ACLS Flashcards

1
Q

What are the only two things at have affected survival in cardiac arrest?

A

1) early CPR

2) shock

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2
Q
VFIB=
VT=
Asystole= 
PEA=
Bradycardia/Hb=
A

1) Shock
2) stability
3) Epinephrine
4) Reversible cause?
5) symptomatic?

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3
Q

VFIB protocol:

A

1) shock
2) CPR + 02 (NRB, gently bag)
3) Shock
4) CPR+ 1 amp epi + 02/ventilate/intubate
5) Shock
6) CPR+ 300 amio /1.5mg/kg lido
7) Shock
8) CPR+ half dose
9) Shock
10) CPR + esmolol 1/2 weight of patient push then 1/10 weight infusion
11) switch pad direction

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4
Q

After which shock in VFIB can you start epi?

A

second shock

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5
Q

If someone survives VFIB and makes non-purposeful movements what is the next step?

A

Therapeutic hypothermia

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6
Q

How do we carry out therapeutic hypothermia in VFIB?

A

minimum of 24 hours, 35-36 degrees

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7
Q

Epinephrine pharm

A
  • alpha and beta
  • vasoconstrictor
  • b1 agonist ( ionotropy, chornotropy)
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8
Q

Asystole protocol ( 5 steps)

A

1) confirm that its asystole
2) oxygenate and ventilate
3) epi 1 mg IV push
4) repeat epi 3-5 minutes later
5) terminate resus

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9
Q

When should you terminate resusitation?

A
  • give minimum of 3 doses of epi, 3 minutes apart
  • if end tidal co2 less than 20 , or less than 10 after 10 minutes of high quality CPR
  • US confirmed
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10
Q

5 reversible causes of PEA

A

1) hypoxia
2) tension pneumo
3) tampanade
4) toxic/ metabolic: hyper k drugs including BB, CCB, antiarrhthmics
5) cardiovascular: hemorraghic shock, hypovolemia

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11
Q

PEA protocol

A

1) oxygenate and ventilate to r/o hypoxia, pneumo and to help hyperK
2) IV wide open
3) look for 3 signs: EKG,Temp, Cardiac echo
4) Epi Q3-5 1 amp
5) Review 5 causes ( drugs, Pe, tox)

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12
Q

Acute pea arrest in an asthmatic caused by what?

A

Tension pneumo. be ready to decompress!

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13
Q

Lidocaine Role in ACLS

A

Lidocaine and amiodarone show benefit in witnessed arrest

1-1.5 mg/kg over 15 secs (max total 3mg/kg)

Either works or doesn’t
CNS side effects, perioral numbness/tingling, can cause seizures

Try to give 1 dose over 15 seconds so that it’ll dramatically and precipitously ↓ likelihood of seizures

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14
Q

2 options for shock resistant VT/VF (after 3-4 shocks and amiod/lido)

A

Change position of the pads—put posterolateral.

Beta blockade – Esmolol 0.5mg/kg

  • give 30mg IV push then start drip at 3 mg/min
  • 5–10 min to effect
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15
Q

Epinephrine MOA for

  1. ACLS
  2. anaphylaxis
  3. asthma
  4. croup
  5. hypoglycemia
A

Non-selective alpha and beta agonist produced by adrenal glands.

  1. ACLS:
    ↑ perfusion pressure to the brain and heart. b1-aderenergic: ↑HR, ↑contractility, ↑ AVN conductivity
  2. anaphylaxis
    - bronchodilatation
    - Down-regulates the release of histamine, tryptase, and other inflammatory mediators from mast cells and basophils
  3. asthma
    bronchodilatation
  4. croup
    decreased laryngeal edema
    bronchodilatation
  5. hypoglycemia?
    Liver: Stimulates glycogenolysis (↑ glucose)
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16
Q

5 Reversible causes of PEA

A

1) Hypoxia
2) tension pneumo
3) Hypervolemia
4) hypovolemia
5) toxic metabolic

17
Q

5 causes of symptomatic bradycardia

A

1) Hyperkalemia
2) vital sign abnormalities
3) MI
4) Drugs ( CCB, BB, Narcotics)
5) Systemic ( hyperthyroid, ect)

18
Q

Treatment of Symptomatic Bradycardia

A

1) secure ABCs, give atropine if Ps correlate with QRS’s
2) Atropine .5 MG IV w/ flush
3) wait 1 minute, if that doesn’t work use atropine 1 MG IV w/ flush
4) Transcutaneous pace starting at 10
5) wait one minute, put pacer up to 20
6) IV epi
7) Transvenous pace

19
Q

PSVT Rate

A

Regular, Tachycardic, No Ps 160-180

20
Q

PSVT algorithm

A

1) Modified Valsalva
2) Adenosine 12, repeat if needed
3) If unstable Synchronized shock

** Make sure you flush line after giving adenosine, helps deliver med to heart faster, if not it gets eated up by ACHe

21
Q

What patients should you avoid giving adenosine?

A

1) Irregular rhythm
2) 150 or less ( usually a flutter)
3) MAT/ COPD patients
4) Wide and irregular
5) Old people- try giving bolus of fluids before resorting to adenosine- could just be volume deficient and in sinus rhythm

22
Q

Stable V tach tx:

A

1) Modified Valsalva
2) 12 Adenosine ( don’t give if its irregular!) - can use, but don’t have to
3) Procainamide 19 mg/kg loading dose then 50 mg/min for max of 10 minutes
4) if meds don’t work you can sedate and synchronized shock

    • other options include amio, lidocaine
    • DON’T use dilt
23
Q

HR= RHYTHM

1) 25-40=
2) 50-60 no ps=
3) 75 ( won’t budge)
4) 60-100
5) 100-149=
6) 150 (won’t budge)
7) 160-180=
8) 200-220

A

1) 3rd degree HB or ivr
2) junctional rhythm
3) a flutter 4:1
4) sinus
5) sinustach
6) a flutter 2:1
7) PSVT
8) accessory pathway

24
Q

Two possibilities for monomorphic wide complex tachycardia

A

1) Vtach

2) aberrant conducted SVT

25
Q

Adverse effects of procainamide

A

1) Prolongation of QT

2) Hypotension