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Cardiac Arrhythmia Emergencies > ACLS > Flashcards

ACLS Flashcards

1
Q

What is cardiovascular collapse?

A

A sudden loss of effective blood flow that is caused by cardiac or peripheral vascular factors that may revert spontaneously (e.g., syncope) or only with interventions (e.g., cardiac arrest)

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2
Q

Define Cardiac Arrest

A

The absence of cardiac mechanical activity as confirmed by the absence of a detectable pulse, unresponsiveness, and apnea or agonal gasping breathing

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3
Q

Define Sudden Cardiac Death

A

Sudden cardiac death is a natural death of cardiac cause that is preceded by an abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status.

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4
Q

What are the 2 shockable cardiac arrest rhythms?

A

V-Tach

V-Fib

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5
Q

What are the 2 non-shockable cardiac arrest rhythms?

A

Asystole

Pulseless Electrical Activity

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6
Q

What are the 2 types of electrical therapy?

A

Defibrillation and synchronous cardioversion

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7
Q

Define defibrillation (aka synchronized countershock)

A

Electrical energy (shock) is delivered without regard to the cardiac cycle

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8
Q

Define synchronous cardioversion

A

Electrical energy (shock) is delivered during ventricular depolarization (when the patient’s QRS complex is sensed)

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9
Q

What are the 3 indications for defibrillation?

A

Ventricular fibrillation

Pulseless monomorphic ventricular tachycardia

Sustained polymorphic ventricular tachycardia

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10
Q

What are the 4 indications for synchronous cardioversion?

A

Unstable atrial fibrillation

Unstable atrial flutter

Unstable monomorphic ventricular tachycardia

Unstable narrow-QRS tachycardia

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11
Q

V-Fib: What types of defibrillation do you use?

A

Yes. Use biphasic (120-200 J) monophasic (360 J), AED

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12
Q

V-Fib: What is the CPR protocol?

A

CPR for 2 minutes: 30 compressions + 2 breaths and repeat

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13
Q

V-Fib: What drugs do you give?

A

Epinephrine: 1 mg every 3-5 min
OR Vasopressin: 40 U (in lieu of 1st/2nd Epi dose)

Amiodarone: 300 mg IVP (may repeat IV bolus once in 5 min @ 150 mg)
Lidocaine (if no amiodarone): 1.5 mg/kg (max=3 mg/kg)

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14
Q

V-fib: What do you do between each step?

A

Defibrillation + CPR and recheck rhythm

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15
Q

What is the rate/rhythm for monomorphic V-tach?

A

100-250 bpm and regular

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16
Q

What does unstable monomorphic V-tach indicate and what are the accompanying Sx?

A

Indicates hemodynamic compromise

Sx: Lightheadedness, hypotension, SOB, diaphoresis, chest discomfort

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17
Q

What drugs do you give for stable (aka asymptomatic) monomorphic V-tach?

A

Give one of the following:
1. Amiodarone: 150 mg IV over 10 minutes

  1. Procainamide: 20-50 mg/min IV
  2. Sotalol: 100 mg over 5 minutes
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18
Q

What is the protocol for unstable monomorphic V-tach?

A

Sync. Cardioversion @ 100 J

19
Q

What is the protocol for monomorphic V-Tach that is pulseless?

A

Same protocol as V-Fib

20
Q

What is the rate/rhythm of polymorphic Vtach?

A

150-300 bpm. Can be regular or irregular.

21
Q

What is almost always associated with polymorphic V-tach? What does this indicate in terms of Tx?

A

Indicates hemodynamic compromise, which means it should be treated with defibrillation, even if pt has a pulse

22
Q

How does non-sustained polymorphic V-tach usually present?

A

Syncope and seizures

23
Q

What is it called if there is polymorphic V-tach with a prolonged QT interval? How do you Tx it?

A

Torsade de pointe: Tx with 1-2 g IV magnesium sulfate

24
Q

What is the first thing you do once you confirm ventricular asystole on an EKG?

A

CPR + IV access

25
Q

What drugs do you give for ventricular asystole?

A

Epi: 1 mg IV every 3-5 min

OR

Vasopressin: 40 U IV (1 dose to replace 1st or 2nd epi dose)

26
Q

When do you terminate resuscitation?

A

Persistent asystole or agonal EKG pattern despite appropriate ACLS protocol and no reversible cause identified

27
Q

Define Pulseless Electrical Activity.

A

PEA is the presence of some type of electrical activity (other than VT or VF), but a pulse cannot be detected by palpation of any artery.

28
Q

How do you Tx PEA?

A

Same protocol as Ventricular asystole

29
Q

What are the treatable causes of PEA?

A

H’s and T’s

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hyper/hypokalemia
Hypothermia
Tablets (drug OD, accidents)
Tamponade, cardiac
Tension pneumothorax
Thrombosis, coronary
Thrombosis, pulmonary (embolism)
30
Q

What is the rate/rhythm for AV Nodal Reentrant Tachycardia ?

A

180-200 bpm in adults with very regular ventricular rhythm

31
Q

What pts are prone to AVRT?

A

Pts with pre-excitation syndromes

32
Q

Define pre-excitation.

A

The term is used to describe rhythms that originate from above the ventricles but in which the impulse travels via a pathway other than the atrioventricular node and the bundle of His.

33
Q

What are the 3 pre-excitation syndromes?

A

Wolff-Parkinson White (WPW) syndrome

Lown-Ganong-Levine (LGL) syndrome

An unnamed syndrome that involves the Mahaim fibers

34
Q

What is the triad of findings in WPW syndrome?

What is the rate/rhythm?

A
  1. Short PR interval
  2. Wide QRS complex
  3. Delta wave

Rate is 60-100 bpm with regular rate (unless there is a-fib)

35
Q

What is the rate/rhythm of junctional tachycardia?

A

101-180 bpm and very regular

36
Q

What is the rate/rhythm of A-fib?

A

Atrial: 400-600 bpm
Ventricular: Variable

Rhythm: Irregularly irregular

37
Q

What is the Tx for unstable a-fib?

A

Sync. cardioversion

38
Q

What is the Tx for stable a-fib?

A
  1. Anticoags (if no contraindications)

2. Something to control ventricular rate (B-blocker, CCB, Digoxin)

39
Q

What is the rate/rhythm of A-flutter?

A

Atrial: 250-300 bpm
Ventricular: Variable

Rhythm: Regular or irregular

40
Q

How do you Tx A-Flutter?

A

Same protocol as A-Fib

41
Q

What is the Tx for UNSTABLE, Wide QRS Tachycardia (monomorphic and polymorphic)?

A

Monomorphic: Sync. Cardioversion
Polymorphic: Defibrillation

42
Q

What is the Tx for STABLE, Wide QRS Tachycardia that is REGULAR and MONOMORPHIC?

A

Adenosine: (1st dose 6 mg rapid IV push/2nd dose 12 mg if required

Otherwise: )
Amiodarone 150 mg IV over 10 minutes, or
Procainamide 20-50 mg/min IV (initially), or
Sotalol 100 mg over 5 minutes

43
Q

Give some examples of vagal maneuvers:

A 
Coughing
Squatting
Breath holding
Carotid sinus massage
Application of a cold stimulus to the face 
Valsalva’s maneuver
Gagging
44
Q

What is the Tx for sinus bradycardia?

A

Atropine, 5 mg IV

Treat underlying cause. If none found, pt may require a pacemaker

Cardiac Arrhythmia Emergencies (1 decks)

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