ACLS Adult Cardiac Arrest Algorithm - PEA/Asystole

hi I'm mark for ACLS certification Institute and in today's video we're gonna review another arrest algorithm with the focus on asystole and peña so let's take a look at our arrest algorithm of course it starts with establishing unresponsiveness getting some help coming activate the EMS or color code if you're in the hospital you're going to make sure they have an airway bagging them assessing the rhythm and then we're going to see is this a shockable rhythm or not if it's not a shockable rhythm is the patient in asystole or PE eight now I know what you're thinking when we're talking about asystole and PE a you're probably thinking this and you wouldn't be wrong asystole in PE a carry with them horrible outcomes dismal prognosis is usually these are end-of-life rhythms PE a and asystole so don't get your hopes up but what we're looking for is should this occur suddenly is there reversible causes or something we can do to fix this immediately so starting with asystole the name asystole has nothing to do with the rhythm it doesn't describe the electrical activity systole is actually Greek for contractions a the prefix means without so asystole means without contractions on the monitor it'll appear like this a flatline there is no electrical activity in the heart thus no contractions no cardiac output dead gang according to the AAA guidelines we're going to start chest compressions immediately and should this asystole occur at a younger person start chest compressions immediately we need to find a cause we need to be looking for y2 this patient become a systolic the guidelines recommend epinephrine be administered one milligram every three to five minutes and reassess the patient while you're trying to find a cause next PE a pulseless electrical activity PE a used to be called EMD back in the day which stood for electrical mechanical disassociation and what we have in peña is any organized rhythm that's not generating a palpable pulse I go on further to say it's a rhythm that should have a pulse for example let's look at this rhythm right here what does that look like you same thing it looks like to me a normal sinus rhythm except in this case the patient has no pulse no appreciable pulse with this rhythm but they should but they don't and that's what makes the PE a PE is not a rhythm it's a state it's a condition now there's three rhythms that can't be PE 8:1 v-fib v-tach and asystole why because we wouldn't expect a pulse with these rhythms PE a is an organized electrical activity where we expect to see a pulse but we don't have one looking at our algorithm the treatment again epinephrine and continuous chest compressions we need to focus on what is the cause of this why does this patient have a pulseless electrical activity state when the two leading causes of PE and the adult population hypovolemia and hypoxia address the airway you're going to be bagging in with chest compressions consider an advanced airway early because they're not generating a pulse peripheral IV vascular access may be difficult to obtain don't waste any time go straight to IO infusion it's fast reliable and you can put a lot of fluid in through an IO so do not hesitate gain IO access on this patient tank them up get some fluid and then see if that's a reversible cause now they estimate that it takes a pressure between 40 and 60 systolic to actually generate a peripheral pulse in PE a and this pulseless electrical activity they may still have contraction they may still be moving blood forward we just can't feel it so maybe a quick Doppler listen for heart tones to see are we generating heart tones and what creates heart tones valves opening and closing what causes those valves to open and close pressure changes within the chambers of the heart the papillary muscles and the chordae tendineae do nothing to open and close the valves all they do is keep the valve from going too far but if you're hearing heart tones that means that valves are opening and closing more you have pressure within the chambers of the heart that are causing those valves to open and close and make that sound again consider hypovolemia tank your patient up if appropriate when we go back and we look at the algorithm for PA and asystole we can see if there's not a whole lot going on we have chest compressions and we have epinephrine and we're doing those so we can buy some time and figure out what's going on when it comes to asystole a PA you have to very quickly become this guy well with the medical detection unit I'm here investigating the possible causes of this PA or asystole like any good medical detective when it comes to PE a we need to look for clues and a great place to start is by looking at the cardiac rhythm if the rhythm is narrow complex and tachycardic that tells us a couple of things a couple of clues one it's narrow complex which means the electrical activity is taking a fairly normal pathway the heart's doing okay but it's tachycardic it's fast it's compensating usually for a volume loss so if you have a narrow complex tachycardia pe a rhythm be thinking hypovolemia and fluids may be the answer as opposed to a wide slow peña this is usually a dying heart hypoxic and dying not good but they're great clues to start with to determine what is the cause of this PE a remember the goal in a pulseless electrical activity is to find the underlying cause and we have a list of our usual suspects who are they the HS and TS that's who we need to question interrogate and see if one of these characters is responsible for this pulseless electrical activity find it identify it and fix it quickly I'm mark for ACLS certification Institute thank you for watching and I will see you in our next video a CLS certification Institute is now brought to you by career step comm look at your career then step up to career step comm

Channel: ACLS Certification Institute

Views: 585,839

Keywords: paramedic, Nurse, Doctor, Dentist, Firefighter, EMS, Flight Paramedic, Emergency Resuscitation

Id: mYtKqRVjbkE

Length: 6min 53sec (413 seconds)

Published: Tue Jan 19 2016