ACLS

Question 1

Treatment of pulseless v-tach?

Answer 1

Shock 200 J
CPR 30 x 2
Epi 1 mg, amiodarone 300 mg, 150 mg

Question 2

Treatment of v-fib?

Answer 2

The treatment for VF is electrical defibrillation and that the probability of successful defibrillation decreases over time. Unresolved VF tends to deteriorate to asystole.

Defibrillation is used when there is no recognizable QRS complex (eg, VF) or if the QRS complex is sufficiently erratic so that the cardioverter/defibrillator is unable to recognize existing QRS complexes (eg, torsade de pointes). The energy levels used for defibrillation are usually higher than those used for synchronized cardioversion.

In the circumstance of witnessed cardiac arrest due to VF, a single shock should be delivered with immediate resumption of CPR.

Vasopressors (epinephrine or vasopressin as per ACLS guidelines) are indicated if VF persists after failure of 1 or 2 episodes of defibrillation with ongoing chest compressions to restore spontaneous circulation.

Question 3

Which group of patients are more likely to survive CPR/ACLS, those who present with VF/VT or those who present with asystole/PEA?

Answer 3

VF/VT- these patients have a better prognosis because their initial presenting arryhthmia is more treatable with defibrillation to restore circulation, whereas PEA/asystole are not. Also, VF/VT are more likely to be a manifestation of a cardiac cause (like a myocardial ischemic event), whereas asystole/PEA are more likely to be related to a non-cardiac cause and less likely to be treatable.

Question 4

What are the role of chest compressions?

Answer 4

Chest compressions aim to increase circulation of blood to the rest of the body through manual compression of the heart and through increases in intrathoracic pressure.

Question 5

What is the recommended rate of chest compressions?

Answer 5

100 bpm

Question 6

What events may interrupt chest compressions during CPR?

Answer 6

Airway placement, pulse checks, rhythm analysis, preshock pause. All of these interruptions must be minimized in order to ensure the best quality of CPR and the most circulation of blood.

Question 7

What is the goal of pharmacologic interventions in ACLS?

Answer 7

To achieve and maintain spontaneous circulation

Question 8

What is the mainstay of pharmacologic intervention in ACLS?

Answer 8

The use of vasopressors including epinephrine and vasopressin