Mastering ACLS

318 Pages·2006·20.12 MB·English

by  Springhouse

Mastering
ACLS
SECOND EDITION

Mastering
ACLS
SECOND EDITION
STAFF The clinical treatments described and recommended in this
publication are based on research and consultation with
Executive Publisher
nursing, medical, and legal authorities. To the best of our
Judith A. Schilling McCann, RN, MSN
knowledge, these procedures reflect currently accepted prac-
Editorial Director tice. Nevertheless, they can’t be considered absolute and uni-
H. Nancy Holmes versal recommendations. For individual applications, all rec-
Clinical Director ommendations must be considered in light of the patient’s
Joan M. Robinson, RN, MSN clinical condition and, before administration of new or in-
frequently used drugs, in light of the latest package-insert
Senior Art Director
information. The authors and publisher disclaim any re-
Arlene Putterman
sponsibility for any adverse effects resulting from the sug-
Art Director gested procedures, from any undetected errors, or from the
Elaine Kasmer reader’s misunderstanding of the text.
Clinical Project Manager © 2006 by Lippincott Williams & Wilkins. All rights re-
Mary Perrong, RN, CRNP, MSN, APRN,BC served. This book is protected by copyright. No part of it
Clinical Editors may be reproduced, stored in a retrieval system, or transmit-
Joanne Bartelmo, RN, MSN; ted, in any form or by any means—electronic, mechanical,
Kate McGovern, RN, MSN, CCRN photocopy, recording, or otherwise—without prior written
permission of the publisher, except for brief quotations em-
Copy Editors
bodied in critical articles and reviews and testing and evalua-
Kimberly Bilotta (supervisor), Scotti Cohn,
tion materials provided by publisher to instructors whose
CarolynPetersen, Lisa Stockslager,
schools have adopted its accompanying textbook. Printed
DorothyP.Terry,Pamela Wingrod
inthe United States of America. For information, write
Designers Lippincott Williams & Wilkins, 323 Norristown Road,
Corporate Imagination, Jan Greenberg Suite 200, Ambler, PA 19002-2756.
Illustrators
ACLS2010506—021006
Judy Newhouse, Joseph John Clark
Digital Composition Services
Diane Paluba (manager), Joyce Rossi Biletz, Library of Congress Cataloging-in-Publication Data
Donna S. Morris
Mastering ACLS.—2nd ed.
Manufacturing p. ; cm.
Patricia K. Dorshaw (director), Beth J. Welsh Includes bibliographical references and index.
1. CPR (first aid) 2. Cardiac resuscitation. 3. Cardio-
Editorial Assistants vascular emergencies. I. Title:Mastering advanced cardiac
Megan L. Aldinger, Karen J. Kirk, Linda K. Ruhf life support. II. Lippincott Williams &Wilkins. [DNLM:
1. Cardiovascular Physiology. 2. Advanced Cardiac Life
Indexer Support—methods. 3. Educational Measurement—meth-
Dianne L. Prewitt ods. 4. Heart Arrest—therapy. WG 202 M423 2006]
RC87.9.M375 2006
616.1(cid:1)025—dc22
ISBN13 978-1-58255-363-4
ISBN10 1-58255-363-7 (alk. paper) 2005003208
CONTENTS
Contributors and consultants vii
Foreword ix
PART 1
Overview 1
CHAPTER ONE About ACLS 2
PART 2
ACLS core concepts 7
CHAPTERTWO Know the essentials 8
CHAPTERTHREE Airway management 16
CHAPTERFOUR Cardiac arrhythmia recognition 51
CHAPTERFIVE Cardiovascular pharmacology 88
CHAPTERSIX Electrical therapy 135
CHAPTERSEVEN Therapeutic and monitoring techniques 159
PART 3
ACLS in action 187
CHAPTEREIGHT Emergency cardiac care 188
CHAPTERNINE ACLS in special situations 224
CHAPTERTEN Megacode review 259
Posttest 276
BLS guidelines: Cardiopulmonary resuscitation (Adult) 289
BLS guidelines: Obstructed airway management (Adult) 290
Guide to common antiarrhythmic drugs 292
Selected references 293
Index 294
v

