ACLS Flashcards
The best indicator that a patient has stopped perfusing is to check _____ because they do not have to have a ______ to have cardiac arrest
Pulses
Bad rhythm
What will be the first indicator your pt is arresting?
End tidal CO2
ACLS algorithm
First vital sign to get after a code?
BP
What can you use an ultrasound for post arrest?
To see if the heart is squeezing or if an artery is pulsing
Who is someone you can ask to do CPR during surgery?
The surgeon!
We have to delegate compressions/ventilations to lead the code
What rhythms do we shock?
Vfib
Pulseless vtach
Treatment for stable vs unstable SVT
Stable: adenosine
Unstable: Cardiovert
If you have biphasic equipment, how many joules do you start with to defibrillate?
200 J
If you have monophasic equipment, how many joules do you start with to defibrillate?
360 J
After defibrillation, what should you immediately do?
Restart CPR
After a pulse check, normal etCO2 could be due to:
Amazing compressions
Return of perfusion
What is an alternative route to give meds if you didn’t have an IV? What meds can you give this way?
ET tube
Lido, epi, narcan, atropine (LEAN)
First med we give for pulseless rhythm?
Epi 1 mg
How often do you repeat Epi 1mg during ACLS?
3-5 minutes
After epi, what would your next medication be for ventricular arrhythmias?
Lido or amio
What is the dose for amio during ACLS?
300 mg initally
Second dose: 150 mg
What is the dose for lido during ACLS?
1-1.5 mg/kg
What are the H&Ts?
Hypoxia
Hypovolemia
Hypothermic
Hydrogen ions (acidosis)
Hyper/hypokalemia
Toxins
Tamponade (cardiac)
Tension pneumo
Thrombosis
What are the 2 most common causes of cardiac arrest?
Hypoxia and hypovolemia
If pt is hypovolemic, how do you treat?
Crystalloids
Blood
How do you treat acidosis?
Bicarb
Good (hyper)ventilation
Replace volume
What are the 2 common rhythms in someone who is hypothermic?
Bradycardia or vfib
How to treat hyperkalemia?
Stabilize cells (calcium)
Insulin/D50
Bicarb
Volume
Albuterol
HD if needed
How do treat tension pneumothorax?
Needle decompression
Chest tube
We will see JVD in tension pneumo due to:
Increased thoracic pressure
What is beck’s triad? What do we see this in?
Tamponade
Hypotension, JVD, narrowed pulse pressure
What are potential different toxins? How do you treat each?
Opiods: narcan; focus on ventilation
Tylenol: hard to treat, kills liver
Benzos: flumazenil
Beta blockers: usually accidental
- glucagon: 3-5mg
- If unstable, may need to pace
Psych meds
- tricyclics: causes acidosis and messes up heart
- treat with bicarb
How do treat PE or cardiac thrombosis?
Systemic anti-thrombotic (tPA)
IR (thombectomy)
Catheter directed therapy for localized tPA
Asystole/PEA causes:
Hypoxemia: get an airway
Hypovolemia: replace volume
What 2 rhythms have a worse prognosis?
Asystole
PEA
Bradycardia algorithm
Basic treatment for bradycardia
If unstable: start with electrical therapy
If no access to electrical therapy, start with epi gtt; if no epi, use dopamine
What is considered as unstable bradycardia?
Hypotensive
Decreased LOC
What is the dose for an epi gtt?
2-10 mcg/min
What is the dose for a dopamine gtt?
5-20 mcg/kg/min (more like 10-20)
Adult tachycardia with a pulse algorithm
If you have unstable tachycardia, what is the first treatment?
Cardioversion
What is the electricity dose for cardioversion?
1-2 J/kg
If you have stable and narrow QRS tachycardia, what is the treatment?
Adenosine 6 mg
What medications can you use for narrow AND wide QRS tachycardia?
Amio
Cardizem
If you have stable and wide QRS tachycardia, what is the treatment?
Lidocaine: 150 mg over 10 min
Lido gtt dosing
1-4 mg/kg
Amio gtt dosing
1 mg/min for 6 hours
0.5 mg/min after
How to preform vagal stimulation? In kids?
Rub on carotid
“bear down”
In kids, put ice on their face
What is the risk with vagal stimulation?
If they are at risk for plaque, it could break a clot off
Pediatric ACLS algorithm
What is usually the number one cause of arrest in pediatrics?
What is one exception?
Respiratory complications
Unknown heart issues
What is different with pediatric dosing from adult dosing?
You have to adjust your doses based on weight
What are common vfib/vtach causes in kids?
Underlying cardiac issue
Electrocution
Pediatric dosing of atropine
0.02 mg/kg
Pediatric dosing of epi
0.01 mg/kg
Causes of cardiac arrest in kids:
Accidental OD
Drowning
Trauma
Choking
“Pill parties” in HS students
Pediatric defibrillation is ______ based
Weight
What is the defibrillation pad placement in kids?
Anterior and posterior
Pediatric bradycardia algorithm
Pediatric bradycardia is usually caused by:
Hypoxia
In kids, if the heart rate is less than 60, what do you do?
Start compressions
What is the initial treatment for unstable bradycardia in kids?
Epi
What other meds can you use for unstable bradycardia in kids?
Atropine
Glycopyrrolate (onset 10 min)
Atropine (onset 30 sec - 1 min)
What medication that we use in OR has bradycardia has a side effect in kids?
Succs
*Have atropine available
If you give TOO low of a dose of atropine in adults, what can this cause?
Reflex bradycardia
Pediatric tachycardia algorithm
A normal “cut off” for HR in a 2-8 yr old would be:
180 bpm
A normal “cut off” in a child <2 for HR would be:
220 bpm
Biggest cause of tachycardia in kids:
Volume depletion
Elevated temp
Treatment for pediatric tachycardia is more directed at:
Treating the underlying issue
It is _____ to have to cardiovert a pediatric patient
Rare
Neonatal resuscitation algorithm
Common causes of neonatal arrest:
From C-section with complications to baby
Airway issues
Post C-section, it’s important to keep baby ___ and ____
Warm
Dry
What 3 questions do we ask if we suspect neonatal code?
Are they breathing?
Are they gasping?
What is the HR?
One way to stimulate newborn:
Push nail bed onto the heal
If the heart rate is less than ____ in a newborn, start ventilation
100 bpm
What 2 things (if done appropriately) are enough to bring a newborn back if HR <100?
Ventilation
Good suction
If a newborn HR is <60, what do you do?
Start CPR
What is something that can cause volume depletion in babies immediately after birth?
If baby is still connected to mom via umbilical cord, and you pick baby up
Volume will leave baby and go to mom!
Cardiac arrest in pregnancy algorithm
Causes of cardiac arrest in pregnant women?
Trauma
Thrombotic events
