ACLS Flashcards
How many compressions per minute should be being provided?
100-120
What is the first step for V fib?
Shock
When should ventilation be started in V fib protocol?
After the second shock and during the second round of chest compressions
When is cardiac epi given in the v fib protocol?
After the second shock
What is the dosage of cardiac epi?
10 cc of 1:10,000
Each cc has 100 mcg
What drug is given after epi and how much?
300 mg of amiodarone
What must you do after giving amiodarone?
Flush the line - amiodarone eats veins!
What is the next med and dose given after the first dose of amiodarone?
150 mg of amiodarone
What can be given after amiodarone?
Lidocaine (100) or magnesium (1-2 grams over 60 minutes)
What is the maintenance dose of magnesium?
0.5-1 gram q hour
What is the first step in the treatment of anaphylaxis?
0.3 mg epi IM
What are the subsequent steps of treating anaphylaxis?
Steroids
Benadryl
H2 blockers
Fluids
What is the IV drip formula for epi in a patient in anaphylactic shock?
1 liter of normal saline + 1 amp or 1 mg of epi hooked into a fast running bag at 1 cc/min increasing by 1 cc every minute
What is PSVT?
Narrow, 180, regular
What is the first thing you say for PSVT?
Stable or unstable
What is the second thing you ask about PSVT?
Old or young?
What is the first step in treating PSVT?
Vagal maneuvers:
- Valsalva
- Carotid massage
- 1+2
- Ice
What is the medicine you give for PSVT?
6 mg of adenosine IV push or 12
What is the PSVT protocol for older people?
- Valsalva
2. Adenosine
What is the PSVT protocol for stable young people?
- Valsalva
- Carotid massage
- 1+2
- Ice
- Adenosine 6 mg IV push then flush
What do you do for unstable PSVT?
Synchronized cardioversion
What are the contraindications to adenosine?
- Sinus tachycardia
- Atrial flutter or fib
- Irregular rhythm
- Rate of over 220 (=bypass tract)
- History of a fib, a flutter, or MAT
- COPD, ACS, or HF
What is a clean kill if you give adenosine?
Wide, irregular rhythm = a fib with WPW
What is the first thing you say with PEA?
Reversible!
What are the reversible causes of PEA?
A: hypoxia
B: PTX
C: hypovolemic, hypervolemia (tamponade)
D: toxic (drug OD: TCA, BB, CAB) , metabolic (hyper K)
What is the first step in treating PEA?
- Oxygenate and ventilate
What is the second step in PEA protocol?
- Get open IV access
What is the third step in PEA protocol?
Look at 3:
- EKG
- Temperature
- Volume status
What drug can you give in PEA?
1 mg of epi q 3 min
What is the PEA protocol?
- Oxygenate and ventilate
- IV access
- Look at EKG, temp, volume status
- Give 1 mg of epi q 3 min
Wide complex, rate = 25-40, no p waves
Idioventricular rhythm
What is the first step in the BLS protocol?
- Check for responsiveness
What is the second step on BLS.
Activate the emergency response system/get an AED
What is the third step in BLS?
Check for carotid pulse
What do you do if there is no pulse?
Start chest compressions
What do you do next if there is a pulse?
Start rescue breathing at 1 breath every 5-6 seconds
How often should you check a pulse?
Every 2 minutes
How often should you switch CPR givers?
Every 2 minutes
What does a end tidal CO2 less than 10 tell you?
The chest compressions are of poor quality
Which patients should have induced hypothermia?
ROSC patients after out of hospital Vfib
Comatose patients with ROSC with cardiac arrest in the hospital or out of hospital with PEA or asystole
What temperature is induced hypothermia?
32 to 34 degrees Celsius
What should oxygen supply be titrated to?
The lowest level that can keep sats above 94%
What should ventilation rates be titrated to?
35-40 ETCO2 or PaCO2 of 40-45
What is the MAP goal?
65
Where should the glucose be kept in a patient with ROSC after cardiac arrest?
144-180
How frequent do you give breath during a cardiac arrest with BMV?
2 ventilation after every 30 compressions
How frequently do you give breaths with an advanced airway in cardiac arrest?
1 every 6-8 seconds
Why so we resume chest compressions after successful defibrillation?
Because the rhythm the heart comes back with is usually slow and does not create a pulse or give adequate perfusion
What does defibrillation do to the heart?
Briefly terminates all electrical activity
