2010 ACLS

1

2010

1. 1.1 2010 AHA CPR ECC 1.2 1.3 1.4 1.5 (first aid)

2

14

15

20

22

2. 2.1 CPR 2.2 2.3 CPR

31

42

46

3. 3.1 3.2

50

56

4. 4.1 4.2 4.3

61

71

78

5. // 88

6. 89

7. 7.1 7.2

97

103

8. 105

9. 137

2

1. 1.1 2010 AHA CPR ECC

Circulation 2010 10 2010 AHA CPR ECC

() CPR 50 1960

KouwenhovenKnickerbocker Jude 14

(1962) 1966

CPR 50

CPR

()

CPR (

)

356 ( 29 )

277 411

2005

CPR

3

18 4

CPR

() CPR

CPR (

)CPR CPR CPR

CPR

CPR

CPR

CPR

CPR

CPR CPR

2010 CPR

()

()(

) VF()

VF

''

4

CPR

2010

2010 CPR A-B-C ( Airway

Breathing Chest compression) C-A-B ( Chest compression Airway

Breathing)()

CPR CPR

VF VT

A-B-C (

) 18 ( 30

)

CPR A-B-C

CPR

() VF

CPR

CPR 5

CPR

()(

)

(DNAR)()

( DNAR ?)

BLS

5

ACLS

ACLS ()

()

Basic Life Support

BLS

CPR

2010 CPR

BLS

(

)

CPR CPR CPR

CPR 1.5 2 2 ( 5 )

CPR

6

()

CPR CPR

CPR

()

''

(

) 10

CPR

CPR

CPR AED

4 5 CPR 1.5 3

2 2

()

Atrial fibrillation

120 200

200 Atrial flutter PSVT

7

(50 100 ) Asystole

BLS ACLS BLS CPR

(VFVT)''

ACLS BLS

Class recommendation

CPRLMAET

TUBE ''

()1. Adenosin

Atropine Dopamine

Epinephrine

(

CPR )

CPR PEA Asystole

Atropine

CPR CPR (

)(

)

9 (Goal-oriented)

8

EMS

STEMI

()

EMS

(Class )(Class )

National Institute of Neurological Disordes and Stroke (NIND) Third European

Cooperative Acute Stroke Study (ECASS-33)

( 11 )

3

BLS ACLS

9

15

()

(Pediatric Basic Life Support)

(cardiac arrest)(asphyxia)( 5% 15%)

(VF)(asphyxial arrest)

(resuscitation)(ventilation)(chest compression)

(community pediatric study)

(ventilation)(chest compression)

CPR(chest

compression-olny CPR)(no bystander) CPR

(ventilation)(chest compression)

(witnessed cardiac arrest)()

VF (early defibrillation)

CPR(chest compression-olny CPR)

(ventilation)(chest compression)

C-A-B ()

18 ()

(push hard, push fast, allowing the chest to completely recoil

in each compression, minimizing interruptions in chest compression, and avoiding excessive

ventilation)

(anterior-posterior dimension)()

()

(Pediatric advanced Life Support)

2005 AHA guidelines for CPR and ECC

(healthcare providers)

10

10

CPR

(cuffed endotracheal tube)

(cricoid compression)

(cricoid compression)

(capnograhy/capnometry)(

) CPR

(defibrillation)()

VF VT 2 4 J/kg (

) 4 J/kg ()

(titrated)(hyperoxemia)

(single ventricle)(pulmonary hypertension)

(genetic ion channel defect, channelopathy)

(genetic analysis)

(channelopathy)

(Neonatal Resuscitation)

(cardiac arrest)(asphyxia)

A-B-C

(peripartum sunctioning)

(cardiorespiratory transition)

(good tone)(hyperoxia)

()(room air)

100%

11

(oximeter)

()

(amniotic fluid)(non-vigorous)

(endotracheal suctioning)

(Chest Compressions)

-(compression-ventilation) 3:1

(asphyxia)

(15:2)(epinephrine)

0.01 0.03 mg/kg (0.05

0.1 mg/kg)

(Postresuscitation Care, Post-Cardiac Arrest Care)

(therapeutic hypothermia)

10

(Education)

2010 (Education, Implementation, and Team)

CPR (bystander CPR)(cardiac arrest)

CPR CPR

CPR CPR(compression-olny CPR, Hands-Only CPR)

CPR

(EMS)(

(gasping)) CPR(dispatchers)

CPR(compression-only CPR, Hands-Only CPR)

BLS (practice while watching)

12

(defibrillation)AED

AED

ALS

BLS ACLS

(debriefing)(learner-focused,

nonthreatening)

(system-based approach)

(variability)()

(First Aid)

(laypersons)

(anaphylaxis)(symptoms and signs)

(anaphylaxis)

(first aid providers)

(first aid providers) aspirin

(unresponsive) (recovery position)

2005 (tourniquets)

(gangrene)()

(spinal immobilization)

(secondary spinal cord injury)(spinal stabilization)

(movement restriction)

2005(pressure immobilization)(neurotoxic snake bite)

(non-neurotoxic snake bite)

(jellyfish stings)

(refreezing)(thawing)

(chemical warmers)(frostbite)

(dehydration)(oral fluid replacement)

13

-( carbohydrate-electrolyte

mixture)

14

1.2 2010 (AHA) (CPR)(ECC)

AHA ECC

CirculationResuscitationILCOR 2010 International

Consensus on CPR and ECC Science With Treatment Recommendations

ECC 277

411

Class I recommendations

(should)

Class IIa recommendations

(is reasonable)

Class IIb recommendations

(may be considered)

Class III recommendations(is

not helpful and may be harmful)

2010 AHA CPR ECC Class Indeterminate recommendations

(level of evidence, LOE)

AHA Level A(RCTs)

(ILCOR LOE 1)

AHA Level B(ILCOR LOE 2 or 3)

AHA Level C

(ILCOR LOE 4 or 5 or Expert Opinion)

15

1.3 (Ethics)

BLSACLS

NOT STARTING

()

Healthcare Advance Directives, Living Wills, Patient Self-Determination

DNARDo Not Attempt Resuscitation order

ANDAllow Natural Death

(DNAR)

OHCA

DNAR

Surrogate Decision Makers

18

()

1.

2.

Adult OHCA WITHDRAWING

BLSBLS

BLS

1. EMS 2. CPRAEDROSC 3. AED

BLS

16

BLS

BLS

37%

EMSALSALS

20ALS

ALS

Adult IHCA

DNR

CPR

arrestrhythmROSC

10

Class IIb

(1) Extreme prematurity 23 400 g(2) anencephaly

1. 2. BystanderCPR 3. ALSROSC 4.

