Acls

Question 1

Medications used in V Fib or pulseless VT

Answer 1

Epinephrine 1mg q3-5 min
Amiodarone 300mg x 1 then 150mg x1 or lidocaine 1-1.5 mg/kg X1 then 0.5 - 0.75 mg/kg X1

Question 2

Medication for polymorphic vt associated with a long qt (torsades de pointes)

Answer 2

Magnesium

Question 3

Medications for arystole/pea

Answer 3

Epinephrine 1 mg q3-5 min

Question 4

Meds for bradycardia

Answer 4

Only if symptomatic:
Atropine 0.5 mg iv q 3-5min (max 3mg)
If atropine is ineffective →
Consider transcutaneous pacing or dopamine 2-20 mcg /kg /min infusion or epinephrine 2-10mcg /min infusion
If ineffective → transvenous pacing

Question 5

Meds for symptomatic tachycardia

Answer 5

sedated cardioversion

Question 6

Meds for narrow complex tachycardia

Answer 6

Vagal maneuvers
Adenosine 6 mg iv push, 2 min then 12 mg iv. If regular
Consider CCB (verapamil 2.5-5mg or diltiazem 15-20mg) or beta blocker

Question 7

Meds for wide complex tachycardia

Answer 7

Witnessed, monitored unstable, no defibrillator available → precordial thump
If regular monomorphic → adenosine
Amiodarone, procainamide, sotalol

Question 8

Compression depth

Answer 8

Adults and adolescents: 5 Cm (2inch)
Toddler to puberty: 5 Cm or 1/3 ap diameter of chest
Infant: 4 Cm or 1/3 ap diameter of chest

Question 9

Compression to ventilation ratio

Answer 9

Adults and adolescents: 30-2
Infant, toddler upto puberty: 1 rescuer → 30 -2
2 rescuer → 15-2

Question 10

Compression ventilation ratio with advanced airway

Answer 10

100-120 compressions per minute
1 breath every 6 seconds for adults
I breath every 3-4 seconds in a prepubertal child

Question 11

Dose of synchronized cardioversion

Answer 11

Narrow regular 50 - 100 j
Narrow irregular 120-200 j biphasic, 200 j monophasic
Wide regular 100 j
Wide irregular → defib dose (not synchronized. 120-200j biphasic. 360 j monophasic )

Question 12

PEA Narrow complex management

Answer 12

Right ventricle problem:
Give fluids and consider causes including: Pulmonary embolism, tension pneumo, tamponade, mech ventilation, severe hypovolemia, acute MI (myocardial rupture)

Question 13

Pea wide complex management

Answer 13

Left ventricle problem:
Iv calcium and bicarbonate bolus + consider cause including severe hyper k, TCA toxicity, Acute MI (pump failure)

Question 14

Which antiarhythmics can be used for wide complex tachycardia with prolonged qt

Answer 14

Amiodarone (procainamide and sotalol are contraindicated)

Question 15

Post ROSC management algorithm

Answer 15

• Maintain airway→ ETT with waveform capnography or capnometry , to confirm placement-resp parameters of 10 breaths/min and SpO, 92 - 98 %, paco2 of 35-45mmhg
• Maintain systolic bp > 90 and map > 65
• 12 lead ECG with appropriate management
• comatose/not responding to commands → temp management of 32-36 degreesfor 24 hrs with continuous temp monitoring (bladder, rectal , esophageal), EEG monitoring, brain Ct
• treat ethologies (5Hs, 5ts), maintain normoxia, normocapnia, euglycemia

Question 16

In maternal cardiac arrest what should be done if patient is receiving iv magnesium

Answer 16

Stop and give iv calcium gluconate or chloride

Question 17

Important obstetrical interventions in maternal cardiac arrest

Answer 17

Continuous lateral uterine displacement
Penmartem C-section if no ROSC in 5 minutes

Question 18

Potential ethology of maternal cardiac arrest

Answer 18

Anesthetic complication
Bleeding
C vs
Drugs
Embolus
Fever
General non-obstetrical C5 Hs and ts)
Hypertension