ACLS

Question 1

4 types of cardiac rhythms in cardiac arrest

Answer 1

Ventricular fibrillation (VF)
Pulseless ventricular tachycardia (pVT)
Pulseless electrical activity (PEA)
Asystole

Question 2

Which rhythms are shockable?

Answer 2

Ventricular fibrillation (VT)
Pulseless ventricular tachycardia (pVT)

Question 3

Which rhythms are not shockable?

Answer 3

Pulseless electrical activity (PEA)
Asystole

Question 4

What is the only specific therapy proven to increase survival in cardiac arrest?

Answer 4

defibrillation of VF and pVT

Question 5

VF or pVT arrest algorithm

Answer 5

shock 1 -> CPR 2 min ->
shock 2 -> CPR 2 min, consider epinephrine ->
shock 3 -> CPR 2 min, consider amiodarone or lidocaine + treat reversible causes

Question 6

PEA / Asystole algorithm

Answer 6

Epinephrine ASAP -> CPR 2 min->
check rhythm, shockable?
- yes -> go to VF / pVT algorithm
- no -> CPR 2 min, repeat

Question 7

Meds that can be given via endotracheal route (NAVEL)

Answer 7

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine

Question 8

Endotracheal considerations

Answer 8

Give 2-2.5 fold IV/IO dose down ET tube
Dilute in 5-1 mL sterile water or NS

Question 9

Epinephrine

Answer 9

Vasoactive agent
MOA: increase arterial and aortic diastolic pressures -> increase in coronary and cerebral perfusion
Dose: 1 mg IV Q3-5 min
Indication: VF/pVT or PEA/asystole

Question 10

Antiarrhythmic agents

Answer 10

Amiodarone
Lidocaine
Magnesium

Question 11

Amiodarone

Answer 11

MOA: potentially normalizes abnormally depolarizing and conducting myocardial cells
Indication: VF/pVT
Dose: 300 mg IV bolus -> may repeat 150 mg IV bolus every 3-5 minutes
- bolus followed by 20 mL NS flush to get drug into circulaiton
ADE:
- bradycardia
- hypotension
- QT prolongation

Question 12

Lidocaine

Answer 12

MOA: potentially normalizes abnormally depolarizing and conducting myocardial cells
Indication: VF/pVT
Dose: 1-1.5 mg/kg IV or IO
- repeat 0.5-0.75 mg/kg Q5-10 min
Consider if:
- amiodarone not available
- TdP due to minimal risk of QT prolongation

Question 13

Magnesium

Answer 13

antiarrhythmic
Indication: VF/pVT IN TdP PATIENTS ONLY
Dose: 2 g IV bolus
flush with 10-20 mL NS

Question 14

Reversible causes of arrest (H’s)

Answer 14

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hyperkalemia
Hypothermia
Hypoglycemia

Question 15

Reversible causes of arrest (T’s)

Answer 15

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary or coronary)

Question 16

Hypovolemia

Answer 16

loss of effective circulating vol
Crystalloid fluid replacement
- NS
- LR
blood transfusion

Question 17

Hypoxea

Answer 17

lack of oxygen
give 100% O2 by mask

Question 18

Hydrogen ion (acidosis)

Answer 18

routine use of bicarb not recommended
- may consider in pre-existing severe metabolic acidosis

Question 19

Hypothermia

Answer 19

Warm the patient up

Question 20

Hyperkalemia

Answer 20

Suspect in dialysis patients
Stabilize myocardial membrane:
- Calcium chloride or calcium gluconate

Temporary intracellular K+ shift
- bicarb
- insulin & dextrose
- albuterol nebulized

Excretion long term”
- diuresis
- kayexalate
- dialysis

Question 21

Toxins

Answer 21

Opioids: Naloxone IV
Local anesthetic: lipid emulsion
TCA: bicarb

Question 22

Thrombosis

Answer 22

Pulmonary embolism:
- Alteplase (tenecteplase)

Myocardial infarction:
- Tenecteplase
- Alteplase
- PCI