ACLS Flashcards
CPR depth and rate
at least 2 inches
100-120 bpm
if no advanced airway, what is the
compression : ventilation ratio
30 : 2
what does the ETCO2 value during CPR need to be?
if it’s abnormal, what do you do?
above 10 mmHg
if it’s too low then improve CPR quality
what does the intra-arterial pressure need to be during CPR?
if it’s abnormal, what do you do?
above 20 mmHg in the relaxation (diastolic) phase
if it’s too low, improve CPR quality
biphasic defibrillator-
how many joules do you use to shock someone in cardiac arrest
120- 200 J for the first shock (if unknown use max)
subsequent shocks should be equivalent, maybe higher
monophasic defibrillator-
how many joules do you use to shock someone in cardiac arrest
360 J
VF
what’s the treatment?
(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
-
1st dose- 300 mg bolus
asystole
what’s the treatment?
(not shockable)
Epi- 1 mg Q 3-5 mins
+ CPR
+ evaluating Q 2 mins to see if rhythm becomes shockable
pVT (pulseless)
what’s the treatment?
(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
-
1st dose- 300 mg bolus
Cardiac Arrest: shockable rhythm
what’s the treatment?
-
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
-
1st dose- 300 mg bolus
Cardiac Arrest: not shockable
what’s the treatment?
(not shockable)
Epi- 1 mg Q 3-5 mins
+ CPR
+ evaluating Q 2 mins to see if rhythm becomes shockable
PEA
what’s the treatment?
(not shockable)
Epi- 1 mg Q 3-5 mins
+ CPR
+ evaluating Q 2 mins to see if rhythm becomes shockable
Cardiac Arrest- who is shockable?
VF
pulseless VT
Cardiac Arrest- who is NOT shockable
asystole
PEA
what are the reversible causes of cardiac arrest
- 5 H’s
- Hypovolemia
- Hypoxia
- Hydrogen
- Hypo/hyperkalemia
- Hypothermia
- 4 T’s
- Tension pneumo
- Tamponade
- Toxins
- Thrombosis (pulm/ cardiac)
5 things that will qualify a patient as
UNSTABLE
hypotension
AMS (acute)
signs of shock
chest pain
acute heart failure (rales/ ronchi)
what does the HR need to be for a bradycardic pt to initiate workup?
< 50
bradycardic pt who’s stable
what’s the treatment?
none
just monitor and observe
(order EKG)
bradycardic pt who’s UNSTABLE
what’s the treatment?
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:
- transcutaneous pacing
- dopamine 2-20 mcg/kg/ min (titrated)
- epinephrine 2-10 mcg/ min (titrated)
tachycardic pt who’s UNSTABLE with a narrow RRR QRS
what’s the treatment?
- synchronized cardioversion- 50-100 J
-
Adenosine
- first dose- 6 mg IV push + NS flush
- second dose (PRN)- 12 mg
- give sedation if possible
tachycardic pt who’s UNSTABLE with a RRR and you can’t tell if the QRS is wide or narrow
what’s the treatment?
- synchronized cardioversion- 100 J
-
Adenosine
- first dose- 6 mg IV push + NS flush
- second dose (PRN)- 12 mg
- give sedation if possible
tachycardic pt who’s UNSTABLE with a narrow irregular QRS
what’s the treatment?
- synchronized cardioversion
- biphasic- 120 to 200 J
- monophasic- 200 J
tachycardic pt who’s UNSTABLE with a wide RRR QRS
what’s the treatment?
synchronized cardioversion- 100 J
tachycardic pt who’s UNSTABLE with a wide irregular QRS
what’s the treatment?
defibrillation dose cardioversion
NOT synchronized
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
tachycardic pt who’s stable with a wide QRS, RRR, monomorphic
what is this?
VT with a pulse
when can you give adenosine to a pt with stable tachycardia and a wide QRS
only when they are
REGULAR
and
MONOMORPHIC
when should you AVOID giving procainamide to a pt with stable tachycardia and a wide QRS
if they have
prolonged QT
or
CHF
when should you AVOID giving sotalol to a pt with stable tachycardia and a wide QRS
if they have a
prolonged QT
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
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
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
tachycardic pt who’s stable with a narrow QRS
what’s the treatment?
- vagal maneuvers
- adenosine (if RRR)
- BB or CCB
- consider expert consultation
what are you doing 1st on EVERY pt who is stable with tachy/brady-arrhythmia
IV/IO access
EKG
post cardiac arrest, what O2 sat do you need to maintain
94+ %
post MI, what O2 sat do you need to maintain
90+ %
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
- vasopressor infusion
in post cardiac arrest care, what do you do if the pt has a STEMI or you have high suspicion of AMI
coronary reperfusion
in post cardiac arrest care, what do you do if the pt can’t follow commands
initiate (TTM)
Targeted Temperature Management
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
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)
Dopamine infusion dose
(post cardiac arrest care tx of hypotension)
5-10 mcg/kg/min
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)
atropine dose
0.5 mg bolus
repeat Q 3-5 mins
max dose 3 mg
for bradycardia w/ a pulse
dopamine dose for bradycardia with a pulse
2-20 mcg/kg/min
IV infusion
titrated to pt response
epinephrine dose for bradycardia w/ a pulse
2-10 mcg/min
IV infusion
titrate to pt response
epinephrine cardiac arrest dose
1 mg Q 3-5 mins
amiodarone cardiac arrest dose
1st dose- 300 mg bolus
2nd dose- 150 mg
adenosine dose
1st dose: 6 mg IV push then NS flush
2nd dose: 12 mg (if required)
for narrow QRS RRR tachycardia
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
- until
- maintenance: 1-4 mg
anti-arrhythmic for tachycardia w/ a pulse
amiodarone tachycardia w/ a pulse dose
150 mg/ 10 mins
repeat if VT reoccurs
maintenance infusion 1mg/min for first 6 hours
sotalol dose
100 mg/ 5 minutes
(or 1.5 mg/kg/ 5 minutes)
anti-arrhythmic for tachycardia w/ a pulse
epinephrine post cardiac arrest dose
0.1 to 0.5 mcg/kg/min IV infusion
(7-35 mcg/min in 70 kg adult)
dopamine post cardiac arrest dose
5-10 mcg/kg/min IV infusion
norepinephrine dose
0.1 to 0.5 mcg/kg/min IV infusion
(7-35 mcg/min in 70 kg adult)
for post cardiac arrest
ASA MI dose
160-325 mg
