !. -x{ lro,dr t! ,rlr b . pdx. ndo.r F.Fdol b ,r
,arorf.be.Paic.ny&.tnrt .air..soBEyqficoiac),

! s{e, y M. oE ta. r. l-iM. iNdt . .r rh. .neL ol trE n &l p*


! Ar.fipr ph!.@nr $@0n lh. orha i6tl1 b€&s pdlml! h*. dltlr.

R*arU.I.lt€qsnlyMslfuinh6.n
MUcu3bbod'!m(,dfu$frti*6ol!h.ph'
b.@€p.ey

ae Awar! ol lh€ Following Wh.n Using 3n l{PA

aido,Gabls€dng,wi$pGsb]€&prcllonol
mo.ery lo Emov6 brmd e *rd ois
lhsdop66!Gwlh&lvsvsllal'm,such4
b.orukdidt6,lkNPAmay.
ddvomd]i!d6hougn€@mmmlyb!(d€d
b,sr..G@pd]ds.
tuma b.c&e o, rtu nsk ot misregM
'.ro
ft
@nl.lB'tyhugha'.ddeddeMp'd.
o

-t -t
\ a
a

I
Pneudoc lor OPA. dd l{PA!
Lk nr rdlslns Fduion! whn !.hs e d NPA: OPA

! a*.ys d€ck 3podffiw ElpiErkrm immal.i. y .t, ni.rt on ol ofis an oPA or

.licpftlj@eab#e]..d.qft3l'npcnl6'lsuEddidalo@
ds3,pl.oli,l.de@
tl'dllffieumv.'l.bl.,@m@GlofEr

3{ctlonlng
sktoniig is M .snr6 Mpoft nr oI maitulnng a p.ild!, .y. PBidoG $eu

sr$on dai6 c.@ o1 bo$ @rrue


.Pmabl€sctd&Y6&rylota$lbddynolqfuadeqd.afu
0 nm H! b qd-dt ddy.
e capabl6 ot proud'no M .id!w or s.ars M
umn ai Ihoadorh. d.l'sy
40 tob€.nd av*umoln@ rh 30omH0
wh6lhefubescl'mp.ddfun$d0
. dicr tE nouit or sucrbi loEo 16 u$ in ch dm .nd rnlubalod palisb.

dt n Ao$ &ft iexibb sd nord 6ucl'6'no @th€6 s .vrrabr€


"rgH so, &r/D& €rErffi nBy b. us.d h th. roJf' tr ,e s.( nsrlu. c!fr'h d rvlL
h len lU El tub. d..p Mjming.
Ag/der,,.rrt les, Y k u4 e @d ro ffi ,E epha,ynr rhe e b.td rd
luo1]oniig}ick*l.l'oN5i!p.nicuhbm.td

'A&]6ioiollhinffi,rmlh.odpfurynx&tn3$pha,y
.P.iionrr{'nhfrr,Elghm'ng
' sd6i0 rhd4h e n pla,.my l€. !PA)roGtub&(
oldEo.@x'naFftd*]t'cl.ftMlef'
r iron.r..tlv.lJcddre ollhr@prf,ry@ p.tdE,rlnI
o

.App]ysucionbyMcudnqlhe'd

E
I
lsdi,fur'Pa'ho!]d.ordc!.d

Motrt.tthe patlentshott nte pulse, oxy1c. srrnoan. andclhrcrt


rpttca?1ce dutinq sutt.mq t btadycatdta drvctopr axygen satu.ro"
ttt\t\ or chnicat.1pp.r. t e.tetenarates tthxn4r sEnanng at an(r
A rrt'stet hBhltaw L\rqe. I

Providing Ventilation With an Advanced Airway


ril. @ d ffibn4 ror rlnr tp6 or 6dY'd.r*aF l,fuih h rho !rt-
oredM ot tH rrv@ b bleid ,r dp. omE b4i. lcls PB/ider cd*. lo
b. pFided in tl* E or ad!..... de.y d416, yd m6r hm ld.quaL in'rrd ld+
rnc r.d ono.rn! .rponm, Psvrdd *rb im.n .dvso.d aldly0 hd parllcDn. F I
q*d ol COI ro d*um..l irld mlni,mD @mplioaliMt
r^ ,r. mua, ,!! will pr&rE MtltiiE widr s.dE in d8e&n l.n.C..l_
r'o rdbrhn wir' clEi MpME. 'o.d.k!ty

b,ry,|a.dH lb b.t114.d ne* dtu.y E5 dfld.i*zr


.aMrb5 E dtur,, h i! @irhle b 6
dE
nE
6tt b EI hrt/Dlre,l 4n
l.ly'sd nur ir*ay E , tI4!€
F**
l.5Ertr6.tu aiftzy nst.odmrn . €!E ad or,.ip..anc.d p,Dre.i drd

r
,.tun t r,Pd rBtt d .Y ht tu
56 tE slffi llhrE& tmh-i3s/...errt{ l, lm i"lb@tan 6

rr, dv.nt 96 o, tE lrrno..l iub. e gimid lo rh( ol r,t. @phac..r-tadE l lub.l


howr, tE I'yE d rub€ E nm oonpd atd la Mplb.r.d b ild.
n aft@ prd6so.ak t r.r.d ln ,E @ oI rh. layic-l h.a. m3v .tsds h ! ,
.rrndlir b b6snEr vdid. 6 EI ina.lih lg .,My rolqdmrn h dn*
d our.:p...xid rlvdrr. rr4rd Fran *f$t ttu ww
s6 $€ Lryn!€.r rriut toi .dio m lt sru<hd v\r.6.i1.
E lrd.h.rtoq/cr.txt .9 hl m@ iiftlrulhi on fli! p'!..d@

Lopr.r..Frtci.., iE sDrDloar-h.ll..l s .d!.n €d s,rsn .ll,nsirv. ro Er mrba o. Tnn


lub. B
dlie pi.vrd6 ad.qd€ FiLlrrl dnrE d. r. e Er rub. rl 6 aepLbb ro @ $.
ad{@-tdE rt4..e.n r!}E b, Er tub. kr m., tr@aes-n h t_
dr& .tr* Oiy p.olrd..s .rpd,. *I,, 6 d rrro,id rta dp'Ls'arttdEr
'd

I s€ ,s sri.rt [&6.]i. iffi,hdnd!r'G6ib!0


fi . 6@reorl-r..lE.r I(.{o.
o
a b.fr eflEry or rE bs srD. i.. p'ro.n'ne Er nnlb.tid € offi h6€ b rrn't&a
rh. AcLs s.rts w trtry ein wirr s6 r.c.d6.
r Prupm ir inru!.tron by esb .g s. nr4q,y .qdpnnl
'! P4tom Er dubaion i* lh6 srudmr whbs .)
rhfar6 cu{ or culrs on rho lub..
. alllch nEv ridbnb!!.
. Confim @d pb6jr by phFEr oiffrdim sd . d!fi.nanon et
Cdtl@ ,&.rem c.!.Eo€phy b lg,.rh-(,.d lin adllon io dinial e.
nd) a tu rci,!r'-r. nll,'.d o, @.fimng a$ Mirniq @rer dsd
o, e Er [b.. lldn'@ Fwdds nEy
d!x.l d6ld* tts ,.v,dfr dpnqlphy ! rcl &obl,e

O.ty d@iflin eturid* shetd Nt m Ett ntun i@.

|a (rN.ndtdt/...n
se rlE E
'd.telr@r
e.ton n ih. sllrdd \i/.brb
lnrubali..
d.rrl re I'rc inr(E @ o hu ,.o.€dE

Ul6 of C.i@id P!.!rlr!


. cico'd pleuB in nmgre$ @r ods mry on r $m. ltl.6!e or Dddioi io lh.
i 4 a/ tor 6D tiol fd gei ( ns,,tldio1 dr.! b.9 hek 4n'r.nol. r()shd. tr

Fltcaullona lor Tiaulna P-licnL


wF Arcvid ns aesr.d 6 {t$ kewi or suspet d c*Fl dpri.
arhn ror par.nE
vftd
E@srv. h..d 6nd Mk mdms n
pardswrh u*bl. @,.d sp ercolumn m euB inju.y ro rh. lpin.l
d d wds 3 mimr 3d.dr cold AppErrnndy 2%'Ewrbt€
or paii,E win dud ldm
'nir/.
ru'&9hloo!ul,.!ph.l'n'ao'ngnth.EDhaal!pf.ll4uyftbE*6hpl.d
ilBpdf,dhe.hddl.cdh|u'y'AgIredd-yp.tMgfimultoi'h@
injry B. pdtey d/ijoc if . Fr6l rs
tuspd.d (pjd 3pft ,ipry Elmpra @ pdigns *rE ha€ bm invorv€d ,n . rygh.
lr€€d mdd v6hEr€ cdl6M. haw r.rhn iim a hsilnl 4 e nluEd wrrite di,1.c
F. ow rh6o pEaur oN it tou ,{p
. orn rheai ay by urtis5l6w rhcr,nnounsd6res6, sd@ rudrint.!.
vs dbn e Eis rk. e , h€d rh+nt,fr

'm'p!1'tg
l,n,Du.,c-ddrfu',.ffi.1 l.dl.. o'mffil'-
sslac*ddEs@ygnpbd.lifu.y
I sp,Gr d&rE m hdptu dui@ n.@e
'mmdi.ar6n
Acute Comnary Syndrom€s Case
Tn€ rcLs allrdd m61 hd. lh. baic knowlsds€ ro ese .id eblta par {ft *]lh
ACS Prr'."b ,, drE cas. h.E s/grr sd stmptdB ot acs, Lctudhs pastble 4 4. \4
wil u& rh. ACS Asdfim a rho eu'd. ro c lnical sid.gy
ACs @ io ol.Fry p6ln8 ldo 1 ot 3 EcC ..r-
.!ffi. a.n dh difllM rtrLqi6 ot i:rc ald m.n ctu n&.ir nE 3 EcG d
4m @ sr*.qM *dd s4odr^g d'{dE d. iiidy, sI s.sd d.rGs
3!t {Frig erFi4 aild Md'aodt qn niar EcG. Tt6. e dnined i. rErCS
,Jsdihm, bd sr€]d *in rm'BritE 6p€ii!6n .fd.oG r! r\. rs or ths dB

K.y 6mpon.nE o, rhie @. .rc


. rdsntfcalion, Mmml ,nd uas
!ln't,lffitol@]bl.Acs
! Etr8lEs*l d st Eotfus ol dE o.!dn wfr ACS/SIEM

ii,,Ird,m. rot reE Suddal @d?r de$ $d r'@l@. Bldydhidh6 @ @ 6 ltr i:Eh.tu
Prdtd?r *1rr u'&rBr!.d ro *nEForo ts nry$m M s FlrrEd r.. inm.dE .
.idprs ar dsfibdndiM .^d .dmhisr.don or drus d .rocr,icar $(apy tor s)nBom.i.

Aihoush i 2- ead EcG ! b€rdd tE sop. ol tu rCLs PiDMdt c.ue,


!m ACLS
'il&pl!t{]on
p.lvdqs *llrtus i2-Lod Ecc Edino JdE Fd $m.lhis .ag llm.
d6 nE idsnifdiM .nd man€orE r ol pdid *{h sTEMr

ort'. lt rca atlg re@y ,'d ll!.ljd @.06 ffiE


,Mnd
io &016 6pd,
dti06
imp.rlanr
'n
$E ndd ol Acs. AcLs
llr€ Aclsi tt vds
coe pr6..ls onry bao kD*l.asE rEEing d .diy rEtrEd and b€ p.iodt ol
6FgIB on, dri.r or lcMmrc pri, and tsrmdr or ..ny r,+thEaldrn! @mpra!-
"pB
rbnr. R€FriGton @y nvorv. t,r. us or llblinorirc lh.Epy n dMa'Y oLqEpiy wth
PCr (lo, brroon angioprary/slf'rhgl wh u$d 4 ln. n[r.r reprl6M $ar.qy lq
sTIMr, PCl a cdrod pnm,y Fl,

.brt .nd nhd rrcmbo ..d ddd.E rlE d14! @

. Fb'ircMrc hs@y {os'.w)


Addltodsg*tde&Nrcli.lohMtr,pya,n*{db.fus.di.llE

. diphGpiab (Aoa dasoni:tu lcrood.s,lr p.4,{d lies6rd)


. ^dffiim
Anororftin{onwn .l .n4m. {AcE) inhib ss
! NMG-coA reducrE5€ lsrdin tEdpy)
'nhrbi@
. Gryoos.cn lb,4l16 inirbtors
o
Goals lor ACS Patients

found.d.El F,Ej. oHcA F6sponse

S advan.e di oi orrha,e.e,vnq hosp rr


Eady prrq$ ro.mdon

C Unstabb argins

I
a&nifidr D|lc- ro.tn thll
D Micrc€mboli

Pl.qu. ruplur./thrombs. c
D

t{stE.aqs

SIEMI E
FGolutlon/ra.bL.nd
o
ld/r. cdnrEt srtdffi x!odnm-2o!s uprh.