17

(3) trisomy 13Class IIb

Providing Emotional Support to the Family

()

2010 () 3

72

2005 ()

33

3

72

24 N20 3

ROSC 3

2

18

N20

2005 ()

BLS ALS EMS

40%-60%

EMS

ED ()

19

1.4

CPR CPR

1.

CPR 2.

1.

2.

CPR

CPR

CPR

CPR, CPR

15%~30%

CPR CPR

1. CPR

CPR CPR

CPR CPR CPR

CPR

20

2.

(gasping)

3.

CPR

4.(AED)

AED AED

1.

AHA ECC

2.BLS

3.(AED)

4.ALS

5. ALS

6. ACLS PALS

ATLS ACLS

PALS

7. ACLS

8. 2

21

1./-

2.CPR CPR

3. ACLS

CPR

1.

2.RRTsMETs

MET/RRT

3.

4.

22

1.5 (First Aid) (AHA)(Red Cross)(National

First Aid Science Advisory Board) 2005

2010

:

?

?

2010

Peter Shepherd Francis Duncan

1903

(first aid) ()

()(First aid provider)

(Calling for Help)

(EMS)(One-site emergency response

planERP)

(Positioning the victim)

23

High Arm IN Endangered Spine (HAINES)

(Class IIbLOE C)

6~12 ( 30~45 )(Class IIbLOE C)

(Oxygen)

(Class IIbLOE C)(Class IIb

LOE C)

(Medical emergencies)

(Breathing Difficulties)

(Class IIaLOE B)

//

(Anaphylaxis)

(Anaphylactic reactions)

24

(Class IIbLOE B)

18%~35%

(Class IIbLOE

C)

(Seizure)

(Class IIaLOE C)

(Chest Discomfort)

(EMS)

()(Class IIa

LOE A)

(Injury Emergencies)

(Bleeding)

(Direct Pressure)

(Class ILOE A)

25

;

(Tourniquets)

(Class IIbLOE B)

(Class IIaLOE B)

(Pressure Points and Elevation)

(Class IIILOE C)

(Hemostatic Agents)

(Class IIbLOE B)

(Wounds and Abrasions)

(

)(Class ILOE A)

(Class IIaLOE A)

(Burns)

(Thermal Burns)

26

(15 25 )(Class ILOE

B)

(Class IIILOE

B)

(Burn Blisters)

(Class IIaLOE B)

(Electric Injuries)

(Class IIILOE C)

()

(Spine Stabilization)

2%

10~30

()

()

(Class IIbLOE C)

27

(Class IIILOE C)

65

2

(Musculoskeletal Trauma)

(Sprains and Strains)

20 10

(Class IIbLOE C)

(Fractures)

(Class IIILOE C)

(Class IIaLOE C)

(weight bearing)

(Human and Animal Bites)

(Class ILOE B)

28

(Snakebites)

(Class IIILOE C)

(:40~70 mmHg:55~70 mmHg)

(Class IIaLOE C)

(Jellyfish Stings)

:

(nematocyst)

(Vinegar4% 6%) 30 (Class

IIaLOE B)

(Class IIaLOE B)

( 45) 20

(Class IIbLOE B)

(Class IIILOE C)

(Dental Injuries)

()

(Class IIaLOE C)

(Environmental Emergencies)

(Cold Emergencies)

(Hypothermia)

29

(Class IIaLOE B)

()

(Frostbite)

(Class IIILOE C)

24(37 40) 20 30(Class

IIbLOE C)(Class

IIILOE C)Ibuprofen NSAID

(Heat Emergencies)

(Drowning)

30

(2 )

(Poison Emergencies)

()

(Chemical Burns)

(Class ILOE B)

(Toxic Eye Injury)

(Class ILOE C)

(Ingested Posions)

(Treatment with Milk or Water)

(Class IIILOE C)

(Activated Charcoal)

(Class

IIbLOE C)

(Ipecac)

(Class IIILOE B)

31

2. 2.1 CPR 2010 (AHA) (CPR) (ECC)

(CPR)

CPR:

CPRCPR2010

CPR

CPR

35 ()

10 50-55

25%

3 6 25%

(VF)(pulseless VT)

Asystole PEA

:

()

1.

2. CPR

3.

32

4.

5.

VF

50%

CPR

CPR

2010 AHA CPR ECC

2010 AHA CPR ECC

: 1.

2. CPR3.

33

BLS

()

()

10 ( HCP )

CPR CAB

100 /

5

1/3( 5 )

1/3( 4 )

2

10

()

()

30:2

30:2

15:2

()(HCP)

6-8 1 (8-10 /)

1

AED

CPR

34

CPR

ALS

CPR :

CPR

CPR

CPR

CPR ()

35

CPR

: CPR

( BLS)

()

/

(AED) AED CPR

AED CPR/

AED

AED AED CPR

CPR

36

BLS

CPR

CPR

CPR

37

1. 100

2.

1) 2 (5 )

2) 1.5 4

2 5 )

3.

4.

5.

6.

()

()CPR

6-8 1 ( 8-10 /)

CPR

CPR --

38

(1)

(2) (3)3(

)

/

39

Utstein

CPR

EMS

EMS

.

;

(CARES)NRCPR

()

40

CPR

CPR

CPR

/

2010 AHA CPR ECC 501960

19621966

CPR50

41

50

2005

ECC

BLS

42

2.2 (Basic Life Support) ()

CPR ==> CABD

(Supine)

119

*90

(EMS)

AED

C(Circulation)

10

2~3(

)

2

100/

25

(302)

A( Open Airway)

(

)

B(Brithing)

2

1

43

5(2)

CPR(2

(6-818-10/)

AED

DDefibrillation

AED

CPR

1.

2. CPR

3. ()

()

AED ()

4. 10 10

CPR AED

5.

6. CPR (

)

7.

8. (C-A-B A-B-C) 30

CPR 2

9. 100 / 100

10. 1. 2 (4 5 ) 2

( 5 )

11.

44

12. CPR

CPR

100 /

25

/

5-612

302

/

1CPR 2

CPR 221ALS

10

()

1.

2.

3A.3.

4.

5.

6.

7. 8.

/

5-612

302

/

1CPR 2

CPR 221ALS

10

()

1.

()

1.

2.

3A.3.

4.

5.

6.

7. 8.

45

CPR

1. BLS

2.

() CPR

3.

