1997 99 Advanced Cardiac Life Support AHA p

取自 1997 -99 Advanced Cardiac Life Support AHA p 4 -2

心外按摩(Cardiac Output 25 -33 %)

Cardiac dysrhythmia

ACLS的流程 1. Tachycardia Stable: drug Unstable: cardioversion (Unstable signs: conscious change, persist chest pain, hypotension, or shock) 2. Bradycardia Atropine, Transcutaneous pacing, dopamine, epinephrine

ACLS的流程-Tachycardia 1. Narrow QRS: PSVT, atrial fibrillation, atrial flutter, multiple atrial tachycardia, junction tachycardia 2. Wide QRS: VT, Vf , SVT with abrrant conduction

ACLS的流程-Tachycardia Cardioversion: Synchronized: PSVT (50 J), atrial flutter (50 J), 其餘多是 100 J開始 (monomorphic VT) Unsynchronized: Vf, polymorphic VT (360 J)

ACLS的流程-Tachycardia Drug: 1. Adenosine: PSVT 2. Amiodarone 3. B-block 4. Calcium channel block 5. Digoxin 6. Mg. SO 4

PSVT

ACLS的流程-Bradycardia 1. Sinus Bradycardia 2. First degree AV block 3. Second degree AV block (Mobitz I and Mobitz II) 4. Complete AV block

Sinus bradycardia

First degree AV block

2 nd degree AV Block Type I

2 nd degree AV block Type II

Complete AV block

治療 1. Atropine (0. 5 mg IV, 3~5分鐘重覆注射, 最大劑量 3 mg) 2. TCP (high degree AV block 要立刻使用) 3. 二線藥物 Dopamine Epinephrine Glucagon (B blocker或Ca channel blocker, 3 mg) (等候節律器或節律器無效時使用)

使用TCP的注意事項 1. Symptomatic bradycardia (class I) 2. Mobitz type II and complete AV block要立 刻使用 3. 疼痛控制 4. 非侵襲性, 緊急時暫時使用 5. 儘快會診專家

使用TCP的準備事項 1. Prepare the patient 2. Clean and dry skin 3. Apply pads 4. Turn the pacer functionality on 5. Select mode (demand or fix) 6. Capture the heart rate 7. Evaluate the patient

Transcutaneous Pacing

Transcutaneous Pacing

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