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Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines established by the American Heart Association (AHA) for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques.
Indications for Class Ia agents are supraventricular tachycardia, ventricular tachycardia, symptomatic ventricular premature beats, and prevention of ventricular fibrillation. Procainamide can be used to treat atrial fibrillation in the setting of Wolff–Parkinson–White syndrome , and to treat wide complex hemodynamically stable tachycardias .
Orthodromic conduction usually results in a narrow complex tachycardia, and antidromic conduction usually results in a wide complex tachycardia that often mimics ventricular tachycardia. Most antiarrhythmics are contraindicated in the emergency treatment of AVRT, because they may paradoxically increase conduction across the accessory pathway.
Amiodarone may be used in cases of ventricular fibrillation, pulseless ventricular tachycardia, and wide complex tachycardia. [110] Lidocaine is a class Ib anti-arrhythmic, also used to manage acute arrhythmias. [111] Anti-arrhythmic medications may be used after an unsuccessful defibrillation attempt.
Synchronized electrical cardioversion is used to treat hemodynamically unstable supraventricular (or narrow complex) tachycardias, including atrial fibrillation and atrial flutter. It is also used in the emergent treatment of wide complex tachycardias, including ventricular tachycardia, when a pulse is present.
Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. [3] Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period of time are referred to as an electrical storm.
The pads are then attached to a monitor/defibrillator, a heart rate is selected, and current (measured in milliamps) is increased until electrical capture (characterized by a wide QRS complex with tall, broad T wave on the ECG) is obtained, with a corresponding pulse. Pacing artifact on the ECG and severe muscle twitching may make this ...
Stable tachyarrhythmia treatment is subcategorized based on narrow QRS vs. wide QRS. If narrow QRS/ SVT, perform vagal maneuvers and give adenosine. If wide QRS/ VT with regular rhythm and monomorphic QRS, the provider can give adenosine and should consult pediatric cardiology for recommendations.
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