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CPR Consultants, Inc.

7404 G Chapel Hill Road, Raleigh, NC, 27607

CRNA ACLS, PALS, & BLS REFRESHER

Attn: Certified Nurse Anesthetists (CRNA)

CRNA American Heart Association Triple Certification (BLS, ACLS, and PALS)

CPR Consultants offers American Heart Association certifications in BLS, ACLS, and PALS to be completed

in one day of training. This is only available for CRNAs.

CPR Consultants understands that CRNAs have advanced training in many of the topics covered in the

American Heart Association courses. CPR Consultants uses this experience, knowledge base, and a unique

blending of eLearning and traditional critical thinking class work to deliver this training in a one day format.

This unique format for American Heart Association training allows for CRNAs to have a time and economic

value to their training experience. Classes are conducted in a small format to allow for maximum amount of

hands on training and critical thinking learning.

CPR Consultants has experts in the field of resuscitation to help deliver this approach.

This is how it works:

1.

Complete the BLS for Healthcare Provider online provided with your class fee, prior to the class

date. This is sent to you in an email format. If not received please check your Spam/Junk email filter.

If not received please contact our office by email

info@cprconsultants.com

or

919-850-9295/866-990-2772

2.

From 8 am – 12 pm, ACLS Renewal is completed.

a.

Science Review

b.

CPR Teaching and Testing – Adult and Infant Skills Check

c.

Review of Respiratory Emergencies

d.

BLS and ACLS Survey

e.

ACS and Stroke Review

f.

Team Approach

g.

Algorithm Review

h.

Putting It All Together

i.

Megacode and Written Testing

3.

From 1 pm – 5 pm, PALS is completed.

a.

Science Review

b.

Pediatric Assessment

c.

Review of Core Cases

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Upper Airway

Lower Airway

Lung Tissue

Disorder of Breathing

Shock Emergencies

Hypovolemic

Obstructive

Distributive

Cardiogenic

Rhythm Recognition and Management

Tachycardia

Bradycardia

Pulseless

VF/VTach

PEA/Asystole

d.

Putting It All Together

e.

Megacode and Written Testing

Please be sure to complete the eLearning BLS Certificate prior to coming to the class date. Instructions are

attached.

Please complete the Pre-Test for ACLS and PALS using the algorithms provided as a guide prior to the class.

If any questions are not clear please be ready to address those questions at the start of class.

To complete the ACLS Pretest

www.heart.org/eccstudent

password: compression

To complete the PALS pretest

www.heart.org/eccstudent

password: palsprovider

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AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) – 2010 ECC GUIDELINES

An Automatic External Defibrillator (AED) is a computerized battery-operated machine that is used to 1) analyze the heart rhythms of an unresponsive person; 2) recognize the abnormal rhythms that requires an electrical shock; 3) advise the operator through voice prompts and lighted indicators when a shock is needed; and 4) deliver the electrical shock to the heart. The prompt use of an AED after a sudden cardiac arrest greatly increases the victim’s chances of survival. During Cardiac Arrest, every minute that goes by without the use of an AED, the patient’s chance of survival decreases by 10%. The goal is to have an AED by the victim and have the AED delivering a shock within 3 minutes if it is available.

Steps for CPR and AED use with 2 rescuers

1. One person checks victim for responsiveness and evaluates for breathing. The rescuer initiates C-A-B. 2nd person activates emergency response team or calls 911 and gets AED if available and will initiate AED use if trained to do

so. Use protected barrier equipment.

2. C = Check for definitive pulse. No pulse then begin chest compressions (30 chest compressions and 2 breaths, 5 sets every 2 minutes) until AED arrives onto the scene. Compression rate: at least 100 per minute.

Compression depth: at least 2 inches for adult, full pressure release but keep hand placement and skin contact on upstroke

3. A = Open airway with a head tilt-chin lift (use a jaw thrust with any suspected head and neck trauma). 4. B = Give 2 breaths if victim not breathing (use barrier devices and supplemental oxygen whenever available). 5. D = Defibrillate by following voice prompts regarding cardiac arrthymias and shock deliverance.

