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AHA > ACLS > Flashcards

ACLS Flashcards

1
Q

Improvement in quality CPR is needed if PetCo2 is less than?

A

10 mm Hg

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2
Q

Improvement in quality CPR is needed if relaxation phase/diastole (intra-arterial pressure) is less than?

A

20 mm Hg

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3
Q

Monophasic shock energy for defibrillation:

A

360 J

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4
Q

Biphasic shock energy for defibrillation should follow manufacturer recommendation (eg, initial dose of 120-200 J); if unknown, use:

A

maximum available

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5
Q

Drug Therapy: Epinephrine IV/IO dose:

A

1 mg every 3-5 minutes

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6
Q

Drug Therapy: Amiodarone IV/IO dose:

A

First dose: 300 mg bolus

Second dose: 150 mg

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7
Q

Advanced airway placement: how many breaths/min?

A

1 breath every 6 seconds (10 breaths/min) - WITH CONTINUOUS CHEST COMPRESSIONS

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8
Q

Advanced airway placement requires confirmation documentation with what device?

A

waveform capnography or capnometry

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9
Q

ROSC is suspected with abrupt sustained increase in PETCO2, typically above?

A

40 mm Hg

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10
Q

ROSC is suspected with identification of what in intra-arterial monitoring?

A

spontaneous arterial pressure waves

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11
Q

Reversible causes (H’s):

A 
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/Hyperkalemia
Hypothermia
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12
Q

Reversible causes (T’s):

A 
Tension pneumo
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
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13
Q

Epi & Amiodarone used for shockable or non-shockable?

A

shockable

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14
Q

Epi solo used for shockable or non-shockable rhythms?

A

non-shockable

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15
Q

Acceptable depth and rate for CPR Quality?

A

at least 2 inches (5 cm) with full recoil

100-120/min

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16
Q

Minimize __________________ in compressions.

A

interruptions

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17
Q

Avoid excessive _________________.

A

Ventilation

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18
Q

Rotate compressor every ___ minutes, or sooner if fatigued.

A

2

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19
Q

If no advanced airway, _______ compression-ventilation ratio.

A

30:2

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20
Q

Heart rate typically less than ______ in bradyarrhythmmias:

A

50

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21
Q

Oxygen if _________.

A

hypoxemic

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22
Q

Symptomatic signs & symptoms:

A 
Hypotension
Acutely AMS
Signs of shock
Ischemic chest discomfort
Acute HF
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23
Q

If Atropine ineffective in bradyarrhythmia:

A

TCP

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24
Q

Alternatives to TCP in bradyarrhythmia:

A

Dopamine or Epinephrine

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25
Q

Atripine IV dose:

A

0.5 mg bolus
repeat every 3-5 minutes
Maximum dose: 3 mg (0.04 mg/kg)

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26
Q

Dopamine IV infusion dose:

A

2-20 mcg/kg/min

Titrate to patient response; taper slowly.

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27
Q

Epinephrine IV infusion dose:

A

2-10 mcg/min

titrate to patient response

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28
Q

Heart rate typically more than ___/min if tachyarrhythmia.

A

150

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29
Q

Unstable tachycardia ->

A

synchronized tachycardia

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30
Q

Consider ________ with synchronized cardioversion.

A

sedation

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31
Q

If regular narrow complex tachycardia, symptomatic, consider __________ in lieu of synchronized cardioversion.

A

adenosine

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32
Q

Wide QRS =

A

greater than/= 0.12 second

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33
Q

In wide QRS tachycardia, consider adenosine only if:

A

regular and monomorphic

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34
Q

In wide QRS tachycardia, consider:

A

antiarrhythmic infusion and/or expert consultation

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35
Q

In stable tachyarrythmia, begin with:

A

vagal maneuvers
adenosine (if regular)
B-Blocker or Calcium channel blocker
Expert consultation

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36
Q

Initial recommended dose for synchronized cardioversion of narrow regular:

A

50-100 J

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37
Q

Initial recommended dose for synchronized cardioversion of narrow irregular:

