ACLS Flashcards
What are the only two things at have affected survival in cardiac arrest?
1) early CPR
2) shock
VFIB= VT= Asystole= PEA= Bradycardia/Hb=
1) Shock
2) stability
3) Epinephrine
4) Reversible cause?
5) symptomatic?
VFIB protocol:
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
After which shock in VFIB can you start epi?
second shock
If someone survives VFIB and makes non-purposeful movements what is the next step?
Therapeutic hypothermia
How do we carry out therapeutic hypothermia in VFIB?
minimum of 24 hours, 35-36 degrees
Epinephrine pharm
- alpha and beta
- vasoconstrictor
- b1 agonist ( ionotropy, chornotropy)
Asystole protocol ( 5 steps)
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
When should you terminate resusitation?
- 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
5 reversible causes of PEA
1) hypoxia
2) tension pneumo
3) tampanade
4) toxic/ metabolic: hyper k drugs including BB, CCB, antiarrhthmics
5) cardiovascular: hemorraghic shock, hypovolemia
PEA protocol
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)
Acute pea arrest in an asthmatic caused by what?
Tension pneumo. be ready to decompress!
Lidocaine Role in ACLS
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
2 options for shock resistant VT/VF (after 3-4 shocks and amiod/lido)
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
Epinephrine MOA for
- ACLS
- anaphylaxis
- asthma
- croup
- hypoglycemia
Non-selective alpha and beta agonist produced by adrenal glands.
- ACLS:
↑ perfusion pressure to the brain and heart. b1-aderenergic: ↑HR, ↑contractility, ↑ AVN conductivity - anaphylaxis
- bronchodilatation
- Down-regulates the release of histamine, tryptase, and other inflammatory mediators from mast cells and basophils - asthma
bronchodilatation - croup
decreased laryngeal edema
bronchodilatation - hypoglycemia?
Liver: Stimulates glycogenolysis (↑ glucose)