ACLS

Question 1

ACLS

Pulseless Arrest Resus
ASAP:

Answer 1

ABCs, IV, O2, monitor / defibrillator.
CPR: > 2 in depth Compression Rate 100-120,if no advanced airway 30:2, if advanced 6-8 seconds

Question 2

ACLS

Pulseless Arrest Resus
If PETCO2 <10….

Answer 2

PETCO2 <10 attempt to improve CPR

Question 3

ACLS

Pulseless Arrest Resus
Asystole/PEA

Answer 3

CPR x 2 min,Epi 1mg (1:10,000) IV/IO q 3-5 min,

Question 4

ACLS

Pulseless Arrest Resus
If VT/VF:

Answer 4

Shock and CPR (30:2)x 2 min: Biphasic 120-200 J, Monophasic 360 J, shock and CPR Epi 1mg (1:10,000) IV/IO q 3-5 minutes dose of epi Continue CPR x 5 cycles

Question 5

ACLS

Pulseless Arrest Resus
Amiodarone Dose

Answer 5

Amiodarone 300 mg IV, may repeat w/ 150 mg IV x 1

Question 6

ACLS

Pulseless Arrest Resus
H&Ts

Answer 6

H+ ion (acidosis)
Hypovolemia
Hypothermia
Hypoglycemia
Hypoxia
Hyper/hypokalemia
Tamponade
Trauma
Toxins
Tension PTX
Thrombosis (PE, MI)

Question 7

ACLS

Pulseless Arrest Resus
Post ROSC Care

Answer 7

Maintain O2 > 94%
SBP >90
IVF bolus 1-2 L
Epi 0.1-0.5 mcg/kg/min
Dopamine 5-10 mcg/kg/min
Norepinephrine 0.1-0.5 mcg/kg/min
Follows commands
No- induce hypothermia
Yes- STEMI? → coronary reperfusion

Question 8

ACLS

Bradycardia Resuscitations
Definition of Unstable Bradycardia

Answer 8

HR < 50 + inadequate perfusion
S/Sx: AMS, CP, ↓BP, shock

Question 9

ACLS

Bradycardia Resuscitations
ASAP:

Answer 9

ABCs, IV, O2, monitor/pacer pads, VS, EKG

Question 10

ACLS

ACLS Bradycardia Resuscitations
If perfusion poor or 2nd or 3rd degree block…

Answer 10

Pace
While awaiting pacer: Atropine 1.0mg IV q3-5min (up to 3 mg total)
While waiting or to augment pacing: Epi 2-10 mcg/min IV or Dopamine 2-10 mcg/kg/min IV Prepare transvenous pacer, treat causes and consult cards

Question 11

ACLS

Tachycardia Resus
ASAP:

Answer 11

ABCs, IV, O2, monitor / defibrillator, VS, EKG

Question 12

ACLS

Tachycardia Resus
pt unstable…

Answer 12

Syncronized Cardioversion:
Narrow regular- 50-100 J
Narrow irregular- 120-200J biphasic or 200J monophasic
Wide regular- 100J
Wide irregular defibrillation dose

Question 13

ACLS

Tachycardia Resus
If pt stable and QRS wide…

Answer 13

Amiodarone 150mg IV (over 10 min), may repeat x 1, then 1 mg/min IV
Procainamide 20-50 mg/min IV til better, than 1-4 mg/min IV- avoid in prolonged QTc or CHF
Sotalol 100 mg IV (1.5 mg/kg)- avoid if prolonged QT

Question 14

ACLS

Tachycardia if pt stable and QRS narrow…

Answer 14

Vagal maneuvers
Adenosine 6mg IV, then 12 mg IV prn x 2
Diltiazem 15-20mg IV, followed by infusion of 5-15mg/hr
Metoprolol 5mg IVP x 3 followed by 50mg PO