acls 2000
Post on 30-Dec-2015
21 Views
Preview:
DESCRIPTION
TRANSCRIPT
ACLS 2000
The Tachycardia Algorithms
胡為雄
Major New Concepts for the International Guidelines 2000
• Unstable tachycardias → Cardioversion
• Stable tachycardias– Making a specific rhythma diagnosis– Recognizing patients who have significantly impaired cardiac function ( EF < 40%, overt signs of heart failure )
Specific Rhythm Diagnosis Rationale
• Overuse of adenosine has often delayed more appropriate treatment
• Unpleasant side effects of adenosine, the possibility of worse rhythms, and a destablilization of heart rate and blood pressure
• Lidocaine is ineffective for termination of hemodynamically stable sustained VT
Specific Rhythm Diagnosis
• 12-lead ECG• Esophageal lead
~ Looking for AV dissociation ~
Specific Rhythm Diagnosis
• History– CAD, structural heart disease– accessory pathways, preexisting BBB, rate-
dependent BBB, previous aberrant rhythms
• Physical signs of AV dissociation– Irregular cannon A waves in the jugular venous
pulse– Varying intensity of S1– Beat – to – beat changes in SBP
Antiarrhythmics or Proarrhythmics
• Negative inotropic effects• Proarrhythmic effects
~ never use more than 1 agent unless absolutely necessary ~
Af/ AF with Normal Cardiac Function
Contro l rate Convert Rhythm ( < 48 hrs )
D C Cardiovers ionAm iddarone ( Ia)Ibutilide ( I Ia)F lec ain ide ( I Ia)P roc ainam ide ( I Ia)S otalo l ( I Ib)D is opyram ide (I Ib)
Calc ium bloc kers (I)£ ]- Bloc kers ( I )
Af / AF with Impaired Heart Function
Convert Rhythm ( < 48 hrs )D igoxin ( I Ib)D iltiazen ( I Ib)Am iodarone ( I Ib)
D C c ardiovers ionAm iodarone (I Ib)
Contro l Rate
Af/Af > 48 hrs or unknown duration
• Delayed cardioversionAnticoagulation x 3 wks
DC cardioversion
Anticoagulation x 4 more weeks
• Early cardiovesionBegin IV heparin at once
TEE to exclude atrial clot
Cardioversion within 24 hrs
Anticoagulation x 4 more weeks
Af / AF with WPW syndrome (< 48hrs)Normal Heart
D C c ardiovers ionAm iodarone (IIb)F lec ain ide (IIb)P roc ainam ide (IIb)P ropafenone ( I Ib)S otalo l ( I Ib)
Adenos ine ( I I I )-Bloc kers ( I I I )Calc ium bloc kers ( I I I )D igoxin ( II I )
Af / AF with WPW syndrome (< 48hrs)Impaired Heart
• DC cardioversion
• Amiodarone (IIb)
Af / AF with WPW syndrome( > 48 hrs or unknown )
• Anticoagulation
• DC cardioversion
top related