Actions for the AED user

1. POWER ON. Turn on the AED first. (Note: some AEDs automatically "power on" when the lid is opened.) Listen and follow AED voice prompts.

2. ATTACH PADS.. Check pictures on pads to ensure correct placement and attach the AED adhesive electrode pads to the victim. Try to attach the pads while CPR is in progress. Make sure cables are securely connected to AED.

3. "CLEAR" TO ANALYZE. Make sure everyone is not touching the victim before and during analysis, saying “I’m clear, you’re clear, everybody’s clear.” Visually scan the victim from head to toe to make everyone is cleared away.

4. "CLEAR" TO DELIVER SHOCK. Check again that the victim is clear of human contact, saying “I’m clear, you’re

clear, everybody’s clear" and look to check that no one is touching the victim before pushing shock button.

5. NUMBER OF SHOCKS DELIVERED The AED may shock up to two more times if AED signals “shock indicated”.

Clear the victim before every analysis and again before each shock is delivered. With the new AHA Guidelines 2010, AHA is recommending AED’s shock only once every 2 minutes. Follow the prompts of the AED.

6. NO SHOCK INDICATED MESSAGE. Begin compressions immediately after shock or no shock advised Resume CPR for 2 minutes. Switch rescuers to perform compressions every 2 minutes if available. Re- analyze rhythm and follow the voice prompts regarding shock deliverance steps. If victim is breathing normally, carefully turn the victim onto his side (recovery position) if there is no suspected head/neck injury. Otherwise do not move the victim and maintain an open airway.

7. Do not remove the AED pads once they are in place! Once EMS arrives, they may replace pads if needed to use their own medical equipment.

Special conditions to consider while using an AED

 It is currently recommended that adults, children, and infants in cardiac arrest have the AED applied. If using adult pads on children or infants, one pad may be placed on the chest and the other pad on the back (anterior – posterior placement)

 If victim is wet, dry the chest off before attaching and using AED. If victim is in water, remove them from water and dry the chest before using AED.

 If victim has an implanted defibrillator or pacemaker (a hard lump under the skin) do not put AED directly over the device - place the pad at least one inch away from any implanted machines.  If victim has medication patch on skin, remove the patch and wipe skin dry before attaching AED pads.  If victim has a very hairy chest, you may have to dry shave the area so the AED pads can be attached.

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POST-CARDIAC ARREST

Optimize Ventilation and Oxygen

Maintain SaO2 >94 –99 %

Consider advanced airway and ETCO2

Avoid hyperventilation

TREAT HYPOTENSION

IV/IO BOLUS

Vasopressor Infusion

Treatable causes H’s & T’s

12 Lead EKG FOLLOW COMMANDS? NO YES Consider Induced Hypothermia STEMI Or

High Suspicion of AMI

PCI Reperfusion Or Fibrinolytics YES NO Advanced Critical Care

TACHYCARDIA

UNIVERSAL ASSESSMENT

Reversible Causes? H’s & T’s

 Airway? BVM as necessary

 Oxygen if Hypoxic

 Pulse, and Blood Pressure

 Cardiac Monitor

 IV Access

 12 Lead EKG. DO NOT delay therapy

Persistent tachyarrhythmia with HYPOPERFUSION:  Hypotension

 Altered Mental Status

 Shock

 Ischemic Chest Pain/ discomfort

 Acute heart failure

YES SYNC Cardioversion  Consider Sedation  If regular narrow complex, consider adenosine HR typically > 150 BPM NO Wide QRS? > .12 second YES

 Consider Adenosine if regular and monomorphic

 Consider antiarrhythmic infu-sion  EXPERT CONSULTATION  Vagal Maneuvers  Adenosine (SVT) 6mg IV Bolus 12mg IV Bolus  β-Blocker or Calcium Channel Blocker  EXPERT CONSULTATION NO

