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1 VF/pulseless VT Asystole/PEA Bradycardia Tachycardia ACLS Shock/pulmonary edema Acute coronary syndrome

2 Case 1 療 理 錄 50 亮 立 來?

3 Triad : (ABC,s)

4 VF 150J

5 VT

6 VT/VF Epinephrine 1mg/1cc, every 3-5 min Vasopressin 20U/1amp Amiodarone (Cordarone 150mg/amp) MgSO4 Lidocaine (Xylocaine 100mg/5cc)

7 Epinephrine (Bosmin) 刺 狀 流 VF 率 : 1mg IVP Q 3-5 min

8 Vasopressin 療 EV bleeding 狀 流 40 U IV st Half-life: min

9 Amiodarone : 1. Pulseless VT/VF 2. Polymorphic VT 3. Wide-QRS tachycardia 4. Stable VT 5. SVT/PSVT, atrial tachycardia 6. Rhythm control of AF 7. Rate control of AF ( 療 )

10 Amiodarone 量 : 療 VT VF, 300mg IV push 150mg 律 復 900mg in D5w 500cc iv drip 34cc/hr (1mg/min) for 6 hr, then 17cc/hr(0.5mg/min) for 18hr 量 : 2.2gm/24hr 2gm/24hr QT 不 Torsades de points

11 MgSO4 magnesium sulfate) 硫 --Torsades de points (Tdp) -- VF/VT --Rhythm control for PAF < 48 hrs duration -- 量 - dp 1-2 gm in 10ml NS (or D5W) IVP slowly - Tdp PAF: PAF 1-2 gm in 50ml D5W IV drip 5-60min ( 不 AV block 神 DTR 降 calcium

12 Lidocaine 1%, 2%, 10% Na 離 epinephrine VT/VF 1 to1.5mg/kg IV bolus, 5-10 量 量 不 3mg/kg g IV bolus 若 律 復 maintenance infusion 1-4mg/min. (2gm in D5W 500cc, IVD 15-60cc/hr) 60 kg, 2% xylocaine c c? Ans: 4.5 cc ( 20mg/cc)

13 Asystole

14 PEA

15 Asystole/PEA Epinephrine IV Q 3-5min Atropine 1mg IVP 3-5min, Max. 0.04mg 04mg /kg 神

16 Case 2 64 來 12? VT PSVT AF/Af

17 Triad : 路 O2, IV, Monitor

18 EKG VT, 臨 VT VT? 不!

19 VT? Widen-QRS tachycardia???? Triad : id 若 BP 120/80 mmhg, stable? Or Unstable?

20 Tachycardia 2A-B-2C-D-L 2C denosine 6mg/vial miodarone 150mg/amp Inderal 1mg/amp p( ( -blocker) Verapamil 5mg/2cc/amp( -channel blocker) Diltizem 50mg/amp ( ) igoxin 0.25mg/amp idocaine

21 Adenosine (adenocor) 6mg/amp 療 PSVT SA AV node Half-life lif 9 sec 6 mg IVP 1-2 sec, 1-2 min 12mg IVP g, g 1-2 sec 1-2 min push 12mg

22 Amiodarone in stable tachycardia VT rhythm control for PAF W-P-W with Af PSVT loading 150 mg IV push 10min, mg in D5W 500cc, 1mg/min X 6hrs 0.5mg/min X 18hrs 降, AF, PSVT, VT, VF 律不 QT 不 Torsades de points

23 Varapamil (Isoptin 5mg/2cc/amp) PSVT, AF AV node 2-5mg IV push slowly l over 2 min Onset of action: 2-5 min Duration: 2 hours 降

24 50mg/1 amp Diltiazem (Hebessor) For PSVT: 0.25mg/kg IVbolus over 2 min 15 量 Onset of action: hr Duration: 1 to 3 hr 降 verapamil p

25 Digoxin 0.25mg/amp SA AV nodes 神 ATPase 離 流 力 Indications: 狀 --Rate control for Af/AF --PSVT -- 不良 易 若 異 SA block or complete AV block 量 : loading 0.013mg/kg 0.25mg IVD30min q 48h 4-8 h.

