ACLS

Question 1

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

Answer 1

1) early CPR

2) shock

Question 2

VFIB=
VT=
Asystole= 
PEA=
Bradycardia/Hb=

Answer 2

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

Question 3

VFIB protocol:

Answer 3

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

Question 4

After which shock in VFIB can you start epi?

Answer 4

second shock

Question 5

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

Answer 5

Therapeutic hypothermia

Question 6

How do we carry out therapeutic hypothermia in VFIB?

Answer 6

minimum of 24 hours, 35-36 degrees

Question 7

Epinephrine pharm

Answer 7

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

Question 8

Asystole protocol ( 5 steps)

Answer 8

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

Question 9

When should you terminate resusitation?

Answer 9

• 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

Question 10

5 reversible causes of PEA

Answer 10

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

Question 11

PEA protocol

Answer 11

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)

Question 12

Acute pea arrest in an asthmatic caused by what?

Answer 12

Tension pneumo. be ready to decompress!

Question 13

Lidocaine Role in ACLS

Answer 13

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

Question 14

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

Answer 14

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

Question 15

Epinephrine MOA for

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

Answer 15

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)

Question 16

5 Reversible causes of PEA

Answer 16

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

Question 17

5 causes of symptomatic bradycardia

Answer 17

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

Question 18

Treatment of Symptomatic Bradycardia

Answer 18

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

Question 19

PSVT Rate

Answer 19

Regular, Tachycardic, No Ps 160-180

Question 20

PSVT algorithm

Answer 20

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

Question 21

What patients should you avoid giving adenosine?

Answer 21

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

Question 22

Stable V tach tx:

Answer 22

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

Question 23

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

Answer 23

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

Question 24

Two possibilities for monomorphic wide complex tachycardia

Answer 24

1) Vtach

2) aberrant conducted SVT

Question 25

Adverse effects of procainamide

Answer 25

1) Prolongation of QT

2) Hypotension