ACLS

Question 1

MOA of nitroglycerin

Answer 1

peripheral arterial + venous dilation reduces LV + RV preload

Question 2

contraindications of nitroglycerin & why

Answer 2

inferior wall MI + RV infarction, bc they depend on RV filling pressures to maintain CO + BP

Question 3

MOA of morphine

Answer 3

reduces LV preload + reduces LV afterload by decreasing systemic vascular resistance

Question 4

benefits of morphine

Answer 4

alleviates dyspnea + redistributes blood volume in pt with acute pulm edema

Question 5

negatives of morphine

Answer 5

reduces absorption of oral antiPLT

Question 6

characteristics of STEMI on EKG (ST segment)

Answer 6

ST segment elevation in 2 or more contiguous leads/1mm or more in all other leads OR new LBBB

Question 7

characteristics of STEMI on EKG (J point)

Answer 7

J point elevation of >2mm in leads V2 + V3

Question 8

characteristics of High Risk NSTE-ACS (3)

Answer 8

ischemic ST segment depression of 0.5mm or greater/dynamic T wave inversion with pain or discomfort/transient ST segment elevation of 0.5mm or greater for <20min

Question 9

never give fibrinolytics to these two pt’s

Answer 9

> 24h after symptoms & those with ST segment depression (unless a true posterior MI is suspected)

Question 10

what tidal volume is needed for adults in respiratory arrest

Answer 10

6-7 ml/kg (500-600 ml)

Question 11

what to do with a pt that has a pulse but not breathing

Answer 11

ventilate q6sec

Question 12

2nd degree type 1 AV block (Wencheback)

Answer 12

PR interval progressively longer until a beat is dropped

Question 13

2nd degree type 2 AV block

Answer 13

PR interval stays same length but random QRS complexes are dropped

Question 14

3rd degree AV block

Answer 14

p wave and QRS are completely independent of each other

Question 15

Tx for poor perfusion s/t bradycardia

Answer 15

atropine 1mg (up to 3x for 3mg total)

Question 16

Next steps if atropine is ineffective for poor perfusion s/t bradycardia

Answer 16

TCP/DA/EPI

Question 17

when to avoid atropine for bradycardia

Answer 17

2nd or 3rd degree blocks

Question 18

MOA of atropine

Answer 18

reverses cholinergic mediated decreases in HR + AV node conduction

Question 19

infusion rate for DA

Answer 19

5-20 mcg/kg/min

Question 20

infusion rate for EPI

Answer 20

2-10 mcg/min

Question 21

TCP HR considerations

Answer 21

set to 60-80/min, but lowest HR to reduce myocardial O2 demand is preferred

Question 22

safety margin for TCP

Answer 22

2mA above level at which consistent capture occurs

Question 23

unstable tachycardia: action

Answer 23

immediate synchronized cardioversion

Question 24

stable tachycardia: action

Answer 24

determine if QRS is wide/narrow and regular/irregular

Question 25

stable tachycardia: wide QRS >0.12

Answer 25

adenosine if regular + monomorphic and antiarrhythmic

Question 26

stable tachycardia: normal QRS

Answer 26

vagal maneuver + adenosine if regular and BB/CCB

Question 27

what is SV

Answer 27

volume of blood ejected by both ventricles with each contraction

Question 28

equation for CO

Answer 28

CO = SV x HR

Question 29

limits for sinus tach

Answer 29

100-130

Question 30

stable tach: narrow QRS + regular rhythm --> what to do when vagal maneuvers fail

Answer 30

adenosine 6mg + flush & elevate arm immediately

Question 31

stable tach: narrow QRS + regular rhythm --> what to do if first dose of adenosine doesn't convert within 1-2 min?

Answer 31

give another dose of 12mg + flush and elevate the arm immediately

Question 32

MOA of adenosine

Answer 32

slows AV conduction

Question 33

which rhythms does adenosine not convert

Answer 33

atrial flutter + fibrillation

Question 34

big caution with adenosine

Answer 34

may cause bronchospasm

Question 35

what does synchronized cardioversion mean

Answer 35

delivers the shock on the R

Question 36

procainamide infusion dosing + max dose

Answer 36

20-50 mg/min + max dose = 17 mg/kg

Question 37

amiodarone infusion dosing (bolus + maintenance)

Answer 37

150 mg over 10 min + 1 mg/min for 6 hours

Question 38

sotalol infusion dosing

Answer 38

100 mg over 5 min

Question 39

what two rhythms require CPR until a defibrillator is available to deliver unsynchronized shocks

Answer 39

VF + pVT

Question 40

MOA of EPI

Answer 40

improve aortic diastolic BP + coronary artery perfusion pressure

Question 41

MOA of amiodarone

Answer 41

blocks Na channels at rapid pacing frequencies + lengthens action potential of cardiac cells + antisympathetic

Question 42

MOA of lidocaine

Answer 42

suppresses automaticity of conduction tissue

Question 43

magnesium sulfate only indicated for

Answer 43

torsades

Question 44

EPI dosing for cardiac arrest

Answer 44

1mg q3-5 min

Question 45

amiodarone dosing for cardiac arrest unresponsive to defibrillation (first)

Answer 45

300 mg

Question 46

lidocaine dosing for cardiac arrest unresponsive to defibrillation (first)

Answer 46

1-1.5 mg/kg

Question 47

what is PEA?

Answer 47

any organized rhythm w/o a pulse

Question 48

h's and t's of cardiac arrest

Answer 48

hypovolemia/hypoxia/acidosis/hypo-hyperkalemia/hypoglycemia/hypothermia toxins/tamponade/tension pneumo/thrombosis/trauma

Question 49

TTM target temp

Answer 49

32-36 C for 24h

Question 50

Tx for hypotension post ROSC: DA dosing

Answer 50

5-20 mcg/kg/min

Question 51

Tx for hypotension post ROSC: NE dosing

Answer 51

0.1-0.5 mcg/kg/min

Question 52

Tx for hypotension post ROSC: EPI dosing

Answer 52

2-10 mcg/min