i-...rb&fcouBs6fuffi
f,eiaglltf lce Tha louta Corcnrry qrdr!.tra. Atecdth
1}E A@!. c@uy Sy ru0qir6 lF'98 4 qiitc rr &d .n od ,ls
lrE
.o.d p.Ebg ,,$ ?ir9i6 rllE€0s ., lcs, tu ars
d€r. rr, . edinr
Bp.''daindEd{l+.6{iEl.lffi6b.!htrr..dd.sffi&\d
.clim. IlEg kElud. lrins orr9€n. api*l hib.ci/*rn,
.nd DdpnrE ( i..d.d. ud
o fii^g h[h Eed d rh. EcG l\ndi{.i $. El\irs pdids
12 ldd tcc (si,lp 21.
my cMpr€i' a irbanotn $-.!y dr*k*r rn noll'y th. lGrtB ED or . p6rrrid
aMl-srEu .pp.or do lstsp 3). lr M-ol-hGpibl pBid.B e unabl. ro .mCar.
llB i,'idal "rf,n
n f6 botq€ t5 p.ddr! di!!r rr f'€ hcoilal u. ED povidr *.!rd impre

sr$6€quor ,uhd leB oi tE pari€nt ! nnvd at dr. h4pi.r. €o pdsnn r lhourd


Ev e
th. or-or-h6pirar r 2-tsad Ec,c [ *inabh. I nor p.dmsd, ac{u si(on o, th.
12,hadECGlnqrdbeadon .ho006rr.ro6n r,2€lh.12redECca!@GE
ddqdia p.lldn! do i ol3 o@!e a..dding 16 e.rylR o, rh. sr sald (nE
p@6 o, r€t blndrs ble,r dmk 0tBB) d tr. i 2 r{d Ec€. TEtrndr lwlM-

. Lk anr$i.ddeisr Acs
Th. ACS C& wn iocr. M rh6 oany Ep.rtlio o, ri. SrrMr pdbd, .mph$Utis hiriil
cs ed oold rd@ rd E@tulron tE@e
nf acs [!E 20) s.vn6 s@.r srid€riE rq appY b $. dd rE€E
. ^llorh
pdi€nll bd.d d syspim d tE 12ri.d EcG H@[hc@ p€Mn€r ori.. obrr].
qr.l cadr.. h.,*.E (c(-MB. odr4 lEp.nr6) n m6r prird! rhar srbw .dd[irRr
ddronr Tm rmFdanr pdnb for sIEMr n€sd

decson ro .dmrnisr€r flbrlioldc il*Eoy or pslom d d0iorric mmry aishsBphy


snh ffi.ry i'ljMrim {.nqioor..t/.tsrhs) srEMrpdr.nt3.
'n

rno sbr6 6 rh. dle hn 0!'d. @t .nd tEt6':


,Ca flg.tllrt n LsqBtrv' or'&1.tria (sr€p ',

h..pbl rdnvd noimdrd (9.o e)


arn
t rmm.ar.i' ED .wr rd ffil ls!4 3,
. crarrf.ns ot pah3 &ddinq b sr-!.!nd e4$ lsier6 s s .nd l1)
' STEMIIST@ 5 t'@h 3J

ldrntl0c.Uon ol Cha.l Dl.corrilott SugoGiUY. ol l3chdnla


abr..,'d Ydxd]djdkwho*lododlydddiM,.n'{eefuoldmi.c''d.rdFd{,
&rd rrgd.d .rdudron ol &ay p3t€n1 $w hiu l atsltu 4496r pdsbro acs

dadnh 1}' paM nEy prqiE t'B disqirdt ,l@ 4 p.Be s igNlE ds

Srnpbms &!sdi$oIACS m.yats imle


. ulwbrdbb Dc$6. rull,B. {
rasrr{ !€€ar mitu6 luMry lr@ ftr a ro* mind6l
. CB d!{i.n 3p.B.d.,O b h srB*k, ,'€c*. @ t bod' ffi, d r*
. chd d@riod sp..id.'s do ,*
o

STEMI Charn ot Su iv.L

EMS Assessment, Carer and Hospital Prep.ration


ft.vu6 lhoud bo ief ilE wn[ tf, *rim indrc.tons, caurim $d rEffi or .rdo

Hish i6p.!ddys6.1 ie.5 s[ ri'd r. muimiD drhr oxygs 66rio. r]d, ,r M,


rlrr.r orrlo ffi T'i' srrorr oryrd d.rvry (c.,6. drbl, x rld
w]l hca
dyld oonir$ trB cad& dnpd E rim[€d. rh6 !rM-h or]gd rlE py dc nor

EMs p.!vld... stdud adminl.td drrm r in. p.t d i!: dysp6ic, b hy?ormiJ, h6
06r* d96 ot td riir@, ha e dslJ oryle dlr.tir r8. tu so96. d $ts
oxyld sna!.. E hkff p,!v{,.G ,s.& tffi. oxysr d*&y ro , dhEivdy
fsrr.r.d orri.rEgro6i^ {rE roi s% r sd, aGe il5 u!.n E ha d b-i
*bnah.d ]n ,'morrc pl|rnE win !6per.d & c6tu Acs, @'doB nEy @
sido. w thh.rdhg lupprffi.7y 6xy! nBapy rn trrdo parisrts

Asphk (A.etlsalictat. Aci.l)


A d4 o{ l8a b 325 ms or 6-rnN@&d .spsi c.te mnEdrd€ lnd lB.-iobr
inr*nbn ol thmbore ar r@ducroi by (hbtrs Cdda cl/ddrylde (cox t)
tr.r.r6i. e m or s. lrrlEFd rn erid prt.'p.ni3 n tEnlr. roMir. Ina
6pidln,'lhllbaEod@@i',y@du,msdot''elM€d.hdFl'
don{y md .ft, ib,imMrc ih.Epy.

rf nE pdrtti h& id e*s ..prb 3nd hE do hi{ory ol rw 6prdn a[r!r/ aid m di-
d.(s ol lEnr Gr d€edino, sN rh€ p6r6r &ptl. 1160 io 325 hr) b clEn h nE hiud
ndE ol s Acs. rsm a .bo.rt d bd.i rrH .rt*.d ,B *rb *.n6,.d, pertar-
My ll 6oBr*r ,6 bal 0i6 r.k€ ErJ dphi 3'J0r6ito.E (r0o Ds) id !.rraE
si,I nffi, Mtiis, d.rir p€9irc urq dE@, d dn* disrds or rh. lppe 6r f.d
Mrcgty$k (Clycqyl t kltete)
Nitboly.dn .ftdlvdy Ed@a i&h6lc .lEr dLco'n n. a'd ha bs.fd.r Far'.dy'
.lhcts. rh. physrro!'c .ltd8 or niu& c.4 r.ddim . Lv dtd ,rgri €nrlar-
'wic
t lFv) e,iL.d ftdsh P.r'rld ,6i,
Gis e ,6H 1 dinsud ,ir,rslrEn bbbr ld 3r.Ey -tul .,!ry 3 ro 5 nhLr6
tor ono.ln! lynptoms I i k pqnitld by DodLd enrD] &.d no oont lndLrrro.B di.r
H. nce Drovidds may 6xat rhs d@ iric. (rot or 3 d@l Admrnrdr nrtlohdrn
o6ly ir rh. p.i-r h-iody@i.ally d'br.: s8P b si€ale fs 9o hm Hs - tu
bM ,ri 30 nm 'ffiiF
r'{g b.r.* b.!.rrt€ 0, kmrn) ald oE halrn. ! 50 ro 1o(Vmin,

Nibogtqin €. €dhro. -d r'..dsb b.6.d dfio5ly r dd.n n p.lirB rltn


i..d.(ud. d,1c!rr pEro.d. T}e 3nu!t.B h.ruds
. hLrtd rill lll nd iV lil.rcdn. tw rnlmllon may complhaL e rnidor wall Ml.
v(y d.Pd.d o Fv rl 9i.su6 to mrn
r.ri c!.r* e$', .nd bb.n saM. r Rv cfu ^0b. tur.d d, pr.ed$
nd e Etm h sm.Ebj.g niillB b p.td 'nr'did6 f'lri' sTEMr. rl tlv irrft-
rirn ! dnld by nlnl{tu F!d.di.r r.d d dini.a f,6'n9. by r .rpdsE d
prov'dr nin {Dd. ,'d oihd lEdrdor! (mdrrx'€} d vd@{.pLtiE dru93
{didB) m (d.Lnh.!.n a w.rr.
. lt!.t 8r.., t .dyqrd., d r.drya'dl r'6id u* or .koolyc.n. h pdr.nL
wnn hrld.i6id lsBP r* rhu so mm Ho), m .d brady..rdh 116r aEn sryih),
. Bdn ,l.nh.d..ir.. mra.b. q, Avold trE R ol ,*Etrr*in ir ir rs M'
pd.d&klM'hddEp.Mhaid(o,l(h.8'l-ffi'6ldi\hh@iu
. Ih66 .Oifr e OrE rry 6.d i0 dEd. drr.
furil.o h .c6 ol Frmn,y lr}!.rb!i.6 &n h win ,Ey
' 'sbhds ^ih€
o
c !. rf .p ale ieq mo@r nel ior che

e wlh.ador n lSrE

Ct alc.l conapa. Parn Fohel wilh Nilroglycerid

Use oi Nonsleroidar Antnidlammatory Oruqs


EMS @!'k slukl obrrn r i2-r€id EcG Th€ AlrA ,enn ndt d oi hcpir.r
l2.Ln t zCtD u,ar od sl{rhu EMS sFl€ro

Th. Ara @mnErd. outrm !s ol 12-Lad out{l-hdplral


Eco. ld F dtE *1h doE .nd .ynortu oi pdlbh
F€evar mr,fids or rh. c0 slds rh€ rm b @i

'61
a,t ,9..d. EpdtusM rh.6py ,th fb.mrync d Pcr
d both whrch nEy 6dG. md.liy and hin'm'.€ myG.

lt SIEM| L idtrrii.d oi tr r2-r.a cco, .Mpr.r. . frbrr-


ndtrh ch..t]h .pBlpn n,
('w]fddycrtxld)
E s& $. slulhni v,bo.,r. ttr a smd€

lmm.dlrt. ED Ar!.i.mcnt and t .ttn.rll


ri. hEh-pslm € r6.m shourd q
p.iionradb.r@mvrr) da!c6rhopdsl
th. I2-lead ECe ktnet ih Ftstre 22) is at tha centq of the d*is@
palhwal k lhe milagfieat ot i*henjc chest dt*ofrlon and is the onb
n@4s ol i<ledtryina sfEMl
dmsdmdl@6mch6ldff,od'sigMsd
!ymp16s or h.an t6 uc .ad e h'story dsk racb6 rd rcs, aid hisldical l3aru6 lhlr
may p.Erud€ rhs @ or rLb rc\ras Forrhe pdis w n1 srEMr $€ ooars oi mp€duio
@ lo orw ibdnot{G withh 30 mrdss o, md or p€nom Pcr virhin eo minuiB ol

t.

i.ou'kml*ML6.t&!tcc
o
F{@ 2a effi ho* ro ,1u@ SIenEr dMin

,lr l'fr 10 ttu A.Byn€nr an r€birrlnd or rf, @i'n ii nE fiin r 0


'xr6. !ru,& indrd.

. chek vti.r.Ed lrn.v.ru.r. oxylH erlraron,

. Tak a b.iel re6.d hr3r.?y a.d prlom . a\y!r.3r *!nidim.


. cmpbr6 rh. fb,rndlnc dekrin fd dEk ror enroMEnldB ir radidngd
. o6i.f a b56d ent,r. ro d.r4 rrfiiar .'di* Edr( r.v€ts, .ler!t6, .r,
. oar.. nd lfu r..$h dEd rfay [* nB 3) mrin- je dE Fd..i! evd
h tu rq. nri' ,eb mt d.r!v r5.ndylk r!*,y 16 SrEMr d &rv.roi . dE pcr

IlE EU[s or c.dr.c mri(@, .h6t I Ey, -d r.bdlhry 6tudks 3no!E not
,'Jor.:
d.rry rEo*tus on *'€Epy unl€s cri^tc.lty @65ay, .9, .u3p.chn &dic di@noi

din'4.!dfuyb.cG*kDdinpdxddh
6danii: rYp. cts dMid:
. ory!6 ir hr!.Mic (or x rE rhs $96) d no6 or hi b{B

. (hitu defilo.t d m €!pon$ to nlttul


(es, moDhim t dEorig
Beru$ $e .!€6 m.y h&. bs !i@ oui or ho.pli.r, admintErs inii, or &ppt.-
tur,y d6 6 .drc€r€d lse h drr&io ot re dtuo6 in rl p.ai@ r&!.i,
EMs a$s,6, c&, .'n H6Bbr PEp6'!t n.)
tlt Ll, C.*rata. C!ffiy AF.r6r..

Oxygen, Aspirin, Nii..l6s, and Opiaros

Ctassity Patient3 According to ST.S€gmenl Deyiation


Ct.sllt lnto 3 O@op, .tand. ass( prieib nio r oirhe r ro o{rq chi
l.r.d on Si-S.rr.ra

add I ona ,nrodsr on lr'oPon,nl may

STEMI

fhe mAnstay ol teafient to' SrEMt E eartr Gpe||u'.n .hFtapv achreve.l


Mth ptn ary PCIartihn otYhcs-
o
FeFico.lhd.D}lolSrEMspenl

hea4hu<.|Feiioner.h€'nel.t,edusonlhe

lFcor tromd,raiods.noi.adnomd.craioniodtuglorPcrr rh6se4n.lor

iqaibmol,l.c[.cknlappro/ak

nElo|dll'ioii'lhecJ!oIacl!

.Fd'Il:,,hssoalolFodoollc

lilblroyssslhedgdele!€n

a pc rac q.e!ardr6s! or doray The

heprci6r.{jl.pedusof,n.alsgyov,ionnolyrC
ry afier rhrno nr.s n pal eds who ma! hale eor

s( ed pro! dea tpedo,mnq no/e rhan 7s pcrs Fr leart 3 sk sd pc rac ry ip.dorn


|r.ICLS Crsa tq.t Corcn rys]t<fo,n.

