Ebook Advanced cardiovascular life support (16/E): Part 2

(BQ) Part 2 book Advanced cardiovascular life support has contents: Respiratory arrest case, acute coronary, syndromes case, acute stroke case, cardiac arrest - Pulseless alectrical activity,... and other contents.

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 dd.fbi1]aion*henrcqu'dbylh6p.trIsEcG,tryirm,roimFvsc@,l,ad.6mciasss ,E Fdmanc6 or eh 3y3r6n cmpo.st o''t *lEn podm.@ 6 &dua'd

anorhs chaEcroisr c or h th,qu.hy

siud'* dnondare rhar he rh.ac poudm

'nrmpi mmpEsss ru @ on.^ and rd

ltu !ons in $mo ca* epsnd ng 25

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.

Managing vFlPulseles3 VTI The Adult cardiac Ariest Algorithm

rhe Ad! r cad ac Ared A eor rhm lF que 3rl s rhe mosl

'mpodanr aqorrhm ro knos

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

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

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

lderbnrraioi and Fosc) Tlrus, i s reaenab e

/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 seresumhqhqla]lycPR,b{'nnfq*

The inh.l lrod conaAs ro Mbl lalion rs @ ol rh€ md lmp.tur dereminft or

$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 acstu d6ibr 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 by 7% b 1096 Pd minuie rm

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

darbilr.-ol paliqb witr add6n eJde mer

II II I I

I I II

I II

Clearing lor Delibdllalion

To 6isu 6 etety dur nq d6r b rrato n a ways announce rtu shdk war^'ng s1ai6 th6

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

".$

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

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

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'

'v.n aiiadihm,c druss h6r beiorc or afis ths

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

,o\ernes u.6ko snaua telu.c

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

&66ns la96 6m6 ll srus red pareqn

o

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

fh Ac[s CM Cdfr* M WAtMd Yl

Ex

fteatnent o, YFtDw

Routes ol Access Ior Drug!

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,

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

ftitanes.cdsssnotng6gld

onloibono}irlheGpynpatenbwlhAcs

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

Endoaddr l Rolae

Ftuid A.lnini.tr.aion

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

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

I

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

Antiarrhythmic AEents

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

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 '.

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,

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,

'Mrbb eu$ or edLc rrct utro h{ rc! o$ond.d ro init'l dlldio r cPn

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

Managing PEA: The Adult Cardiac Arrest AlEorithm

flp ACIs C,*s Ca.dia Aru', Puts.t s Etecni@l Adtulty

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

iotqalzedlnJiifrorlhemJrdorb,.lo.]serha

ndi.i 6 PE4 rsiep 3t chen ror

iFqre39l beq nn .rry ri s1 I0

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

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

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

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

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

Foon rali@rl Faclt Asystole and Technical Problens

iranaging Asystole

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

Adult Caruliac Aftaa

r rhe I qir :i da or i[e arqorlhm 1slaps s thEuq[

.n]al],1hmhn{.arPul

Application of the Adult Cadiac Arrest Algorilhm: Asystole Pathway

mteniohe nredenronsou nod i rtuaqorrhm

rcsus.1al€elionslobepdeilay

wheyo!periormarhlthmche.kYo!nlerp.eilhedyihmonihemonlorasasysloe

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

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

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

'Ei l@r'd dts @ ol TcP lo pe6 s& aevd!- d* .d 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€

Taarrilnrtllc iaa{acltadlr lfloal,

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

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

qr{r-tr 9tur ,eitaris {d! dn m ol ,E ldl*tE rcu6:

! 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

''el.gomr

! IlE q.!.G ot .dl'rl6 cnt ra lndtnho rru66ibh !.'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

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.rvbyFda 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 @.

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

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 lhe alsodnn E d.l€rd d 5y t leny d tF p8i?nloddllL Yd tr6y 6.d lo Inpl€rn*, tunlpL lic.qrlldE Lrut.e6lv rl .*dr*

,r.l dlrloD., ao to t\a cad& &.d abodltf

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

E -F-,F.chds.dF!.tureash

lppllcatlon o, the Bradycrrdla Alaorithrn

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

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,

's e sd"E is r'd ldns tBbr cdbln'rE la.rm.

rdsiry*iEoxtub.adE ds6

tPl!s'byd€fllfu'i€.hddolc,ls5o/nh llnad@El.iofEBM!Brdful'i:d@l''€lt6]

A!.El lraihinC a n .dd:llF dy!- rn cu ol riy!.mi.t Moniior br@d pbsu€ md rr.d €re:obrain lid.€vl.w 12-r.6d ECGI

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

tt.l po.rlbr Mfibdns ,&tdr

t &

'k "snG'!*r€ d srnpdE?

t & rh e'sN aad s:ynp|m dtu lo ru 3b* lE n dl.?

Ldldadllg.igGdsylrEbco,nEb dttgd.:

synprms n*, waks lee dr6 difflon srtu or b€dr, dn s.d bv€r c, cdee

{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

ttEaar.ra Sesuerc.

(chmnotop'c o, hean Eie do*)

rrl rots Crla A.dlE &

Avodrsynqoianopiatrlype

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

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

'nfu$oi 1e dopamae epiep$nel s

No knowi vasop,essor 1ep nsPhnne)

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

gVe'ely3lo5inndestoalo'3doseol00rme]

kq tmar num tora dos6or3ms) Ar

,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

ranxsry and mus.e coftad o1 !

,nare bGdlcxd,a deDendenr vc r.urar hnhms

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

un r.ue tsdts}dr .rle glu lF6 h€ui d 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

'!d@ rdd q,sur

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

, tt r., & r r|apE Bogiird t'd ri prt nl Esir,rt errysr,i,trrd d .E 6l.bE

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

\d hu 4*5, Mt tu,t $!at tdrr*dt a Fauq tzraf

',rttu t E *, d qt ?

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 FiB, 3, tE t*hr

cara ri6 nt! E hp*rd trtioL l\ftrbn- A rs El tEt r tu 150h,' a

8dt n iEper.o.in6

'!.p 'e ro drysliric tu (.s, l&r( d.rr/ddtr) d drlr

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