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
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
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.
POST-CARDIAC ARREST
Optimize Ventilation and Oxygen
Maintain SaO2 >94 –99 %
Consider advanced airway and ETCO2
Avoid hyperventilationTREAT HYPOTENSION
IV/IO BOLUS
Vasopressor Infusion
Treatable causes H’s & T’s
12 Lead EKG FOLLOW COMMANDS? NO YES Consider Induced Hypothermia STEMI OrHigh Suspicion of AMI
PCI Reperfusion Or Fibrinolytics YES NO Advanced Critical Care
TACHYCARDIA
UNIVERSAL ASSESSMENTReversible 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
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 PacingCARDIAC ARREST ALGORITHM
C
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C
P
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—
M
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START CPR
Give Oxygen
Attach Monitor/DefibrillatorHELP—ACTIVATE EMERGENCY RESPONSE
A
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2 M
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C
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CHECK RHYTHMVF/VT
SHOCK
Drug Therapy IV/IO Access Vasopressor 3-5 min Amiodarone VF/VT CONSIDER ADVANCED AIRWAYTREAT REVERSIBLE CAUSES
H’s & T’s
ROSC
NO
YES
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/kgH & 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 minCPR 2 min
CPR 2 min
Shockable Rhythm? NoCPR 2 min
Advanced Airway PETCO2H & Ts
Hypovolemia Hypoxia Hydrogen Ion (H+) Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Tension Pneumo Thrombosis Pulmonary Coronary TraumaH & Ts
PALS Tachycardia (2010 Guidelines)
Identify and Treat CauseMaintain 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
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