Pr n.1 PCr may a so be ofred ro p.i

ard . nra{r onl n a surpods rhe traisrer oi

[and rc ower monarl! liei FC!Gi be

cortaid.arom r. r ioncs aid s .dcared

Alblro}lCaqeilol
€eralo. qffirerrhan 2 mm irl2 mV

|.asetrasihef5lf'bl.ol,1:lsedtde!bU1is

,tctharapyaleasroows

slsaso€a$nabaloq!g,blno}1]cSlo

..,.,".,,..."..""'.-'",".,-""

arnasprnmoFhneandlbltro,l
sllMl Ihe assnt s. blorry d scus!.d b.row u$ 6r bNar rud 6, P2Y ! rnhibrtoq
D b@kots..id orycop6l6n rrtl/rrra.hrb16w nor b. @v6*€d Us ortEelodh
k E .nd a d.r.ir.d kn*r.d!. or Ih. lp.dtum o,
'n9know]..o€o'tErofuhsoicllnlcalld'13
ttapatin (UntQctioo.tod d Lo*.naohcul -Waiohl
H.9r'n ..unftry qi6 6 .n aapd rd Fq ,rn ibnmryrE h.r.ry wih ribi'i.le'fc
's
4ds 1nPA. Bropre. r.i&r.prel [ 6.r!o hdd.d h dh, sp*ilc hishnsk r
d nbir6rFi, ed p@phruE r@ vs* r'Mh.
emb.r's Floirs *irr pEroi96d b.d 6r &1d h.d L @ Emd@ri! Ml n rlu @
rhe druss ,!u m6r b6 r i@ w'th d6n9 sh.dore ltr lp.ofrc cl'n'c.t M.!i6
the inapqop al6 dosing ahd fronionnq ol l6pon t6apy ha c6us6d
** hnedebtul dgdling d naiot hqnoohaCo in S7EMI prtimte
P@vi.@s @ng hopsh to XN* tha hdicetbft, dosiaq, a.d us l.
'toed
rhe spernc.4CS calogo.iss.

fhe dosaC, end.lLdl@ h* b@n dditod lfrh !s. in clihical ,i,att


uso,
Spaili. nar EquiE doe n@dilicali@. an th. ECC lledb@k
patlohts
tor woghf-blsed dosrrg guid.],G. tntwals ol adninistztion, ert zdj6t-
6enl ol low-tute)laLw.rght h€pa.n b td.l tuNtic., so6 tho acctatla
gddelh* t@ dotailod dt*@ion ,D 5p6rfic 4t69di..,

RMre e oi e n(rcttFi € mr a.! h& d hei ehM 16 eli'tur y


mdE Mar'ry n slrMr N ndDrtdn 'tu.n.d
6 ,ndi€rd d ud w'd.ry ri r*h.f,€
3r11dffi h tr prcrdr.d oyr ros.ar o rd!.dh! roG bea* 4 e b. fuabd
ap.tdw'hpotmia!|yund.bl.nJn..,ls 'n
.[Ere o, iv nr€rr*n n sllMr e
. rl.Lv6r c 6l'nu,E crdd &@nvl 6y..oors to &dhqld d sp.sy d.crrdin
. Pulmnry q,€nd comprd'ng sTEMr
r rtlda3tr
cmpio'in! srEMt
TElmnlo@3ugnqlvn]n@l@niealolb6

i.lldo'et3.cn.ddr6n'l.n
r xa sBP oer.r rhrn so mm 8!
. L'h[ dDp SsP lo 30 mh Hs bde
'i
bexn.'ihyp.n6w.DdM.
lnFofrnr s rd*rr..hr ri
t umll dED h saP b r0* or lqr in

r umli dEp h aBP 1o 30 hm Hc b.t *


bunN h tuDrItrEls Ddqn
Acute Stroke Case
rh. idstf.ad.n ,td irlr lM.c.'En ol pltAtu *$ &ri. lrdc ! sf5 ,r *oa.
ora rcLS FBt!' 4@6 ptttd,t. ol Mrr-tu t'd d
116 an iatuBrd
asp* d lrrtd h-lr6pnt ai! rrDr, @
orrr eub dok @ roc'e d
rEp,Lrd
r tr.pE r.knni*lon &'d 6shrt or po €d uhh d6k
! R.pE n 3p.n lwillr p@n!d nolfl{toi) liJ a ladlity c.p.lr. ol rB'dlng el.
li+cphal @t srok 4E hdlds i,t.
t ,.brr'ty io €prary r,€Lnr pdhnr dlqlbll y ls fh.rrdrric th..r4
r ramh*llEtd ol tl@ ro +@Fial crrddd6, *u' lkbrrlt ol
rbndric
Bxdoqi: mldrcd &P*!ab. rlhn!.1iiM
. Cdik arb.i ol R t{trB .rddr. lro drdd@la th'roy
.l.ilidh.6l,l.|trco.fi@l,ldr{!dn.ffi*,nloa!t6l.6iiil.v€ll.!l€
nE Eld t E s..L - iEEE d.d by tE MNo6, *r"d' 16 ll@mcxr.d
'd
llElr*o6dro.t d.rrdoi ol *do F.ri,ft.IB B!€ls d goae,El(' b.
drb".d ld.t lcl 30!t ol o'.!.tu *rrr *!i. !n!*.

rE EcG do6 nor rat Blsriy d, .6idn.c 6 omplrsd rm.gr$ny pI m. No


,r''i''ltml.. lll,' ettdr6b. s lp.cirE is nDl., bu{ rh. Ec6 mr E {lly otlddr4 .r . lxd aMl d
drtyhmiE sud, & dnLr flbn{.llon a . {@ oI e mbdh .tE*. Maiy Fdor. *{h
tuk may d..M$aro {rhr$nl.r, but It tf, p.r6nr is hmody.e 41y d.br., mo.r
atrfu1hmilB srl mt rcqoLr. lEnlm. . Inm . qdr6 .slMd 16 lemmnd edh.
mm[o.rns dudr€ rh. f6l 2,1 hoE ol e.rurtoi in pa8* w]f' &ulo eh.n'c srEk io
ddd al',qr ,rariLranon &t pd.nll.lly M+$@L.hg amymmiis

Dtt g, lor *oL. rhic d$ iisr6 te di4.:


. i..ndrirc {ri 6P l
^!Fo€d
o
F.or.W.i.l F.ca. Majo.lypes ot Slroke

heb.aiA{houq[6r,dlolsn'ore.JI.sm@,

3a/n

Approach to Strote Care


,r,. iClS c.3* l@r. strL

Fdddanool F.cb Siroke Chain ol Suruival

Thestokecn3iorsur a lFsue25)&scrbddbyrheANA3:orheAne.caistok

,[

Fddndrdd.l F.da. The a D's ot Slroke Ca.e

. orus/Devic€: Foriof. o, erdovasct ar rie6py

C@k o, Slroke Ca.e


o
The N NDS has esrab shed oftcari. rrospla rme goars ror a$essmenr ad m.nage

4. n raron or rfu ioryr c I h erapy n apprcs are pai etrb 11hos6 wihour c onra'ndra

The Natioflal lnstituie of Nourological DisordeB and Strcke

Crili@l fim. Peio.k ave a tme depende benef r ror r br norrl c rheiapy

a[onol/y,&io}1|clheEpybegiswlhilr6onslof

hm.dld€ndElogi..$smd

lftlpBt {on or th. CT e.n


adhindranon or iib noDric rEEpy,

Admini*aliono,fibddy{crtl.B,y,
tm.rllomon$lol3ympbn.

rin.d foh onser or rymdoms


ldil S.4.cld Ah*. llaprt rn

C'-ll-F-*

o h-ll.d#**

o baera.b.drbca5(rr.h-

*.-Ha'*|.-{.r$.*t.*

bi-l*r-r.d-I+

'...hdg.,d'd,JFih
o
ala..M.a,.llsotig'.ld.dlo@
. ldd'fdtr or 3En3 Md rynproro o1 p6!lt . nEr. ad acr,\dion oi -dgfty
. cdicd EMs as6hsirE ed adpns (s'op 2)
jabi zarE. lst.p 3)
d
. rnh€d ar€ nercrds'c aeMd by tE *oro 16 or d€sisne l$op a)
r cr gtr, Mdn'a!. d io hslBhase (srap 5)
. Fdr.o\rir thmpy 61 3nttirEdir. ir cdidor. lSrG 6, 3. ,nd 10)
. c:.ld sde l)e (sr.pr r d 12)

ldontlfic.tion ol Slgn3 of Porslble Strok.


'lh6 s'EB .nd symolms ol r slioro may b. subto. ft.y ftruds

d r€s, 6!4ELt d @ sd6 ol tE b.dy

.Trubbsp6d].Edd.llbdrE

. tlz'n63 0r ro$ o, b.r€no. or coo.dinat$

lfl ry.rt' ddd FHid egns - rrndds oI sdc clJdry h.n or aI 3r'.i<o paiffi e div'

EMS pov@ rhe srd od @r .rfiJst ldd or m.ipsfty tanspon ro nE hoss


r.L ]}rs adv hss or Et s rscpd th. f.ltowh!
'ndtne
. EMs peeind can rd.nro and respd a srEt6 lal d ro a hosp i. epabt. or
pbv'd nq acds srrck. ce and nolt ih6 hsp[.r .r th. patisrs impondino .r var

day € cdicd e lr.ry rDahdn or pd.nlic


'n

r r6rrrE p@ue sre Fts


. Pd'd'ns hqh piuny d6p.ich
i rNrdd os bFidna?. ,i tdevta cPR skr13 d o$r .uD@n vo @

th. aHA Eommonds rha! .l EMS p.lsd b€ tr4n a io 6..sn ze shk. b, ude .
naroioljc d,Lrroi iod Mh a b6 circiM,
ftor'6o[d sde s..h lcpss) ITabrc 5t

Citinndri Prctaspital Strcke Scale


1n. CPss dsi{6 3r6lc m rh. b6h or 3 physicat 1\nd'ieu:
. Fac'ar dmp thdv. in. p.r ftr mLr6 or ty i. sho* r6lh)
r Amdfrlhavarhs$.nrcos.!6aodhordb.rh&mour w h d6, up)
. Abiomar s@ch thdv. rh. p.risnr say, .you can Mch u oid d@ n& rhk l
sy 6ino ih. cPSs, m.dlcd pren €l .
4allats rhe pdid in r€s $d 1 min'n6. rh.
p.se or 1 fndinq on n* cPSs h4 a 3s.itiv t
or s9% &d . spsirEary ot 8s*i *tEn
uEd bv DEncdEl Nvd*.
wfi dadard raliing ln nFtc E ognnb., pdeEdc d@nsr'Elod a scirNity of
61% io 66% t6 Bq An, @iving lr.lilng li !s ol . 31rcr.
rE pali.'lls win s1bk6.
't rV ior idslrtins parionls wid' shlo indsdsd b

Itl. a Th. cxdnm! lt t€pltd 3t b aeh

t*hl d.o9: tiarc t'€ palid slw ,{md-bdh 5id6 of ra6 mv€ €quar,

lrr .tltt Pdrr .lr$ .F rd taond-bdnrftlll4lh.m


.!d,nd botl am dEttt dr, *ttl db<dl,@do i.rlMnd @!..
,dB uo ior 10 *dtd. {rh@ 2!) ir*t , 1d' B piq'do. d,it nw b.

F@md*@r,md
Abstn
m m dni. &u. dped mt nx

,'!.6tr1.oG+Hawp.nsl Nml-Pa$.d @t cod wods sirh


*y, '!!u @1 rffih old do! m
Alllomd-paried stuB wods, t€ !r.
wdg *o]ds, or E unabre rd sp.a*

[nreeor [ .!y 1 ol tiii 3 rio6 ls drmd, tts ptadlv or a tt!&. L 7296.


T} tffi ol al3 rhdte6 hdlcd. fd t E gob.frv ol.rr.,5 b oBt.f- 3516.
MdrrMlrm t(. an BU, PsEkrliA, Llu I s.otl T, Brcd€'i.k J. cincin^afi PEiDsp br
stuk. sar6: rcpodu.ibirry .id v.rEit. /4ft Fd,s 1esei3314):373_37s rv6 p*_
^r.d
o
:.?;r:---i.g

Crilical EfS ALcairrsnt3 and icllons


Pespib EMspmv]dmmunminmn6!}6 .,dbeg.nlh.oisoiolgymplma.d
parifir .nvar ii rha ED sfftnic arrcke ft6py on be poided only n th8 arpop.i:n8
ruMns hosrihr ED, so r m ]n rh6 fi6rd 6t d.rays (and may p'denr) d€rin'r'E $eapy

Crrllc.t EfS
Bcnriry siqrc .s or stoke lstep t)
s{poon $. AaG {n p6v do $ppl€modary oxyqEn ro
hypo\mic {eg, oxy$n satudiod bs dr& e4%) srrck

Pdrom . 6pid od-d rEpibl .ih*. .'Md (Ct65,

b tm zm. r rh€ Parbd


wai6 rrm s sp *t$ symploms of

Ln+.it rrE pdld't .apidly ind cm8idd tiiS. b . tur.


