Transcript Algorithm Approach to ACLS Emergencies 高級心臟救命術聯合委員會 林口長庚醫院急診醫學科

Algorithm Approach to ACLS
Emergencies
高級心臟救命術聯合委員會
林口長庚醫院急診醫學科
陳日昌
Key Principles in the
Application of ACLS
 The
Importance of Time
 The "Periarrest" Period
 Never Forget the Patient
Code Organization
 Primary
and Secondary ABCD Surveys
Primary ABCD Survey
 Airway:
with noninvasive techniques.
 Breathing: with positive-pressure
ventilations
 Circulation: CPR until an AED
 Defibrillation: assessing the cardiac
rhythm for VF/VT and providing
defibrillatory shocks
Secondary ABCD Survey
 Airway: Advanced
rescuers manage a
compromised airway by placing a
tracheal tube.
Secondary ABCD Survey
 Breathing: Assess
adequacy of breathing
and ventilation by checking tube
placement and performance; correct all
problems detected. Manage breathing by
treating inadequate ventilation with
positive-pressure ventilations through the
tube
Secondary ABCD Survey
 Circulation: Assess
and manage the
circulation of blood and delivery of
medications by —Starting a peripheral
IV line —Attaching ECG leads to
examine the ECG for the most frequent
cardiac arrest rhythms (VF, pulseless VT,
asystole, and PEA) —Administering
appropriate rhythm-based medications
Secondary ABCD Survey
 Differential
Diagnosis: Assess and
manage the differential diagnoses that
you develop as you search for, find, and
treat reversible causes
Understanding the Algorithm
Approach to ACLS
 Observation:
series of decision-making
points or "decision nodes."
 Action: identify the problems present at
the decision node and then select the
proper action to take
The Structure of the Algorithms
 Observational
boxes: curved corners
 Action boxes: square corners
BLS algorithm
 Check
responsiveness
 Open the airway
 Check breathing
 Give 2 effective breaths
 Assess circulation
 Compress chest (no signs of circulation
detected)
All cardiac arrest victims
 VF/VT
rhythms
 Non-VF rhythms
asystole and PEA
All cardiac arrest victims
receive the same 4 treatments
 CPR
 Tracheal
intubation
 Vasoconstrictors
 Antiarrhythmics
International ACLS Algorithms
 ILCOR
Universal/International ACLS
Algorithm
 Comprehensive ECC Algorithm
 VF/Pulseless VT Algorithm
 Pulseless Electrical Activity Algorithm
 Asystole: The Silent Heart Algorithm
 Bradycardia Algorithm