ACLS Flashcards
vasopressin for cardiac arrest
40 units IV push in place of first or second dose of epinephrine
adenosine for tachyarrhythmia in stable patient
6 mg rapid IV push
give in centrally located PIV line (e.g. antecubital)
can give 12 mg repeat doses x 2
be prepared for cardiac arrest
avoid in asthmatics
use only for regular, monomorphic tachyarrhythmias (paroxysmal SVT with/without aberrancy)
diltiazem for tachyarrhythmia in stable patient
20 mg IV bolus over 2 min
repeat dose 25 mg x 1
use for PSVT (alternative/adjunct to adenosine) and for rate control in atrial tachyarrhythmias
avoid in pre-excitation syndromes (WPW)
epinephrine infusion for symptomatic bradyarrhythmia
2 - 10 mcg/min
in patients failing atropine or with unstable rhythms (2° type II or 3° AV block)
first three interventions (for nearly everything)
IV access
supplemental O2
set up Lifepak monitor
amiodarone for tachyarrhythmia in stable patient
150 mg IV bolus over 10 mins
repeat PRN
maintenance infusion of 1 mg/min for 6 hrs
use for wide-QRS tachyarrhythmias (stable VT)
procainamide for tachyarrhythmia in stable patient
20 - 50 mg/min IV gtt to maximum 17 mg/kg
maintenance infusion of 1 - 4 mg/min
monitor QRS duration (can be prolonged) and BP (can cause hypotension)
use for stable monomorphic VT
also use for tachyarrhythmias (e.g. afib/RVR) in patients with preexcitation (e.g. WPW)
fluid bolus for BP support after ROSC
1 - 2 L IV bolus (NS or LR)
chilled to 4°C if hypothermia indicated
vagal maneuvers for tachyarrhythmia in stable patient
bear down: 10 sec straining, 5 sec relaxing x 3
use for regular, narrow-QRS tachyarrhythmias (e.g. paroxysmal SVT)
CPR breaths with advanced airway in place
one breath q 6 - 8 seconds
(8 - 10 breaths/min)
do not interrupt chest compressions for breaths
avoid over-ventilation
atropine for symptomatic bradyarrhythmia
0.5 mg IV bolus
repeat q 3 - 5 min up to 3 mg
ineffective in 2° type II and 3° AV block (acts at AV node) - skip directly to TCP or infusion
parameters to monitor for CPR effectiveness
diastolic BP > 20 mm Hg
PETCO2 > 10 mm Hg
metoprolol for tachyarrhythmia in stable patient
5 mg IV bolus
repeat q 2 - 5 min for 15 mg total
avoid in CHF or asthmatics
use for rate control of atrial tachyarrhythmias (afib, aflutter, EAT, MAT)
dopamine for BP support after ROSC
5 - 10 mcg/kg/min IV infusion
epinephrine/norepinephrine for BP support after ROSC
0.1 - 0.5 mcg/kg/min IV infusion
amiodarone for cardiac arrest
300 mg IV bolus (after first dose of epinephrine)
repeat dose 150 mg x 1
only for refractory VT/VF (give only for shockable rhythm)
ROSC interventions
maintain SBP > 90 mm Hg (fluids, pressors)
maintain SpO2 > 94%
12-lead EKG
address treatable causes
induced hypothermia (32 - 34°C) if unresponsive
coronary reperfusion if indicated
magnesium sulfate for torsades des pointes
2 g IV bolus in 10 mL D5W
maintenance infusion of 0.5 - 1 g/hr
use in addition to other indicated treatments for torsades des pointes (polymorphic VT)
dopamine infusion for symptomatic bradyarrhythmia
2 - 10 mcg/kg/min
in patients failing atropine or with unstable rhythms (2° type II or 3° AV block)
defibrillation for cardiac arrest
manufacturer recommended initial dose (150 - 200 J biphasic; 360 J monophasic)
escalate subsequent doses
shock only VT or VF
transcutaneous pacing for symptomatic bradyarrhythmia
start at 60 bpm / 60 mA (can start 80/80)
increase current incrementally until capture
set current 5 - 10 mA above capture
consider analgesia before initiating
first-line for unstable rhythm (2° type II or 3° AV block) or in unstable patients
general treatments for (suspected) ACS
aspirin 325 mg po chew
nitroglycerin (sublingual/spray)
supplemental O2 (4 L/min, titrate to SpO2 > 94%)
morphine IV
5 H’s (reversible causes of cardiac arrest)
hypovolemia
hypoxia
hydrogen ion (acidosis)
hypo/hyperkalemia
hypothermia
(hypoglycemia)
5 T’s (reversible causes of cardiac arrest)
tension pneumothorax
tamponade, cardiac
toxins
thrombosis, pulmonary
thrombosis, coronary