6b., supp..r c@d@rlm.ry rxc!6 doilis lreleo't H
pe,ibr€, brrng 6 {1rnB, tdiry Mb.r1 or ca.llwr w n lh.
p€ridb cMfim tmo,onido,nEk synprm..
ftovdeoHiva]ndmdimloldaEeisqhosp]b'
cirino tnrEpdt ch{k bk d gll@ rpDl@lr d rEdic.l

Ihe pari6it wllrr *u16 stoke is * r s


aiB.y obstldion, hypdd ialron, d (atdy) Mrclm c p! mona.y €d8m. fto 6mbi
narlon of poor polnqon d hypoxmE wirr exacebate ad .ri.nd i{hemic brain inlurv.
aid r6b€tras*ai.d wihwG
B.lhoutn,+ospiizldn.h6pll.lmdicalp366ndshdldp.oidssuppftnbry
oxyqsn b hypdnic (8, ox),s.n duErtr s rhe e4%) sto*s parients d D.lretu In
o
Fn$.tun 1 F.cb Skoke CenteE and Stioke Units

on6plo,dulnsou|oihosptaha$olSlrcke

nromar m ro the EMs sy$em and the commun'ry


e$urcesio*leyadmnGlelibnoy{csole.do

L^qd€ntlyi9souc6soln6u.oldg'csxpedse
I br no[r cs or ef,dovascu r rturapy ar rhar rac' ry

qELlyoJlewhenpaieshosplaz

In-Hospilal, lmmedi.le General Assessment and Stabiliration

fhe goal ol the strcke teafr, emergency physician, ot othet erpeds shootd
be ro assess rhe patient w,th suspected strcke within 10 ninutes af anivat
h the Eo: 'tine is brain" (Step 3).

PEvi& $pprmenlary orys€n b hypdflc 1oo. drre-


tt aCUl*aarLll*

troipny M hYp.!rrsr',

skr. scae lN Hss) o(. sm ar r@l

.xpdb&donpd.lm'ndpmimob
oda an Bmdadr cr *ao or rhe b

obdi B 12 ead EcG, wh,.h ay iden y a emr or onq.ins


AMr d a$rhmias lBe. ardd abrirr.riM) .r a cau* dr mb6rc

dofus&u''ali'6i'ms9{,d

t,+lhrcdmngdy1lm'amldlo
p&culadynlrel*.lh.nud'.!€|lboFtdl6k|.dy
6 c3rly ebbr6. rdmd or ionr'ia-rhErd'n! &myrf,nE
(b.rdy@dE vr. a"d armMnfl , IAvl mnducrtr bL.k)

oo not tNat th. cf w to obtdn uN tco.

lmm.diale ]{eurologic by Stmke TGam ot Deslgn.c


^.3.s!ment

The goat tbr neutotoEc assessnent is wnhn 25 ntnutes at the patients


atuvat h the ED: "tine 1s brain" lstep 4).
o
ass rhe pdEnr\ ntudrogic ddus by usino m or rh.
'Ie advanosd srrcrc ed6

l{ational Institur.. of a[h Sirol(e Sc.Llt


Ite NlHss ls 15 nc b assa 0E EpqEv. !f!*6pslid . llrb is a
valldaled @su€ ol 3lDk6 *vdty basod m a d6lailed EologD .rdinat6.
a dorail€d discu*bn is b6yond lh6 $op€ ol lh6 AcLs Povids ctue.

Cf Scan: Hamordraga or xo HamoEhaga


ssd oI tE pdtrl *llt d. Jlrc{. rs b6 pqlor

.h.s . llroks. A.s€ss@.r are dhd 3tudu'ar abnsnaliriG rhar iLY


b. cpsBbb rd rh. ptu's .ynptm d iEl oe.en cftr.dad.. lo fbndnE
'nclLdG 'dqniryr.s
k py.IIErd'.r ll@,161cT !., BtE nd ler ld. pa d,iU' d.
'nip...rn
r rt a cT scan s nor @di y av.irsblo, dabirts 3nd pbmprry irangt* lh. patsr
loaiacillyw]lhth6capabiy
.DonolgMas'lmh€pam'(rlP^

fhe CI scan shootl he conDlelad sithin 25 inns ol lhe ralist s dnvel


h the ED a.d shoold be redd wlho 45 hi nes lreh EO etual: \iN is

CJ p.,n!ro.. CT {Eiosraetry n nasdii lE*


l@'m:g''gffioIpd*6hlGF:ted3l,<,G6hdldb.pl!frpuydgD.Er'd
bv . .iirtd.n .k rod in ndDm.d4 inkp.eralo. oaraniq te 3rud* 6terd nol
drray iniriahon 01 ru n PA n diorb o p6rhds. ft. pE*nc. ol h6mdrn4. vaB3 rc h.m
o|h{e d6im'n* tho en st@3 In llaal]rHr lRou6 20A d Bl

Yes,HemonlEge ls P6st
I hmoda!. s ior.d m h€ cT s the paiqn R mr a cd'd'dar. rq rlbnrclrE.
cone t . n&6log'sr ( ntumtu'ssn considd tdt& ld appDpd6r. c.tr (9€? 4

No, Hnoihago ls Not tu$ont


ntEcTsasllffim&i(k or h.nuh!s. d rc s'gn or o$*.hdnEtiry (.s,
r|ry ll]h s!!r€), dE pat d rEy b. . ardidd. rr fib.i.dyrc r6.py tsr6r6 5 sd 3)
lr h€mo6.!. k nor pEsr on rhs cT e6 &t th. p.ii.d b nor . endi&ro rd
tb.noMi6 rtr orhfl @ois 6dd, '^trar
oM.€ &prin (st4 9) srlE 4cialy or orllv drt
pd1m'ns a s*6rosne m l* b.bw) Arhoroh.!plm i! d. itu.tu inr..

rerbnmrsE rh. pd d mud h e b sdy 3*db* b.rd. Gpi,tn 6 9,s d.iy.


olhw s, us. rh. .uo@irq rdn
7t ict s c,€,l@l. sai*,a

h-
o
Fibrinolytic Therapy

haqe,lhspanenlmaybea.and'ddelol,blno,lc
FibriDofilc fher.Dy ar e bi t and 6k ,rar r car on

sfapdympmvnqlo,adnoma'ibmo|tCs

. s qni, canl h.ad aauma or prior sr

. Eevatdbr@dprcsd4(sydoic>1s5 mm|sordiasrol,c>rlommNql
7n lcLs c.t!r ra,r. StEr.

bilo6 or d d dor xa nh'btuB vrh ebvarad


sonsirive 6b.rarory G4h as aPrr. rNF, plal.rol @uii, and €cr: rr or
1*
et vity asaF)
apprcpdft tuclor xa
. siood ucoss con6l61's <50 mddl 12.7 mmo!/L)
q
r cI d ondGr€s murliobar inladim thyp.ddsiiy >"{ cercblar h6m6pheE)

.pal6smayEeElbrno,lclhaapydspe

rcke symproms 1cb* ns sp.nbneorsy)

6c1 hemoihase (wth n pev ous 21 davs)


lwrhin pcvio$ 3 monlhs)

r a..hEkrd emo us F
'ncluds fiMd Arwasa suid€Li6 Evsiotrs
smic srrcke.
ph}.]od*lh{pe'tgi4uiedokeGE

4 dtoaquars c 1+ (rl iPA


' '@rea
iinued r NF 13 >r 7 0r Pr is ere\ialed by ocal labdalorv $adads

mbr .@ min d pbr; ot mr I d

Asuliad.Uqsi$no)dcshalep

E p'eenr iTatr e 6)

ft e maior comp.atoi or rv dPAto


nqe rrom m no ro malol Aiq'cdema and taB sr
o
r $ no,1c theEpy lstep 3). d scuss rhe rsks and
Iamiy i avanab e lsiop ]ot Aner rh s ds.csoi. f
eropdc6d wrhrbnno}1crherapy qv.lheparenr

Da not addtnislet anticaagulants or antelatetet tteatmqt tot 24 haos


allet adnrntslntian ol nPA, ,prcal\ until a lollow-ub Cf scan at 21 haub
shaws na lnta.Gnial hehonhage.

2e r a lEcAss 3 lEuropean coopsd !e Atub sroke srdylr thd sp{r m y am bd

N|NDS or EcAss.3 e qrb q crietra fiabs 7),s

. save6 sroke (NiHss s.ore >25)


,n tCtS c...*Idi 8tr*.

Endovascular Therapy
subsbnialne{hqhqlalyevdenc

Aswhiblno}tClherap}'Flenlsm

.arci d adeB or Ddin! MCAIMr)

caneral Stroke Care


o
E€dln Strote Pathway anmi patenG ro a srrcke un t 1'r ala abldlror c a€rur o bsenal'on lst p 1II m. ud iq

ftntavasc u a, voru me les apprcxmate y 75 ro 1 00

Hy06qycema s6sc'dedwrhro
n rsimenr o, hyo6arycem a n orheorG y

s ucose r.ve s q€al€.rhar r35 mEdL

an.genena in nPA

1a par enr se srb3 ror rbrf,ornc h

r* ror Acda B.p.dusjon rheBpr

.NG'npreN5mg/hltdeUpby,.5mqAse.y515mflUbsmaimum15mg/h:

. cnh6' aetrr thydEraz n8 marapl ai, olc) may b. consdedd when arpopiaro
rr-*rrr ol uod, s., drtg.n & lf acl--ritlFtlddratl
. ltoiE M r.. Ey 15 tr*xll-b.2 lE- nsr rrE dr.t iFA o:pv.
n! dy 3D lr 16 hq-.
nl'rn6 ld 6 hqr., .ld ,- Ey ,ur
r, rr&Ic Ee l&2lo m l! rdEl.lc l,b6d EEft 1&1m m Hc
br.od
. t-a&l 10 fi N ioxoEd by dr*Ifu lv ffir$n 2{ n!r'r*r d
. ltr.sSti lv 5 nE,l ftn tp t d..rt<, dl. r by 2.5 nl,,t Ey 5.15 mkpt+
lrbio.d FBe nor 6itdhd ddl6t h blooi EB6 >lao mm rh, Mddd

!dBdfudy'84fr{ldBlhi,dd.l*E
d*i,rddhld,l.!i!ED,fu

I! @..odffir or drdi rt,?qLndo. h pdltdts d und€rlo.e ca€rnao lnnc


ddijillg.M''yp.6h.E!..nl,BB
24 ho,!.n.dErolst!*.. u isd.f,nEde*ad*b,Ean 6l oir!.tE
,rdld hyp..kEi. 6 r,l sing ol @r! tui,; .hlo € rcr *dr d6l!lr.d lcla
rtb: Ld.r or Er{r.n6 o. pddr' $lE rM fr&rt rlrlEM d o$d m.dr.rl
indicdjc {o. aos@16 !€.LE n d uod rxeE 3}erd i. M.d t @n'i9rv
(Bi:.d ftm rE P.eoB ourddh.).r
o
Catdiac Arrest VFlPulseless vT Case

Nreds vT s.r 6 cnidoy lu^doqswl b tu f6r 3n@k

ewhg€aoppdunylodm',€.fi{-
16hghp€j,orurcol@mbeilvo6*n'bpcilmhqlhssssdand&lon
skL s. Duiiq rhe BLs ars@nr r. nflboE ril p€rrom coniitr h si.quEriy

Pdmary asesmtrr. mrudr.! ftyihm @osniis lshdkzbte ldus rci.h@kab.l d.n.

1 o) &cs, and advanc.n areays

TIE sl]@s or aiy '6u$rars mri 6 b!'[ s. sr..no be oi h'gn-q@r'ry CpR d


d.fbi1]aion*henrcqu'dbylh6p.trIsEcG,tryirm,roimFvsc@,l,ad.6mci
asss ,E Fdmanc6 or eh 3y3r6n cmpo.st o''t *lEn podm.@ 6 &dua'd
6 patciFfu a sFlm gt,d'v€ly lo ca rhs @4 ol qudiry
'nlffi 'mprove
'n
fudtnffqf,eo,
.s}<mfuevaBionol,&*ia
.sbalelcEnodslosdfudili€d&Ir.ff.i.g
anorhs chaEcroisr c or h th,qu.hy
siud'* dnondare rhar he rh.ac poudm mmpEsss ru @ on.^ and rd
ltu !ons. in $mo ca*. epsnd ng 25 'nrmpi

chesr cm@ssio" rmb, iCCF) s


im *+en dsr .ompEsois ,€ p6.lom3d. ccF srEu d bs as hEh N p6'b.r ar r@!

fiOSc dd sun'varro h€et, dr*h.rg..

odtymqtvffid66va,da.MlolBeldioErlglr]@aIdMdft
i{ee€d(,111@n1€&B.rclqdmg

suryryar b tussllr dL-h&g.


. 11 is mpglail to sMru h,maio^ .nong dl nrs ii lhs sys6 ol c&, 'rc]Ud]h!