26 Lidocaine 1%, 2%, 10% VT, Widen-QRS tachycardia 1 to1.5mg/kg IV bolus, 5-10 量 量不 3mg/kg 1-1.5mg/kg IVP, Max. 3mg/kg 量 1-4mg/min. (2gm in D5W 500cc, IVD 15-60cc/hr) 列 量 1-2mg/min) --After 24hr infusion --CHF AMI with shock, Age>70 不良 SSS AB block W-P-W syndrome 律 暈 不 亂 Onset of action: sec Duration: min

27 Case 3 60 來 力? (SSS) AV block)

28 Triad : 路 O2, IV, Monitor

29 Complete AV block Triad : BP 80/50 mmhg, Unstable?

30 Bradycardia Atropine TCP Transcutanous Cardiac Pacing) Dopamine Epinephrine

31 Atropine 1mg/amp 神 療 狀 narrow-qrs PEA/asystoley epinephrine 0.5mg-1mg q3-5min 0.5mg bradycardia VT/VF AMI 不 Mobitz II 2nd AVB, 3rd AVB with widen QRS

32 Dopamine 200mg/amp 尿量 量 量 : 1-2 ug/kg/min, 刺 dopamine 量 : 2-10ug/kg/min 刺 量 : >10ug/kg/min 刺 不 NaHCO3 漏 Standard dose, double dose, half dose 800mg in D5W 500ccdouble dose), 60KG, 12cc/hr 量?

33 度 800mg/500cc= 1.6mg/cc= 1600ug/cc 量 12cc/hr = 12 microdrops/min = 12/60 cc /min : 1600ug/cc X 1/5 cc/min= 1600/5 ug/min :60kg 量 = 1600/5X60 = 5.33 ug/kg/min

34 400 mg in D5W 500cc, 80KG, 量 5mg/kg/min? 800/ 80 X a = 5, a= 2 ½ cc/min = 30cc/hr = 30 /min

35 Epinephrine 療 不 1mg IV push 2mg in D5W or NS 500cc = 4 ug/cc 2-10 ug/min (30cc-150cc/hr)

36 Pulmonary edema Lasix 20mg/amp, 0.5-1mg/kg IV push Morphine 10mg/amp, 1-2 mg IV push q5 min NTG (0.6mg/tab; 25mg/vial) 5-20 ug/min Isoket 10mg/1amp, 2amp in D5W 80 cc 20mg/100cc, 200ug/cc; 3cc/hr = 10ug/min

37 Lasix 力 尿 0.5-1mg/kg IV push slowly over 2min -- 類 利尿 -- anuria --Hypotension -- 不 Onset of action: venodilation < 5min, diuresis:5min, peak effect < 30min Duration: venodilation < 2hr, diuresis: 2hr

38 Morphine 10mg/amp 降 神 量 2-4 mg IV slowly 5-15 量 -- CO2 retention) -- 識不 --IICP --Asthma undiagnosed abdominal pain -- 例 ABG: PH 7.30, PO2 52mmHg, PCO2 48mmHg CO2 retention) endo orphine Apnea Onset of action: immediate (peak 20min) Duration: 2-4 hrs Naloxone 0.4-2mg IV

39 Nitroglycerin 滑 狀 狀 流 Indications: -- 行 : 量 5ug/min 3-5 5ug/min, 若 10-20ug/min 量 (30-40ug/min) 量 (>150ug/min) : --viagra use with 48hrs --RV infarct --Hypotension (SBP < 90mmHg) --IICP and inadequate cerebral circulation --Tachycardia and marked bradycardia (< 50bpm) --Uncorrected hypovolumia Onset of action: immediate (<1.5 min) Duration: 1-10 min after DC IV NTG

40 Shock Dopamine Dobutamine (250mg/20cc/amp) SBP >100mg, CHF, 療 量 5-20ug/kg/min 500 mg in D5W 460cc Norepinephine (Levophed 4mg/4mg/amp) SBP < 70 mmhg or dopamine > 15ug/kg/min / 療 量 ug/min. 4 mg in NS 96cc; 40ug/cc if 1cc/hr = 40ug/60min= 0.7ug/min

41 Heparin (5000u/cc), 60U/kg loading 4cc in D5w 500cc, 40u/cc, 15-20cc/hr, APTT sec Glycoprotein IIb/IIIa (Aggrastat), 50cc/vial t-pa: 50mg/vial, 15mg iv bolus, 50mg IVD 30min, 35mg IVD 60min

42 Atropine 0.02mg/kg IV Lidocaine 1.5mg/kg IV over 60 sec Midazolam mg/kg 05 0 IV slowly Valium 5-10mg iv push slowly Propofol 2-2.5mg/kg IV