ACLS



Glasgow coma score >=8 are associated with recovery, 7 or below are associated with residual brain dysfunction.  https://nf.aafp.org/Assessment/Take/306/c/072c0fa7-a524-4828-b3d6-dd9e6500cf91

On entering the room ask:
Who is the nurse ?
Do you have a pulse ?, if not start compressions.
Who is writing ?
IV access, heart monitor - tell me when you have a rhythm, pulse ox, 1 mg of epinephrine ready.
At least 100 compressions / minute.
Heart monitor is now in place
Do we have a shockable rhythm ? If so, shock and continue compressions for 2 min.
At 2 minutes of  compressions:
- Do we have a shockable rhythm ? If so, shock and continue compressions for 2 min.
- Give epi 1 mg 
At 2 minutes of  compressions:
- Do we have a shockable rhythm ? If so, shock and continue compressions for 2 min.
- Give Amiodarone 300 mg bolus
At 2 minutes of  compressions:
- Do we have a shockable rhythm ? If so, shock and continue compressions for 2 min.
- Give epi 1 mg

In a code use these for rapid assessment of reversibles: (There is no reason not to have made a quick pass on the reversible within the first minute of your arrival, or faster).

HARPO K. GAVOT

tHrombosis
- check: history of thrombosis ?, on anticoags ?, last INR
tAmponade
- check: good BP with no narrowing ?, good heart sounds ?, no JVD, 
tRauma
- any recent or relevant trauma history ?
Pnuemo (Tension PTX)
- good bilateral breath sounds ?
tOxin
- what medications has Mr. __ received ?, any toxins possible here ?

K Potassium

Glucose
Acid
Volume 
Oxygen
Temperature

Mg
- is the patient an alcoholic ? Do we have a magnesium level ? Are we in Torsodes ?
- give 1 - 2 gm IV/IO diluted in 10 mL D5W over 5 - 20 minutes

 
 VF/VT - in brief:
give 1 shock
5 cycles CPR
check rhythm
give 1 shock
5 cycles CPR +
1 mg epinephrine IV push at the same time.
check rhythm
see ACLS booklet beyond this point. 


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