.na mmpaEd inina ty ro pdor D.rtoM.. d


0 r.grdris .an i'citihb hE b€ichm.,kns .fion.
rt ,/tc[s qr.G C..d.c ,^rt vFlPt/E',.', W

reFs$r}bdedlyaeslolmpo€ms'ids

Ihsca*ivoiveslhaseEcGfi,lljms
' vF lexampre
'n
F su€ 30)

Managing vFlPulseles3 VTI The Adult cardiac Ariest Algorithm


rhe Ad! r cad ac Ared A eor rhm lF que 3rl s rhe mosl aqorrhm ro knos
'mpodanr

r Ashocrlbredrthm(vF/pursessslrndspravedonthe.fi sdeorrhe3rsorrhn
. A ronshockab e hllhn 1ay or3/PEA) d spraved on he rqhr s de o1 $e a sorrhm

Al€sr asorrhm lFqurc 3rl Fapdt*t


o
estheSequen.eolacllonsloperlomllhehtlhms

,t

l*"
"t

,tt*
*l
rr,..4c4t cdr: c.rdrc /an *t lFthrt,&,iw

Application of the Adull Cardiac ArrE3t Atgorithm: VFlpW pathway

aracr"nq rhe manua derrbnlatoi and dervemq the 16r shock lsteps I rhrclqh 4)

ini .l lnaeflptid

nued DF.r 3i AED lor rhe sromrc modelrMn


pctalonuh}lhmanayssandshoc

r€ d.r oi l"diaslo . ') pfssu'e mnu s r qhi at'ar rdealon ( d asto c "l p€ssuG Du ms

) (
o
FMd.ddDl F.cb Besume CPF While Manual Delibrillalor ls Charging

lderbnrraioi and Fosc) Tlrus, i s reaenab e

kabeh}lhmand'nlaliglhecha'!nqsequence

lfi,rhmaBysscompaedwlhaulomatCmone

hlrhmanaySsaid

B4ha,.&l'bnalo6U*avar]etyol

d eneay dose (es n drdosorr20lo200J).Mmy

h.arih,lhma.sU6aIel'nihe6usctaloi

/nnEdiare,y a4e, rae


"no,
| 4suDe CpA. D4g,rnrig rtn cnes, -onpres-

a.r v ry terri or sponransus dyihmt rrrar urrmare y


€su is n a perrusnq hrlhh lFoscl
l'eb[onho?sveianyspMlan4ushllhmsIypi
or adeqGr psriuson. rhe pa' ed iesds cFH (bes n
n'.s {ir chesr .ompEs onst ro. se

resumhqhqla]lycPR,b{'nnfq*
The inh.l Mbl lalion rs @ ol rh€ md lmp.tur dereminft or
lrod conaAs ro
$divar ftom B-dr ad. E ry dafbrirrsiim rs qricar rd p.rr6nrs wih sulds cadLc

' A .ommn iniial dryrhm in d-ol-hosoirrl witner.a 3udd.n caEiac msr k VF.
Pu sl€* w @idrv d61dioEk5 io VE rvb VF s p@l( t\e h@n qui$ 6nd
' Er€ddoar def'b'irbrio. E rhe md dfidiE My 1o rmt w (do'lvsy ol a s\dr( b
. Ih6 p6b.bi rt or acstud6ibr raion d{lEes quicldy d4 dtu.
(
' vF.,6Lrmais !o a.rdo e iol t@red
In. &nbr (l.nbrjrars @@q rhe hisher dr€ ffi val raL. wn.n vI'b p@i1. cPB En
lo lr'. h6an and b@o bd .annd di'w{y csre d
oE.nr.d ,ny$m. rne lkofih@d oI @bin! a p€itudio ,6y6m B oplLmted wih imhsdl
w mai0l6 ot lhe nt'al Er6t (Fhue 33).

Fd e!€ry mnuie frlal pass b.s*n cokp66 dd d.fbrilraiion, he chre or su ival


msr decllE Pd minuie rm
by 7% b 1096
bysbnder cPq is p,.vid€d.r whn br.land@ p€tu cPR, t'e dedim i:: moc oEdual
dd .vdas6 3% ro 4% pd minur€.r" cPR p6/irn€d dt €n doubrdr or alprd

tly cdsr p'.sms l!@ in nkol h@d ol dny cP€ d allnpr€d darbilr.-
AED
t6. Ihis h.h6 3nodd rk t e bei*ffi c.ll.p$ and .r.fib.irarim rbr a srcab. numba
ol paliqb witr add6n eJde mer

I
I II II
Eoo !
d50 I
!I
II II II I
I II II I
II
II II II II I II
I I I I r r r!l
ta
Ift (min)

F''$.BdGhr'@dlwdfu
o
Clearing lor Delibdllalion
To 6isu 6 etety dur nq d6r b rtu shdk war^'ng s1ai6 th6
rrato n. a ways announce
b.rorc der e nq each shock (his enr're sequoic
shoud rak6 srhan 5 €onds):

!e,ylhaInooie€sumadcoalaclwi$theFlienl

neG! de fes @onm6nd thal hea

i.h.sr.omp6ssof,slrhercby mp.ovnq.hat.omp6sonrtuton). usordfi€rcnl

I3*examp6oioptmzngccFaidhgh.quaily

Mulir€$u.r CmrdiMt d CPR

".$
7he ,Cl.s Cr* Crrdb. t r*t VFlPutuLs Yf

Ihe pause rn chesl comFressionsta check the thythm should not exceed

petnbrt dtrrq n\hn andt.E art r at

.lihe.h,ihm.re.leleasanom

. i rh. firrh'n.,e.k €r*s a sho.kabe ihn q!e I 3ho.k 3id resume cPF mme

usaq.ondrcrremaEr.slsa

lmn)etllately aftet the shock rcsumeCPR, beginningwnh chest camptes'


si.n. Gtve 2 hhutes .f CPR

rruu!E.b'onpna !tu 6[adrerelq.

Fn 2.,1!J Odden*E

I
o
co^duclafi,llrmcheckaltel2mn

lntenuption in cohptessons ta canduct a.htrhn analysis shoLld nar

rr 3 ioish..iab . s p€s and the lhnhm s oQantred a rem mamber


'nyihm

. rftiehnhmcheckrcleasanonshmkabehnhmaidrharc.ioFrs.,oroG6d

. rr rhe hnhm check relea s a shockabre hllhm €s!m6 ch6sr comp€ssons {,nd!
q (srep 3r ne bam eader 6 rcspon. bre fo'

aiiadihm,c druss.. h6r beiorc or afis ths


'v.n
a.kngoniheefiectolantarh,thmr

o'ad,lhmicdrugbullpossessAeie.

ant symp3rhei c ad on (c ass I efi€d) ore d he man 6r,eds or prc onqed amr
or rhe cad'ac acron p.reir a l.ras n dfscl)

.Lidoc.im110],5mg/kq]vnoif

L do.a ne suppresses auiofrarot o

6 po ares load i€ doss 1 ro 2 q rv/ro d uled ,n


romLlaq D.w. noma sahe) e ven
tt lcls C1*'Crt!.canrrt lf/Ptr!.,'l' W

sequen.eo]cPRrh,ihfr.h€kss

Aduh Cardia. Aresl Ctcslar Algo.ilhm-

codr,.rl,,..drh,
ftftk*rr.icn.,.a.4.,
,o\ernes u.6ko snaua telu.c

,hssald ,o4etuloa puopv 10 nts.a uatsnpaa tueuqaa)

&66ns la96 6m6 ll srus red pareqn

rns sr:uer€d rsoros^qd F@,EA {lrpr,66 pu

m Eqr azu rdo 1se an6 rtlwnb Hdc roluoa


oslugtEdp€leqn|uU]^qd']6.JdEr

o
fh. Ac[s CM Cdfr* M WAtMd. Yl
o

Ex

unnq cpRwrhRosc n s .apnog.aph y rac,ns

ar a Gio s ghuy ta*er than I00hin bui a€ nor v s

i.€as6 n Pnco. iv sbre rud 8frer ihe ioudh vefrtcar hq io searer rhan 50 nn Hq,

fteatnent o, YFtDw
ss rhan 30'c less rhan e F)

tlhn].druglher4ynhypolhemtp.0snlsn.a.da.

o.sare hyporhemal3o.c ro 3,1,c 136"F 10 e3 2,F}.


slancPFatomp{dejbr

Routes ol Access Ior Drug!

ftitanes.cdsssnotng6gld

onloibono}irlheGpynpatenbwlhAcs
tt /rc[scrlB'cr,ti.cl'*!vFlPuLlslf

I rhe studenl webele lM.head.ors/€ccsruddr)

Endoaddr..l Rolae

Ftuid A.lnini.tr.aion

ne s tpcd v tsi.Ed wdh nomd * ie or actared


o

. Epnephrie r ms v/ o i€pa! elery 3 10 5 m nubo

Renenbea lollaw each dase given by penpheral injectian wnh a 2A-nL


flush ol lv flud and elevate the extredt, abave the level al the heai lat

Antiarrhythmic AEents

l aiso has tr 3dr.n6,q. and p adrei.

lihmcoio.q$andnqandwdespGadfamady
d b,,s bm erircat n cdd ac are{. Prc! dqs

br0miulederu!5loamaxmumol3mg/kq
fh. ACLS cM cardLE An.t: Whtutd vt

o.ma s nus h,nhi, \!hei vFrpr se ess w car

iFCI , !olnq ro0 rtscA pate s rie lse or

.;craihdriF,m's. '.
o
anrason6i nihe bEn sp na cord a^d Gl

ih an op o d assoc ated resusc ralv€ en.4eicy

at a dose or 2 ms N r 01mq M,V

opioid-Associared Lite-ThEaienirg Emergency {Adulr) Algorithm-

a*ess and acrivar6,

evn9bpbeFyo.aeh@ffiy

Adhirislor n.l6rcm.

MqBpdaig4nn!6

Sltmullt .nd @*$,

conliru. CPR and use AED


a3 300n as ir isavail.bte.
ErtrecorFoG.l CPR (for YFlPukele.. VU^.yrtole/PEll
Efelpffir cPF (Ecm) dds ro v
dur'g@'!acaM,includingdm'porcdrumblamoxyg€Gtma.dcadbpumnary
byoas IhN r4hn qu6,equitE a3
Ir'e ue ol ECPR,Ey alrow Fdidm add bd time t lreai 6mbr6 mdsiyins c sot
€di* ad (eg, ede .@,y aiory @.rusin, PE, Efr-*rory vi prcid'n hyp.homra,
caldit iiluly, fly@dditb. 6d ohylpanr]4 Cmgdive h@r iai6e dtr]g idoxb3t onl (

Wr b b.E e dMrry m ddr 16


.,€nce Biesd rd rhe 2015 arra Guicer,"6 updare to, cPJ? ,rd Ecc eoq8ls a b6^.ir
lo sNval and hwabl. n6u6 o9 c o
cg16limcPRnpd6bwlhEfrdoqd&esl
h ernru8 rn.E Ecln ..n b. Eordry .nddrcnr.d, pDrrda m.y e..d. t u$
tu ,i,I porJrn.rr, eu$ or edLc
rrct utro h{ rc! o$ond.d ro init'l dlldio 'Mrbb
rcPn.

Ultr.sound (for YF,/Fulsele3. yT/Ary.tolc/PEAI


uneund may b€ appr.d to parianls ftcoiv ns cPF ro he p ffi m)nadbL anrtuul-
lly*'d|oh6lp]dollypoteduy'sl
m6dalr..l.dby|hoi.4,'neUseolU[6ound
mq pal.rns dpd 4.ins card,e

adiui.r ro dandad paiifir *aruar on


o
Cardiac An€st Pulsele5s Electdcal Activity Case

Description of PEA
qDrp or h}1hms rhar are oEanzad or semro'n:tr zad

AnyoQanzed,lr'ihmwi[oa.!sssdefLnedasPEAEveisnusfryihmwlhoula
eessh,rhfrslhlld.3icldedbydelntonncLude

sed he lem ./..rrcre.hanG, dsso.Eron IEMDI


*t..actvt!onlhe.ad]acnonlorbutacke
flp ACIs C,*s Ca.dia. Aru',. Puts.t s Etecni@l Adtulty

Managing PEA: The Adult Cardiac Arrest AlEorithm

LFsure 3sl rhe .fl sd-a or rhe 3qo,


pln rhe rnhr sde or he aqo hr 1

perods 12 m iuresior !i nrerqr.d h lrh q$ rr cFB

ehe.r ve cPF 3.d r. ded! rd:o

lhe Ei P.thwey o,

iotqalzedlnJiifrorlhemJrdorb,.lo.]serha
..ndi.i 6 PE4 rsiep 3t chen ror
iFqre39l beq nn .rry ri s1.. I0

The pause in CPR ta cohduct a thtlhn check should nat erceed

Adninistet dtugs dunng CPR- Do nat stap CPR ta a.ln)nislet dtDgs

, ,o ere.ti.il ..1 ,l], 5 pr.5.d 13sy


o
adull cardEc Ar€sl abonthm-2015 upd.te

t
t

l
I;
't*"
?1,./16[A C.r.- C rirc/lrrrrl t tN E dd *t

itherhythmch{k€v6alsashockabah}1hm.€sumecPR*lhch6lcomple.

ded saqueice oicFF hrlhmchecks md

povde6shoulddGmplbdsllya

Common Underlying Causes of PEA


o
Cardiac Arrest Asystole Case

nietupls cPR ror 10 seconds or ress ror a drthm


therhJrhn.,ihano,[o,]s?sys'o/echoslcom

c Aresl A sor rhm lF sure 3l


@rAlsorrhml belr nn'nq { th step i 0

E ,nette.nre ot he aast ts Gtse q hwan at hish pedat@c. tdn n nhe6 nrsl

Rhyrhh. lq Asyraole

lsowPalem'naiiqibradyasystolclh,thm

Approach to Asystole
Asy3loesamid]a.arcSlfi}lhma

. Noi another,hylhm l8s fne vn m


,he ,CLS C8sa Cad,ic ,,Et Alyrlbb

Foon rali@rl Faclt Asystole and Technical Problens

i,lhmCarda.lUdoihasdm-nsndAAil..
.hnhr.r 3 pa:e1 rr a ! i vF or p!

