ACLS Flashcards
What is cardiovascular collapse?
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)
Define Cardiac Arrest
The absence of cardiac mechanical activity as confirmed by the absence of a detectable pulse, unresponsiveness, and apnea or agonal gasping breathing
Define Sudden Cardiac Death
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.
What are the 2 shockable cardiac arrest rhythms?
V-Tach
V-Fib
What are the 2 non-shockable cardiac arrest rhythms?
Asystole
Pulseless Electrical Activity
What are the 2 types of electrical therapy?
Defibrillation and synchronous cardioversion
Define defibrillation (aka synchronized countershock)
Electrical energy (shock) is delivered without regard to the cardiac cycle
Define synchronous cardioversion
Electrical energy (shock) is delivered during ventricular depolarization (when the patient’s QRS complex is sensed)
What are the 3 indications for defibrillation?
Ventricular fibrillation
Pulseless monomorphic ventricular tachycardia
Sustained polymorphic ventricular tachycardia
What are the 4 indications for synchronous cardioversion?
Unstable atrial fibrillation
Unstable atrial flutter
Unstable monomorphic ventricular tachycardia
Unstable narrow-QRS tachycardia
V-Fib: What types of defibrillation do you use?
Yes. Use biphasic (120-200 J) monophasic (360 J), AED
V-Fib: What is the CPR protocol?
CPR for 2 minutes: 30 compressions + 2 breaths and repeat
V-Fib: What drugs do you give?
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)
V-fib: What do you do between each step?
Defibrillation + CPR and recheck rhythm
What is the rate/rhythm for monomorphic V-tach?
100-250 bpm and regular
What does unstable monomorphic V-tach indicate and what are the accompanying Sx?
Indicates hemodynamic compromise
Sx: Lightheadedness, hypotension, SOB, diaphoresis, chest discomfort
What drugs do you give for stable (aka asymptomatic) monomorphic V-tach?
Give one of the following:
1. Amiodarone: 150 mg IV over 10 minutes
- Procainamide: 20-50 mg/min IV
- Sotalol: 100 mg over 5 minutes
What is the protocol for unstable monomorphic V-tach?
Sync. Cardioversion @ 100 J
What is the protocol for monomorphic V-Tach that is pulseless?
Same protocol as V-Fib
What is the rate/rhythm of polymorphic Vtach?
150-300 bpm. Can be regular or irregular.
What is almost always associated with polymorphic V-tach? What does this indicate in terms of Tx?
Indicates hemodynamic compromise, which means it should be treated with defibrillation, even if pt has a pulse
How does non-sustained polymorphic V-tach usually present?
Syncope and seizures
What is it called if there is polymorphic V-tach with a prolonged QT interval? How do you Tx it?
Torsade de pointe: Tx with 1-2 g IV magnesium sulfate
What is the first thing you do once you confirm ventricular asystole on an EKG?
CPR + IV access
What drugs do you give for ventricular asystole?
Epi: 1 mg IV every 3-5 min
OR
Vasopressin: 40 U IV (1 dose to replace 1st or 2nd epi dose)
When do you terminate resuscitation?
Persistent asystole or agonal EKG pattern despite appropriate ACLS protocol and no reversible cause identified
Define Pulseless Electrical Activity.
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.
How do you Tx PEA?
Same protocol as Ventricular asystole
What are the treatable causes of PEA?
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)
What is the rate/rhythm for AV Nodal Reentrant Tachycardia ?
180-200 bpm in adults with very regular ventricular rhythm
What pts are prone to AVRT?
Pts with pre-excitation syndromes
Define pre-excitation.
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.
What are the 3 pre-excitation syndromes?
Wolff-Parkinson White (WPW) syndrome
Lown-Ganong-Levine (LGL) syndrome
An unnamed syndrome that involves the Mahaim fibers
What is the triad of findings in WPW syndrome?
What is the rate/rhythm?
- Short PR interval
- Wide QRS complex
- Delta wave
Rate is 60-100 bpm with regular rate (unless there is a-fib)
What is the rate/rhythm of junctional tachycardia?
101-180 bpm and very regular
What is the rate/rhythm of A-fib?
Atrial: 400-600 bpm
Ventricular: Variable
Rhythm: Irregularly irregular
What is the Tx for unstable a-fib?
Sync. cardioversion
What is the Tx for stable a-fib?
- Anticoags (if no contraindications)
2. Something to control ventricular rate (B-blocker, CCB, Digoxin)
What is the rate/rhythm of A-flutter?
Atrial: 250-300 bpm
Ventricular: Variable
Rhythm: Regular or irregular
How do you Tx A-Flutter?
Same protocol as A-Fib
What is the Tx for UNSTABLE, Wide QRS Tachycardia (monomorphic and polymorphic)?
Monomorphic: Sync. Cardioversion
Polymorphic: Defibrillation
What is the Tx for STABLE, Wide QRS Tachycardia that is REGULAR and MONOMORPHIC?
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
Give some examples of vagal maneuvers:
Coughing Squatting Breath holding Carotid sinus massage Application of a cold stimulus to the face Valsalva’s maneuver Gagging
What is the Tx for sinus bradycardia?
Atropine, 5 mg IV
Treat underlying cause. If none found, pt may require a pacemaker
