ACLS

Question 1

What is the first treatment for Bradycardia?

Answer 1

Atropine IV 0.5 bolus
repeat every 3-5 mins
max = 3 mg

Question 2

What are the 2nd line treatments for bradycardia if atropine is ineffective?

Answer 2

TC pacing or
Dopamine IV infusion (2-10 mcg/kg per minute) or
Epi IV infusion (2-10 mcg/min)

Question 3

What is the first treatment for an unstable patient with tachycardia?

Answer 3

Synchronized cardioversion
50-100 J narrow reg
120-200 J biphasic or 200 J monophasic narrow irreg
100 J wide reg

Question 4

What treatment can you consider in a patient with unstable tachycardia if regular, narrow complex?

Answer 4

Adenosine IV
1st dose = 6 mg rapid IV push f/b NS flush
2nd dose = 12 mg if required

Question 5

What is the first line treatment in a patient with stable tachycardia with QRS <0.12s?

Answer 5

vagal manuvers

Question 6

What are other treatment options for a patient with stable tachycardia with QRS <0.12s?

Answer 6

If regular - Adenosine
BB or CCB
Expert consult

Question 7

What is the first line treatment in a patient with stable tachycardia with QRS >0.12s?

Answer 7

If reg & monomorphic - Adenosine
Amiodarone IV (anti-arrhythmic)
1st dose = 150 mg/10 min, repeat PRN if VT recurs
Maintenance infusion 1mg/min for 1st 6 hr

Can also Procainamide or Sotalol but avoid if prolonged QT

Question 8

What are things to keep in mind regarding CPR quality?

Answer 8

Push HARD (>2 in (5 cm)) & FAST (>100/min)
allow complete chest recoil
minimize interruptions in compressions (<10s)
avoid excess ventilation
rotate compressor q2 min
if no advanced airway = 30:2

Question 9

What is Quantitative waveform capnography?

Answer 9

most reliable indicator or ETT placement
PETCO2 Do BETTER CPR!
Normal = 35-45mm

Question 10

What do you do for VF/VT?

Answer 10

Shock them, then CPR for 2 mins & IV/IO access

then recheck rhythm

Question 11

If rhythm is still shockable (i.e. remains VF/VT)?

Answer 11

Shock them, then CPR for 2 mins & Epi IV/IO 1 mg q3-5 min (or Vasopressin IV/IO 40 units)
consider advanced airway & PETCO2
then recheck rhythm

Question 12

What if rhythm is still shockable after 2 shocks (i.e. remains VF/VT)?

Answer 12

Shock them, then Amiodarone IV/IO 300 mg bolus
begin thinking of reversible causes (5 H’s 5T’s) and treatments
then recheck rhythm

Question 13

What would the next drug therapy if patient already received Epi and Amiodarone 300mg?

Answer 13

You could give epi IV 1 mg again or Vasopressin IV 40 untis

Question 14

When can you give Vasopressin?

Answer 14

Vasopressin IV/IO dose can replace 1st or 2nd dose ofEPI

Question 15

What is the 2nd dosage of Amiodarone?

Answer 15

150 mg

Question 16

What are the 5 H’s of reversible causes?

Answer 16

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypothermia

Question 17

What are the 5 T’s of reversible causes?

Answer 17

Tension PTX
Tamponade (cardiac)
Toxins
Thrombosis (PE)
Thrombosis (coronary)

Question 18

What are the types of advanced airways?

What is the ventilation required during CPR?

Answer 18

Supraglottic & endotracheal tube

8-10 bpm with continuous chest compressions

Question 19

What should you do if the patient no longer has a shockable rhythm?

Answer 19

Begin treating using the Asystole/PEA algorithm:
CPR 2 min
IV/IO access
EPI IV 1 mg q3-5 min

Question 20

What is the treatment for ROSC?

Answer 20

O2 >94 %
advance airway - do NOT hyperventilate (start at 10-12 bpm & titrate to PETCO2 35-40 mm HG)
Treat Hypotension (SBP <90):
IV/IO bolus of 1-2L NS or LR
Vasopressor infusion
consider treatable causes
EKG

Question 21

What are the Vasopressor infusion options for ROSC?

Answer 21

EPI IV infusion 0.1-0.5 mcg/kg per min
Dopamine IV infusion 5-10 mcg/kg per min
NE IV infusion 0.1-0.5 mcg/kg per minute

Question 22

During ROSC, after oxygen/ventilation and hypotension have been address, and patient is NOT following commands what can be initiated?

Answer 22

Induced hypothermia

can use 4 degreesC IVF

Question 23

During ROSC, after oxygen/ventilation and hypotension have been address, and patient is following commands but EKG indicates STEMI or there is a high suspicion of AMI, what can be done?

Answer 23

Coronary Re-perfusion