By Q. Cyrus. University of Minnesota-Crookston. 2017.

Open airway with tongue-jaw lift; finger sweep to clear airway 70mg alendronate with mastercard, open airway (head-tilt, chin-lift). Open airway (head-tilt, chin-lift), determine breathlessness (look, listen, feel). Attempt to ventilate, if unsuccessful, repeat sequence until ventilations are effec- tive. Hold child with head lower than body, give five back blows or five gentle abdominal thrusts. Adjust the leg you are holding until both the thigh and knee are at right angles to the body. ADVANCED CARDIAC LIFE SUPPORT AND EMERGENCY CARDIAC CARE ACLS includes the use of advanced airway management (See Endotracheal Intubation, Chapter 13, page 268), defibrillation, and drugs along with basic CPR. Most cardiac arrests are due to VF and are unwitnessed outside the hospital setting. ACLS protocols incorporat- ing all these emergency cardiac care techniques are reviewed in the following algorithms for adults: • Universal/International ACLS algorithm (Figure 21–1) • Comprehensive emergency cardiac care algorithm (Figure 21–2) • Ventricular fibrillation and pulseless VT algorithm (Figure 21–3) • Pulseless electrical activity algorithm (Figure 21–4) • Asystole: The silent heart algorithm (Figure 21–5) • Bradycardia algorithm (Figure 21–6) • Tachycardia overview algorithm (Figure 21–7) • Narrow complex SVT algorithm (Figure 21–8) • Stable VT algorithm (Figure 21–9) • Acute coronary syndromes algorithm (Figure 21–10) • Acute pulmonary edema, hypotension, and shock (Figure 21–11) Advanced Cardiac Life Support Drugs The most commonly used agents are listed on the inside covers for quick reference. Abbreviations: VF = ventricular fibrillation; VT = ventricular tachycardia; BLS = 21 basic life support. Abbrevi- ations: VF = ventricular fibrillation; VT = ventricular tachycardia; BLS = basic life sup- 21 port; PEA = pulseless electrical activity. Persistent or recurrent VF/VT Secondary ABCD Survey 2 Focus:more advanced assessments and treatments A Airway:place airway device as soon as possible B Breathing:confirm airway device placement by exam plus confirmation device B Breathing:secure airway device; purpose-made tube holders preferred B Breathing:confirm effective oxygenation and ventilation C Circulation:establish IV access C Circulation:identify rhythm monitor C Circulation:administer drug appropriate for rhythm and condition D Differential Diagnosis:search for and treat identified reversible causes •Epinephrine1 mg IV push, repeat every 3 to 5 minutes 3 or •Vasopressin40 U IV,single dose, 1 time only Resume attempts to defibrillate 1 360 J (or equivalentbiphasic) within 30 to 60 seconds Consider antiarrhythmics: 4 amiodarone(llb),lidocaine(Indeterminate), magnesium(llb if hypomagnesemic state), procainamide(llb for intermittent/recurrent VF/VT). Resume attempts to defibrillate 5 21 FIGURE 21–3 Ventricular fibrillation and pulseless ventricular tachycardia algo- rithm. Abbreviations: VF = ventricu- lar fibrillation; VT = ventricular tachycardia; EMT = emergency medical treatment; 21 ACS = acute coronary syndrome; PEA = pulseless electrical activity. No Yes Type II second-degree AV block 6 Intervention sequence 3,4,5 or •Atropine0. Abbreviations: BP = blood pressure; ECG = electrocardiogram; AV = atrioventricular.

