ACLS Flashcards
which rhythms are shockable
VF, pVT
which rhythms are not shockable
asystole, PEA
high quality CPR
rate 100-120 compressions/min, depth at least 2 inches, allow chest recoil, minimize interruptions
what are the ABCs
airway, breathing, circulation
which line is preferred
central line, meds reach the heart faster
intraosseous
used when IV access not available, treat as a central line
endotracheal
last line option for vascular access, absorption occurs in alveolar capillaries, doses often 2-2.5x higher than IV
administer _____ after each med administered
NS flush 10-20 mL
how does epinephrine work
increases coronary perfusion pressure
negative side effects of epinephrine
tachycardia, dysrhythmias, increased myocardial oxygen demand
IV/IO dose for epinephrine
1 mg q3-5 min
endotracheal dose for epinephrine
2-2.5 mg q 3-5 min
how does amiodarone work
antidysrhythmic properties through inhibition of sodium, potassium and calcium channels and alpha/beta adrenergic receptors
IV/IO dose for amiodarone administration
300 mg push once followed by 150 mg push
endotracheal dose for amiodarone
can’t be given via endotracheal tube.
pearl for amiodarone
only give IV push if patient is pulseless, IV push can cause hypotension and bradycardia in patients with a pulse
what is one alternative to amiodarone in ACLS algorithm
lidocaine
how does lidocaine work
antidysrhythmic properties through inhibition of Na channels
IV/IO dose for lidocaine
1-1.5 mg/kg once then 0.5-0.75 mg/kg if needed. may repeat for maximum total dose of 3 mg/kg
endotracheal dose for lidocaine
2-4 mg/kg once then 1-2 mg/kg if needed
what are the reversible causes
H’s and T’s
H’s
hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia
T’s
tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), thrombosis (cardiac)
magnesium indication
cardiac arrest due to torsades or hypomagnesemia
magnesium mechanism
inhibits calcium channels, suppressing early abnormal depolarizations responsible for arrhythmias
magnesium dose
1-2 g diluted in 10 mL D5W or NS given over 5-20 minutes. rapid administration can cause hypotension in patients with a pulse
sodium bicarbonate indication
acidosis or hyperkalemia
mechanism of sodium bicarbonate
neutralizes acidosis; pushes K into cells via H/K exchange
dose of sodium bicarbonate for acidosis
1 mEq/kg/dose IV/IO; repeat doses as needed guided by arterial blood gas
dose of sodium bicarbonate for hyperkalemia
50 mEq once IVP/IO
naloxone indication
suspected opioid overdose
naloxone mechanism
opioid receptor antagonist
naloxone dose IV/IM/SQ
0.4-2 mg
naloxone dose intranasal
4-8 mg
naloxone dose endotracheal tube
0.8-4 mg
when should you give atropine for adult bradycardia
persistent bradyarrhythmia causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure
what meds to give for adult bradycardia if atropine is ineffective
dopamine or epinephrine
atropine mechanism
inhibits muscarinic acetylcholine receptors, increasing automaticity of SA & AV nodal cells
atropine dose
0.5-1 mg q3-5 min, max total dose 3 mg
dopamine mechanism
dopaminergic & beta-1 adrenergic receptor agonist
dopamine dose
5-20 mcg/kg/min; titrate by 5 mcg/kg/min every 2 minutes
epinephrine mechanism of action
beta1 receptor activation results in increased inotropy and chronotropy
epinephrine dose
initial dose 2-10 mcg/min, max 40 mcg/min
treatments for adult tachycardia
atropine (nonpharm: vagal maneuvers)
what to do if persistent tachycardia causing: hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure
synchronized cardioversion, consider sedation; if regular narrow complex, consider adenosine
if persistent tachycardia with no symptoms and wide QRS > 0.12 s
IV access & 12 lead ECG, consider adenosine only if regular & monomorphic, consider antiarrhythmic infusion
if persistent tachycardia with no symptoms and no wide QRS
IV access & 12 lead ECG, vagal maneuvers, adenosine if regular, CCB or BB
how do vagal maneuvers work
intended to stimulate vagal nerve, resulting in acetylcholine release and slowing of conduction through AV node
examples of vagal maneuvers
bear down, blow through a syringe, immersion of face in ice water
adenosine mechanism
slows conduction through AV node, 6 mg rapid IVP, can follow with 12 mg IVP if needed… MUST BE RAPID PUSH
what to counsel patient before adenosine
may feel impending doom or feeling of dropping on a rollercoaster
which line is preferred for adenosine
central line. if peripheral, raise extremity
