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ACLS 2000

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

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ACLS 2000

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  1. ACLS 2000 The Tachycardia Algorithms 胡為雄

  2. 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 )

  3. 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

  4. Specific Rhythm Diagnosis • 12-lead ECG • Esophageal lead ~ Looking for AV dissociation ~

  5. 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

  6. Antiarrhythmics or Proarrhythmics • Negative inotropic effects • Proarrhythmic effects ~ never use more than 1 agent unless absolutely necessary ~

  7. Af/ AF with Normal Cardiac Function

  8. Af / AF with Impaired Heart Function

  9. Af/Af > 48 hrs or unknown duration • Delayed cardioversion Anticoagulation x 3 wks DC cardioversion Anticoagulation x 4 more weeks • Early cardiovesion Begin IV heparin at once TEE to exclude atrial clot Cardioversion within 24 hrs Anticoagulation x 4 more weeks

  10. Af / AF with WPW syndrome (< 48hrs)Normal Heart

  11. Af / AF with WPW syndrome (< 48hrs)Impaired Heart • DC cardioversion • Amiodarone (IIb)

  12. Af / AF with WPW syndrome( > 48 hrs or unknown ) • Anticoagulation • DC cardioversion

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