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PHM 703: Critical Care/Cancer > ACLS > Flashcards

ACLS Flashcards

1
Q

best place to survive cardiac arrest

A

vegas

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2
Q

Cardiac arrest rhythms

4

A
  1. VF
  2. pVT
  3. PEA
  4. Asystole
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2
Q
A
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3
Q

immediate goal ACLS

A

return of spontaneous circulation (ROSC)

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4
Q

Cardiac arrest survival dependens on

A

BLS +/- ACLS

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5
Q

CPR cycle

A

Start CPR: give O2 + attach monitor (defib)
2 min cycle
End of cycle: pulse + rhythm check
Drug therapy:
* IV/IO EPI every 3-5 min
* Amio/Lido if refractor VF/pVT (try 2-3 shocks first)
Treat reversile causes

quality CPR: 100-120/min; 2cm deep

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6
Q
A
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6
Q

Medication role in ACLS

A

No proven benefit
Only specific therapy proven to increase surivial to discharge = defib of VF/pVT

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7
Q

Shockable rhythms

A

Ventricular Fibrilation
pulseless Ventricular Tachycardia

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8
Q

Non-shockable rhythms

A

Asystole
Pulseless electrical activity

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9
Q

VT/VF treatment

A

CPRx2min
Shock #1: CPR 2min + IV/IO access
Shock #2: CPR 2 min + EPI 3-5min
* Consider advanced airway capnogrpahy
Shock #3: CPR 2min + Amio/Lido+ treat reversible causes

if non-shockable rhythm - CPR+ EPI

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10
Q

Asystole/PEA treatment

A

EPI ASAP
CPRx2 min + EPI 3-5 min
* Consider advanced airway capnogrpahy
CPRx2 min, treat reversible causes
If still no signs of ROSC: continue CPR/EPI

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11
Q

Medication ROA

A
  1. IV
  2. IO
  3. ET*

* NAVEL drugs

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12
Q

NAVEL drugs

A

Naloxone
Atropine
Vasopressin
Epi
Lidocaine

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13
Q

Endotracheal ROA considerations

A

give 2-2.5x of IV/IO dose down ET tube (lung absorption)
Requires dilution 5-10ml SWFI or NS

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14
Q

Vasoactive agents role in ACLS

Epinephrine

A

vasoconstriction = organ perfusion (cerebral/coronary)
increases arterial/aortic diastolic pressures

15
Q

Epinephrine dose

A

1mg IV/IO every 3-5 min
Give ASAP for non-shockable rhythms for ROSC

16
Q

Antiarrythmics role in ACLS

A

Help cell re-establish electrical activity
normalize abnormally depolarizing/conducting heart cells
Poor evidence to suggest routine use = improve survival
Lido ≥ Amio
Magnesium: torsades (+) VF/pVT only

17
Q

Amiodarone dose

VF/pVT, stable VT with pulse

A

VF/pVT: 300 mg IV bolus
* may repeat 150 mg IV bolus in 3-5 min
* flush with 20 ml NS for circulation
if stable VT (pulse)
* 150mg IV over 10 min

18
Q

Amiodarone ADR

A

bradycardia, hypotension d/t diluent
* consider adding vasopressor to minimize hypotension

QTc prolongaiton - avoid use if hx, opt lidocaine instead

19
Q

Lidocaine dose

weight based dosing

VF/pVT, stable VT with pulse, ROSC

A

VF/pVT: 1-1.5 mg/kg IV or IO
* may repeat 0.5-0.75 mg/kg every 5-10 min
stable VT with pulse
* 0.5-0.75 mg/kg IV

with ROSC: give as drip to prevent arryhtmia
* infuse 1-4 mg/min

20
Q

Magnesium dose

A

dose not well established
generally: 2g IV bolus
flush with 10-20ml NS
if pulse: infuse
no pulse: bolus

wide complex QRS
Torsades (VF/pVT)

21
Q

reversible causes of arrest acronym

A

H & T

22
Q

H’s

reversible causes of arrest

A

hydrogen ion
hyperkalemia

hypothermia
hypoglycemia
hypovolemia
hypoxia

23
Q

T’s

reversible causes of arrest

A

Tension pneumothorax
Tamponade,cardiac
Toxins
Thrombosis
* pulmonary
* coronary

24
Q

Hypovolemia tx

loss of effective circulating volume
* trauma, blood loss

A

restore volume:
Lactated ringers
Normal saline
PRBC
other blood factors

25
Q

Hypoxia tx

lack o2

A

give 100% O2 mask

26
Q

Hydrogen ion Tx

H+ acidosis, acidemia

A

Severe metabolic acidosis
* No buffer/bicarb
Pre-existing metabolic acidosis (pH <7.1-7.2)
* consider bicarb

27
Q

Hypothermia Tx

A

CPR + restore body temp simultaneously
Do not stop CPR until core temp reached

28
Q

Hyperkalemia tx

A
  1. stabilize myocardial membrane
    * Calcium Cl or gluconate
  2. intracellular K+ shift
    * Sodium bicarb
    * Insulin + dextrose if hypo
    * Albuterol neb not feasible
  3. Excretion once ROSC
    * diuresis, kayexalate, dialysis, potassium binding resins

renal, dialysis, drug induced

29
Q

Toxin tx

A

Opioid: IV naloxone push
Local anesthetic tox: lipid emulsion
TCA: sodium bicarb
etc

30
Q

What is the utility of bicarb in ACLS?

there are three

A
  1. Hyperkalemia
  2. TCA toxicity
  3. Severe pre-existing metabolic acidosis - maybe
31
Q

Cardiac Tamponade tx

A

needle
relieve pericardium fluid

32
Q

Tension pneumothroax tx

identified by ultrasound/CXR

A

Needle
release air
caused by lung injury, broke ribs, trauma, etc

33
Q

Thrombosis tx

pulmonary, cardiac

A

PE: alteplase/tenecteplase
* ECLS, ECMO catheters
MI: tenecteplase, alteplase, PCI

PHM 703: Critical Care/Cancer (17 decks)

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