iranaging Asystole

Adult Caruliac Aftaa


r rhe I qir :i da or i[e arqorlhm 1slaps s thEuq[
.n]al],1hmhn{.arPul
o
mteniohe nredenronsou nod i rtuaqorrhm
b dmitmdcorstmmdsyhs €6e r r,€s

rcsus.1al€elionslobepdeilay

Application of the Adult Cadiac Arrest Algorilhm: Asystole Pathway

wheyo!periormarhlthmche.kYo!nlerp.eilhedyihmonihemonlorasasysloe

Con ime., Asyraole

son as rv/ o ac.ess s a€itrbrs. srve ep nephr ne

Adninistet drugs dunhq CPR. Oo not stop CPR ta addhister dtugs.

chtklherh'ihmafle.2mnul€solcPF
lnteauption af .hest conpressions to conduct a rhyihm chqk shoutd not

. r no e/shcara.rydr 6 prese"r lasrsro et so r,ack ro slep j0orrl

beh/hm,ftparetode ler 3 sho.( 1.6um ns


rapprcp,are) Rerer ro the reri s de or ih6 a soBrhm

Trre draqra^r i F€ure 391rhe cad.. &rcsr Arqorrhm) slmmalzes rhe €.onmended
sequen.eolcPRfilihm.he.k.a
rc" xoa s&rd Bldqn .a dtrl.d tEb e lo ,w b.mfi 116 .nsnd€d rcP h. Bvllo'
ra ,B Ali dG l@r'd dts @ ol TcP lo. pe6 s& aevd!- d*. .d
'Ei

A.r,lih. tto.t lie b rc nldrB M tumllrN lo "d.nb.rlhrd avtioL B b@fi.lal lh m lttv


dr g@p lh.t E Cv.d dro.l€ had o hrn iowrd w@ odl]fu crd rh. impqtts
o, f,*rfnirm liimwion ol ch6l Ms6ro., lhm b rc lGllioatd r, inrdtopl.g
.fi.! .ompEslonBtodoriwadEkiop.ll€,tlwhha,!lol€.
I n urcr.d *tEnu rho ,@s b fm vf d .!ytlor.. 4 hiri.l frspr al d.ft rlb
.
m.y b. ffit a. Fl€ vF dy b. t! ran ol . prordE€d .tct r! $E nr' fE b-'
dr ., dd.rttg r,.ib.$s.., b Frrf, cPn b.rd d.ft.i't'm a md.., EMs svno
r!d6r 4-io.. iEy 6E L arpkEtng ! pr.r@l $d *s Eils 6p4tdi3 L
qofi cpF *r- EEiE rs d.iir{.Er ol ldfir' h,rd by B,ls pdsra to b. h vf

Taarrilnrtllc iaa{acltadlr. lfloal,


tb,,',|,'tu'{ I hdnh.m p6v]ds dnor Epldly lddriry u udqyig {)M sd tE pd dn &6
nor EF.d io lrE Brs $d Acls Ero]MiMt, lsmh.uon ol Blr BEitsiv. .t ont

,E d.olon ro!.mimb @*r * .lldE EE wrr' h hrdig C'v:tb h rt


ho6ph, dtd b b€.d o insid.6t . ol @y tEr6, inddrlg
r lmrr. c.ir.D.. b ct fi
. Itu tfi €rr.p!. io fi.n dsfar-td sniripr

. Adp6o io 6u*r.ll6 llrl;6@c


, Eafc.:L.ha 10dn ,dtnt,3o,cPe
Nft ol ,p lEcl6 dds r in cdbinatd i. clery p.odLtv. or our.omc HMs
oE tfudih ol G@irad* 6ftd b s mp..ld t.fu 4sod.d wfi pd arcom
ft. dl@ n[l fE p.lidn *fl ui6 b ,r6.dEl dEdll! -d b. Bd.lndv i:i.cr
. s@ nE BeHid dspr *r5 vor d.rt_

niE Brtr r hdn d.o6 ol (furv tn4 tE pdl.n n[ d EFlId b ffi a€rs atn

nlr"ht tz cdfiM qr{r-tr..9tur ,eitaris .{d! dn m ol ,E ldl*tE rcu6:


o&.,!ng'pl.'I ! Fdd.rio ot .n.dvs, sr.nLndt clrcur.li@ .nd wtratM
t T@r, or o@ lo a s.rk .6r.,!6ev m.dlc.r
! IlE q.!.G ot .dl'rl6 cnt .ra lndtnho rru66ibh
''el.gomr
!.'rh
6d'Mruois,tusllsddd'ltM
. ffibr riasd. d b-aE cd
. A v.Id DN B d& i P.BItsd
.(''lallEi6h.fud..l..tElc*i'dr.,!El,i,yp'irn'.dd,eol
o

pGanenh* remra les srbm-qson I cy {atral,hende.diqlhe


'orroe{oid

1yk,h.an.o4llssusciblion]
7I',,!P,'. ol N.nE Eni!.tur madclr rr3rdE aliai$ andE nd nqdEn Id p@o$l b r:rtF.l
6€y p.trrt $ ddl& 4id !d lo a l!.!nd 6b 6 ED. T@!.rl!r@ tltt .orliu
i{ cf,R blrdf.d hr-EnidB @']bbl. h ,E Eo 6n I b. !.rloirEd ln $. olr
or-lldpilrl sdit &d nty ff tldlcd.d fo. 6p.qd dt@ttd@ fq e'dbgrM.rv
byFda. d .rn&dPo@l ctrlbrioi ior p.lx.n3 vrdt !.@ ttypotEtub).

AndoHcasd,tao6c,r.ftpdrn Fdhrn ro s !ppr.9dd€ hGplrd {.ln . |)@


pdEn 16 pGr-o.die add Iql,rdllsys..n ct 6. fd lndird.. eon! 6@rv
kr.Midr midoq. c& 6nd rs .fd trvponEhb l@p'd h' h_ha.plttr
p6*an!E 4n6r pdl€sl lo s.m,!!.&ie clrdel @ 6lt dFabh al ptblrtuE @_
@ndes !.rr-drdt& ar!.i @.
o
Bradycardia Case

.add thead Ere ess rhatr 50/m it.

sus paoiq arcP)

rype lw4ckd{h'Mobr )

.irrierypeoibo.iprcsediFsure.rl conp6reAVbo.r ss€neraryrhenosr mpor

."0,""",""q,,u,..-
rh.ACISc.*W

UE- TEF=-

IE= IE- E=t

h=
o
Description of Bradycardia

Anyhylhdd$rderlvhaheanr.l

S,sis aid symproms duo 1o th6 dow hd Gre

cehelemb€dym,dndgchmg€ablywth

S,srs and SrDpaoDs nd phys ca erm mrm b dentry $e ssis md

rdta rc alen tescap6) rrcqueni orematlre venr.urar


Li.tftra Sr.dr.;.dL: Tlr. Lrdtlc.ls. Ieorl{t tt
nrr.r, B!rq{. wfi r Pt*. agdt (Fac aa ediE nE rr.p b E.
rr rn riluaqd ol t ldrn rEnis *'/$ tlcloiE c hrldrsr.*lor prb..
rr?iri&r d otr .holltm b.gi6 *i!l tE rr-t16.dio. ol b. dl/.td. (9Q oi tlr
tri a!. B 16 !a sonlh. tu n6 hdrd. n drE .r!l ol th. ats r€4n
!n !f, ftrEy a6rE( srdr c r4r..lt .rald..r ttd .ha, nE!.gmrn,
sivhc ory!$ il hdd(! nEro.iig n' tdnm ftd $rr qgE, .ddbrrta rv @!
.rd oai*tE. 12 Lsd Ecc, &55 61O ?. h !I diiirdrd d.C.E i voJ !.rr_
mrE n dE o.En ,6 !4E d rynplffi d po. priE6. rd ir ts & casd by

'Ilrldn y d..b,r p.rn hd. JrEiUm i'rh d.enimU..t ol.d.e.r.Itt h.r.li


tr ot n ha .6qrro !dn6rh, !q .6-rE .d lMh( (9.p ,1, n tu Flbil hr
p.d pdnrd6.l yrr .dmhrr.. d!d4 (s!.p q. r dEclE B ht rli,t, arlp.it i4 IcP
d 6Erd.r dooriltu q .9dr$nu rfilio. {sr.p g, I Ld€La, yo] pt 90 t0 te_
vt@ p&nrc, sdr l' .nd tld @nrM^! ca&, ,t dl .rr.i .du!t d..r

Th! ht*md..qllm ln lhealsodnn E d.l€rd..d 5y t leny d tF. p8i?nl


oddllL.. Yd tr6y 6.d lo Inpl€rn*, tunlpL lic.qrlldE .Lrut.e6lv. rl .*dr*
,r.l dlrloD., ao to t\a cad& &.d abodltf.
Artfi lr@. r{lth. AiL Abqdi.n

r-E!f-n**.6dq!

E---F-

,F.chds.dF!.tureash
o
lppllcatlon o, the Bradycrrdla Alaorithrn
nlh€ce'ydhaeapalEnplsd4ms,el@so'U.dr,dl6,Yo!cdld''t
bm a drin€d h n* B..dy.!d6 ,'l!dnlh At $.
9e tru, e sd"E is r'd ldns tBbr. cdbln'rE la.rm.
's
rdsiry*iEoxtub.adE ds6
tPl!s'byd€fllfu'i€.hddolc,ls5o/nh
llnad@El.iofEBM!Brdful'i:d@l''€lt6]

Prhn q ,,!.ar,,.n Ne{. pdl@ th6 rhm,y assmd, in 16[10 tE rorb*i{

A!.El lraihinC a n .dd:llF dy!- rn cu ol riy!.mi.t Mirdy!-

Moniior br@d pbsu€ md rr.d €re:obrain lid.€vl.w. 12-r.6d ECGI

cndlcl . p6bhn-r..!s€d ht.t ry $d prryr,r..l .*it.xkni {hh t rd


tt.l po.rlbr. Mfibdns ,&tdr.

sr.p 3 p@mpG yo! 1o cids i, ttu qrE or tynprm3 oI poor E .rlCon aE os.a by
S,,rpllrrc..dD,
t &. "snG'!*r€ d srnpdE?
t &. 'k
rh. e'sN aad s:ynp|m dtu lo ru 3b* lE n dl.?
Ldldadllg.igGdsylrEbco,nEb..dttgd.:
. synprms lee. dr6 difflon. srtu or b€dr, dn s.d bv€r c, cdee
n*, waks. {a!s6. &h]r€d€dB @6, pBrtuop6 ( 5yn@p.l
. ssnr loe. hyFr€ns, 6.Edi€ h€.n talw, MrErar adntu ed b h

ssnoic $.'srmp6" a d dE l. rE n dlc,le Fe .ep1q rry!.rmie


's

Grnh., C.r..pt
habEd}s'd.sca6in0ihsp.isnl!oymplm

Ad.q!.| hrntdorr? . rr rh partrr h& .d.qid. p..r!'&n ob.ea qid mon6 isr.p 1)
.lilh.p.islhep@rF'n,'&,,girdlosl.p5
rrl. rots Crla A.dlE &

ttEaar.ra Sesuerc.

(chmnotop'c o, hean Eie do*)

Avodrsynqoianopiatrlype

Nrh rcP or D ad'eneG'c srppod as reniporzin

tema p.. iq or D adreneQ c qils .n ror pa1 ents

1e dopamae. epiep$nel s
'nfu$oi

No knowi vasop,essor 1ep nsPhnne)

oi a D b ockar or carc um .Mrne b o

,t€raDeDt Scquercr:

gVe'ely3lo5inndestoalo'3doseol00rme]
kq tmar num tora dos6or3ms) Ar
o
,Erarrcrt S.{rercer
be perromed by acLS prcv de6.

dncar3nd m*han ca €dure. Becarse han Eh a

dyiam[slabtyG!ean:ges.said.odatlesfol

ro d.nrt and corccr thecau*.r rhe rr4dycad a

ne reatmenr and I s 3iso .efie*!616q. fcons'stenr


.!pi!ro) beq n an lnfuson or dop3n

Fou.lda,rond F.ct Sedation and Pacinq

ranxsry and mus.e coftad o1 !

llc.lD.rt Seqlcrc.: a
'hoqh
0 adeners c lson ns w ih

srancas s!.h as ovedose !rh a ts b

ol2lo]omcghnandttalelolatenlEFoiF

doses (qr$ler 1han r0 mcqk Erm


,Ir tc(s Cr....' 8,.O,!.,rt

Transcutaneous Pacinq

,r'D. dr ,,rb retAH. rr@r4sml

E
EPb-um.L-1.&."

E
Erdmde@F,m

caolur€ s obseaed lsabry m3q,n)


o
4...., E..pon a ao

vc r.urar hnhms
,nare bGdlcxd,a deDendenr
lalf,][dsomeliA.3g]^/vAlfraym.UilhF
rha ACtSCq* rE@ SbDb rd Uit!.ta

Yachycadia: Stable and lJnstable

rhs.ase aloleslrres. EcG rFrtims 1e\ampes i Fsue.3r

. neenrry sup6!eitr.u3,la.rl.ad a 1s\41

rr
:!

