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ACLS > ACLS > Flashcards

ACLS Flashcards

1
Q

Cardiac Arrest Algorithm

VF/VT

A
  1. Shout for Help/Activate Emergency Response
  2. Start CPR - give O2 and Attach Monitor/Difib
  3. After 2 minutes check Rhythm. Shock if VF/VT.
  4. If return of Spontaneous Circulation go to Post-Cardiac Arrest Algorithm. If not resume CPR 2mins, IV/IO access, epi q3-5 minutes, Amiaodarone for refractory VF/VT. Consider Advanced Airway with capnography. Treat H&T’s
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2
Q

Cardiac Arrest Algorithm

Asystole/PEA

A
  1. Shout for Help/Activate Emergency Response
  2. Start CPR - give O2 and Attach Monitor/Difib
  3. After 2 minutes check Rhythm.
  4. If return of Spontaneous Circulation go to Post-Cardiac Arrest Algorithm. If not resume CPR 2mins, IV/IO access, epi q3-5 minutes, Consider Advanced Airway with capnography. Treat H&T’s
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3
Q

Return of Spontaneous Circulation Algorithm

ROSC

A
  1. Optimize ventilation and oxygenation
    - Maintain Sat >94%
    - Consider advanced airway with capnography
    - Do NOT hyperventilate
  2. Treat hypertension
    -Iv/IO bolus
    - administer vasopressor
    - H&T’s
    - 12 lead EKG
  3. Does pt follow commands
    -YES - Is it a STEMI OR AMI -
    Yes - Coronary Reperfusion,
    NO - Advanced Critical Care
    -NO - Consider induced hypothermia - STEMI or AMI?
    Yes - Coronary Reperfusion
    No - Advanced Critical Care
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4
Q

Reversible Causes

H&T’s

A
  • Hypo volemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypo/Hyperkalemia
  • Hypothermia
  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary
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5
Q

Ventilation/Oxygenation Dose

A

Avoid excessive ventilation, start at 10-12 breath/min and titrate to target PETCO2 of 35-40mmHg. Titrate FIO2 to achieve SPO2 of >= to 94%

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6
Q

IV bolus dose

A

ROSC: 1-2 L of NS or LR if inducing hypothermia may use 4degree C fluid.

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7
Q

Epinephrine IV infusion Dose

A

ROSC: 0.1-0.5 mcg/kg per minute
(in 70kg adult: 7 -35mcg/min)
Bradycardia with a pulse: 2-10 mcg per minute

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8
Q

Dopamine IV infusion dose

A

ROSC: 5-10 mcg/kg per minute

Bradycardia with a pulse: 2-10 mcg/kg per minute

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9
Q

Norepinephrine IV infusion dose

A

ROSC: 0.1-0.5 mcg/kg per minute

in 70kg adult: 7 -35mcg/min

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10
Q

Shock Energy

A

Biphasic: Manufacturer recommendation; if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses may be considered.
- Monophasic: 360J

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11
Q

Epinephrine IV/IO dose

A

1 mg q3-5 minutes

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12
Q

Vasopression IV/IO dose

A

40 units can replace first or second dose of epinephrine

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13
Q

Amiodarone IV/IO dose

A

First dose: 300 mg bolus

Second dose: 150 mg bolus

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14
Q

Advanced Airway

A
  • Supraglottic or ET intubation
  • Waveform capnography to confirm and monitor ET tube placement
  • 8 -10 BPM with continuous compression
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15
Q

Bradycardia with a pulse algorithm

A
  • Assess for appropriateness for clinical condition. Is thier HR typically this low? Athlete?
  • ID and treat underlying causes (patent airway, oxygen if hypoxemic, cardiac monitor to ID rhythm, monitor BP, IV access, EKG.
  • Is bradycardia causing: hypotension, AMS, Shock, Chest discomfort, heart failure
    No: Monitor and Observe
    Yes: Atropine. If ineffective transcutaneous pacing, OR dopamine infusion OR epinephrine infusion
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16
Q

