Analysis
of the AHA Year 2000 ACLS Guidelines
ACLS EMS Quick Summary Overview
PEA
Pulseless Electrical Activity
Initiate Secondary ABCD
Add:
"C": Rule out pseudo-PEA with handheld
doppler.
Look for evidence of low-flow state.
1. Vasopressor
Vasopressin 40U IV push x 1 only
or
Epinephrine 1mg q 3-5min (Class Indeterminant) if vasopressor needed 10-15 minutes after vasopressin administration;
2. Consider fluid challenge empirically-typically 500-1000 ml minimum
3. If electrical rate is slow, Atropine 1 mg IV q 3-5 min up to 0.04mg/kg (2-3 mg)
4. Rule out most common etiologies:
5Hs -(Hypovolemia, Hypoxia, Hydrogen Ion (acidosis), Hyper/hypokalemia (electrolyte disturbances) , Hypothermia;
5Ts -"Tablets" (OD),Tamponade, Tension Pneumothorax, Thrombosis of coronary site, Thrombosis of pulmonary site)
Additional Notes:
Consider Sodium
bicarbonate: prolonged arrest (Class 2b), high K (Class 1), bicarbonate-responsive
acidosis (2a), tricyclic OD (2a), to alkalize urine for aspirin OD (2a); not
for hypercarbic acidosis.
*EMS—does not include
additional medications such as specific beta-blockers, digoxin, or other calcium
channel blockers.
See
previous Protocols or use ECC handbook 2000 for further explanation, dosages,
and reference.