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)
5 Reversible causes of PEA
1) Hypoxia
2) tension pneumo
3) Hypervolemia
4) hypovolemia
5) toxic metabolic
5 causes of symptomatic bradycardia
1) Hyperkalemia
2) vital sign abnormalities
3) MI
4) Drugs ( CCB, BB, Narcotics)
5) Systemic ( hyperthyroid, ect)
Treatment of Symptomatic Bradycardia
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
PSVT Rate
Regular, Tachycardic, No Ps 160-180
PSVT algorithm
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
What patients should you avoid giving adenosine?
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
Stable V tach tx:
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
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
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
Two possibilities for monomorphic wide complex tachycardia
1) Vtach
2) aberrant conducted SVT
