algorithms bradycardia with a pulse stable cardiopulmonary status cardiopulmonary compromise ...

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REVIEW OF PALS ALGORITHMS

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Page 1: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

REVIEW OF PALS ALGORITHMS

Page 2: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Algorithms Bradycardia with a Pulse

Stable Cardiopulmonary statusCardiopulmonary Compromise

Tachycardia with Pulses and Poor PerfusionSinus TachycardiaSupraventricular TachycardiaVentricular Tachycardia

Pulseless ArrestVentricular Fibrillation vs. Ventricular TachycardiaAsystole vs. PEA

Septic Shock

Page 3: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Steps involved when called to evaluate a patient Help can be called for at any time!!! The sooner the better! #1

LOOK AT YOUR PATIENT!! Sick or not sick

#2 Examine

#3 Cardiac Monitor

#4 Check wires/tubing

#5 Call for help and Establish Roles

#6 Identify Algorithm

#7 Resuscitation Supplies/Meds

Page 4: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Sick or Not Sick?

Page 5: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Sick or Not Sick

Page 7: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Examine

Get history (RN/family concerns, HPI, hospital course)

Vital signs (trends and current) Physical Exam (ABC’s)

AirwayBreathingCardiovascular

Page 8: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Physical Exam

AirwayCan patient speak or cry?Look: for respiratory distress (i.e. grunting,

flaring retractions), choking, cyanosisListen: air movement in neck and chest,

quality (stridor, wheeze, etc..), I:E, RRFeel: movement from mouth, nose, chest

rise, crepitusAssess: can airway be maintained with

basic maneuvers/positioning, suction

Page 9: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Physical Exam Breathing

Is patient moving sufficient air in and out to maintain effective oxygenation and ventilation?

Look: RR, trachea position, symmetry of chest rise, accessory muscles, skin color

Listen: symmetry and quality, adequacy of air movement, intrathoracic sounds (stridor, crackles, wheeze)

Feel: subcutaneous air, tenderness, instability of chest wall

Assess: stable or not? Respiratory failure? BMV? Intubate? Trumpets?

Page 10: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Physical Exam Cardiovascular

Adequate circulation to support end-organ function?Look:

○ poor perfusion: cyanosis, mottling, pallor, altered mental status

○ Chest trauma: asymmetry of chest expansion○ Jugular Venous Distention

Listen○ Heart rate: tachycardic vs. bradycardic vs. normal○ Heart tones: murmur, rub, gallop○ Breath sounds: rales vs. wheeze○ Diminished Breath sounds

Feel○ Central pulses, temperature of skin, capillary refill

Assess○ Adequate vs. inadequate vs. absent

Page 11: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Cardiac Monitor Know what the numbers on the monitor mean Make sure connections are correct and

wires/leads actually attached to the patientLead placement: White is right, Smoke (black)

over fire (red)WaveformHeart rate from leads and pulse oximeter should

correlate If patient on oxygen, make sure connected

appropriately to wall with no kinks and cannula/mask placed appropriately

Page 12: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Establish Roles

Code TeamTeam LeaderAirway PhysicianFloat PhysicianMedication NurseBedside NurseCirculating NurseDocumenterAssistants

Page 13: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Identify Algorithm

Pulse vs. No Pulse

Pulse No Pulse

Shockable

Ventricular Fibrillation

Ventricular Tachycardia

Not Shockable

AsystolePulseless Electrical Activity

Page 14: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia
Page 15: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

What makes a Rhythm Shockable? The heart is active, but in a life-threatening

and dysfunctional pattern. In Ventricular Tachycardia, the heart is unable to pump blood effectively as it is beating too quickly to fill. This will ultimately lead to ventricular fibrillation. At this point the electrical activity in the heart becomes chaotic – again preventing the heart from pumping effectively. Over time, the fibrillation will decrease and the heart will become asystolic from lack of appropriate oxygenation.

Page 16: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

What makes a Rhythm Shockable? Defibrillation – for UNORGANIZED

rhythmsTherapeutic delivery of an unsynchronized

electrical current through the myocardium over a brief period to terminate the dysrhythmia

Does not jump start the heartPurpose is to depolarize the ventricular cells

simultaneously (including fibrillating cells) asystole natural pacemakers will resume normal activity

Page 17: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

What makes a Rhythm Shockable? Synchronized Cardioversion – for

ORGANIZEDDelivery of a shock to the heart to terminate

a rapid dysrhythmia that is times to avoid vulnerable periods in the cardiac cycle (peak to end of T wave)

Heart cells will contract simultaneously interrupting and terminating the abnormal electrical rhythm without damaging the heart allowing the sinus node to resume normal pacemaker activity

Page 18: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Identify AlgorithmPulse vs. No

Pulse

Bradycardia

Cardiopulmonary system stable?

Yes

ABC’s

Compromise

CPR

Tachycardia

Pulse

Page 19: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia
Page 20: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Identify AlgorithmPulse vs. No

Pulse

Bradycardia Tachycardia

Narrow QRS (<.0.8 seconds)

Sinus Tachycardia

Supraventricular Tachycardia

Wide QRS (>0.08 seconds)

Ventricular Tachycardia

Pulse

Page 21: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia
Page 22: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythms

Page 23: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythm

Page 24: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythm

Page 25: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythm

Page 26: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythm

Page 27: Algorithms  Bradycardia with a Pulse Stable Cardiopulmonary status Cardiopulmonary Compromise  Tachycardia with Pulses and Poor Perfusion Sinus Tachycardia

Rhythm