Atropine IV dose

A

First dose: 0.5mg bolus
repeat q3-5 minutes
Maximum of 3mg

17
Q

Tachycardia with a pulse algorithm

A

-Assess for appropriateness of rhythm.
-ID and treat underlying cause (maintain airway, oxygen if hypoxemic, cardiac monitor to ID rhythm, monitor BP and O2)
- Persistent tachy causing: Hypotension, AMS, Shock, Chest discomfort, Heart failure?
-NO: is there a wide QRS >12 sec
NO: IV, EKG, Vagal manuvers, Adenosine
(if regular), Beta or calcium channel blocker,
consider expert consultation
-YES: Synchronized cardioversion: consider
sedation, if narrow complex consider adenosine.

18
Q

Synchronized Cardioversion

A

Initial Doses
Narrow regular: 50-100J
Narrow irregular 120-200 biphasic or 200j monophasic
Wide regular: 100J
Wide irregular: defibrillation dose (NOT synchronized)

19
Q

Adenosine IV dose

A

First dose: 6mg rapid IVP; follow with NS flush

Second dose: 12mg if required

20
Q

Procainamide IV dose

Antiarrhythmic infusions for stable wide-QRS Tachycardia

A

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.

21
Q

Amiodarone IV dose

Antiarrhythmic infusions for stable wide-QRS Tachycardia

A

First Dose: 150mg over 10 minutes. Repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours.

22
Q

Sotalol IV Dose

Antiarrhythmic infusions for stable wide-QRS Tachycardia

A

100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT

23
Q

Acute Coronary Syndrome Algorithm

(Beginning Basics

A

Symptoms suggestive of ischemia or infarction

  • EMS assessment and care and hospital preparation (Monitor, support ABCs, Be prepared to start CPR or defibrillation, MONA, mobilize resources of possible STEMI.
  • Concurent ED assessment (
24
Q

Acute Coronary Syndrom Algorithm for ST elevation or new or presumably new LBBB; strongly suspicious for injury.
ST-elevation MI (STEMI)

A
  • Start adjunctive therapies as indicated.
  • Do not delay reperfusion
    How long ago did symptoms start?
    - >12 hours
    -Troponin elevated or high risk pt: start
    adjunctive treatments as indicated: Nitro,
    heparin, consider PO B-Blocker, Clopindogrel,
    Glycoprotein IIb/IIIa inhibitor.
    - Admit to monitor bed. Assess risk status,
    continue ASA, heparin and other therapies as
    indicated (ACE, ARB, statin therapy. Not high
    risk cardiology to risk stratify
    -
25
Q

Acute Coronary Syndrome Algorithm for ST depression or dynamic T-wave inversion; strongly suspicious for ischemia.
High risk unstable angina/ non-ST elevation MI (UA/NSTEMI)

A
  • Troponin elevated or high risk pt: start adjunctive treatments as indicated: Nitro, heparin, consider PO B-Blocker, Clopindogrel, Glycoprotein IIb/IIIa inhibitor.
  • Admit to monitor bed. Assess risk status, continue ASA, heparin and other therapies as indicated (ACE, ARB, statin therapy. Not high risk cardiology to risk stratify
26
Q

Acute Coronary Syndrome Algorithm for Normal or nondiagnostic changes in ST segment or T-wave.
Low/intermediate risk ACS.

A
  • Considert admission to ED chest pain unit or appropriate bed and follow: serial cardiac markers, repeat ECG/continuous St-segment monitoring, consider noninvasive diagnostic tests.
  • Develops 1 or more: Critial high risk features, Dynamic ECG changes consistent with ischemia, Troponin elevated.
    - YES - go to high risk unstable angina/ NSTEMI
    algorithm.
    - NO - Abnormal diagnostic noninvasive imaging or
    physiologic testing?
    YES- Admit to monitored bed Assess risk
    status continue ASA, heparin, and
    other therapies as indicated.
    NO - If no evidence of ischemia or infarction
    by testing, can discharge with follow-up

ACLS (1 decks)

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