2015 ACLS

(AHA & ERC)

A1-A9
A1 AHA 398 IHCA, OHCA 2
A2 AHA Highlights BLS CPR Summary of High-Quality CPR for BLS Providers 3
A3 AHA 418 BLS BLS 4
A4 AHA 452 Cardiac arrest 5
A5 ERC 23 Tachycardia 6
A6 ERC 24 Bradycardia 7
A7 ERC 265 ACS definition 8
A8 ERC 267 ACS treatment 9
A9 ERC 30 Post-resuscitation care 10
A10-A20
A10 ERC 6 The chain of survival 12
A11 ERC 7 BLS/AED Basic Life Support 13
A12 ERC 15 In-hospital Resuscitation 14
A13 ERC 18 Advanced Life Support 15
A14 ERC 25 Anaphylactic reaction 16
A15 ERC 26 Traumatic OHCA 17
A16 ERC 27 Drowning 18
A17 ERC 29 Avalanche 19
A18 ERC 34 Post-resuscitation prognostic plan 20
A19 ERC 152 Hyperkalaemia 21
A20 AHA 506 Opioid BLS 22
B1-B4
B1 AHA 521 BLS Paediatric single HCP-BLS 24
B2 AHA 522 BLS Paediatric multiple HCP-BLS 25
B3 AHA 532 Paediatric cardiac arrest 26
B4 AHA 544 Newborn Life Support 27
B5-B9
B5 ERC 225 Paediatric BLS 29
B6 ERC 228 Paediatric FBAO 30
B7 ERC 236 Paediatric ALS 31
B8 ERC 237 Paediatric Cardiac arrest-Shock and non-shockable 32
B9 ERC 250 Neonatal life support 33

&
 &

A1-A9

1
 &

AHA 398 (A1)

(AHA 2015)

ICU

ED ICU

2
 &

AHA Highlights (A2)
BLS CPR (AHA 2015)


1

10
10




AED CPR
2 CPR
AED
AED CPR
CPR AED
AED
1
30:2

1 2
2
30:2
15:2
100-120 /
6 1 10 /
100-120 /


2 5cm*

2 5cm 1.5 4cm

1
2


2



10
* 2.4 6cm

3
AED(Automated External Defibrillator)CPR(cardiopulmonary resuscitation)

*
 &

AHA 418 (A3)

BLS (AHA 2015)

2



5
AED
5-6
10-12 /
3 2
4
()



2
10 ?
CPR
CPR

Naloxone

6 AED
CPR
30 2
AED

7
AED

8




9 10
1
CPR 2
CPR 2
AED
AED
ALS
ALS

4
 &

AHA 452 (A4)

(AHA 2015)
/ CPR
(5-6 )
100-120 /min
CPR


/
2

30:2

VT/pVF Asystole/PEA
- PETCO <10mmHg

2

Torsa de CPR

-<20mmHg
CPR

CPR 2
IV/IO 2 (120-200J)




360J

Epinephrine 3-5 1mg IV/IO
Amiodarone IV/IO

CPR 2 CPR 2 300mg

Epinephrine 3-5
IV/IO 150mg Max2200mg/day
Epinephrine 3-5

6 (
10 )


ROSC

CPR 2
CPR 2 PETCO (40mmHg)
Amiodarone 2

()

check pulse

pulse: Hypovolemia

pulse: Hypoxia
Hydrogen ion(acidosis)
/ Hypo-/Hyperkalemia Gas
Hypothermia
5 7
ROSC 10 11 Tension pneumothorax
Tamponade, cardiac

ROSC Toxins
Thrombosis, pulmonary

5
Thrombosis, coronary

*
synchonize(R)
 Rate
volume &

ERC 23 (A5) Pump

Tachycardia
()
ABCDE

12

* 1. 3.

3
2. 4.

Amiodarone 300mg IV
10-20
QRS (<0.12 )
Amiodarone 900mg
24

QRS QRS

QRS

12mg
12mg Beta


>48

()
QRS Amiodarone 300mg IV
20-60
( torsade de pointes- 900mg 24
12 ( beta )


adenosine
QRS

* Carotid massageA fibPSVT

6
 &

ERC 24 (A6)

1
()
ABCDE

12

1. 3.
2. 4.

(Atropine) 0.5mg IV

*
Aminophylline
Dopamine
Glucagon ( beta
)
Glycopyrrolate
atropine

7
 &

ERC 265 (A7)

(ERC 2015)

3 5
ST
>0.1mV

/0.2mV
LBBB

6 7

c troponin c troponin
= ST =

4 8
ST ST


ST
/

TIMI, GRACE

8
 &

ERC 267 (A8)

(ERC 2015)
1

2
>90mmHg 3-5

3
150-300

4 7
ST ST
5 6 8 9






enoxaparin enoxaparin

bivalirudin bivalirudin
fondaparinux

enoxaparin enoxaparin
Ticagrelorclopidogrel
bivalirudin Ticagrelorclopidogrel
Ticagrelor fondaparinux streptoainase

prasugrel clopidogrel clopidogrel

9
 &
(ERC 2015)
ERC 30 (A9)

1

94-98%

2

12

>100mmHg
()-

3

32C-36C

6 7

8 9



10 11

12

32C-36C24 72

(ScvO2CO/CI)


()
72

13

14
10
ICD

 &

A10-A20

11
 &

ERC 6 (A10)

(ERC 2015)

ERC Resuscitation Guidelines 2015

12
 &

ERC 7 (A11)

BLS/AED (ERC 2015)

1

CPR 30:2

AED

13
 &

ERC 15 (A12)

(ERC 2015)

4 3 9
?

