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Advanced Cardiac Life Support (ACLS) Protocols
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Ventricular Fibrillation
1. Initiate CPR. 2. Administer shock via defibrillator. 3. Continue CPR immediately after shock. 4. Administer Epinephrine every 3-5 minutes. 5. Consider advanced airway and capnography.
Asystole
1. Confirm the absence of a pulse. 2. Begin CPR immediately. 3. Administer Epinephrine every 3-5 minutes. 4. Do not defibrillate. 5. Search for reversible causes.
Pulseless Electrical Activity (PEA)
1. Confirm the absence of a pulse with electrical cardiac activity present. 2. Begin CPR immediately. 3. Administer Epinephrine every 3-5 minutes. 4. Search for and treat reversible causes.
Supraventricular Tachycardia (SVT)
1. Stable patient: attempt vagal maneuvers. 2. If unsuccessful, administer Adenosine. 3. Consider synchronization cardioversion if Adenosine is ineffective. 4. Treat underlying cause.
Atrial Fibrillation with Rapid Ventricular Response
1. Stable patient: rate control with beta-blockers or calcium channel blockers. 2. If unstable, prepare for synchronized cardioversion. 3. Anticoagulation therapy consideration for stroke prevention. 4. Address underlying causes.
Bradycardia with a Pulse
1. If symptomatic, prepare for transcutaneous pacing. 2. Administer Atropine as the first-line drug. 3. Dopamine or Epinephrine infusion can be second-line treatments. 4. Identify and manage underlying causes.
Acute Coronary Syndrome (ACS)
1. Immediate 12-lead ECG. 2. Administer aspirin and consider nitroglycerin. 3. Pain management typically with opioids such as Morphine. 4. Beta-blockers and antithrombotic therapy may be included in the treatment. 5. Urgent reperfusion therapy with PCI or fibrinolysis in case of STEMI.
Torsades de Pointes
1. Magnesium sulfate is the treatment of choice. 2. If unstable with a pulse, synchronized cardioversion. 3. Address underlying causes including electrolyte abnormalities.
Stroke
1. Assess using FAST (Face, Arms, Speech, Time) acronym. 2. Immediate CT scan or MRI. 3. Fibrinolytic therapy if indicated and within the time window. 4. Supportive care and neurology consultation.
Hypovolemia
1. Administer isotonic crystalloid fluids. 2. Control source of volume loss. 3. Reassess patient regularly to avoid fluid overload. 4. Administer blood products if indicated.
Hyperkalemia
1. Stabilization of cardiac membranes with Calcium Gluconate or Calcium Chloride. 2. Insulin with glucose to shift potassium intracellularly. 3. Diuretics or dialysis for potassium removal if needed. 4. Monitor ECG and repeat potassium levels.
Hypokalemia
1. Oral or IV potassium supplementation. 2. Monitor for signs of digoxin toxicity if applicable. 3. Continuous ECG monitoring for arrhythmias. 4. Replete magnesium if deficient.
Hypomagnesemia
1. Administer Magnesium Sulfate IV. 2. Monitor closely for adverse effects, especially with renal impairment. 3. Check serum magnesium levels and replete accordingly. 4. Address underlying causes and associated electrolyte imbalances.
Hyperthermia
1. Remove patient from the hot environment. 2. External cooling methods (cooling blankets, ice packs, fans). 3. Hydration with oral or IV fluids. 4. Antipyretics are generally ineffective for non-fever hyperthermia.
Hypothermia
1. Passive rewarming with blankets. 2. Active external rewarming with heating pads, warmed IV fluids. 3. Advanced measures include extracorporeal rewarming. 4. Continuous cardiac monitoring as hypothermia can cause arrhythmias.
Aortic Dissection
1. Pain control, typically with IV opioids. 2. Antihypertensive therapy to lower blood pressure immediately. 3. Surgical consultation for possible repair. 4. Continuous hemodynamic monitoring.
Pulmonary Embolism (PE)
1. Evaluate for hypoxia and hemodynamic instability. 2. Anticoagulation therapy initiation. 3. Thrombolytic therapy for massive PE if stable. 4. Consider surgical embolectomy or catheter-directed therapy in certain cases.
Tension Pneumothorax
1. Immediate needle decompression. 2. Followed by chest tube placement. 3. Secure and monitor for re-expansion and potential re-accumulation. 4. Treat associated respiratory distress.
Cardiac Tamponade
1. Pericardiocentesis to remove fluid from pericardial space. 2. Intravenous fluids to maintain blood pressure. 3. Urgent echocardiography to confirm diagnosis. 4. Surgical consultation if required for recurrent effusions.
Hypertensive Emergency
1. Lower the blood pressure gradually (25% reduction in first hour). 2. Intravenous antihypertensive medications. 3. Monitor closely for end-organ damage. 4. Transition to oral medications once stabilized.
Anaphylaxis
1. Administer intramuscular Epinephrine immediately. 2. Airway management may be necessary for severe respiratory symptoms. 3. Intravenous fluids for hypotension and shock. 4. Monitor for biphasic anaphylaxis.
Sepsis
1. Early antibiotics following cultures. 2. Aggressive fluid resuscitation. 3. Vasopressors for refractory hypotension. 4. Monitor lactate levels and organ function.
Status Epilepticus
1. Benzodiazepines are first-line treatment. 2. IV antiepileptic drugs if seizures persist. 3. Intubation may be necessary for prolonged seizures. 4. Identify and manage underlying cause.
Acute Asthma Exacerbation
1. High-dose inhaled beta2-agonists. 2. Oral or IV corticosteroids. 3. Monitor for respiratory fatigue and possible need for ventilatory support. 4. Magnesium sulfate for severe exacerbations.
Acute Heart Failure
1. Noninvasive positive pressure ventilation for respiratory distress. 2. Diuretics for volume overload. 3. Vasodilators if blood pressure is elevated. 4. Inotropic agents if hypoperfusion persists despite adequate filling pressures.
Hypoglycemia
1. Administer oral glucose if patient is conscious and able to swallow. 2. IV Dextrose or IM Glucagon if patient is unconscious or cannot swallow. 3. Monitor blood glucose levels frequently. 4. Identify and treat underlying cause.
Hyperglycemic Hyperosmolar State (HHS)
1. Aggressive IV fluid resuscitation. 2. Insulin therapy after initial volume repletion. 3. Electrolyte monitoring and repletion. 4. Monitor for signs of cerebral edema.
Diabetic Ketoacidosis (DKA)
1. IV fluid resuscitation. 2. Insulin therapy with continuous infusion. 3. Electrolyte monitoring and repletion, especially potassium. 4. Assess and treat the precipitating cause.
Opioid Overdose
1. Assure airway patency and support ventilation. 2. Administer Naloxone to reverse respiratory depression. 3. Monitor for withdrawal symptoms and repeat Naloxone as needed. 4. Consider activated charcoal if oral opioid ingestion is suspected.
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