ACLS Flashcards
What is the dose of adenosine that should be given for first line stable SVT treatment?
6 mg
Second dose is 12 mg
What dose of epinephrine drip should be given to those with unstable bradycardia who fail to respond to atropine and pacing?
2-10 mcg/min
In a VF/VT cardiac arrest, what is the order of shock, epinephrine, and amiodarone?
1) Shock
2) Establish IV
3) Shock
4) Epinephrine 1 mg
5) Shock
6) Amiodarone
7) Shock
8) Epinephrine
9) Amiodarone
Essentially, it goes shock, epi, shock, amio… forever.
Per ACLS, when should you consider intubation?
At two minutes of CPR
Those with STEMI should receive what dose of aspirin?
162 to 325 mg
What dose of epinephrine is used in cardiac arrest?
1 mg IV/IO every 3 to 5 minutes
Before you give nitroglycerin, you need to assess for what medication use?
PDE inhibitors
If a patient has taken Cialis or Viagra, then NO could cause unstable hypotension.
What doses of amiodarone are used for cardiac arrest?
First dose is 300 mg and second is 150 mg (both IV dosings)
True or false: aspirin should be given to those with tPA therapy.
False
Aspirin needs to be held for 24 hours if tPA is given.
What dosing of atropine can be given in unstable bradycardia?
1 mg IV/IO boluses up to 3 mg max
The right rate for compressions is _____________.
100-120 compressions per minute
The max interval for pausing compressions is ______.
10 seconds
To avoid air entering the stomach, you should ventilate only until __________.
the chest rises
Adults should receive how much compression depth?
2 inches
Bag-mask ventilation should be done every _____ seconds.
6
Always attempt ______ first in stable SVT.
vagal maneuvers
The ideal chest compression fraction is ________.
60-80%
This is the amount of time that compressions are being done in a resuscitation.
Coronary perfusion pressure has to reach ______ mm Hg to achieve ROSC.
15
The AHA recommends that people doing compressions should switch every _______ minutes.
2
What tidal volume is recommended in resuscitations?
500-600 mL or about half a squeeze of an adult ambubag
In addition to gastric inflation, what does excessive ventilation cause?
Increased intrathoracic pressure, decreased preload, and decreased cardiac output
What is AVPU?
It’s a part of the primary assessment that documents how alert someone is (the D for disability).
- Alert
- Responds to Voice
- Responds to Pain
- Unresponsive
What is the SAMPLE mnemonic?
It’s a tool for taking a focused history in the secondary assessment:
- Signs and symptoms
- Allergies
- Medications
- PMH
- Last meal
- Events that led to presenting illness
Review the H’s and T’s.
H’s:
- Hypovolemia
- Hypoxia
- Hyperkalemia
- Hydrogen ion (acidosis)
- Hypothermia
T’s:
- PTX
- Tamponade
- Toxins
- Thrombosis (MI or PE)
True or false: intubation should never be performed with compressions running.
False
The AHA recommends that intubation be done through compressions if possible.
What is an ideal range for ETCO2 in a resuscitation?
35 - 45 mm Hg
If someone is unconscious, follow _____.
BLS
Check their pulse, check if they’re breathing, get an AED, and call 911.
If ST segments are elevated in _______, then NO is contraindicated.
II, III, and aVF
The inferior leads indicate possible RV involvement.
Which type of stroke is more common in the US?
Ischemic
These account for 87% of strokes.
The stroke team should perform the stroke assessment within ______ minutes of patient arrival.
20
Fibrinolytic therapy can be given up to ______ hours after stroke-symptom onset.
3
In addition to starting compressions, you should also immediately do what for a pulseless patient?
- Attach an AED
- Obtain IV access
- Begin giving supplemental oxygen
AHA says you should treat hypotension less than _____ mm Hg with IVF.
90
What temperature range goes with post-ROSC care?
32-36
The goal door-to-balloon time for STEMI patients is __________.
90 minutes
The minimum systolic BP that should be maintained after ROSC is _________.
90 mm Hg
What is the code dose of lidocaine?
1-1.5 mg/kg IV/IO as a bolus
If they are in refractory VF or pulseless VT then you can repeat 0.5-0.75 mg/kg every 5-10 minutes.
True or false: perform synchronized cardioversion on unstable ventricular tachycardia.
False
Perform defibrillation on unstable VT.
What are the differences in where you do compressions based on age?
Children and adults go midway between nipples at the nipple line.
Infants go midway between the nipples just below the nipple line.
True or false: it’s ok to do the hand encircling technique only in newborns, not infants.
False
The technique can be done in both infants and newborns.
The shock dose for VF and pulseless VT is ___________.
200 J
When do you give epinephrine in a code?
If CPR has been going on for 2 minutes and a shock has failed to convert.
What is the adult code dose for epinephrine?
1 mg IV
What is code dose of amiodarone?
300 mg IV for the first dose then 150 mg for the subsequent doses
What is adult dosing of atropine for bradycardia?