A

120-200 J biphasic

200 J monophasic

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38
Q

Initial recommended dose for synchronized cardioversion of wide regular:

A

100 J

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39
Q

Initial recommended dose for synchronized cardioversion of wide regular:

A

defibrillation dose (not synchronized)

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40
Q

Adenosive IV dose:

A

6 mg rapid IV push and flush

12 mg repeat dose if required

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41
Q

Procainamide (antiarrhythmic) infusion IV dose:

A

20-50 mg/min until arrhythmia suppressed, HoTN, QRS duration increases >50%, or max dose of 17 mg/kg given.

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42
Q

Procainamide maintenance infusion:

A

1-4 mg/min

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43
Q

Avoid procainamide if:

A

prolonged QT or CHF

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44
Q

Tachycardia amiodarone IV dose:

A

150 mg over 10 minutes

repeat as needed if VT recurs

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45
Q

Tachycardia amiodarone maintenance infusion:

A

1 mg/min for first 6 hours

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46
Q

Sotalol IV dose:

A

100 mg (1.5 mg/kg) over 5 minutes

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47
Q

Avoid sotalol if:

A

prolonged QT

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48
Q

Sotalol brand name:

A

BetaPace

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49
Q

Procainamide brand name:

A

pronestyl

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50
Q

In ROSC, maintain oxygen saturation at or above 94% and do not:

A

hyperventilate

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51
Q

Treat HoTN (SBP<90 mm Hg) in ROSC with:

A

IV/IO bolus
vasopressor infusion
consider treatable causes

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52
Q

After ROSC, and 12-lead, treat STEMI OR high suspicion of AMI with:

A

coronary reperfusion

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53
Q

If a patient is unable to follow commands s/p ROSC, initiate:

A

Targeted temperature management

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54
Q

If a patient is able to follow commands s/p ROSC, initiate:

A

advanced critical care

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55
Q

Avoid excessive ventilation s/p ROSC. Start at 10 b/min and titrate to target PETCO2 of:

A

35-40 mm Hg

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56
Q

When feasible, titrate FIO2 to minimum necessary to achieve SpO2 of _______ in ROSC.

57
Q

HoTN fluid bolus s/p ROSC dose:

A

1-2 L NS or LR

58
Q

ROSC epinephrine IV infusion:

A

0.1-0.5 mcg/kg/min

59
Q

ROSC dopamine IV infusion:

A

5-10 mcg/kg/min

60
Q

ROSC Norepinephrine IV infusion:

A

0.1-0.5 mcg/kg/min

61
Q

First drug for most forms of stable narrow-complex SVT.

62
Q

Effective in terminating stable narrow-complex SVT’s due to reentry involving AV node or sinus node.

63
Q

This drug may be considered for unstable narrow-complex reentry tachycardia while preparations are made for cardioversion.

64
Q

This drug may be used for regular and monomorphic wide-complex tachycardia, thought to be or previously defined to be reentry SVT.

65
Q

This medication does NOT convert atrial fibrillation, atrial flutter, or VT.

66
Q

This drug is used as a diagnostic maneuver: stable narrow-complex SVT.

67
Q

This drug is contraindicated in poison/drug-induced tachycardia or second- or third-degree heart block.

68
Q

Transient side effects of this drug include flushing, chest pain or tightness, brief periods of asystole or bradycardia, or ventricular ectopy.

69
Q

This drug is less effective (larger doses may be required) in patients taking theophylline or caffeine.

70
Q

Reduce the initial dose of Adenosine to _______ in patients receiving dipyridamole or carbamazepine, in heart transplant patients, or if given by central venous access.

71
Q

If administered for irregular, polymorphic wide-complex tachycardia/VT, this drug may cause deterioration (including hypotension).

72
Q

This drug commonly causes transient periods of sinus bradycardia and ventricular ectopy after termination of SVT.

73
Q

Adenosine is _____ and _________ in pregnancy.