4. CPR (

)

5. (C-A-B

A-B-C) 30 CPR 2

6. 100 (100 /)

7. 1. 2 2 (5 )

46

2.3 CPR 25

(manual) CPR CPR

CPR

CPR CPR

CPR CPR CPR

CPR techniques

High-Frequency Chest Compressions

120

9 23

( 120 ) CPR

2010 CPR guidelines

100

(class IIb)

Open-chest CPR

Open-chest CPR

(stroke volume)

open-chest CPR CPR

: 2 2

open-chest CPR

(return of spontaneous circulation, ROSC)

open-chest CPR

open-chest CPR

open-chest CPR (Class IIa)

CPR(Class IIb)

47

Interposed abdominal compression

(IAC)-CPR

IAC-CPR CPR IAC-CPR

randomized

randomized IAC-CPR IAC-CPR 426

IAC-CPR (Class IIb)

IAC-CPR (Class Indeterminate)

Cough CPR

CPR()

1

3

(

92)CPR(

)

CPR devices

Devices to Assist Ventilation

Automatic and Mechanical Transport Ventilators (ATVs)

73 ATV bag mask

ATV

bag mask ATVs 5

(

Combitube )ATVs (Class IIa)

Manually triggered, oxygen-powered, flow-limited resuscitators

104

(; ) oxygen-poweredflow-limited resuscitators

mask-bag devices CPR

48

oxygen-powered flow-limited

resuscitator(Class III)

Devices to Support Circulation

Active Compression-Decompression CPR

ACD-CPR : CPR

ACD-CPRROSC (return of spontaneous circulation)3

(826)(4162)ROSC

ACD-CPR

ACD-CPR(Class IIb)

Impedance Threshold Device

Impedance Threshold Device(ITD)

ITD ROSC

ITD (Class IIa)

Mechanical Piston Device

mechanical piston CPR

(end-tidal CO2)

CPR

()

(Class IIb)mechanical piston CPR

100 5 30:2 ( advanced airway

)

Load-Distributing Band CPR or Vest CPR

load-distributing

band CPR ROSC

load-distributing band (LDB)-CPR (Class IIb)

Phased Thoracic-Abdominal Compression-Decompression CPR with a Hand-Held Device

49

(PTACD-CPR)

IAC-CPR ACD-CPR

Extracorporeal Techniques and Invasive Perfusion Devices

Extracorporeal CPR (ECPR)

CPR

ECPR

: ECMO

(: ) ECPR

()()(Class IIb)

Summary

CPR

CPR

CPR

50

3. 3.1

PQRS T 60~100 beats/min

QRS

QRS complex P P QRS complex

(Tachyarrhythmia)

100 (ventricular fibrillation, VF)

(ventricular tachycardia, VT)(paroxysmal supra-ventricular

tachycardia, PSVT)(atrial flutter, AF)(sinus tachycardia, ST)

51

52

VF PQRS T VF asystole

( paddle 90 ) VF asystole

QRS ( >0.12ms)(

53

AV block)(2AV block)(3AV block)

(junctional rhythm)(idioventricular rhythmIVR)(nentricular

asystoleVA)

54

VA(Asystole) VA

QRS

a. P IVR(< 40beats/min)

b. P 3AV blockSB with complete BBB

3AV blockP QRS P QRS

3AV block

QRS P ( P )

QRS complex

a. P Junctional rhythm 40~60 beats/minQRS P

QRS P P QRS P

b. P SB2 I AV block2 II AV block AV block

SBPQRST (

55

2 II AV block P-R P QRS

AV block QRS ( 40~60beats/min)P

AV block

AIVR(accelerated idioventricular rhythm)

60~100 beats/min P QRS( IVR)

Pacemaker rhythm spike() QRS

56

3.2 (AED, Defibrillation, Cardioversion, and Pacing)

( AEDs )( cardioversion )

( pacing )AEDs (BLS)

cardioversion pacing ACLS

CPR

VF CPR 7~10%

CPR 3~4% CPR 5~10

VF CPR VF Asystole

CPR VF

CPR AED

VF AED

1. EMS

2. CPR

3. AED

1 2

CPR

AED

CPR AED AED

CPR

AED CPR

AED

EMS EMS AED (ECG)

CPR 5

CPR( 2range 1.5 ~ 3 )

CPR CPR

VF

3 CPR

57

1-Shock or 3-shock

2010 ( 2005 ) 2010

VF 1 3

1 VF CPR

1-shock CPR5 cycle(30

compressions and 2 breaths) AED

200

VF

()

ROSC

(120 200 )

-(();

,)

(---)

( implanted cardioverter defibrillator)

--

ICD 8

58

8~12cm

(4.3cm) myocardial necrosis

gel

AED

1995,AHA AED SCA

3~5 CPR , 41~74%.

1. CPR AED

2.(,,) AED

3.AHA EMS

AED

(ex.NTG, nicotine, analgesics, hormone replacements,

antihypertensives)

AEDs AEDs

AED in children

VF

5~15%,

,> 4J/kg(

59

4J/kg

AED

2010AED

AED( 3 )

VF

(synchronized cardioversion)

QRS VF

surpaventicular tachycardia due to reentry, atrial fibrillation, atrial flutter,atrial

tachycardia, monomorphic VT with pulses junctional tachycardia multifocal atrial

tachycardia

VF, pulseless VT, polymorphic ( irregular ) VT

120-200

200

50-100 ()

0.5~1J/kg 2J/kg

VT VF

VT 100 ()

VF

QRS VT VT (

VT) ()

0.5~1J/kg 2J/kg, QRS

( VT),,,

60

(Pacing)

Pacing asystole

(symptomatic bradycardia with a pulse ) atropine

TCP(transcutaneous pacing) TCP

transvenous pacing

61

4. ACLS

return of spontaneous circulationROSCACLS

ACL

BLS

2005 ACLS

1.

2.

3. Atropine PEA/

4.

5. (Chronotropic drug)

6. Adenosine

62

4.1

CPR

CO2(Tidal

volume)

VF

CPR ,/

CPR Advanced airway

CPR

CPR

CPR

CPR

Class ILOE C

CPR

CPR100

FiO2 1.0 100

CPR CPR 100

CPR 100classaLOE

C 9

CPR

CPR

EMS CPR 6

BoussignacCPRCPR

oxygenation

63

CPR

5

1 2 600

1

CPR 30

3 4 2

Class IIILOE C

(Class IIa, LOE C).

30%

64

Class IIa, LOE

C

Advanced Airways

CPR BVM BVM

BVM

BVM ACLS

ACLS CPR

ACLSCPR

ACLS

5

24 12

13

/ VT

ACLS

CPR (Class IIb, LOE

C)

EKG monitor oximeter

BVM

ACLS

BVM

65

Continuous waveform capnography

(Class I, LOE A)

CPR

100 6 8 8 10

()

LMACombitubeLaryngeal Tube or King LT

BVM

CPR BVM(Class IIa, LOE

B)(Class IIa, LOE A).

