ACLS Flashcards
On top of Atropine, Dopamine, and Epinephrine what other treatment can you provide for Adult Bradycardia?
Transcutaneous Pacing
What are the medications and their dosages you can give for Adult Bradycardia?
Atropine IV Dose: First dose, 0.5 mg bolus. Repeat every 3-5 minutes with max dose of 3 mg
Dopamine IV Infusion: 2-10 mcg/kg per minute
Epinephrine IV Infusion: 2-10 mcg per minute
What is the first step in the Adult Bradycardia Algorithm?
Assess appropriateness for clinical condition
After assessing clinical condition what is the next step in the Adult Bradycardia Algorithm?
Identify and treat underlying causes:
Maintain patent airway; assist breathing as necessary
Oxygen (if hypoxemic)
Cardiac Monitor to identify rhythm; monitor blood pressure and oximetry
IV Access
12 lead ECG if available; don’t delay therapy
What do you do if persistent bradyarrhythmia is NOT causing hypotension, acutely altered mental status, shock, ischemic chest discomfort or acute heart failure?
Monitor and Observe
If persistent bradyarrhythmia IS causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what do you do next?
Atropine first dose: 0.5 mg bolus repeated every 3-5 minutes for a maximum of 3mg dose
If Atropine is ineffective for persistent bradyarrhythmia what are your other options for treatment?
Transcutaneous pacing OR Dopamine Infusion (2-10 mcg/kg per min) OR Epinephrine (2-10 mcg per min)
What is the first step in Adult Tachycardia algorithm?
Assess appropriateness for clinical condition
After assessing for appropriateness for clinical condition what is the next step in the Adult Tachycardia algorithm?
Identify and treat underlying causes:
Maintain patent airway; assist breathing if necessary
Oxygen (if hypoxemic)
Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
If persistent tachyarrhythmia is causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what is the next step?
Synchronized cardioversion
Consider sedation
If regular narrow complex consider adenosine ( 1st dose: 6mg rapid IV push; follow with NS flush; 2nd dose 12mg if required)
If persistent tachyarrhythmia is NOT causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what is the next step?
Check QRS complex width
What medications are indicated for stable Wide-QRS Tachycardia?
Procainamide IV Doses: 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose 17mg/kg given. Maintenance Infusion: 1-4 mg/min, Avoid if prolonged QT or CHF
Amiodorane IV Dose: First dose 150 mg over 10 minutes, repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours
Sotalol IV Dose: 100 mg (1.5mg/kg) over 5 minutes, avoid if prolonged QT
What treatment is indicated for stable narrow-QRS tachycardia?
IV Access and 12 lead ECG Vagal maneuvers Adenosine (If regular) B-Blocker or calcium channel blocker Consider expert consultation
What are the recommended dosages for Synchronized Cardioversion?
Narrow regular: 50-100J
Narrow Irregular: 120-200J biphasic or 200J monophasic
Wide Regular: 100J
Wide Irregular: Defribrillation dose (NOT synchronized)
Synchronized Cardioversion is in relation to which wave?
R Waves
True or False: Adenosine can be considered for unstable Tachycardia and stable tachycardia with wide QRS (if regular and monomorphic)
True
What is the first step in VF/Pulseless VT treatment algorithm?
Start CPR
Give Oxygen
Attach Monitor/defibillator
Check if Rhythm is shockable
In VF/Pulseless VT what are the two UNSHOCKABLE rhythms?
Asystole/PEA
What are the two shockable rhythms?
Ventricular Fibrillation and Pulseless Ventricular Tachycardia
If there is unwitnessed or non-quality CPR on a cardiac arrest what should you do prior to shock?
2 min cycle of CPR
If you have a witnessed arrest would you begin CPR prior to shock?
No, shock immediately if you have a witnessed arrest with quality CPR
What are the two medications you give during cardiac arrest?
Epinephrine IV/IO: 1mg every 3-5 minutes
Amiodarone IV/IO: 300 mg bolus first dose, 150 mg ssecond dose
Cycle drugs between CPR cycles
If during cardiac arrest the patient is in Asystole/PEA what is the next step?
CPR cycle 2 min
IV/IO access
Epinephrine 1mg every 3-5 minutes
What are the H’s and T’s?
Correctable Causes: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-/hyperkalemia Hypothermia Tension Pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary
Go through stable symptomatic bradycardia algorithm.
Vitals, 02, monitor, IV, Fluids, Transport
Atropine 0.5mg bolus repeat 3-5 minutes max dosage of 3 mg
Go through algorithm for unstable symptomatic.
Pacing at rate of 70-80 bpm
milliamps at 40 ma increase 5-10 until mechanical and electrical capture is achieved
Dopamine or epi drip
Dopamine: 5 mcg/kg/min drip
epi: 2-10 mcg/min drip
Go through treatment algorithm for Asystole/PEA.
CPR 30:2, BVM 100% O2 15 - 25 LPM, OPA
Every two minute cycle perform pulse/rhythm check and switch CPR roles.
Monitor with Defibrillator pads and 12 lead
Start IV with fluid, intubation with at least 2 confirmation devices, CPR changes to 100 compressions a minute continues with BVM breath every 5 - 6 seconds.
EPI 1:10,000 1mg repeat 3 - 5 minutes
What is the acronym MATCHED mean?
MI
Acidosis - 1mcg/kg sodium bicarbonate
Tension Pneumothorax - Needle decompress
Cardiac Tamponade - Nothing medic can do
Hypoxia - O2
Hypoglycemia - Check sugar, if needed push D50 25g
Hypothermia - Blankets, Take patient out of environment
Hypovolemia - Assess lung sounds, give fluids
Hypokalemia
Hyperkalemia
Embolism - Nothing medic can do
Drug overdose - Narcan 0.4 mg - 2 mg max 4 mg
Go through V-Fib/ V-Tach treatment algorithm.
Assess pulse, pulseless
Defibrillate immediately if witnessed with quality compressions
CPR 30:2 BVM 100% OPA 15 - 25 LPM after shock or unwitnessed arrest, Monitor with 12 lead and defib pads, IV large bore with fluid TKO
1 mg epi 1:10,000 repeat every 3 - 5 min
Defib after every 2 min cycle
CPR 30:2 with BVM 100% O2 and work on intubation at beginning of new cycles, once tube is confirmed switch CPR to continuous 100 bpm with breath every 5 - 6 seconds
Amiodarone 300 mg 1st dose
CPR, Defib
Epi 1:10,000
CPR Defib
Amiodarone 150 mg
CPR Defib
repeat
What is the dosage for Lidocaine?
1 - 1.5 mg/kg first dose
0.5 mg - .75 mg/kg second dose