A

safe; effective

74
Q

Adenosine Adult Dosage; Rapid IV Push

A

Initial Bolus of 6 mg given rapidly over 1-3 s followed by NS bolus of 20 mL (extremity elevated)

75
Q

Prior to adenosine administration, place patient in mild reverse ________________ position before administration of drug.

A

Trendelenburg

76
Q

Second dose of Adenosine:

77
Q

How soon after 1st dose of Adenosine should 2nd dose be given?

78
Q

During administration of adenosine, begin recording ______________.

A

rhythm strip

79
Q

Because its use is associated with toxicity, ______________ is indicated for use in patients with life-threatening arrhythmias when administered with appropriate monitoring (VF/pulseless VT unresponsive to shock delivery, CPR, and a vasopressor or recurrent, hemodynamically unstable VT)

A

Amiodarone

80
Q

With EXPERT CONSULTATION, this drug may be used for treatment of some atrial and ventricular arrhythmias.

A

Amiodarone

81
Q

This drug has multiple, complex drug interactions!

A

Amiodarone

82
Q

Rapid infusion of amiodarone may lead to:

A

hypotension

83
Q

With multiple dosing, cumulative doses of this drug >2.2 b over 24 hours are associated with significant hypotension in clinical trials.

A

Amiodarone

84
Q

Do not administer this drug with other drugs that prolong QT interval (eg, procainamide)

A

Amiodarone

85
Q

Terminal elimination of this drug is extremely long (half-life lasts up to 40 days).

A

Amiodarone

86
Q

Amiodarone dose for VF/pVT Cardiac Arrest unresponsive to CPR, Shock, and Vasopressor

A

First dose: 300 mg (IV/IO push)

Second dose: 150 mg (IV/IO push)

87
Q

Amiodarone dose for Life-Threatening Arrhythmias, Rapid Infusion:

A

150 mg IV over first 10 minutes (15 mg/min).

May repeat every 10 min as needed.

88
Q

Amiodarone dose for Life-Threatening Arrhythmias, Slow infusion:

A

360 mg IV over 6 hours (1 mg/min)

89
Q

Amiodarone dose for Life-Threatening Arrhythmias, Maintenance infusion:

A

540 mg IV over 18 hours (0.5 mg/min)

90
Q

What is the first drug for symptomatic sinus bradycardia?

91
Q

Atropine may be beneficial in the presence of:

A

AV nodal block

92
Q

Atropine is not likely to be effective for:

A

type II second-degree or third-degree AV block or a block in nonnodal tissue

93
Q

Routine use of this medication during PEA or asystole is unlikely to have a therapeutic benefit

94
Q

Extremely large doses of atropine may be needed in nerve agent poisoning such as:

A

organophosphate

95
Q

Use atropine with caution in the presence of MI and hypoxia. Atropine increases:

A

myocardial oxygen demand

96
Q

Avoid this drug in hypothermic bradycardia

97
Q

Atropine may not be effective for infranodal (type II) AV block and new third-degree block with wide QRS complexes. In these patients, may cause

A

paradoxical slowing

98
Q

In the event of paradoxical slowing after atropine administration, be prepared to pace or give

A

catecholemines

99
Q

Doses of atropine <0.5 mg may result in

A

paradoxical slowing of heart rate

100
Q

Atropine dose in Bradycardia with or without ACS

A

0.5 mg IV
every 3-5 minutes as needed
max dose 0.04 mg/kg (total 3 mg)

101
Q

Use shorter dosing intervals (3 minutes) and higher doses of atropine in severe

A

clinical conditions

102
Q

Atropine in organophosphate poisoning (extremely large doses may be needed)

103
Q

Second drug for symptomatic bradycardia

104
Q

Use this drug for hypotension (SBP <70-100 mm Hg) with signs and symptoms of shock

105
Q

When using dopamine, correct ________________ with volume replacement before initiating dopamine