(Esophageal-Tracheal Tube)

Combitube BVM

66

CPR 62-100

BVM (Class IIa,

LOE C)(Class IIa, LOE A)

(Laryngeal Tube)

(Laryngeal Tube or King LT)

40

853 cuff 3

157 97

BVM(Class IIb, LOE C)

(Class IIb, LOE C).

(Laryngeal Mask Airway)

BVM

CPR 72 97

BVM (Class

IIa, LOE B)(Class IIa, LOE C)

Endotracheal Intubation

67

EMS

(Class I, LOE B)EMS (Class

IIa, LOE B)

BVM

EMS

BVM

cuff

1 BVM 2

10

10

6 25

Esophageal Detector

DeviceEDD)

(Class I, LOE A)

EDD

(Class IIa, LOE B)

68

BVM

100 100

3 64 100

100 100

(Class I, LOE A)

(Class IIa, LOE

B). PETCO2 capnometers

Combitube

CPR ROSC

Esophageal Detector Devices(EDD)EDD

EDD EDD

EDD EDD

69

(Class IIa, LOE B).

EDD

(Thoracic Impedance)

2

6 CPR

(Class I, LOE C).

2

(Class IIb, LOE C)

X

Ventilation After Advanced Airway Placement

CPR

CPR 25

6 12

6 8 8 10 /

(Class IIb, LOE C)CPR

Automatic Transport Ventilators

Automatic Transport Ventilators; ATVs

(Class IIb, LOE C). CPR

CPR

(Class IIb, LOE C).

70

BVM

pharyngeal tips

40 / 300

Summary

CPR BVM

ACLS

CPR

71

4.2 (Cardiac Arrest) (ventricular fibrillation, VF)

(pulseless ventricular tachycardia, VT) (pulseless electric activity, PEA)

(asystole)

2010 ()

() CPR

CPR

()

()

CPR VF/pulseless VT

ACLS () ROSC (return of spontaneous circulation)

CPR

IV IO

/

AED VF/VT 2

VF/VT CPR

()

2

(120 to 200J) VF (Class I, LOE

B) (Class IIb, LOE C)

(Class IIb, LOE B)

360J

2 CPR 3-5 1mg

epinephrine (Class IIb, LOE A) CPR VFVT amiodarone

72

(Class IIb, LOE A) ROSC

amiodarone lidicaine amiodarone

ROSC (Class IIb, LOE B) QT torsades de pointes

atropine 2010 VF/VT/asystole/PEA

73

5H5T

VF/VT ACS/AMI CPR

cardiopulmonary bypass

AMI CPR

(ROSC)

74

(post-cardiac arrest care) ST

(Class I, LOE B) (therapeutic hypothermia)

(PEA) (asystole)

AEDCPR (30:2) 2

(organized rhythm)

CPR

2 ()CPR

()

3-5 epinephrine 1 mg atropine

(Class IIb, LOE B)

PEA 5H5T

PEA

(Class IIa,

LOE B, ) (needle decompression)

PEA

75

Table Treatable Causes of Cardiac Arrest: the Hs and Ts

Hs Ts

Hypoxia Toxins

Hypovolemia Tamponade (cardiac)

Hydrogen ion (acidosis) Tension pneumothorax

Hypo-/hyperkalemia Thrombosis, pulmonary

Hypothermia Thrombosis, coronary

For further explanation of the Hs and Ts, see special resuscitation situations

( ventricular volume)

(ROSC) (post-cardiac arrest care)

(therapeutic hypothermia) (Class IIb, LOE C)

CPR (100/min) (>5cm) (6~8 sec/breath)

CPR

PETCO2 (partial pressure of

end tidal CO2)CPP (coronary perfusion pressure)SCVO2 (central venous oxygen saturation)

CPR (PETCO2, CPP,

SCVO2) ROSC CPR

ROSC CPR

(Class IIb, LOE C)

PETCO2 35~40 mmHg 10 mmHg ROSCSCVO2

60~80% 30% ROSC

76

CPR

CPR

CPR

bolus 20-mL

IO

(Class IIa, LOE C)

SCVO2 CPR

CPR CVP (Class IIb, LOE

C)

lidocaine, epinephrine, atropine, naloxone, vasopressin (NAVEL)

amiodarone

epinephrine beta-adrenergic effect

ROSC IVIO

epinephrine, vasopressin, lidocaine

(Class IIb, LOE B)2~2.55~10 mL

ambu bagging epinephrine

lidocaine

ROSC

4

ROSC

alpha-adrenergic effect (vasoconstrictor) CPR

77

beta-adrenergic effect (myocardial work)

(subendocardial perfusion) IV/IO 3~5 1mg

epinephrine (Class IIb, LOE A)

Vasopressin nonadrenergic peripheral vasoconstrictor

ROSC

IV/IO vasopressin 40 units

amiodarone placebo lidocaine

Amiodarone alpha beta-adrenergic

placebo lidocaine

amiodarone

CPR VF/VT amiodarone (Class IIb, LOE B)

300 mg IV/IO 150 mg IV/IO 6 1

mg/min 18 0.5 mg/min

Lidocaine VF

amiodarone

lidocaine (Class IIb, LOE B) 1~1.5 mg/kg IV VF/VT

5~10 0.5~0.75 mg/kg 3 mg/kg 2~4 mg/min

QT irregular/polymorphic VT QT

irregular/polymorphic VT VF/VT (Class III, LOE

A) 1~2 g 10 mL D5W IV/IO bolus (Class IIb, LOE

C)

78

4.3

Atropine

Atropine0.5 mg (Class IIa) 3~5 3 mg Atropine

Transcutaneous pacing, TCP TCP

Class IIa

Dopamine/Epinephrine TCP Dopamine 2~10g/kg/min Epinephrine

2~10g/min (Class IIb)

TCP(Second degree AV Block, Mobitzs Type II Third degree

AV Block)(Class IIb)

Transvenous pacing TCP Transvenous pacingClass IIa

79

80

QRSsupraventricular tachycardia,

SVT QRS

QRS (SVT) QRS

81

1

6

150 /

2

3

QRS0.12

5

7

12 VagalmaneuversadenosineBlocker calciumchannelblocker

QRSadenosine

4

12

adenosine

50100J 120200J

200J100J

AdenosineIV 6mg IVpush N/Sflush

12mg

QRS

ProcainamideIV 2050mg/min

QRS 50%17mg/kg

1-4mg/min QT

AmiodaroneIV 150mgIV 10

VT 1mg/min 6

SotalolIV 100mg1.5mg/kg 5

QT

82

(synchronized cardioversion) QRS

(VF)

unstable SVT, unstable atrial fibrillation, unstable atrial flutter unstable

monomorphic (regular) VT

Af 120~200 Class IIa

Af SVT 50~100 Class IIa 50J

200 200J

Class IIa

VT 100

torsades de pointes

VT VF )