Wide Complex Antiarrhythmic Infusion  Procainamide - 20-50 mg/min

 Amiodarone - 150 mg over 10 min

 Sotalol - 100 mg (1.5 mg/kg) over 5 min

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BRADYCARDIA WITH A PULSE

Heart Rate typically < 50 BPM with complaint UNIVERSAL ASSESSMENT

Reversible Causes? H’s & T’s

 Airway? BVM as necessary

 Oxygen if Hypoxic

 Pulse, and Blood Pressure

 Cardiac Monitor

 IV Access

Persistent bradyarrhythmia with HYPOPERFUSION:

 Hypotension

 Altered Mental Status

 Shock

 Ischemic Chest Pain/discomfort Monitor and Observe

Expert Consultation

NO

YES

CONSIDER ATROPINE

Atropine Dose:

- First Dose: 0.5 mg IV Bolus - Repeat Dose: 0.5 - 1 mg IV Bolus

Repeat every 3 - 5 minutes Max total dose: 3 mg

If Atropine is not effective:

- Transcutaneous Pacing OR

- Dopamine infusion - 2-10 mcg/kg/min OR

- Epinephrine infusion - 2-10 mcg min

Consider

: Expert Consultation Transvenous Pacing

CARDIAC ARREST ALGORITHM

C

O

N

T

I

N

U

O

U

S

C

P

R

M

O

N

I

T

O

R

C

P

R

START CPR

Give Oxygen

Attach Monitor/Defibrillator

HELP—ACTIVATE EMERGENCY RESPONSE

A

T

2 M

IN

U

TE C

Y

C

LE

RE

-EV

A

LU

A

TE

R

HY

THM

E

T

C

O

2

M

A

P

CHECK RHYTHM

VF/VT

SHOCK

Drug Therapy IV/IO Access Vasopressor 3-5 min Amiodarone VF/VT CONSIDER ADVANCED AIRWAY

TREAT REVERSIBLE CAUSES

H’s & T’s

ROSC

NO

YES

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PALS Assessment

Evaluate—Identify—Intervene Alert Breathing

Skin Color

Primary Assessment

Airway—Patent ?

Breath-Breathing—SaO2? Rate?

Work of Breathing? Supplemental O2?

Respiratory Emergency Circulatory Emergency

Rhythm Tachycardia 0-1y/o >220 BPM > 1 y/o >180 BPM Bradycardia HR < 60 BPM CPR Pulseless VF/VT Or PEA/Asystole Shock Hypovolemic - Nonhemorrhagic - Hemhorrhagic Obstructive - Cardiac Tamponade - Tension Pneumo - Pulmonary Emboli - Congenital Lesions Distributive - Septic - Anaphylactic - Neurogenic Cardiogenic - pulmonary edema - venous congestion - cardiomegaly Fluids 5-10 ml/kg Respiratory Distress vs Failure? Peds Assessment Triangle

Evaluate B/P 0-1 y/o >60-70 systolic 1-10 y/o > (age x 2) + 70 > 10 y/o > 90 systolic Upper Airway - Croup - Anaphylaxsis - Foreign Body Lower Airway  Asthma/RAD  Bronchiolitis Lung Tissue Disease - Infectious Pneumonia - Aspiration - Chemical Exposure - ARDS - Pulmonary Edema Disorder of Breathing - Drug overdose - Poisoning - Increased ICP - Neuromuscular Disease Circulation— Skin Color/Temp Heart Rate-Heart Rhythm -B/P Pulses—Cap Refill Disability— AVPU Response GCS— Pupillary Response Exposure Secondary Survey HISTORY Signs and Symptoms Allergies

Medications Past Medical History Last Meal

Events

Detailed Physical “Head to Toe” Assessment Tertiary Assessment SaO2— 94-99% Bedside Glucose ABG PETCO2 Monitoring Chest X-Ray Expiratory Peak Flow CAT Scan

20cc/kg isotonic crystalloid

Intravenous Intraosseous

PALS CARDIAC ARREST

Call for Help/Activate Code Team START CPR (Hard and Fast)

Give Oxygen Attach Monitor/Defibrillator

Shockable

VF/VT

Asystole/PEA

YES NO Shockable Rhythm? CPR 2 min IV/IO access Shockable Rhythm?

