You are on page 1of 22

ACLS-

Shockable Rhythms
Dr. Obed Morara
MBCHB,DBIT, Resident Thoracic and Cardiovascular Surgery
Learning outcomes
The ACLS algorithm

Importance of high quality chest compressions

Treatment of shockable
Administration of drugs during cardiac arrest (Shockable)

Potentially reversible causes of cardiac arrest (Shockable)


Adult ACLS
Algorithm
To confirm cardiac arrest

Patient response

Open airway

Check for normal


breathing
Caution agonal breathing

Check pulse
Cardiac arrest confirmed activate emergency response team
Cardiac arrest confirmed
CPR ongoing
30:2
Compressions
Centre of chest
5-6 cm depth
Target (100-120 min-1)
Maintain high quality compressions with
minimal interruptions
Continuous compressions once airway
secured
Switch CPR provider every 2 min cycle to
avoid fatigue
IV/IO Access Obtained
Connect to monitor
Vascular access

Peripheral versus
central veins

Intraosseous
Shockable and Non-Shockable
START PAUSE

Shockable
(VF / Pulseless VT)
CPR
Assess
rhythm

Non-Shockable
(PEA / Asystole)

MINIMISE INTERRUPTIONS IN CHEST COMPRESSIONS


Shockable (VF)

Bizarre irregular waveform Uncoordinated electrical


No recognisable QRS activity
complexes Coarse/fine
Random frequency and Exclude artefact
amplitude Movement
Electrical interference
Shockable (VT)

Monomorphic VT Polymorphic VT
Broad complex rythm Torsade de pointes
Rapif rate
Constant QRS morphology
Shockable (VF / VT)

RESTART
CPR

Assess
rhythm
Shockable (VT)

CHARGE
DEFIBRILLATOR

Assess
rhythm
Shockable (VF / VT)

DELIVER
SHOCK

Assess
rhythm
Shockable (VF / VT)

IMMEDIATELY
RESTART CPR

Assess
rhythm
Shockable (VF / VT)

IMMEDIATELY
RESTART CPR

Assess
rhythm

MINIMISE
MINIMISE INTERRUPTIONS
INTERRUPTIONS IN
IN CHEST
CHEST COMPRESSIONS
COMPRESSIONS
Defibrillation energies
Vary with manufacturer

Check local equipment

If unsure, deliver highest available energy

DO NOT DELAY SHOCK

Energy levels for defibrillators on this course


If VF / VT persists
Deliver 2nd shock
1st shock 120J
2nd and subsequent
CPR for 2 min shocks. Can go higher
During CPR 120 200 J biphasic
Adrenaline 1 mg IV 360 J monophasic

Give adrenaline every 3 to


Deliver 3rd shock 5 min
Give Amiodarone after
the 3rd shock 300mg
CPR for 2 min Subsequent Amio at
During CPR 150mg
Amiodarone 300 mg IV
Immediate post-cardiac arrest treatment
Any questions?
Summary
The ACLS algorithm

Importance of high quality chest compressions

Treatment of shockable
Administration of drugs during cardiac arrest (shockable)

Potentially reversible causes of cardiac arrest (Shockable)