QRS

Sinus Tachycardia>100 / 220

Supraventricular Tachycardia (Reentry SVT)Paroxysmal

Supraventricular Tachycardia, PSVTAV Node Reentry Tachycardia,

AVNRTMATjunctional tachycardia

83

(vagal maneuvers) adenosine SVT

7

(1) 25% PSVT vagal maneuvers adenosine SVT

(2) adenosine adenosine 6 mg (Class I)

1~3 20ml 1~2

adenosine 12 mg

(3) adenosine

(Class IIa)

Verapamil 2.5~5 mg 2 ( 3 )

15~30 5~10 mg 20mg

Diltiazem 15~20 mg(0.25mg/kg) 2 15

20~25mg(0.35mg/kg) 5~15mg/hr

QRS 567

3

QRS VT 4

12

67VT SVT with aberrancy

atrial fibrillation with aberrancy, pre-excited atrial fibrillationor polymorphic VT/torsades de

pointes

QRS

(1) Adenosine

Class IIb) Adenosine QRS

Verapamil QRS

(2)VT procainamide (Class IIa), amiodarone (Class IIb)

sotalol (Class IIb) procainamide sotalol QT

84

(3) Amiodarone 150mgIV 10 24 2.2g

VT

Atrial Fibrillation/ Flutter

48

transesophageal echocardiography, TEE

VT VFdefibrillation

VT QT

Long QT intervaltorsades de pointes QT

QT Magnesium QT interval

long QT interval VT amiodarone

-blockers (Class IIb

SVT

Adenosine ()

Adenosine

QRS

QRS

QRS

85

Diltiazem, Verapamil

nondihydropyridine

vasodilators,negative inotropes

QRS adenosine SVT

Af AF

Diltiazem 15~20 mg(0.25mg/kg) 2 15

20~25mg(0.35mg/kg) 5~15mg/hr

Verapamil 2.5~5mg 2 15~30

5~10 mg 20-30 mg

QRS

Af AF pre-excitation Wolff-Parkinson-WhiteWPW

atenolol, esmolol, metoprolol, propranolol

QRS adenosine

Af AF

VT QT

Atenolol (1) 5 mg 5 10

Metoprolol (1) 5 mg 1-2 5 15 mg

Propranolol (1 & 2) 0.5-1mg 1 0.1mg/Kg

86

Af AF (pre-excitation) WPW

Procainamide Pre-excited atrial fibrillation 20-50mg/min

QRS 50% 17 mg/kg

5 100mg

Bradycardia,hypotension,torsades de pointesProcainamide QT prolongation CHF

Amiodarone

QRS AF

QRS

amiodarone 150 mg 10 6 1 mg/min

0.5mg/min 2.2g/

Digoxin

QRS adenosine SVT

AF Af

Digoxin 8-12 mcg/kg(4-6mcg/kg) 5 25%

(2-3mcg/kg) 4-8

VT

Procainamide

VT 20-50mg/min

QRS 50% 17 mg/kg 5

87

100mg torsades de

pointesProcainamide QT

Amiodarone

VT VT QT interval

amiodarone150 mg 10 6 1 mg/min 0.5mg/min

2.2g/ Bradycardiahypotension QT

Sotalol

Potassium channel blocker 1 & 2

VT 5 1.5mg/kg 5

QT

Lidocaine

VT 1.0-1.5 mg/kg 5~10

0.5~0.75mg/kg 3mg/kg 1~4mg/min (30~50g/kg/min)

Magnesium

VT QT torsades de pointes

1-2g 15 Magnesium level

88

5. //

(rate)(volume)(pump)

()

89

6.

ROSC

(1)

(2)(3)

(4)(5)

(6)

24

(PCI)

1

2010 AHA CPR ECC

30

100%

94%

10 12 PETCO2 35-40 mmHg

PaCO2 40-45 mmHg

90

2

90 mmHg

epinephrinenorepinephrine dopamine

90 mmHg 65 mmHg

3

4

ST LBBB

PCI

ST

5

20% 50%

6

5H-5T5H HypovolemiaHypoxia

HypothermiaHydrogen ion (acidosis) Hypo-/hyperkalemia

5T ToxinTamponade (cardiac)

Thrombosis of coronary areteryTension pneumothorax

Thrombosis of pulmonary vasculature

91

Induced hypothermia

12 24

feedback-controlled endovascular cathetersurface cooling device

2010 AHA CPR ECC

(1) VF

32C-34C12 24 Class I, LOE B(2)

92

PEA

Class III, LOE C

Class I, LOE C

PaO2/FiO2 < 300 < 200

PEEP

(FiO2)

100%

94%Class I, LOE C1

2

10 30

3 auto-PEEP

Class III, LOE

C1 6 8 ml2

plateau pressure 30 cmH2O

40-45

mmHg(35-40 mmHg)

Class IIb, LOE C

93

fibrinolyticClass IIb, LOE C

2-adrenergic agonist

butyrophenones

catecholamine

neuromuscular blocking agent

Class IIb, LOE C

ST

Class I, LOE BPCI

Vasoactive

NaHCO3 ( )

2-adrenergic receptor

10 mg phentolamine 10-15 ml

dobutamine inodilator milrinone

Class I, LOE B 65 mmHg

ScvO2 70%

94

144-180 mg/dLClass IIb,

LOE B 80-110 mg/dL

Class III, LOE B

95

hemofiltration

68% 23%

myoclonus

I

Class I, LOE C status epilepticus

Class IIb, LOE C

Thiopentalnimodipinelidoflazine

diazepam magnesium sulfate coenzyme Q10

Class IIb, LOE B

96

97

7. (Acute coronary syndrome, ACS)

7.1

5%5

10%

/

224

(angina equivalents)

1/3

40

84.6%

80.6% ()

1. (visceral pain)

(acute myocardial infarction, AMI)2.

(pleuritic pain)3. (chest wall pain)

() 1.

2. 3.

4. 5.

(inciting) 6.

(Variant Prinzmental angina)

98

(Acute coronary syndromes, ACS)

([biomarkers])

1050%

(creatine kinase) MB24

Troponin I

(sensitivity) (specificity)X-ray

(hypertrophic cardiomyopathy)

1. (

)2. 3.

4. 5.

1.

2. 3. 4.