5 10
ABCDE

6

CPR 30:2

11

7

/

12
8

14
 &

ERC 18 (A13)

(Advanced Life Support, ERC2015)

CPR 30:2
/

(VF/Pulseless VT) (PEA/Asystole)

CPR 2 CPR2

ABCDE
SaO2 94-98%
PaCO2
12

Hypoxia Tension pneumothorax
Hypovolaemia Tamponade (cardiac)
CPR / Hyper-/Hypokalemia, metabolic
CPR / Hypothermia/hyperthermia
- Thrombosis-coronary or pulmonary
Toxins


(IV/IO)
3-5 adrenaline
3 amiodarone

CPR(ECPR)

15
 &

ERC 25 (A14)

(Airway)(Breathing)(Circulation)
(Disability)(Exposure)

(A) / (B) / (C) 1

()

16
 &

ERC 26 (A15)

/
?

ALS

Hypoxia
Tension

ALS
Tamponade ()

/
Hypovolemia

1.
2.
3.
4.
5.
(proximal aortic compression)
6.

(thoracotomy)

17
 &

ERC 27 (A16)

5 /

30:2

AED

18
 &

ERC 29 (A17)

CPR

60min (30)

ALS
2
1
()

>60min (<30)

5
CPR

Asystole
8mmol/L

6

(ECLS)

>8mmol/L
CPR

1.

2.
()
3.
1
4.
<28
5.
CPR
6.

19
 &

ERC 34 (A18)

(ERC 2015)

1 2

3 4 5

6
SSEP
-NSE

7
72 M=1 2

8 9

1.
2. N20 SSEP <5%

35
10
24

11

48
12
NSE

/

13


14

20
 &

ERC 152 (A19)

ABCDE
6.5mmol

21
 &

AHA 506 (A20)

(AHA 2015)

1


119 AED Naloxone

2
CPR

CPR*
2 CPR
119 Naloxone AED

3
Naloxone
Naloxone
2 0.4
4

4 5

?






CPR Naloxone

6
CPR AED

* CPR *
22
 &

B1-B4

23
 &

AHA 521 (B1)

BLS (AHA 2015)

1

2


5

3-5
4 12-20 /
3 60


()
2
()
10 ?

2
CPR
CPR

6 7
(
?
) AED/

8
CPR

30 2
15:2 )
AED

9
2
AED

10
AED



11 12
1
CPR 2
CPR 2
AED
AED
ALS
ALS

24
 &

AHA 522 (B2)

BLS (AHA 2015)

1

2



5
AED
3-5

3 12-20 /
4 60

2
()
10 ?

2
CPR
CPR

6
CPR
CPR
30:2
15:2
AED

7
AED



8 9
1 CPR 2
CPR 2 AED
AED ALS
ALS

25
 &

AHA 532 (B3)

(AHA 2015)

CPR

CPR (
)(

100-120 )
/





15:2
VF/pVT Asystole/PEA

CPR Epinephrine IO/IV
IO/IV 0.01mg(0.1ml/kg
110000) 3~5
IO/IV
0.1mg(0.1ml/kg
11000)
Amiodaronec IO/IV
5mg
VF/pVT
2
Lidocaine IO/IV
1mg
20-50mcg
CPR CPR (>15
3-5 Epinephrine IO/IV 1mg )
3-5 Epinephrine




6
( 10 )

ROSC
CPR
CPR
Amiodarone lidocaine

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypoglycemia
/ Hypo-/Hyperkalemia
Hypothermia
5 7
Asystole/PEA 10 11 Tamponade,cardiac
Toxins
(ROSC) Thrombosis,pulmonary
Thrombosis,coronary

*
26
 &

AHA 544 (B4)

(AHA2015)

100

PPV()


CPAP

LMA

1 60~65%
2 65~70%

3 70~75%
4 75~80%
5 80~85%
PPV() 10 85~95%
100%

Epinephrine
60

*
27
 &

B5-B9

28
 &

ERC 225 (B5)

(ERC2015)

15

2
15

1 CPR

29
 &

ERC 228 (B6)

(ERC2015)

()

5

5
5
( ()
CPR
1 )

30
 &

ERC 236 (B7)

(ERC2015)

CPR
( 5 : 15:2)
/

(VF/Pulseless VT) (PEA/Asystole)

CPR2
CPR 2

3 5 ABCDE
pVT/VF
aminodarone

CPR Hypoxia
CPR: Hypovolemia
/
Hyper-/Hypokalemia, metabolic
(IV/IO) Hypothermia
()
3-5 adrenaline
Thrombosis(coronary or pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins/
Therapeutic disturbances

31
 &

ERC 237 (B8)

32
 &

(ERC2015)
ERC 250 (B9)

()

() 60

5
SPO2

2 60%

3 70%

5 4 80%

5 85%
10 90%
?

( 60 )

(3:1)

30
( 60 )
)

33