ACLS

Question 1

vasopressin for cardiac arrest

Answer 1

40 units IV push in place of first or second dose of epinephrine

Question 2

adenosine for tachyarrhythmia in stable patient

Answer 2

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)

Question 2

diltiazem for tachyarrhythmia in stable patient

Answer 2

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)

Question 3

epinephrine infusion for symptomatic bradyarrhythmia

Answer 3

2 - 10 mcg/min

in patients failing atropine or with unstable rhythms (2° type II or 3° AV block)

Question 3

first three interventions (for nearly everything)

Answer 3

IV access

supplemental O₂

set up Lifepak monitor

Question 4

amiodarone for tachyarrhythmia in stable patient

Answer 4

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)

Question 4

procainamide for tachyarrhythmia in stable patient

Answer 4

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)

Question 5

fluid bolus for BP support after ROSC

Answer 5

1 - 2 L IV bolus (NS or LR)

chilled to 4°C if hypothermia indicated

Question 6

vagal maneuvers for tachyarrhythmia in stable patient

Answer 6

bear down: 10 sec straining, 5 sec relaxing x 3

use for regular, narrow-QRS tachyarrhythmias (e.g. paroxysmal SVT)

Question 7

CPR breaths with advanced airway in place

Answer 7

one breath q 6 - 8 seconds

(8 - 10 breaths/min)

do not interrupt chest compressions for breaths

avoid over-ventilation

Question 8

atropine for symptomatic bradyarrhythmia

Answer 8

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

Question 9

parameters to monitor for CPR effectiveness

Answer 9

diastolic BP > 20 mm Hg

PETCO₂ > 10 mm Hg

Question 10

metoprolol for tachyarrhythmia in stable patient

Answer 10

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)

Question 11

dopamine for BP support after ROSC

Answer 11

5 - 10 mcg/kg/min IV infusion

Question 12

epinephrine/norepinephrine for BP support after ROSC

Answer 12

0.1 - 0.5 mcg/kg/min IV infusion

Question 14

amiodarone for cardiac arrest

Answer 14

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)

Question 15

ROSC interventions

Answer 15

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

Question 16

magnesium sulfate for torsades des pointes

Answer 16

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)

Question 17

dopamine infusion for symptomatic bradyarrhythmia

Answer 17

2 - 10 mcg/kg/min

in patients failing atropine or with unstable rhythms (2° type II or 3° AV block)

Question 19

defibrillation for cardiac arrest

Answer 19

manufacturer recommended initial dose (150 - 200 J biphasic; 360 J monophasic)

escalate subsequent doses

shock only VT or VF

Question 21

transcutaneous pacing for symptomatic bradyarrhythmia

Answer 21

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

Question 22

general treatments for (suspected) ACS

Answer 22

aspirin 325 mg po chew

nitroglycerin (sublingual/spray)

supplemental O₂ (4 L/min, titrate to SpO2 > 94%)

morphine IV

Question 23

5 H’s (reversible causes of cardiac arrest)

Answer 23

hypovolemia

hypoxia

hydrogen ion (acidosis)

hypo/hyperkalemia

hypothermia

(hypoglycemia)

Question 24

5 T’s (reversible causes of cardiac arrest)

Answer 24

tension pneumothorax

tamponade, cardiac

toxins

thrombosis, pulmonary

thrombosis, coronary

Question 25

synchronized cardioversion for unstable tachyarrhythmia

Answer 25

regular rhythm: 100 J

irregular rhythm: 200 J

wide-complex, irregular rhythm: unsynchronized defibrillation dose

Question 26

rescue breaths for patient with pulse

Answer 26

one breath q 5 - 6 seconds (10 - 12 breaths/min)

avoid over-ventilation

Question 27

epinephrine for cardiac arrest

Answer 27

1 mg IV push q 3 - 5 min (every other CPR cycle)

note: cardiac arrest (IV) formulation is 1:10,000; do not confuse with anaphylaxis (IM) formulation of 1:1,000