ABA

B

99

IVO2monitor

ACSACSAMI (ST-segment

elevation myocardial infarction, STEMI)unstable anginanon ST elevation MI (NSTEMI)

STEMI

4D (door) (diagnosis) (decision)

(drug)

5%25~33%

10 MONA

() CBCelectrolyteCK CK-MBPTAPTT X

AMI ST T

AMI NSTEMI

(unstable angina, UA)

UA NTG

1. MONA

MMorphine2-4 mg IVP

OOxygen 4~6L/minACS

Nnitroglycerin (NTG)nitroglycerin

nitroglycerinACSACS

24phosphodiesterase

AAspirin 160~325 mgACSAspirin

2. ClopidogrelNSTEMI/UASTEMI75

600 mg

300 mg75(75-600 mg)

100

3. HeparinUnfractionated Heparin (UFH)Low molecular weight heparin (LMWH)

NSTEMI/UAfondaparinuxenoxaparinUFH

NSTEMI/UAenoxaparinUFH

STEMIenoxaparinUFH

STEMIPCIenoxaparinUFH

4.(reperfusion therapy)AMI

morbiditymortality12

30(door-to-needle time < 30 min)60

90(door-to-balloon time < 90 min)

(1) AMILBBBAMI

rt-PAstreptokinase (SK)rt-PA

15 mg50 mg(30)35mg(60)SK

15013

(3) ()

(>180/110 mmHg) (

185/110 mmHg)

(2~4)10

CPRCPR (3) (2~4)

SKt-PASK

6575

180/110 mmHgt-PA

(2) Primary PTCA(PCI)90

PCIPCI(a)

(b)PCIAMI

3618PCI

PCIPCI

5.

(1)

(2) ACEI/ARBAMI

101

ACEI/ARB

(3) -blocker-blocker

-blocker-blocker

(4) Statin (HMG coenzyme reductase inhibitors)StatinACS

()ACS

6. 40%

intra-aortic balloon pump (IABP)

7.

NSTEMIUA ()

NSTEMIST

STEMINTG IVclopidogrelheparin-blocker

statinACEIprimary PCI

early PCI glycoprotein IIb/IIIa inhibitors (GP)

NSTEMI/UA

PCI (24~36

PCI)ST

UA/ NSTEMIGPPCIGP(Class

I )GPAbciximabeptifibatidetirofibanPCI

Abciximab (Class III )Class IIb

GPGP

STEMI

ICU

CCU

102

CHEST PAIN CENTER

8~12

AMI

AMIAMI 4D

Door-Diagnosis-Decision-Drug (

AMI) ()

()

103

7.2 (Acute coronary syndrome, ACS) (AMI) (unstable angina) (Acute

coronary syndromes, ACS)ST-Segment(STEMI)

ST-segment(depression)(non) ST-segment(NSTEMI)T

ST-segment(markers)

(sudden cardiac death:)ACS

BLSACLS

ACS(1)

(2)(3)

VF/VT

EMT AMI 3

(1)(2) PCI(3)

PCI 3 PCI

3 PCI

PCI ( 100

100) 75 75 STEMI 36

PCI PCI 18

104

105

8. 8.1

2010 ACLS

(bronchoconstriction)

(airway inflammation)

(mucous plugging)

/

(hypercarbia) (acidemia)

(asphyxia)

(lobar atelectasis)

(pulmonary edema)

(wheezing)

(oxygen saturation / SaO2) 2-agonists

(bronchodilation) (vasodilation)

(intrapulmonary shunting)

(anaphylaxis)

106

(bronchiectasis)

(subglottic mass)

(SaO2, ECG)

2-agonists

2-agonists ventilation-perfusion mismatch

2-agonists

2-agonists (dose-dependent)

vs albuterol (nebulizer)

MDI vs nebulizer (metered-dose inhaler spacer) albuterol

vs 2-agonists 15

bolus infusion

2-agonists

levalbuterol albuterol levalbuterol

2-agonists anticholinergic ( ipratropium)

107

(inflammatory component)

6 12

methylprednisolone 125 mg (40-250 mg)

dexamethasone 10 mg

Anticholinergics

Magnesium Sulfate

Epinephrine / Terbutaline

Ketamine

Heliox

Methylxanthines

Leukotriene Antagonists

Anticholinergics

ipratropium bromide

( 20 60 90 )

2-agonists

ipratropium bromide

Magnesium Sulfate

Magnesium

magnesium sulfate -agonists

(severe refractory) magnesium 2 g 20

Epinephrine / Terbutaline

108

adrenergic

epinephrine ( 1:1000) 0.01 mg/kg 20

terbutaline 20 0.25 mg

epinephrine 4%

epinephrine / terbutaline epinephrine

2-agonists

Ketamine

(dissociative)

ketamine

(rapid sequence intubation, RSI)

ketamine

Heliox

70% (helium) 30%

Heliox

Heliox 30% 30% Heliox

Methylxanthines

Leukotriene Antagonists

2-agonists

sevoflurane isoflurane

109

(Assisted Ventilation)

(Noninvasive Positive-Pressure Ventilation, NIPPV)

(NIPPV)

NIPPV

(bilevel positive airway pressure, BiPAP)

RSI ( 8-9 mm)

X

(positive end-expiratory pressure auto- PEEP)

auto-PEEP

(6-8 mL/kg)

( I/E ratio 1:4 1:5)

110

(hypoventilation)

(end-expiratory pressure)

PEEP

auto-PEEP

auto-PEEP (DOPE)

Displacement

Obstruction ( )

Pneumothorax

Equipment failure ( )

2010

BLS

ACLS auto-PEEP

(Class IIa, LOE C)

(lateral chest compressions)

air-trapping

(Class IIa, LOE C)

(Class I, LOE C)

8.2 (Cardiac Arrest Associated With Anaphylaxis)

(cardiovascular collapse)

5001,000

(anaphylaxis) IgE IgG4

(Signs and Symptoms)

(rhinitis)()(stridor)

111

(asthma(wheezing) ACEI(angiotensin converting

enzyme inhibitor) C1 esterase inhibitor

37%

BLS

(Airway)

Class I, LOE C

(Circulation)epinephrine (epinephrine auto injectors, eg, the EpiPen)

Class I, LOE C 0.2~0.5mg(1:1000) 10~15

epinephrine auto injectors 0.3mg 0.15mgClass I, LOE C

ACLS

(Airway)

(surgical airway)Class I, LOE C

(Fluid Resuscitation)1,000cc

(Normal Saline)90mmHgClass IIa, LOE C

Vasopressorsepinephrine0.05~0.1mg

Class IIa, LOE CClass I, LOE B

(vasopressin-agonists such as norepinephrine, methoxamine, metaramino)

epinephrinevasopressin, norepinephrine,

methoxamine, and metaraminolClass IIb, LOE C

Antihistamines (H1 and H2 antagonist), inhaled -adrenergic agents, and IV

corticosteroidsCardiopulmonary bypass Class IIb, LOE C

112

8.3

2

1.

2. 100%

3.

4. 100 80%

5.