CPR 2 min

Advanced Airway PETCO2 Amiodarone 5mg/kg

H & Ts

Defibrillate 2-4 j/kg Defibrillate 4j/kg Epi .01 mg/kg q 3-5 min Defibrillate 4j/kg CPR 2 min IV/IO access Shockable Rhythm? No Epi .01 mg/kg q 3-5 min

CPR 2 min

CPR 2 min

Shockable Rhythm? No

CPR 2 min

Advanced Airway PETCO2

H & Ts

Hypovolemia Hypoxia Hydrogen Ion (H+) Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Tension Pneumo Thrombosis Pulmonary Coronary Trauma

H & Ts

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PALS Tachycardia (2010 Guidelines)

Identify and Treat Cause

Maintain Airway Monitor Pulse Oximetry and B/P Oxygen, IV/IO, Csrdisc Monitor, 12 Lead if available

Evaluate QRS Width Evaluate Rhythm

Probable Sinus Tach Hx suggests known cause

P wave present Regular R-R and PR interval

Infants: <220 BPM Children: <180 BPM

Probable SVT Vague, non-specific hx Abrupt Rate Changes in HR

P waves absent/abnorm Regular R-R and PR interval

Infants: >220 BPM Children: >180 BPM Probable V Tach QRS wide >.09 sec Cardiopulmonary Compromise? Hypotension Altered Mental Status

Signs of Shock Treat Reversible Causes Hs & Ts YES Cardiopulmonary Compromise? Hypotension Altered Mental Status

Signs of Shock NO YES NO Consider Adenosine if regular and mono-morphic Expert consulta-tion advised SYNC Cardio-version Consider Vagal

Maneuvers Consider Vagal Maneuvers

NO DELAYS

If IV/IO present,give adenosine

OR

IF IV/IO Access is not available, or if adenosine is ineffective,

SYNC Cardioversion

Establish vascular access Consider adenosine 0.1 mg/kg IV/IO (max 6 mg) Second dose adenosine 0.2 mg/kg IV/IO (max 12mg) CARDIOVERSION 0.5 to 1 J/kg (may increase if initial dose ineffective) Sedate before Cardiover-sion

Bradycardia

<60 BPM

CARDIOPULMONARY COMPROMISE?? Identify and Treat Underlying Causes Airway and Breathing

SaO2? Oxygen? Respiratory Failure? Circulation

Cardiac Monitor—Blood Pressure- - Skin Color—Cap Refill IV/ IO established 12 Lead EKG HR< 60 BPM START CPR Bradycardia Persists? Cardiopulmonary Compromise  Altered Mental Status

 Signs of Shock  Respiratory Failure  Hypotension NO YES  Epinephrine .01 mg/kg Airway Breathing Circulation Observe

CONSIDER EXPERT CON-SULTATION Bradycardia Persists? NO YES  Repeat Epinephrine  Consider Atropine  Consider Pacing  Treat Hs & Ts

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Basic Life Support for Healthcare Providers

2010 Guidelines

Recommendations

Adult Child Infant

Unresponsive

No Breathing or only gasping/agonal breathes

Evaluation

No pulse palpated within 10 seconds

CPR Sequence

Compressions – Airway – Breathing

Compression Rate

> 100/minute

Compression Depth

> 2 inches

> 1/3 Diameter of

Chest

Approx 2 inches

> 1/3 Diameter

of Chest

Approx 1.5

inches

Chest Wall Recoil

Allow complete recoil between compressions

Rotate Compressors every 2 minutes

Compression Interruptions

Minimize Interruptions

Limit interruptions to less than 10 seconds

Airway

Head Tilt – Chin Lift (suspected Trauma: Jaw Thrust)

Compression:Ventilation

Ratio

With Basic Airway – BVM or Mask

30:2

1 or 2 rescuers

30:2 One Rescuer

15:2 Two Rescuer

Ventilations with

Advanced Airway

1 breath every 6 – 8 seconds (8-10 breaths/minute)

Continuous compressions while ventilations are

delivered

Defibrillation

Use AED as soon as available.

Continue compressions while applying AED if second

rescuer is available.

MINIMIZE INTERRUPTIONS

Resume CPR Starting with Compressions

References

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