ACLS: Specific Algorithm Question

[cytanaka]

Hi, just finished Day #1 of 2 of ACLS today. Quick question while I review...

Say a conscious patient has ekg monitoring and is in stable bradycardia. Then, he becomes unresponsive and v-tach is on the ekg.
Do you go through the BLS check before you do the rest of the pulseless algorithm? So, do you take the time to check for breathing, give 2 rescue breaths and then check pulse?

Thanks

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[waterski232002]

If it's V-tach, you definitely have to re-assess the patient. Unlike V-fib which is always pulseless, V-Tach can be stable, unstable, or pulseless. Depending on which form of V-Tach you have, you will treat differently.

Pt is alert and no complaints --> Stable V-tach --> Amio
Pt has become confused, hypotensive, c/o CP or SOB --> Sync cardiovert
Pt is unresponsive and pulseless --> Defibrillate

Ideally, you should shock as soon as possible, although the revised 2005 guidelines suggest that chest compressions may actually be beneficial before administering a shock. Definitely do compressions until your defibrillator is charged up, then you shock once at maximum capacity. There are no more 3 stacked shocks, and you should not check a pulse immediately after administering a shock. Re-start CPR immediately, and check a pulse in 1 minute. A large percentage of patients will transiently go into asystole or PEA before converting into an organized rhythm after defibrillation... that's why the new guidelines state to check a pulse 1 minute after defibrillation.

 

[cytanaka]

Thanks for the reply.

So, let's then take the case of stable brady -> v-fib.

I know you gotta deliver a shock immediately, but do you take the time to give 2 rescue breaths first to ensure you have an airway?

 

[Planktonmd]

Thanks for the reply.

So, let's then take the case of stable brady -> v-fib.

I know you gotta deliver a shock immediately, but do you take the time to give 2 rescue breaths first to ensure you have an airway?

If you have the defibrilator connected and ready just shock, otherwise you start CPR as you do for a witnessed arrest (yes you do the stupid 2 breath thing and start compressions) until the defib is ready.

 

[cytanaka]

thanks you guys!

 

[VentdependenT]

A giant sternal crushing chest thump is also warrented. Just for the hell of it.

 

[waterski232002]

We did a precordial thump the other day on a guy who had a witnessed v-fib arrest in triage. It didn't work. Neither did the 5 shocks and 2 rounds of amio.

 

[Planktonmd]

We did a precordial thump the other day on a guy who had a witnessed v-fib arrest in triage. It didn't work. Neither did the 5 shocks and 2 rounds of amio.

It does work sometimes.

 

[bubalus]

A giant sternal crushing chest thump is also warrented. Just for the hell of it.

Just make sure he's not in asystole because the EKG cable came loose. He might get a little miffed with the precordial thump.

 

[jwk]

Unresponsive and in V-Tach is, by definition, unstable V-Tach.

 

[waterski232002]

Unresponsive and in V-Tach is, by definition, unstable V-Tach.

Not necessarily.... It's unstable V-Tach only if there is still a pulse. If there is no pulse, than it's pulseless V-Tach.