BLS

30 CPR

27 30

ACLS

ST

PCI

113

PRQRSQT

/

20

4

24 5

114

8.4 (WHO) BMI 40 kg/m2 (morbid

obesity)

2010

BLS ACLS

8.5 PEA (pulseless electric

activity)

2010

(Class IIa, LOE B)

(Class III, LOE A)

(percutaneous) (embolectomy)

8.6

Potassium (K+)Na+/K+ ATPase pump

3.5~5.0mEq/L

(Hyperkalemia)

> 5.0mEq/L >6.5 mmol / L

(flaccid

paralysis)(paresthesia)(depressed deep tendon reflexes)

115

T P PR QRS S T

(sine-wave)(idioventricular rhythms)VF

(Stabilize myocardial cell membrane)

1. Calcium chloride (10%) 5-10 ml(500~1000mg) IV 2-5 minutes

2. calcium gluconate (10%): 15~30 ml IV over 2 to 5 minutes

(Shift potassium into cells)

1.Sodium bicarbonate(NaHCO3) 50mEq IV over 5 minutes

2. Glucose plus insulin25g (50 ml of D50 Glucose) + 10U RI IV 15-30 minutes

3.Nebulized albuterol 10-20mg over 15 minutes

1.DiureticFurosemide 40-80mg IV

2.Kayexalate 15 - 50 g + sorbitol

3.(Dialysis)

(Hypokalemia)

< 3.5 mEq/L()

() (Amphotericin Bcarbenicillinsodium penicillin

severe hyperglycemiahyperalclosteromism) (PH

)(paralytic ileus)

(Rhabdomyolysis)UT(

digoxin) PEAAsystole

K+ < 2.5 mEq/L 40 mEq/L10-20 mEq/ h

ECG monitor(Class III, LOE C)

Sodium (Na_)

(Hypernatremia)

> 145 mEq/L (

)( hyperaldosteronism, cushings syndrome, hypertonic saline or sodium

116

bicarbonate)

()

(Hyponatremia)

< 130-135mEq/L L thiazide

SIADH

1. intravascular volume

2. SIADH:(50-66% of maintenance fluids)

3. Asymptomatic hyponatremia : Na+ 0.5 mEq/L /hr (max. 12 mEq/L in the first 24hrs)

4. osmotic demyelination syndrome or central pontine myelinolysis

5.3% saline= 513mEq Na+/L 1mEq/L/h

0.5 mEq/L /hr

6. seizure 2-4 mEq/L/h

7. Na+ deficit= (desired [Na+] current [Na+]) x 0.6* x BW (kg)

(*0.6 for men, 0.5 for women.)

70 10 8mEq/L4 112mEq/L

(112-108)x0.5x70 = 140mEq

140/513 =0.27L =270ml 3% saline , 270/4 = 67 ml/h

8.

MagnesiumMg++ 1.3-2.2 mEq/L)

1.

2. Na, K, Ca

3.

(Hypermagnesemia)

> 2.2 mEq/L (

)()(

)(Class IIb, LOE C)

1. Calcium chloride (10%) 5-10 ml(500~1000mg) IV 2-5 minutes

117

2. calcium gluconate (10%): 15~30 ml IV over 2 to 5 minutes

(Hypomagnesemia)

< 1.3mEq/L (

)(eg., pentamidine, diuretics, alcohol)

1-2g MgSO4 IV bolus (Class

I, LOE C)

Calcium (Ca++)

Ca

Ca++ K+ Mg++ D

(hypercalcemia)

Serum Ca > 10.5 mEq/L or Ca2+ > 4.8 mg/dL

90%

N/S run 300 to

500 mL/h () N/S at 100 to 200 mL/h K+

Mg++(CalcitoninArediaSteroid indomethacin

oral phosphates)

(hypocalcemia)

Serum Ca < 8.5mEq/L or Ca2+ < 4.2mg/dL Toxic shock

syndromeTumor lysis syndrome Ca2+ <

2.5mg/dL (Stridor)

(Chvostek and Trousseau signs) 10% Ca gluconate 10% CaCl2 IV

4-6 7-9mg/dL K+ Mg++ and pH

8.7 (Cardiac Arrest Associated With Toxic Ingestions)

118

ABC ()

BLS ACLS

()

(evidence- based)(case

reports)(case series)

(decontamination)

( carbamazepine, dapsone, phenobarbital,

119

quinine, theophylline)

(Toxidromes)

, , ,

, ,

, (working

diagnosis),

()

/

/ (

QRS)

/

Clonidine (2 )

Propoxyphene (

)

( quinidine,

flecainide)

/

/

Isoniazid

(benzodiazepines)

(Ethylene

Glycol)

Metformin

120

( bupropion)

(Salicylates)

, ,

, ,

(opioid)

(naloxone)

, , , BLS ACLS

, naloxone

Naloxone ,

, naloxone

, , ,

BVM, naloxone; Naloxone,

()(Class I, LOE A)

, naloxone , ,

, naloxone (0.04-0.4mg),

, 2mg,

( propoxyphene), naloxone

naloxone , , , ,

Naloxone 45-70 (methadone),

, naloxone ,

naloxone

Naloxone , , ,

? , ;

,

121

(benzodiazepines, BZD)

(flumazenil) BZD

, , BZD , BLS ACLS

BZD , flumazenil ,

BZDFlumazenil, BZD

, flumazenil

, flumazenil (Class III, LOE B)

BZD, flumazenil; (

, TCA), flumazenil ,

(), ,

, flumazenil

(-Blockers)

,

, , BLS ACLS

,

(vasopressor), ,

, , ,

(Glucagon)

, ()

, : 3-10mg (

0.05-0.15mg/kg) 3-5 , 3-5mg/hr ( 0.05-0.10mg/kg/hr) (Class

IIb, LOE C)

()

, 100mg,

, ,

122

, dopamine ,

dopamineisoproterenol milrinone,

(Insulin)

, ,

, ,

(J Med Toxicol. 2009;5:139-143) metoprolol

, ,

, 1 U/kg (RI)

0.5g/kg , 0.5-1 U/kg/hr 0.5 g/kg/hr

,

100-250 mg/dL (5.5-14 mmol/L),

, 15(

123

),

,

, ,

(Calcium Channel Blockers)

, , , BLSACLS

,

,

(Class IIb, LOE B),

,

(Class IIb, LOE C)

CCB ,

(Digoxin) (Cardiac Glycosides)

, VT, Vf,

, , ,

, , , BLS

ACLS , ,

Antidigoxin Fab antibodies (Class I, LOE

B)1vial anti-digoxin Fab 0.5mg , ,

:

(1), 1mg , 2 vials Fab

(2), , :

(ng/mL) X (kg) / 100

(3), ,

10-20 vials

124

,

, 5.0mEq/L,

anti-digoxin Fab

(Cocaine)

