ACLS Flashcards
quand défibriller (quelles arrythmies)
- ventricular fibrillation (V fib)
- pulseless ventricular tachycardia (V tach)
pediatric resuscitation do not forget to use
Braeslow tape
get the patient’s weight
quand donner de l’épi ASAP
- Asystole
- Pulseless electrical activity
combien d’épi (posology complète)
1mg épinephrine IV ou IO q 3 à 5 min
défib joules
bi-phasique: 120 à 200 J
monophasic: 360 J
à quel fréquence regarder le rythme
q 2 min après CPR
Si rythme shockable it means c’est quel rythme
V fib
ou
pulseless Vtach
on altèrne quels rx dans Vfib / pVT
épi shock amio
amio posologie dans Vf or PVT
amiodarone 300mg IV ou IO bolus (première dose)
amiodarone 150mg IV ou IO bolus 2e dose
algo pour VF pVT
start CPR
attach monitor / defib
give O2 install I V access (MOVIE)
Shock (do not delay shock and CPR for IV line)
CPR 2 min
shock
CPR + Epi
shock
Amio
shock
Epi
etc
Causes reversibles (5H 5T)
Hypovolemia
Hypoxia
H ion (acidosis)
Hypo-hyperK
Hypothermia
Thrombose - coronary (IM)
Thrombose - pulmonary (EP)
Tension pneumothorax
Tamponade
Toxins
Causes reversibles (5H)
Hypovolemia
Hypoxia
H ion (acidosis)
Hypo-hyperK
Hypothermia
Causes reversibles (5T)
Thrombose - coronary (IM)
Thrombose - pulmonary (EP)
Tension pneumothorax
Tamponade
Toxins
asystole /PEA algo
EPI ASAP
CPR
EPI
CPR
until shockable or ROSC
or stopping REA
signs of ROSC (return of spontaneous circulation) (4)
- Pulse
- BP
- increase in PETCO2 (above 40mmHg)
- spontaneous arterial pressure (if monitoring in place)
CPR quality pushing
at least 5 cm (2 inches)
speed: 100-120 bpm
allow complete chest recoil
CPR quality compressors
minimize interruptions
change compressor q 2 min or sooner
if no advanced airway (no intubation)
compression-ventilation ratio
30: 2
if impossible to give amiodarone give which medication and posologie
lidocaine IV IO
first dose: 1mg per kg (1 to 1.5mg)
2nd dose: 0.5mg per (0.5 to 0.75mg)
PEA narrow vs wide QRS - where is the prob (hypothesis)
Narrow QRS = RV prob
bc the LV is still pumping ++
Wide QRS = LV prob
PEA QRS Wide (LV Problem) ddx
Severe hyperK
Sodium-channel blocker (eg. TCA) toxicity
Acute MI (pump failure)
PEA QRS Narrow (RV Problem) ddx
Cardiac tamponade
Tension pneumothorax
Mechanical hyperinflation (ventilation managment)
Pulmonary embolism
Severe hypovolemia/hemorrhage
Acute MI (myocardial rupture)
PEA QRS Narrow (RV Problem) tx
FLUIDS + Consider causes
PEA QRS Wide (LV Problem)
IV Calcium + IV Bicarbonate boluses + Consider causes
tachyarrthytmia with a pulse: heart rate is typically above
150
Tachycardia with a pulse - what to do when pt arrives
MOVIE
Monitor
Oxygen
IV access
ECG
Tachycardia with a pulse sx that pt is UNSTABLE (5)
HypoTA
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
Tachyarrhytmia - unstable pt what to do
Tachy + UNSTABLE + narrow QRS OR wide QRS:
Synchronized CARDIOVERSION
IF unstable + regular narrow complex: consider adenosine
(for supraventricular tachycardia (SVT))
Tachyarrhytmia - Tachycardia >150
NARROW COMPLEX
STABLE
REGULAR
tx (2)
Vagal maneuvres (souffler dans une paille)
ADENOSINE
Tachy + UNSTABLE pt + narrow QRS OR wide QRS
Synchronized cardioversion
Tachy + irregular + stable pt
dignostic
Atrial FIB
Tachy + irregular + stable tx
Bb or ccb
but almost aways BB cause you dont know the FEVG
Tachy + UNSTABLE pt + narrow QRS
2nd tx that you might consider
1st always synchronized cardioversion
2nd tx to consider
adenosine
ONLY IF regular narrow complex
Tachy + STABLE pt + WIDE QRS tx
consider:
adenosine IF regular and monomorphic
antiarrhytmic infusion
if pt conscious, may consider sedation with which Rx
PAIN
fentanyl 1 μg/kg + slow 0.5 mg/kg lidocaine IV 1 min before sedative
Sedative:
Etomidate superior to propofol
- Etomidate 0.1 mg/kg, followed by etomidate second dose of 0.05 mg/kg just prior to shock
- VS propofol 1 mg/kg, followed by propofol second dose of 0.5 mg/kg just prior to shock
syncronized cardioversion joules
biphasic
if regular narrow OR wide:
(flutter, VT with pulse): 100J
if narrow irregular (A fib): 120 J
adenosine dose
1st dose: 6mg IV push + NS flush
2nd dose: 12mg IV push
antiarrhytmic infusion for STABLE WIDE QRS
- Amiodarone IV
150mg over 10 min
Repeat if VT recurs
Maintenance infusion: 1mg/min for the first 6 hours
AVOID if prolonged QT:
- procainamide
- sotalol
procainomide IV
brady cardio tx
- Atropine IV
1st dose: 1mg bolus
repeat q 3-5 min
max 3 mg
If ineffective:
- transcutanous pacing
AND OR
- dopamine infusion 5-20mcg/kg
or
Epinephrine infusion 2-10mcg/kg
Atropine is what type of drug
anticholinergic = antimuscarinic
excessive vagal activation on the heart
inhibiting the parasympathetic nervous system
bradyarrthytmia causes (4)
MI
drugs or toxico: ccb / bb / digoxin
hypoxia
E abn: hyperK
when to suspect digoxin toxicity
bradycardia + GI sx
what to avoid in cocaine intoxication
bb
how to treat digoxin toxicity
antibody fragments (Digibind)
or if brady - the usual (atropine + pace)
severe hyperk tx
- Calcium Gluconate 100 mg/mL (10%) 3g (30mL) IV over 5-10 mins
Repeat every 5 mins PRN if ECG changes persist or recur
- Insulin
severe k is above
K>6.5
severe hyperk tx
General tx (without posologies)
C BIG K DROP
C: calcium gluconate
B: beta agonist like ventolin nebulized
or sodium bicarbonate
I: insulin
G: glucose
K kayexalate (chronic hyperk)
D: diuretic
ROP : renal dialysis
cocaine intox tx
ABC + treat emergencies:
- Diazepam 5mg IV q3-5 mins for agitation (and hypertension)
- Phentolamine 1-5mg IV for hypertension
Avoid beta-blockers ***
- Sodium bicarbonate 1-2mEq/kg IV push for QRS widening