:='i:=.
=-

-=f. I
o

The Approach to Unslable Tachycardia

Tachya,rhm''tachycard'a.
sFplomalicbchyarh,lhmi.
un r.ue tsdts}dr. .rle glu lF6 h€uid. ls io. l..r Lr rh. D.rids d]hlc.r d'd-
.yntpdEoaue!l.@l(r'dobgg$.
. aari,, & n.lrhd ddb d4rr b,n!6dirnb @ @e lteidwy.d.,q
@@ry b.h€hra Md rrrtoMio. , rh Educid br..d 0o* ro vi.r oEe
. adrE /ditcir€r$ frd @lrLri6 b.rE t!.tlm an Eltrds q nE
Enid6 riErHrE rdd q,sur '!d@
Sirn .nd Unilbb laolry.adia L.& lo sdds :r9o! {rd rymplffi trn iictud.

. aaidv rbrd rEda di6


. r.d'di. .h.d dh.drr.n

,E 2 r.y. ro m&o.d or tsffi ri,l uBbn6 rdlFd. e


,. tt. r., & r. r|apE Bogiird t'd ri. prt nl Esir,rt errysr,i,trrd. d .E 6l.bE
2 Rapid eo{.i(on fdrh.drft,t tyrlotoase@l$dbyn diy. dla
\d hu 4*5, Mt tu,t $!at tdrr*dt a Fauq tzraf
dt{ciotatrdrect6.tl rtt Ob,. t t E *, d qt ?
tdnl*a P,,t dd d,,Eda ',rttu.
r.no n satc,,4'l..,d,ya,dt
Thrs (krihr.lon M b. dnb![. Mn] .rprL r406t lh.t *ra a h*n ,ar. L ld
da rs{y in, n k unnk.ry thd rynloron. ol lndlbrny d6.d 3, tE t*hr
FiB,
cara ri6 nt! hp*rd trtioL. l\ftrbn- A rs. El. tEt r tu 150h,' a
E
8dt n iEper.o.in6
'!.p..'e drysliric
ro tu (.s, l&r( d.rr/ddtr) d drlr

S.r.rr0 aG id. b. p.*E 4 .6.a8 ol .as6 *d rrrFio.D ttc ld iLr l.diy.


Fdqrd p.M sEn ! indrdod
F.pld lddn[l.. d l! lrr{&dh $n hdp }o d.lthltu ,nd,w y@
of synplomnb
$drd 9r*r. rd IRredlsr. cfdbBlim. Fd .md.:
. Iirc Ecry€d*. b . drY!&lo0k Gp@ to roolE l&io.e, dr.i - Ltq a*
D' d l!@l+13d*r' rhd c,* rh. ld ld. an'odEey,n,rry+
oldE.r En d€. rh@ d'dv . hsh d.(r! .' svfp.mh lft xd
'i@6.ractoB
@6nol@sl 'n li lhce ding' ' sh6 lehvcrdla w0 ml dpoid ro csd.-
! h p.n d dth t d'@n[ b *e (.. m *i,6.rc td.d b t{ l!.,ry6@,
r.tdt'nEyft,l.rr'@,t'd.,Ibg.ftdEn,E{Epdqdldim
. Atu rf,turrllcdll s!dr.6. hd 6L or .p9dinf,i.lv ,5dnin lloE Ec n5v
v.d obthrr-. D@, a"ldl iLtu d $i.
r lM d 3cM .vr6lc d'!€4.
. At le c,.d..the 1s0nd, rlmrr@. e onar asn ud cqdirydim I did
GqudepdidnE(sbb
h& u.{rryis cdiar&u, d.@. tndm3 mv
' [ni patin b 3dEl,
b.B*nallMld& 'lrr
Ye md h@ *flsn .!.drov.oo^ i3 .d 4bd, how to pilp.E rh. ptlisr lor lt ([rbd-
i,o spFopill6 trdds), [n twb.*Lh It d.rbdll.b/rsrd io o9!tb 6
o
Managing Unstable Tachycardia: The Tachycardia Algorithfi

lfe ra[/]rrd aAqortho 1r qr r. 1r

tu.Norr.l F* Serious or Sionnacant Symoloms


Adu[ techyc..ri! With. tuh. Algrlthm

bGaIl.t''E!q&L

E-a5-h-

rs*diry,d.fu.lq
Irfufulrfl'h

feh,fufud

,@@{iiirk)o*5ffi

.tdrdMdiot.&

bl*fuUrdE&6.b^]Fn

se ..t6Mr &ld mD'osdr ol rhl. Fdon rr b. suld.d L,v tE Llryh! kry


q'r€.dG FEi6d ln nE ftdrrt rdaalasldm:
'A,..rrrrd E.d6&..tr?
tboEpd,nn..k-d.bh?
. r. 6. oRs nmw or wide?
t b h.nnh 6 i,.eurd
'reurr
. 6 rE ofis llmmdph- r p.lyndDaa?
\t- ffi t, t* qo..[..6 dreti*Eb d spiwle n 0.
o
Application ol the Tachycatdia Algorithm to the Un.table Patient

.t lor
^,lprca.l.len

thc |tn.t.rUnE Ceu..

Crrdc.l Corrc.pb Unstable Par€nrs

C.o.lDg Stgnl,,catn
Slgn. or Srmqtohs?

lidsho.ks!,'n!dbbeduebJi].hyJf[h}ihn3
,?E ACIS C{|G Lcn BE i.r StzbL an ! Ura'l6l.

freatment Based on Type ol Tachycardia

ryrhris Mosr rde.ompex lbroad

pu:e ( rh equ unlori !de.omp 3t w l-'no

. Arhrhm as !r, a poymonh. oFS appeadi.a l,!o]|mophr. .41 nd as ro's.'jes


n.hroizaron I1h. D:lerl has p.r,r,phr.14:

Detetuine the widlh


ol thc oEs codPle, rhP udrh ctif6 oFs.rnrer se
o
CeidioYersion

rdicaldaidwhalt/peolshockloadmislel

Synchrt'ni.e.t Shock

€hen po tri or rhe fi wav4 wh.n rh s opr oo


Lrhe syac opr.n) s eisased rheo

r 3 shock dur nq cad6. repo ar zaiotr tsp.Eented


on lre slrface Ecc as rhe r wavet a Dsrod or vur.erab r./ n uhr.h a shock ca. pG

mth Sy'chr!dianon
l\hq ta Use Synchtunizad Sh@*s

. uchbr6 arla ib aron

.I.]nsbb.@uemonomorphclac

WEh ta Use Unsynchbn|ad Sh@ks


Uns,*hEnizedhgh.saEyshmks
. For a @r ed who h pu se 6ss

sm!!&rdpyroTi !4 r.r 'dtrn1ade3!n 'ordro'r4 \,rir$n

rhe rhsddicar isk). mmgdialo v atempr d6i bd ar on.

se d rh. @lgy dos6 le lhe sr€clfc tpe or dnhm

.Mono.ha,oadrov.Eon:Delivd
.siphascedove6ion:Ddiver

sub€&uolshockdoseasn.eded
C.'dlN€6 oi ol drlal fluter and svT senda v cqu €s ensrgv A' nitial onearv doe

,o*,r"i rr,,,.aa'"o"a,r* **. tt

qlnchtlnlzed C.]dlovcrtlon ?cchnlquc


l1doichoedenapalientha3lsymplmstc
;;r"b;,;^i,., sw. w -,h p,

vo rs rEaturt oI lunct onar rehv'dia or ectop c

-,,,,r-"r"r',"*,*4.u"*,s6s*eyhmshavsdaltomatclocusais'nq
*-",',r,"**."-**lv*
;,;;;;;i;; aci*rv ircEe rhe Gr6 or rhs t*hva.qrrvihmia
"";.,,^.';"".av
., .*
", ^;^"""d
;,";, ""."*. '- "
^d, ^",,".
o
Fo os rhese neps ro pedorm syn.h Modry the srepsto.your

E
E rui oi rhe derr 3lo.lmonophas. or b'phas c)
Atrach mon ror eads to rrre pat enr t
overroihe enshourder')3idoisurcprcperdspayorrhepal,e.lslhnhn
Poslron adhsNe ereclrode (condu.lo4 pads on rhe palionr.

P.rymorphic w {i@urar roh

r s .haqed lsee,Fouidatona facrs:


aron

E
I rhe vFiPursesswcase)

-
,Srrl@ Ili. d 6nd asteat -d nErrs.nar ot . lsb prtEnl (b, m xI@ s,gF
Ebb'tolt *hlcddi4wttt.tpb h.&t6lt. Pln ! eldr hoin l.t.r oBt!.tr{
l ro/min h.s . r.dt'trhnir' d llchrsdr. h frh @, * w]lr e tE l,G bd'r
arn ..d6.rrr-rrrDariEdsrsdrr.not $diGr.dtqdL6.r.rrqdnqn
!D tffi a!..rh s'u ndy.xda 6 ,nEr .rrryr dtyJoscic, d6dlqrrs 6
dp6rs io . drlp.mb. . rErr. vorD d . @r'drF [d ,lqrli n ii
crrre ooBI l.s, dr, nyD@r6'&'l Tlgll6 rnvol!* i(h.fr!.dbn ..d're
6n l,.i ol
Ye tun b. .bb b de}ly tn ryD. ol r..h/.{dk ($,1& d n.,e: d iDquk4
'.orrd
I'd i,'d.nd{ rr.nFd. k{rvanG - adii- ii f: ra.hrEtdr a&situ.

r turlori lnfiid sBr .(l nrr'.o.rrrt


. I!.r ilcol' n!,BdrFh nytrm GrclB lidr d!/..d.) *th vosd
mrus dd ad.ndi.
lrn. lnriri d@ d i4.t Fu *ln lMnd lrE p.lr.ni ntd tn3p.n dorrd'.4.n
dsrt*r n,E p.rE bdr6 q**rly ui!r&, yfl r{ piloei, tnm.di
d dtd.hsibn dt dr d.rrdrsti!.d crromb.r dd6qE a h,E trEral.

,fllrlhrrr 6r tt !r. l*nycrrdLr 4 b. cMllr.d h $!qd war! br&d 6 th. dpp4le. ol ih. ocs
,rdi,c,, . dal.i nen d4 .rd *h.trr flq ,. e€ol.l or lr.q]e
r i!tuoFs Erdd (5/D bd!@dk (of,s 16r t6 0.12 so

. !i[d.-oRs drda t <rry.3di3. (ofis 0.12 ryn d asd

! i&DqdL.
8.ci.dd d imcL!,,
- tn9!1. Jl!@-cffpLr udyad4 N dlb.blv atilr llb,llbrion

D trt.tLl,. hb d rildB nb ldod,ro dirC


tlcltc.r t
ilrt
s€rtEr m.Lo u.d r. E rrd. !1dc*r..nd r.d6ri6 d'r'it! dcrid dla
rcd. rre .s.n1s @ ml dd.d l. t\6 AcLs Prcvi&. c.uE.

lrt oaa{i tc AabL lLdrrc.ld.


r. th! c ! !r.bh b.ltltsdL 6la. b 6 ddrbn ln wndl t pdf,n
,
'6
I A her rn€ !Er.r tu 10O in
. No rJg i.d fl
.i(rr. d lrnipidr. .!x=d bv tE@.d rdt
. r, dr.r&{ crdl& a-tkd srEd t,r.l OdE l* }r 4'rBr
o

Found.do,tal F.cb Unde.srandinq Sinus Tachycardia

iranaging Stable Tachycardia: The Tachycardia Atgorithm


rl a plr(e d pet
. rrd,yc.rd6 .id pdd ..!s6n a.d m.r'6!mt 3r.p5
luid.d A€dBn
by oi Bts .nd b nlrEy rn s@.!(,a'y a!a*d DdsmE
rfuE Jid !ryhprohs s ,9 m pr6.nt sd ll rhm .ymprom aM sltG e du€ ro
dl d!/erfa nii' *lll drld yo b EilE dr sh.i' lstrp6 . tu4' 4 d @r!6E
6eo 4 di6 ot rh6 arloi m.
! ll e0nii@n &re d 3)rr'r'lqB m de ro rf, irdll&adq tE rF t dlyaldb 6
6r!br, tld lnndkE @dbvtao it in.r..td ls nE usr*. rtdryqti.
. h t! odisn .,.t€r@ ar6.as v[ .l€li€ ,Eyr.lEd2€d h€lrtsrv $..k l.Lf-
bdllaliM .E!r) and ,orxrx lh. cadE Ardr r&stntm
r { tF !€ii6i h|s rorrBrrc W lrEl tf n rhm sVf t n.bliE hioh{Elv
dEyidMmd dEdc t€, d.fbdidLn dEg,
rn ihr. ce, tE prtrfir B strb, .rn y& wrl lM.ee eordh! io th. dabl€ *l6i or
lE T*rry6dhrrlo..inm (F'sn r'4. p.air ld.ffiello oI tn nvtm (.s dtv
SVl, alddflund) dY nd e P.sbb ^d I1!' tm

lrDllc.Uon ol th. T.ch!rc.dL llgodrhnr to lh. 3t bl. H.nt


h uB cu, a pdLnr ,rs !&ar. rehls7dra ,nrh . prr$. cddud rtu n'p6
'!t]"d
n
fE I*ll@di. r$didm b ddlre t 'd rMtc. th. p.li-t

,rd.rt L...arlr3tl $., 1 dn ls ye b ** $€ pnidnt .qd!.. Ivpkirr, a rrtttr $8'id tlEn


l50/min d Er b d6 ro t.drr@nvd as oow ne gn6 dtY@e "t

s4dd,, lis ro cuid' vu acp'o'dr a€lolr'


!l! rnd lclt u*rs rir sts, Pim.rv. ,td
riE parb md do lhe lollo*rns s @.*44^sE
! Lodr rr, *r! ot i'r@.r.d wr ol bi-olilro d h/!'n! 6 dddh'ncd
r Grw oxygi lMild orYq, {t .rlo..
t srppo'l ,E .My dnho, an .@dl.'.
r l]M^ - ECC k, iddli, tf, dEk br.'d p'*ud
lhvmmi
r rd..nlry d ter Bdtba ..6
ll ryf,plN ,irdsl. ss..d b sraP 3.

rtu'!, E @Eba *irr E46 d 3Yni@ilt e 6 lid tu bdrv"d' ('9 r'vrE'


o{
i-.J" *u""*.,"a !'l.s o' Ed'd'c cid dkdn'dr d
rxir. o s+ . rp-r.- -''"a,o ryrchE d *o*r
"4.s. 'hdr' *tu u4'da
".