CONTRIBUTORS AND CONSULTANTS
Natalie Burkhalter, RN, MSN, CS-MS, Barbara Konopka, RN, MSN, CCRN,
FNPBC, ACNP-BC CEN
Associate Professor Nursing Instructor
Texas A&M International University Pennsylvania State University
Laredo Dunmore
Deirdre Herr Byers, RN, BSN, CCRN Linda Laskowski-Jones, RN, MS,
Staff Nurse, Cardiac Care Unit APRN,BC, CCRN, CEN
Southeast Georgia Regional Medical Director, Trauma, Emergency, &
Center Aeromedical Services
Brunswick Christiana Care Health System—
Christiana Hospital
Marissa Camanga-Reyes, RN, MN,
Newark, Del.
CNS, CCRN
Clinical Nurse Specialist, Critical Care Abby Plambeck, RN, BSN
& Cardiopulmonary Clinical Consultant
Harbor-UCLA Medical Center Milwaukee, Wis.
Torrance, Calif.
Jonathan Potts, BScN, RN
Kim Gregg, RN, MSN Staff Nurse ICU/CCU
Nursing Instructor United Regional Health Care System
Jacksonville (Ala.) State University Wichita Falls, Tex.
Sandra Hamilton, RN, BSN, MEd, CRNI
Critical Care Nurse
Kindred Hospital
Las Vegas
vii

FOREWORD
This second edition of Mastering ACLSmoves us toward a future of in-
creasing success in patient resuscitation. Mortality rates for the first and
third leading causes of death—cardiovascular and cerebrovascular dis-
eases—have decreased. Health care of cardiac disease is now extended to
community settings where automated external defibrillators (AEDs) are
applied by the public prepared to be first basic life support (BLS) rescuers.
Today, due to educational programs, the public is more informed about
signs and symptoms of stroke and is aware of the need for immediate
emergency care.
In addition to more confident lay rescuers, interdisciplinary health
care professional teams trained in the American Heart Association’s Ad-
vanced Cardiac Life Support (ACLS) techniques have increased prehospi-
tal and in-hospital survival rates from sudden cardiac death. These effi-
cient teams possess a collective confidence in each member’s performance
because they’ve mastered ACLS concepts. This knowledge gives the team
clear direction on further assessments and the actions needed to reverse a
potentially lethal event.
ACLS training emphasizes the importance of evaluating and manag-
ing sudden witnessed ventricular fibrillation/ventricular tachycardia along
with other conditions contributing to sudden death. Dealing with the
challenging role of health care provider to victims of acute coronary syn-
dromes or cerebrovascular events demands the ability to assess and make
patient care management decisions rapidly and with confidence.
ACLS workshops and computer-assisted learning sessions can be a
challenge to the aspiring provider. The course content as case presentations
and review doesn’t always provide the needed background material in a
well-orchestrated learning environment for all learners. This lack is often
frustrating to the learner because the material must be interpreted without
assistance.
Mastering ACLS,Second Edition, provides fundamental information
for various learning styles and helps all health care professionals successful-
ly complete the AHA’s ACLS course and certification examination. The
book’s format and illustrations of techniques allow for quick review, and
the self-tests help to emphasize important ACLS core concepts. The logi-
cal progression of each learning section moves the reader from simple to
complex, enhancing retention and understanding of assessment and ac-
tions needed by the provider.
ix
x Foreword
This new edition of Mastering ACLSis thoroughly up to date. More case sce-
narios and special resuscitation situations have been added to the text. The infor-
mation on AEDs has been expanded to reflect current expectations in health care.
Also expanded are the chapter quizzes and the comprehensive self-test at the end.
Two new appendices cover BLS guidelines. The use of full color throughout the
book makes all of the information more accessible.
After completing Mastering ACLS,Second Edition, the aspiring provider can
confidently enter the learning environment with a fundamental understanding of
the entire process and science supporting ACLS.
Mastering ACLS to become a more efficient member of a health care team or
a more effective provider of advanced health care in high acuity settings is and will
be an expectation of future employment settings. Because your career as a health
care provider will require you to pull out all the stops in decreasing sudden death
events, advance into the future by studying Mastering ACLS,Second Edition.
Linda S. Dune, RN, PhD, CCRN, CEN
Assistant Professor of Clinical Nursing
University of Texas Health Science Center
Houston