A

hypovolemia

106
Q

Use with caution in cardiogenic shock with accompanying CHF

107
Q

may cause tachyarrhtyhmias, excessive vasoconstriction

108
Q

do not mix this drug with sodium bicarbonate

109
Q

Dopamine IV administration dose

A

2-20 mcg/kg/min

titrate to patient response, taper slowly

110
Q

Epinephrine can be considered after atropine as an alternative infusion to dopamine in:

A

symptomatic bradycardia

111
Q

This drug can be used in severe hypotension when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase enzyme inhibtor

A

epinephrine

112
Q

Combine epinephrine with large fluid volume, corticosteroids, and antihistamines for

A

anaphylaxis, severe allergic reactions

113
Q

By raising blood pressure and increasing heart rate, this drug may cause myocardial ischemia, angina, and increased myocardial oxygen demand

A

epinephrine

114
Q

High doses of epinephrine do not improve survival or neurologic outcome and may contribute to postresuscitation:

A

myocardial dysfunction

115
Q

Higher doses of epi may be required to treat poison or

A

drug induced shock

116
Q

Cardiac Arrest Epinephrine Dose (1:10,000)

A

1 mg (10 mL of 1:10,000 solution)
q 3-5 mins during resuscitation
chase with 20 mL flush, elevate arm for 10-20 secs

117
Q

Cardiac Arrest Epinephrine Higher Dose:

A

up to 0.2 mg/kg may be used for specific indications (beta/calcium channel blocker overdoses)

118
Q

Continuous infusion epinephrine dose:

A

Initial rate: 0.1 - 0.5 mcg/kg/min

titrate to response

119
Q

Epinephrine dose ETT route:

A

2 - 2.5 mg diluted in 10 mL NS

120
Q

Epinephrine dose for profound bradycardia or hypotension

A

2-10 mcg/min infusion

titrate to response

121
Q

_____________ is an alternative to amiodarone in cardiac arrest from VF/pVT.

122
Q

This drug can be administered for monomorphic VT with preserved ventricular function

123
Q

This drug can be administered for polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected

124
Q

This drug can be used for stable polymorphic VT with baseline

125
Q

This drug is indicated if QT-interval prolongation is torsades is suspected

126
Q

Lidocaine is contraindicated for prophylactic use in _____

127
Q

Reduce maintenance dose of lidocaine (not loading dose) in presence of impaired liver function or

A

LV dysfunction

128
Q

Discontinue lidocaine infusion immediately if signs of _______________ develop

129
Q

Adult dosage of lidocaine in cardiac arrest

A

Initial dose: 1-1.5 mg/kg IV/IO
Refactory VF re-bolus: 0.5-0.75 mg/kg IV push, repeat in 5-10 mins
Max 3 doses or total of 3 mg/kg

130
Q

Adult dosage of lidocaine in perfusing arrhythmia (stable VT, wide-complex tachycardia of uncertaine type, significant ectopy)

A

Dose range 0.5-0.75 mg/kg and up to 1-1.5 mg/kg may be used.
Repeat 0.5-0.75 mg/kg every 5-10mins
Max total dose 3 mg/kg

131
Q

Lidocaine maintenance infusion (adult)

A

1-4 mg/min (30-50 mcg/kg/min)

132
Q

Recommended for use in cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present

133
Q

life-threatening ventricular arrhythmias due to digitalis toxicity

134
Q

routine administration in hospitalized patients with AMI is not recommended

A

magnesium sulfate

135
Q

An occasional fall in blood pressure with rapid administration

136
Q

Use with caution with this ACLS med if renal failure is present

A

magnesium sulfate

137
Q

Magnesium dose in cardiac arrest (hypomagnesemia or Torsades de Pointes)

A

1-2 g (2-4 mL of a 50% solution diluted in 10 mL [eg, D5W, NS] given IV/IO)

138
Q

Magnesium dose for Torsades de Pointes with a pulse or AMI with hypomagnesemia

A

Loading dose: 1-2g mixed in 50-100mL of diluent (eg, D5W, NS) over 5-60 mins.
Follow with 0.5-1g per hour IV (titrate to control torsades)

AHA (1 decks)

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