Draft

55  ACLS

55.1 What this covers

  • Shockable Rhythms
  • Non-shockable rhythms
  • Hypovolemia – fluid, blood products, stop bleeding, clamp vessels

55.2 Learning objectives

  • Shockable Rhythms
  • Non-shockable rhythms
  • Hypovolemia – fluid, blood products, stop bleeding, clamp vessels
  • Hypoxia – intubation and ventilation (FiO2 1.0)
  • Hypokalemia – K+ replacement
  • Hyperkalemia – treat cause, Ca2+ gluconate 10mL 10%, insulin-dextrose, salbutamol, NaHCO3
  • Metabolic disorders – Mg2+ if low, Ca2+ if low, consider bicarbonate for acidaemia (e.g. with normal anion gap)

55.3 Bottom line / summary

  • Littman Approach: Narrow (<0.12) vs Wide (0.12+) QRS
  • Narrow: mechanical problems (RV inflow or outflow) Wide metabolic, ischemic, or left ventricle
  • Specific reversals: from https://litfl.com/pulseless-electrical-activity/
  • Hypovolemia – fluid, blood products, stop bleeding, clamp vessels
  • Hypoxia – intubation and ventilation (FiO2 1.0)

55.4 Approach

  1. Hypovolemia – fluid, blood products, stop bleeding, clamp vessels
  2. Hypoxia – intubation and ventilation (FiO2 1.0)
  3. Hypokalemia – K+ replacement
  4. Hyperkalemia – treat cause, Ca2+ gluconate 10mL 10%, insulin-dextrose, salbutamol, NaHCO3
  5. Metabolic disorders – Mg2+ if low, Ca2+ if low, consider bicarbonate for acidaemia (e.g. with normal anion gap)

55.5 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

55.6 Common pitfalls

  • TODO: Capture common errors or missed steps.

55.7 References

  • https://litfl.com/pulseless-electrical-activity/

55.8 Source notes

55.8.1 ACLS

56 ACLS

56.1 Shockable Rhythms

56.2 Non-shockable rhythms

Littman Approach: Narrow (<0.12) vs Wide (0.12+) QRS

Narrow: mechanical problems (RV inflow or outflow) Wide = metabolic, ischemic, or left ventricle

Specific reversals: from https://litfl.com/pulseless-electrical-activity/

  • Hypovolemia – fluid, blood products, stop bleeding, clamp vessels
  • Hypoxia – intubation and ventilation (FiO2 1.0)
  • Hypokalemia – K+ replacement
  • Hyperkalemia – treat cause, Ca2+ gluconate 10mL 10%, insulin-dextrose, salbutamol, NaHCO3
  • Metabolic disorders – Mg2+ if low, Ca2+ if low, consider bicarbonate for acidaemia (e.g. with normal anion gap)
  • Hyperthermia – cool, dantrolene for malignant hyperthermia
  • Hypothermia– warm
  • Toxicity – stop absorption, increase elimination, antidote to specific drug
  • Tension pneumothorax – decompress (needle or finger thoracostomy prior to intercostal catheter)
  • Tamponade – pericardiocentesis, open chest
  • Thromboembolism – thrombolysis (proven or suspected pulmonary embolus) +/- surgical embolectomy

56.3 Source materials