[ $. p.tr.r( B .llbrq !o b 9.P 5.

, tu m dNtds '.5d* l. mffi'{E"Fpbsffibtt drrom'


rtu
1r.l-d E@ ;;i",t,..**;"-.-",*.,n.hvhmdd@d'6hl'i FcG ($* d
*.i* , -* .r * 06@ t2_r"d
' 'vdL!'rr edd
ilr,"-, *o *i-"" I *,ins . n* 0a€
""..a, "*","a no *ono d *rd'
o'12 (0'
'2
"
o
rcd by wharhq [ra oFs a trdp lsre! 6] or i3troN

FNr.t ,,oo.l F.ab Tcalins tachycardia

r.id.i.-.! rt-. reAr.4 h,rn5

Dtugs to Avoad in pari€nts Wfth lza


fi. ACLS C@ f.cht@rM S,rrb dl,ffib

oiq i isvr) vasa m..e!ve6 aone 1v. sa !a maneller or ca,oi d s ius ma$asa)w,

oush a a aae ie!. ant6ub rarl ve n over 1 secoad

ilermnaleappmrmaley90%ofienlryatrhtlh,

bockeG iverapam mddt em)orIrbbdss

llherhlrh'ndoesnolconvedwh.

what to Avoid with Av Nodal Blocking Agents

channe brockar o/ D bo.ke6 bec


3r.bre i..hy@d s ihar do rcr Gp.nd tr infrar t@h^r.
acts poider ie
Th€ baac
^tgod',,n ^.r!.n@.l *psr€d b ,Msnia a d.b 6 nmw-@mpr€r ., vrd66mpr.r tachr.rlE and dast
sorMhm 6 rcsd q nesuh Fesdr narow compa r*r'yudl6 may b€ tuaH
rniliarry w rh vagar mmuv* a.d ad6min. rt th& e unsue.stul, se Acls pd ds
sisudaaNp.dgwk6,pdcwf,i,on'
ib tho d'fiogtd diasrcss dtre€pyor*bre
rehy.trdio beymd rnidar m assm*r. tE Tachycardia ,lrodrthm 1613 additidar 3r€p6
6i,lalmodolseehyrhm]6.b.$lol@la
cdrcadlolbm]m'imol'hsaih}4hmia,
ral aty polnt you b@no un@lain d u@ioda . AniE lhs t@l-
hent ol d stabte patiql,..d, orpdl @nqra.r@, Dst drlHl orst bb
pa{Eils may awon oxpan @srrnatua b@@s ,EftMr rE tra poLnli,
,iD ,CtS c'g: Idn d.,t &.a-C.,&c l,r* Crn

lmmediale Post-.Cardiac Arrest Care Case

mod'diyandmonal|.ausedbym

hai.q'me nrM)and treal-..r o

f,lrlouFlhe12r*dEcGpheUsnqthe.ss.ss

You w rced ro €coqn ze the ro owns hnhms

rl6asenlalod.nhlyand
tr€i:iy.ardaCsedlo,lalox.olo
o
e affay and suppon b6a1h'n9 y afier
'mned,are

da. ahldmBs by us nq .onriuous EcG mo dns {hepd€ s hypd4sw (sBP


ess rh..90 mir Hq) ru'd bou$s.

mpy i add t o^ ro corcnary €perfus on les. Pc ) and

tlsesgnbllodeilily
3ndteala.y..rd'dcslecto)1e10

atuqenrylGthe,rhan ater ilhehosprar*ayornoiata),oroEcaparenrswthsus


Sr er6va1 oi on EcG when ih.6 is hrglr suspic'oi
7r. tcls C.* &rnE h ht-6.rdc lrr.t A.rr

anaging P l-Cadiac Arllsi Carc: The PGt-Cardiac Arr€st Car€ Alsorithm

Adull lmmedialo Posi-Cardiac Arest Carc Algorahm-m15 Updata

F.M o' rpmhnaour dffin ltl@)

o,di'L.ffitd.Iys€6
tcoM'dvfu:flrydifuryrry

rd hyFfu FAP O M [q'


o
Application ol the lmmediate Post-Cardiac A.re3t Carc Algorithm

ssof,daryAssessme5ollnqfi}1

aqo hmtr!@ r1 ) rher.im,rd

Opaimi4 Ycnailanon

Wav6lom Capnography

lhafi rrlhn.h..r F!3is rn oaai,d dnhm

Things to Avoid Ouring Ve.titation


lihido'rn Cs.|oarAhy
. €rin dd @ ln* diairi&i orcdiodorid.h and.dd a tl rn oloat-
dni. h bE toty!0r!s6. a 6.0d,ra@ll rii,lrn*r.., eery(Ptrcq).
B&r C.! r! . r!c. !s arBdatc *, cq d..r.d t' qc.n!.!d', n
.nrEdd.bs.dedhxrbodt4add,w.rdrot
'l t tsity.i6i.&t9blood.
' crni-drllli!'{rEt ddrhli.rndicod.6l{y!otBlrnlpl,sdldioib
af.!v.ry@i.rr^tPcrEq...rrd6Ni *rhQrd..d9tlldr&cPR
t Aqffi .rqic eE r lalei 6p..lr.drc ,.vdom *$ {-ldLn io
coinm d @ q El tuD. ds'-i in ts fiol4 h h L.rEF.i v€hE{. 6 tnvEl
d iah..pei. dndt .sry p&t&.6rrlor.dptE.l!&ot dtsgdad trb.
d4+effitdd6,l*6d
! lho{qh .4rl6or.$y ro erltn rnd nrcftr 9olltar tldoor€ti d &l.ladli. 3i.
w.r6(&rryia&rnr.tirlrlr,ldltrrlAct .,qai.dr0..llrdrdd:.)h*8r
hd1&rtu .it fid rrilfion &@dr.r$.aololli. *sdd.vt d6rld rlsll in
. .4.og!dv svddo drr,! cPi llrd dtr Bosc,

-l
l
I

r
E

o
E- la lra'frn.srcs.B4 xld qrtd.it45 mtl$ 1r0m Nsrt0 ffi it
o

yslabhhedVeilylhspalencyolaiyvi.SEcc

" .-9. "". .-.Bpoo%';.aoo


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Appendix
Adult High-Ouality BLS
Skills Testing Checklist
o Heart

Assessment aod Activation


r l chers E@nsvercss L- shouc ror hsp^d lalos emo$.
tr ch{ks teaihnq tr cheb pr s

Cycle 1 of CPR (3O:2)

Ll Ferioms hQh qla iy .omorcss ois' L G los , brerlhs ! rh a b,r s deY.e:

.cfrd.b@ilafrgMh.ompcjm

Cycle 2orCPR {Epeats steps in Cycl€ l) oir.i-th itsbpi'tue*tdtptu&


Ti como'*rong tr BEss tr R6m6lmF*ions nkh rosemds

aED (follows prompls ol AED)


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ResLrmes Compressions
tr Ensues .omprcs oB are Brmd
.seond3udd6um6@pes]m

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Ahray lranagement H6art
Skill! Tcating Chccklist

C nncat Penonnan.e Sre p6

. Tdr. .nd $ouls, "AB yd ol(?'


Adivar$ fE .m6r$ndy respons sys6
.shouislolmarbyhslp,dvdslr

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sto b requre dh*iarion (rcts b iddd
Megacode Tesling Checklist Scenarios 1/3/8 Heart
t
Badycardia Pulseless VT PEA PCAC , ,

En*G h sh.quar ry cPF d ,rr rim*

Siads oryss t needed, pra.es me roi dans v

rnedirery lffis cPB atu Jb.rs

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s ot PEc lH s aid 13)


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lomedaleyrsum€scPRahah,rhm.M.}3

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ll lhac Ansr tr 3€dyd a - modsre Posr aa'!aca(6r cm FMeqrodeP€dce
ilegacodo Tosting Checklkt Sconarios Z5 Heart
Bradycardia, VF + Asystole, PCAC

EntuB h'gh.+.r'v cPA ara rm


Ens6s rh{ t.6 mdmb€B Erfm w.ll

srd. oxysen i needea, p ac6 mondo( sr.ns v

Admin]#corurdosolalop]re

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admii'doc apprcprare dtuolsl md doses

o, asysroi6 iH s and rtl


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lfrfrBdaleyGufrescPBafurlhllhmChecks
PGi-C.rdiac Arresr car.

I
Ensurcs BP and 12 read ECG are p6
eidokachear inb bar on and waveio,m .apnos Gphy, and o'de6 aborarory resrs
Corcid66 k€ered tnpralurc manaoamnr

L cadsc e8i ! &adycad,a L rehts'dE f,- mfld are po* cad€c Amr c* - M4{de ftde
Megacode Tesling Checklist Scenarios 4/7/lO Heart
Yachycardia VF t
PEA, PCAG t

EreuE hioh quarity CPF Er. rim6

Hogniz* symplons du. b la trytadla

rh 6did.ry @m6 cP1i ans 3hod.


ApprcgaleaNaymana€m8nl
ApF.pr.E c1,.r6 ot drug+rhh choovshritPF
Adm'nsr ets appr opna rs druqG) and 6ar

s orPEA(Hsandrlr
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hmedaleyrsum6CPR]ne'h,lhm.he.ls

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kadnesl'bc4fucy
ca.da.An6r tr &advada ftracBcada ! hMEre posr,cd 5c a 6tcarc F M4acde P'drce
Megacode Testing Chocklist: Scenarios 6/1 1 Heart
Bradycardia, VF t PEA, PCAC

E@E har[!@r'ry cPR at all im6

En$E lhai te&n membe6 palm rcll

Pra63 mdnd bad. in pEpd p$nr.i

lmoedaidy Eu 5 CPF an.r shell

&p@:ar€ ry 6 oI dq rtyf m cher./shookcPF


Admin sreE apprcE de dtuqG) a^d do$s

5 or PEA (Hs rd Tsl


adm'nBr@ app6p^.L dn!F) and dos

domed.olgluralon€monto.&.V

C srdm ta!.sd hF.arure ms&m€d

kniigsenco@bc,
Lcdace€d f Bradtsdd tr rachycad,a L mm&ac Po{ cadac ad c&6 LlMeqacdepEdcs
Mogacode Tsting Chocklist: Scenario
Tachycardia ,
PEA VF -t PCAC ,
I
6 Head

Ensrc. htqhoartry cPR at alr t G

EB6lh.llsm.mb66Fdmw6ll

Pr&6 ms[d 16& in pDpq poshio.


Fmoniz6 lachycrdia isri, c d aqnosls)

F@nE6 no symproms due ro hohFddia

s or PEA (H s and rs)


AdminlsrN aop@rab d^413) .nd de6
lmmedale,Bum6cPFane'thll

c ere b.roE ana /ze dd shd k

hmed arsly tam3 CPn .fit 5ho.ls

ApF,opi.b c,cr6 oi drug-rinhm 6@L,sher-cPF


Admnde6 apprcprre d/uq(, md d6s

t9
cNd*EB.l.dbmp€eGmsEgde

hhi@6bdonGmpdry
r edb. trd l sEdE d'a L rehvcad'3
i/legacode Testing Checklirt Scenario 12
)
B6dycardia, vF asystole/PEA, Pcac 6 Heart

E,r.@ r'id quariry cPF ar alL rime

EnsuB rhat rwn mdbs tsdm worr

Ph6 lMhe l€ad3 ln Pops Pcirio.

admiilsh odrd d@ ol or@ine

rmm.diat ly em6 cPf, alrs shftks


ApprcpiateaBaymanaqmnl
App.opi.b cy!r6 ot dn4-rrryrhm dEk/shek apfi
AdminisreB aptropdare dtuq(s) and do*

Adminlll,. 4propi.b dru913) md dc6


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cff3n@ t,!.r.d 1*psdu6 mo.gmrt

tr cadiacaBr ElBadyda Lrlachyda ll rhmd€rs po${dr,c ed.ac


Cardiac Arrest VF/Pulseless vT Learning Station Checklist

Adu[ C.rdiac Arest Also.ilhm-2015 Update

.l

t
Cardiac Arrest Asystole/PEA Leaming Station Checklist

Aduli Ca.diac Aresl Alsorilhm-2015 Update

I
arllryo.nttt L$r ng Adq! OltlcHhi
lart erd!,!-da wlor r a&. X{o*trtr

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Taclrycardia L€aming Stallon Checklkt

Aduli Tachycsdi. With a Puli€ Algorithm

Axl!4lfubdnE.rdih

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rm me li 5 mg/kql ovs 5 nhc.

r !{brh, e6 c!r'. bro.r..


lmmediate Posl-Cardiac Arrest Care Learning Station Checkliat

adult lmmediale Post-Cardiac arrcst carc algorithm-2015 Updale

Fdm d stumur crurem (.rosc)

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ACLS Pharmacology Summary Table

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