Intermediate Advance Cardiac Life Support

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Intermediate Advance Cardiac Life Support

• Joyce S. Bradley
• Assistant Professor
• Dona Ana Branch Community College

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Objectives

• Upon completion the student will be able to
• Identify key dysrhythmias
• Vtach
• Vfib
• Sinus rhythm with PVC
• Asystole
• PEA

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Objectives Continued

• Discuss potential causes of the following
  dysrhythmias
• Vtach
• Vfib
• PVCs
• Asystole
• PEA

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Objectives Continued

• Discuss the appropriate treatment modalities for
• Vtach/Vfib
• PVCs
• Asystole
• PEA

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Objectives Continued

• Discuss the appropriate treatment modalities for
• Acute Myocardial Infarction
• Congestive Heart Failure

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Sinus Rhythm

• Electrical Impulse begins originates in the atria
• P wave before every QRS
• PR Interval .12 .20
• QRS .8 lt.10

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Sinus with PVCs

• Underlying rhythm originates in the atria
• Aberrant beat originating in the ventricles
• QRS of the aberrant beat is gt.10

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Vtach

• Electrical Impulse originates in the ventricles
• No P waves
• QRS gt .10

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Vfib

• Multiple stimulation originating in the
  ventricles
• Chaotic firing occurs with no discernable QRS
  noted

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Asystole

• Lacks any form of electrical conduction
• No discernable P waves or QRS
• Commonly referred to as flat line

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Pulseless Electrical Activity

• Cardiac rhythm is organized with discernable P
  waves and QRS
• Is not pulse producing

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DABCC Paramedic Student After a Typical Day of
Lecture
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Causes of Vtach

• Hypoxia
• Electrolyte Imbalances
• Sudden Death Syndrome
• Drug Overdoses
• Hypovolemia

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Causes of Vfib

• Hypoxia
• R on T phenomenon
• Sudden Death Syndrome
• Drug Overdoses
• Electrocutions

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Causes of PVCs

• Hypoxia
• Caffeine
• Electrolyte Imbalances
• Drug Overdoses

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Causes of Asystole

• Hypoxia
• Hypothermia
• Hypovolemia
• Hydrogen Ion
• Hyperkalemia /Hypokalemia

• Tablets
• Tension Pneumos
• Tamponades
• Coronary Thrombosis
• Pulmonary Thrombosis

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Causes of PEA

• Hypoxia
• Hypothermia
• Hypovolemia
• Hydrogen Ion
• Hyperkalemia /Hypokalemia

• Tablets
• Tension Pneumos
• Tamponades
• Coronary Thrombosis
• Pulmonary Thrombosis

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A DABCC Student Who Did Not Do Well On A Block
Exam
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Treatment for Vfib/Vtach

• Assess ABCs
• Attach AED and defibrillate as directed
• Begin CPR
• Secure Airway
• Provide 100 O2
• Obtain IV Assess
• Administer Epi 1/10,000 1mg q 3-5 minutes

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Benefits of Epi 1/10

• Cardiac
• Increase contractility
• Increase rate
• Increase fibrillatory threshold
• Systemically
• Increased vaso-constriction

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Treatment for PVCs

• Assess ABCs
• Attach AED
• Provide high flow O2
• Obtain IV Access
• Assess patient for chest pain
• Transport in position of comfort

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Treatment of Asystole

• Assess ABCs
• Attach AED
• Begin CPR
• Secure Airway
• Provide 100 O2
• Obtain IV Access
• Administer Epinephrine 1/10,000 1 mg q 3-5
  minutes
• Assess 5 Hs and 5 Ts

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Treatment of PEA

• Assess ABCs
• Attach AED
• Begin CPR
• Secure Airway
• Provide 100 O2
• Obtain IV Access
• Administer Epinephrine 1/10,000 1 mg q 3-5
  minutes
• Assess 5 Hs and 5 Ts

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Acute Myocardial Infarction

• Blockage of the coronary artery leading to
  ischemia to a section of the heart
• Extent of damage is dependant on the location of
  blockage and treatment obtained by patient

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Treatment of AMI

• Assess ABCs
• Provide supplemental O2
• Obtain a thorough history
• Attach AED
• Obtain IV access / blood draw
• Obtain BGL

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Treatment of AMI

• Administer Aspirin 180-325 mg
• Administer Nitro 0.4 mg q 3-5 minutes
• Administer morphine 2-20 mg slow IV push (over 2
  minutes)
• Transport in position of comfort

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Congestive Heart Failure

• Inability of the heart to contract with
  sufficient force to circulate volume throughout
  the system
• Can be a result of age, coronary artery disease,
  COPD, or past myocardial infarction

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CHF

• Right Sided Failure
• Can be secondary to pulmonary hypertension
• Inferior Wall MI
• Peripheral edema
• Ascites
• JVD

• Left Sided Failure
• Can be secondary to anterior MI
• Pulmonary Edema

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Treatment of CHF

• Right Sided
• Sit patient upright
• Assess of ABCs
• Supplemental O2
• IV Access
• Assess lung sounds
• Consider fluid bolus of 250 cc

• Left Sided
• Sit patient upright
• Consider positive pressure ventilation
• IV Access
• Assess lung sounds
• Run IV TKO

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Advanced Treatment of CHF

• Nitroglycerin 0.4 mg q 3- 5 minutes to max of 3
  doses
• Vasodilatation
• Morphine 2-4 mg slow IV push with a max of 20
  mgs
• Vasodilatation
• Lasix 40 to 80 mg
• Diuretic
• Please note these medications can only be
  administered by a Paramedic

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Credits

• American Heart Association Advanced Cardiac Life
  Support
• NM Scope of Practice
• NM Treatment Guidelines
• You can obtain this presentation at
  DABCC-NMSU.EDU/HPS/EMS

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Thank You
DABCC Paramedic Class 2004-2005 Valedictorian