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Joseph generic alendronate 70mg with amex, others) COMMON USES: Mild pain, headache, fever, inflammation, prevention of emboli, and prevention of MI ACTIONS: Prostaglandin inhibitor DOSAGE: Adults. Tabs Fiorinal, Lanorinal, Marnal: Aspirin 325 mg/butalbital 50 mg/ caffeine 40 mg NOTES: Butalbital habit-forming Aspirin + Butalbital, Caffeine and Codeine (Fiorinal + Codeine) [C] COMMON USES: Mild pain; headache, especially when associated with stress ACTIONS: Sedative analgesic, narcotic analgesic DOSAGE: 1–2 tabs (caps) PO q4–6h PRN SUPPLIED: Each cap or tab contains 325 mg aspirin, 40 mg caffeine, 50 mg of butalbital, codeine: No. AMI: 5 mg IV ×2 over 10 min, then 50 mg PO bid if tolerated SUPPLIED: Tabs 25, 50, 100 mg; inj 5 mg/10 mL Atenolol and Chlorthalidone (Tenoretic) COMMON USES: HTN ACTION: β-Adrenergic blockade with diuretic DOSAGE: 50–100 mg/d PO SUPPLIED: Tenoretic 50: Atenolol 50 mg/chlorthalidone 25 mg; Tenoretic 100: Atenolol 100 mg/chlorthalidone 25 mg Atorvastatin (Lipitor) COMMON USES: Elevated cholesterol and triglycerides ACTIONS: HMG-CoA reductase inhibitor DOSAGE: Initial dose 10 mg/d, may be ↑ to 80 mg/d SUPPLIED: Tabs 10, 20, 40, 80 mg NOTES: May cause myopathy, monitor LFT regularly Atovaquone (Mepron) 22 COMMON USES: Rx and prevention mild to moderate PCP 22 Commonly Used Medications 501 ACTIONS: Inhibits nucleic acid and ATP synthesis DOSAGE: Rx: 750 mg PO bid for 21 d. Prevention: 1500 mg PO once/d SUPPLIED: Suspension 750 mg/5 mL NOTES: Take with meals Atracurium (Tracrium) COMMON USES: Adjunct to anesthesia to facilitate endotracheal intubation ACTIONS: Nondepolarizing neuromuscular blocker DOSAGE: Adults & Peds. Use adequate amounts of sedation and analgesia Atropine Used for emergency care (see Chapter 21) COMMON USES: Preanesthetic; symptomatic bradycardia and asystole ACTIONS: Antimuscarinic agent; blocks acetylcholine at parasympathetic sites DOSAGE: Adults. Interaction with allopurinol Azithromycin (Zithromax) COMMON USES: Acute bacterial exacerbations of COPD, mild community-acquired pneumonia, pharyngitis, otitis media, skin and skin structure infections, nongonococcal urethritis, and PID. Rx and prevention of MAC infections in HIV-infected persons ACTIONS: Macrolide antibiotic; inhibits protein synthesis DOSAGE: Adults. Oral: Respiratory tract infections: 500 mg on the first day, followed by 250 mg/d PO for 4 more d. Pharyngitis: 12 mg/kg/d PO for 5 d SUPPLIED: Tabs 250, 600 mg; susp 1-g single-dose packet; susp 100, 200 mg/5 mL; inj 500 mg NOTES: Take susp on an empty stomach; tabs may be taken with or without food Aztreonam (Azactam) COMMON USES: Infections caused by aerobic gram (−) bacteria, including Pseudomonas aerugi- nosa ACTIONS: Monobactam antibiotic; inhibits cell wall synthesis DOSAGE: Adults. Note: Neosporin ointment different from cream (page 576) Bacitracin, Ophthalmic (AK-Tracin Ophthalmic) Bacitracin and Polymyxin B, Ophthalmic (AK Poly Bac Ophthalmic, Polysporin Ophthalmic) Bacitracin, Neomycin and Polymyxin B, Ophthalmic (AK Spore Ophthalmic, Neosporin Ophthalmic) Bacitracin, Neomycin, Polymyxin B and Hydrocortisone, Ophthalmic (AK Spore HC Ophthalmic, Cortisporin Ophthalmic) COMMON USES: Blepharitis, conjunctivitis, and prophylactic treatment of corneal abrasions ACTIONS: Topical antibiotic with added effects based on components (antiinflammatory) DOSAGE: Apply q3–4h into conjunctival sac SUPPLIED: See Topical equivalents, above Baclofen (Lioresal, others) COMMON USES: Spasticity secondary to severe chronic disorders, eg, MS or spinal cord lesions, trigeminal neuralgia ACTIONS: Centrally acting skeletal muscle relaxant; inhibits transmission of both monosynaptic and polysynaptic reflexes at the spinal cord DOSAGE: Adults. IT: Through implantable pump SUPPLIED: Tabs 10, 20 mg; IT inj 10 mg/20 mL, 10 mg/5 mL NOTES: Use caution in epilepsy and neuropsychiatric disturbances, withdrawal may occur with abrupt discontinuation Basiliximab (Simulect) COMMON USES: Prevention of acute organ transplant rejections ACTIONS: IL-2 receptor antagonists DOSAGE: Adults. Repeat once weekly for 6 wk; repeat 3 weekly doses 3, 6, 12, 18, and 24 mo after the initial therapy SUPPLIED: Inj 27 mg (3. BCG vaccine occasionally used in high risk-children who are negative on the PPD skin test and cannot be given isoniazid prophylaxis.