1.0 mg IV Q 3 min for max of 3 doses
What is the usual initial current dose for pacing?
40-80 mA
If the second round of adenosine fails to convert SVT in a stable patient, what two therapies could you try next?
Diltiazem 20 mg or metoprolol 5 mg
Other than amiodarone and lidocaine, what agent could you use in stable, regular, wide-complex tachycardia?
Procainamide 20 mg/min
Therapeutic hypothermia must be initiated within ____ hours of ROSC.
12
How often should you shock pulseless shockable rhythms?
With every 2 minute pulse check if shockable
Therapeutic hypothermia is only for patients who remain ___________ after ROSC.
comatose
What doses of shock are indicated in each of the following cardioversions (with pulse):
- Narrow regular
- Narrow irregular
- Wide regular
- Narrow regular: 50-100 Joules
- Narrow irregular: 120-200 Joules
- Wide regular: 100 Joules
- Wide irregular (defibrillation for TDP, VF, or pulseless VT): 200
Give antiarrhythmics after ______________ rounds of CPR.
3 (so after two shocks and one epi)
What H’s/T’s have widened QRS on telemetry?
Toxins and hyperkalemia
What H’s/T’s are diagnosable by POCUS?
Tamponade
PTX
Massive/submassive PE’s
What form of calcium is given in codes?
Calcium chloride (usually 1 g given over 5 minutes)
CaCl can be given peripherally, but it typically ruins PIVs so only give if you feel you can spare an IV.
For cardiac arrest, both in and out of the hospital, the evidence suggests that _____________ is the best predictor of survival.
early defibrillation
True or false: you should not defibrillate pulseless torsades de pointes.
False
It’s a polymorphic ventricular tachycardia and should be treated like VF but also given Mg.
Why is sodium bicarb not indicated in codes?
- There is not evidence that it helps in the arrest setting (from a randomized controlled trial). There is actually a worse survival rate and worse neurologic recovery rate (from a prospective observational trial).
- It is a high sodium load (it is the equivalent of 8% hypertonic saline).
- It leads to intracellular acidosis.
What is TNK?
Tenectaplase
What does the literature say about giving thrombolytics in the setting of arrest?
Research shows that people with a confirmation or a high suspicion of PE have some benefit (PEAPETT) of thrombolytics.
Note: the research shows that people benefit when CPR is continued for 60 minutes after thrombolytics. You don’t necessarily need to do CPR for this long, but don’t stop immediately after thrombolytics don’t work.
What is the downside of code epinephrine?
It causes cerebral vasoconstriction and decreased tissue oxygenation that may compromise neurologic recovery. Expert recommendations say to stop after 3 rounds of epinephrine (code dose 1 mg) or to lower the dose after the third dose.
As a comparison, vasopressor dose of epinephrine is 10-20 mcg/min. Thus, 3 mg of epinephrine would be given over 2.5 - 5.0 hours in the ICU setting.
Never give IV epinephrine to a conscious patient. The 0.3 mg given in anaphylaxis should only be given IM.
The PARAMEDIC2 trial showed what?
It was a double blind RCT that showed that epinephrine increased the rates of ROSC but did not increase rates of neurological recovery.
What does the data show on bicarb in codes?
RCTs have demonstrated no benefit. Still, if you have a reason to give it (like known severe acidosis) then can be given.
What are the dosing guidelines for tPA for PE in a code setting?
Give alteplase 50 mg IV over 2 minutes then continue CPR for 15 minutes
A study in which pigs were shocked into VF showed that waiting even seconds to start CPR (up to 20 seconds) led to __________.
extremely different outcomes; at 20 s 0% of pigs came back, whereas at 3 s 100% came back
In a trial of resuscitation in pigs who had VF, what was the difference between survival in the groups who had bagging at RR of 12 vs 30?
12 = ~80%
30 = ~15%
An intense resuscitation beats a ___________ resuscitation.
prolonged
ETCO2 should be what in CPR?
At least 12-15
Above 20 suggests ROSC
When you do an icepack for SVT, how should it be done?
Apply ice to the forehead and eyes for 10-15 seconds.
What are the ACLS criteria for termination of resuscitation?
- Arrest not witnessed
- No bystander CPR
- No ROSC
- No shockable rhythms
How is auto-PEEP thought to cause the lazarus effect?
CPR causes auto-PEEP. Stopping CPR allows for the breaths to leave and decrease intrathoracic pressure, allowing for venous return.
What is the dose, route, and concentration of code epi?
1 mg
IV
1 : 10,000 (think, it’s not the 1 : 1,000 form given IM because the IM needs to be more concentrated)
According to the boards, TTM to goal 32-34 is indicated for which age group?
Adults
Review the ventilation management for two-person resuscitation in children, adults, and advanced airway?
Children 2:15
Adults 2:30
Advanced airway (ETT or supraglottic): every 2-3 seconds for kidss, 5-6 seconds adults
True or false: unstable patients with torsades who have a pulse should undergo synchronized cardioversion.
False
Defibrillation for both pulseless TDP and unstable TDP
