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1
Q

CPR depth and rate

A

at least 2 inches

100-120 bpm

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2
Q

if no advanced airway, what is the

compression : ventilation ratio

A

30 : 2

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3
Q

what does the ETCO2 value during CPR need to be?

if it’s abnormal, what do you do?

A

above 10 mmHg

if it’s too low then improve CPR quality

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4
Q

what does the intra-arterial pressure need to be during CPR?

if it’s abnormal, what do you do?

A

above 20 mmHg in the relaxation (diastolic) phase

if it’s too low, improve CPR quality

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5
Q

biphasic defibrillator-

how many joules do you use to shock someone in cardiac arrest

A

120- 200 J for the first shock (if unknown use max)

subsequent shocks should be equivalent, maybe higher

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6
Q

monophasic defibrillator-

how many joules do you use to shock someone in cardiac arrest

A

360 J

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7
Q

VF

what’s the treatment?

A

(shockable rhythm)

  • Epi- 1 mg
    • begins after 2nd shock
    • then Q 3-5 mins
  • Amiodarone
    • 1st dose- 300 mg bolus
      • begins after 3rd shock
    • 2nd dose- 150 mg
      • begins after 5th shock
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8
Q

asystole

what’s the treatment?

A

(not shockable)

Epi- 1 mg Q 3-5 mins

+ CPR

+ evaluating Q 2 mins to see if rhythm becomes shockable

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9
Q

pVT (pulseless)

what’s the treatment?

A

(shockable rhythm)

  • Epi- 1 mg
    • begins after 2nd shock
    • then Q 3-5 mins
  • Amiodarone
    • 1st dose- 300 mg bolus
      • begins after 3rd shock
    • 2nd dose- 150 mg
      • begins after 5th shock
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10
Q

Cardiac Arrest: shockable rhythm

what’s the treatment?

A
  1. Epi- 1 mg
    • begins after 2nd shock
    • then Q 3-5 mins
  2. Amiodarone
    • 1st dose- 300 mg bolus
      • begins after 3rd shock
    • 2nd dose- 150 mg
      • begins after 5th shock
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11
Q

Cardiac Arrest: not shockable

what’s the treatment?

A

(not shockable)

Epi- 1 mg Q 3-5 mins

+ CPR

+ evaluating Q 2 mins to see if rhythm becomes shockable

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12
Q

PEA

what’s the treatment?

A

(not shockable)

Epi- 1 mg Q 3-5 mins

+ CPR

+ evaluating Q 2 mins to see if rhythm becomes shockable

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13
Q

Cardiac Arrest- who is shockable?

A

VF

pulseless VT

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14
Q

Cardiac Arrest- who is NOT shockable

A

asystole

PEA

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15
Q

what are the reversible causes of cardiac arrest

A
  • 5 H’s
    • Hypovolemia
    • Hypoxia
    • Hydrogen
    • Hypo/hyperkalemia
    • Hypothermia
  • 4 T’s
    • Tension pneumo
    • Tamponade
    • Toxins
    • Thrombosis (pulm/ cardiac)
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16
Q

5 things that will qualify a patient as

UNSTABLE

A

hypotension

AMS (acute)

signs of shock

chest pain

acute heart failure (rales/ ronchi)

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17
Q

what does the HR need to be for a bradycardic pt to initiate workup?

A

< 50

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18
Q

bradycardic pt who’s stable

what’s the treatment?

A

none

just monitor and observe

(order EKG)

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19
Q

bradycardic pt who’s UNSTABLE

what’s the treatment?

A

First Drug:

  • Atropine 0.5 mg bolus
    • then every 3-5 mins
    • maximum of 3 mg (6 doses)

If 1st dose doesn’t work then move on to:

  1. transcutaneous pacing
  2. dopamine 2-20 mcg/kg/ min (titrated)
  3. epinephrine 2-10 mcg/ min (titrated)
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20
Q

tachycardic pt who’s UNSTABLE with a narrow RRR QRS

what’s the treatment?

A
  • synchronized cardioversion- 50-100 J
  • Adenosine
    • ​first dose- 6 mg IV push + NS flush
    • second dose (PRN)- 12 mg
  • give sedation if possible
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21
Q

tachycardic pt who’s UNSTABLE with a RRR and you can’t tell if the QRS is wide or narrow

what’s the treatment?

A
  • synchronized cardioversion- 100 J
  • Adenosine
    • ​first dose- 6 mg IV push + NS flush
    • second dose (PRN)- 12 mg
  • give sedation if possible
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22
Q

tachycardic pt who’s UNSTABLE with a narrow irregular QRS

what’s the treatment?

A
  • synchronized cardioversion
    • biphasic- 120 to 200 J
    • monophasic- 200 J
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23
Q

tachycardic pt who’s UNSTABLE with a wide RRR QRS

what’s the treatment?

A

synchronized cardioversion- 100 J

24
Q

tachycardic pt who’s UNSTABLE with a wide irregular QRS

what’s the treatment?