,

, , BLS ACLS

, ,

: ,

(55%)

,

, ,

, -blockers

(phentolamine), benzodiazepines(Lorazepam, diazepam), (verapamil), Morphine,

nitroglycerin , (Class IIb, LOE B)

,

(Class IIb, LOE B) BZD, NTG, /

morphine (Class IIa, LOE B)

, ,

morphine, NTG,

phentolamine verapamil ; Labetalol , propranolol

, , ,

, : ,

(Class IIb, LOE C)

, 1c , QRS

, ,

, 1c (flecainide) TCA

QRS 1ml/kg

NaHCO3 (8.4%, 1mEq/mL), QRS

120ms lidocaine QRS

125

(Cyclic antidepressants)

QRS 1a 1c

(: procainamide, quinidine, flecainide)(: amitriptyline)

2010 , 1a 1c 1a

, , QRS

, BLS ACLS

: Epinephrine NaHCO3 ,

, physostigmine ,

, NaHCO3 (Class IIb, LOE C)

, ,

pH , ,

NaHCO3 (8.4%, 1mEq/mL), NaHCO3 1mEq/kg

, () QRS (Class

IIb, LOE C), pH , (Na >

155mEq/L) (pH > 7.55)( epinephrine,

norepinephrine, dopamine dobutamine),

, bupivacaine, mepivacaine, lidocaine,

,

, , ,

, ACLS ,

, ,

1.5mL/Kg 20%, 5 ,

(Class IIb, LOE C), 0.25mL/Kg,

30 60 12mL/Kg

126

, epinephrine vasopressin

,

,

, ,

, ,

,

,

, ,

, BLS ACLS

: , ,

(),

(), ,

, , ,

,

, ,

: ,

(Class IIb, LOE C)

, , ,

,

, ,

,

127

(Cyanide)

, , ,

,

, , , ,

, ,

, ,

,

(scavenger), ( hydroxocobalamin ,

nitrite, : sodium nitrite/ amyl nitrite), sodium thiosulfate

hydroxocobalamin sodium nitrite ,

nitrite (methemoglobin),

; hydroxocobalamin , ,

Sodium thiosulfate , ,

thiocyanate, thiosulfate (scavenger)

; , thiosulfate hydroxocobalamin sodium nitrite

Sodium thiosulfate , , ,

, : 100%, hydroxocobalamin, sodium thiosulfate

8.8 (Cardiac Arrest Associated With Trauma) BLS ACLS

CPR

(BLS Modifications)

, , ,

, , ,

, , (pocket mask), (BVM)

128

, , CPR

(ACLS Modifications)

CPR, BVM, ,

(),

, ,

, ,

, ,

, ,

PEA , , ,

, ,

, CPR

Part 12.4

, (American College

of Surgeon Committee on Trauma, ACS COT) 1966-1999 :

7.8% (11.2%, 1.6%)

(Commotio Cordis)

, Vf

,

(), Vf,

, 18 , ,

Vf,

AED BLS ACLS Vf

8.9

129

34 C

30 34 C

30 C

cardiopulmonary bypass

extracorporeal blood warming with partial

bypass

VT VF VT VF

BLS

30C

Vasopressor ACLS

8.10

35

32C

8 C

130

8mmol/L

ROSC

8.11 (Drowning)

(

)

(Class I, LOE C)

near-drowning

(drowning) /

20 100%

(1) 25

(2) 25

(3)

() ()

131

132

( 12-15 (NRM))

( X )

4-6

X

24

A-B-C

2010 CPR C-A-B

CPR A-B-C !!!

A-B-C

A-B-C

CPR

BLS A-B-C !!!

(

0.009%)

()

133

(rescue breaths)

(Class III, LOE

B)

(oxygenation)

(ventilation) (perfusion) (

) ()

(suction)

2010 (abdominal thrusts)

(Class III, LOE C)

( BLS A-B-C

)

86%

8.12 (Lightning strikes and Electric Shock)

(Electric Shock)

(VF) R on T

134

(Lightning strikes)

primary VF or asystole

(ROSC)

(catecholamine release)

QT T

30% 70%

BLS

1.

2.

3. CPR

4. AED VT/ VF

5.

6.

ACLS

1.

2.(N/S lactated Ringers solution) 1~1.5

ml/kg/hrNaHCO3mannitol

(myoglobin)

3. VF Asystole ACLS

135

8.13

(Cardiac Arrest During Percutaneous Coronary Intervention)

(PCI)

(chest compressions)PCI

PCI

Mechanical CPR During PCI(Mechanical CPR)PCI

(Class IIa, LOE C)

Emergency Cardiopulmonary BypassPCI

(emergency coronary angioplasty) (Class IIb, LOE C)

Cough CPRPCI(ventricular arrhythmias)

(Class IIa, LOE C)

8.14

(Cardiac Arrest Caused by Cardiac Tamponade) (pericardium)filling

(echocardiography)(Pericardiocentesis)

(emergency pericardiocentesis)

(Class IIa , LOE C)

(Emergency department thoracotomy)(Class IIb , LOE C)

136

8.15

(Cardiac Arrest Following Cardiac Surgery)

1-3%

(ventricular fibrillation)(hypovolemia)(cardiac temponade)

(tension pneumothorax)(pacing wire)

(asystole)

(Resternotomy)

(Class IIa, LOE B)

(Class IIa,

LOE C)

(Mechanical Circulatory Support)

(case series)

()(Class IIb, LOE B)

(Pharmacological Intervention)

epinephrine

epinephrine

137

9.

(fibrinolytic therapy)

Ddetection(

)dispatch()delivery()door()data()decision(

)drug administration() disposition()--

:1.2.EMS

3.EMS4.

138

139

NIHSS()0(

)42 < 4(3)(2

3)(>22)

2545

CT

3

(oxygen saturation 185 ml/dl

thiamine 100

37.5OC;

140

NINDS3tPA30%

3% vs 0.3%6.4% vs 0.6%

(1)tPA(0.9 mg/kg90 mg)10%

60(2)3(3)

(4)

3-4.5tPA3

(FDA)tPA

3-4.5

141

diazepam(5 mg IV 210 mg)lorazepam(1~4 mg IV 2~10)

Pyenytoin18 mg/kg50 mg/min8100 mg

30

thiopentallidocaine

142

PaCO230mmHg

25mmHgPaCO2mannitol0.5~2 gm/kg/dose

2~2020

Nimodipine(60 mg/q4h0.35 mg/kg)

(1)> 230> 120sod. nitroprusside 0.5~10 g/kg/minNTG IV drip(10~20

g/min)

(2)181~230106~120labetalol

300 mg

(3)