A

defibrillation dose cardioversion

NOT synchronized

25
tachycardic pt who's stable with a wide QRS what are the drug options?
* adenosine (consider) * 1st dose- 6 mg IV rapid push then NS flush * 2nd dose (PRN)- 12 mg * procainamide (consider) * 20-50 mg/ min * amiodarone (consider) * 1st dose 150 mg over 10 minutes * sotalol (consider) * 100 mg over 5 minutes
26
tachycardic pt who's stable with a wide QRS, RRR, monomorphic what is this?
VT with a pulse
27
when can you give adenosine to a pt with stable tachycardia and a wide QRS
only when they are **REGULAR** and **MONOMORPHIC**
28
when should you **AVOID** giving procainamide to a pt with stable tachycardia and a wide QRS
if they have **prolonged QT** or **CHF**
29
when should you **AVOID** giving sotalol to a pt with stable tachycardia and a wide QRS
if they have a ## Footnote **prolonged QT**
30
when giving procainamide to a pt with stable wide-QRS tachycardia, how do you dose them
* 20-50 mg/min until * arrhthmia stops * hypotension ensues * QRS duration increases by more than 50% * you reach the max dose of 17 mg/ kg * maintenance infusion * 1-4 mg/min
31
when giving amiodarone to a pt with stable wide-QRS tachycardia, how do you dose them
* 1st dose- 150 mg over 10 minutes * repeat as needed if VT recurs * maintenance infusion * 1 mg/ min for 6 hours
32
when giving sotalol to a pt with stable wide-QRS tachycardia, how do you dose them
100 mg (1.5 mg/kg) over 5 minutes
33
tachycardic pt who's stable with a narrow QRS what's the treatment?
1. vagal maneuvers 2. adenosine (if RRR) 3. BB or CCB 4. consider expert consultation
34
what are you doing 1st on EVERY pt who is stable with tachy/brady-arrhythmia
IV/IO access EKG
35
post cardiac arrest, what O2 sat do you need to maintain
94+ %
36
post MI, what O2 sat do you need to maintain
90+ %
37
in post cardiac arrest care, how do you treat hypotension
* FIRST * **IV bolus- 1-2 L NS or LR** (don't jump to pressors!!) * then * vasopressor infusion * Epi * Dopamine * Norepi * consider treatable causes
38
in post cardiac arrest care, what do you do if the pt has a STEMI or you have high suspicion of AMI
coronary reperfusion
39
in post cardiac arrest care, what do you do if the pt can't follow commands
initiate (TTM) Targeted Temperature Management
40
in post cardiac arrest care, what do you need to keep a pt's temperature between
32- 36 for at least 24 hours to improve neuro recovery
41
Epinephrine infusion dose (post cardiac arrest care tx of hypotension)
**0.1 to 0.5 mcg/kg/min** (in a 70 kg adult, this is 7-35 mcg/min)
42
Dopamine infusion dose (post cardiac arrest care tx of hypotension)
5-10 mcg/kg/min
43
Norepinephrine infusion dose (post cardiac arrest care tx of hypotension)
**0.1 to 0.5 mcg/kg/min** (in a 70 kg adult, this is 7-35 mcg/min)
44
atropine dose
**0.5 mg bolus** repeat Q 3-5 mins max dose 3 mg *for bradycardia w/ a pulse*
45
dopamine dose for bradycardia with a pulse
**2-20 mcg/kg/min** **IV infusion** titrated to pt response
46
epinephrine dose for bradycardia w/ a pulse
**2-10 mcg/min** **IV infusion** titrate to pt response
47
epinephrine cardiac arrest dose
1 mg Q 3-5 mins
48
amiodarone cardiac arrest dose
1st dose- 300 mg bolus 2nd dose- 150 mg
49
adenosine dose
1st dose: 6 mg IV push then NS flush 2nd dose: 12 mg (if required) *for narrow QRS RRR tachycardia*
50
procainaimide dose
* 20-5- mg/ min IV * until * arrhythmia stops * QRS duration increases by more than half * max dose of 17 mg/kg is given * maintenance: 1-4 mg *anti-arrhythmic for tachycardia w/ a pulse*
51
amiodarone tachycardia w/ a pulse dose
150 mg/ 10 mins repeat if VT reoccurs maintenance infusion 1mg/min for first 6 hours
52
sotalol dose
100 mg/ 5 minutes (or 1.5 mg/kg/ 5 minutes) *anti-arrhythmic for tachycardia w/ a pulse*
53
epinephrine post cardiac arrest dose
0.1 to 0.5 mcg/kg/min IV infusion | (7-35 mcg/min in 70 kg adult)
54
dopamine post cardiac arrest dose
5-10 mcg/kg/min IV infusion
55
norepinephrine dose
0.1 to 0.5 mcg/kg/min IV infusion (7-35 mcg/min in 70 kg adult) *for post cardiac arrest*
56
ASA MI dose
160-325 mg

ACLS (1 decks)

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