ACLS Algorithms (1) Flashcards
What is the fasted indicatory that you have a pulse back is unable to palpate?
End tidal CO2
return of cardiac function= return of CO2
What is the first thing to do to an unstable cardiac patient?
Any unstable patient gets electricity
What rhythms do we defib? what energy to defib?
Pulsless VTach
Vfib
200J (or max energy)–depends on biphasic or monophasic
What meds can be given through ETT?
L: lidocaine
E: Epi
A: atropine
N:Narcan
What anti-arrhythmic is the correct dose for initial treatment of vfib?
Lidocaine 1.5mg/kg
or
Aminodarone 300mg IVP
second dose of either is half the first
What is the correct dose of electricity biphasic and moniphasic for adult vfib?
120-200 Biphasic
360 monophasic
What is initial treatment for a patient in UNSTABLE bradycardia?
Transcutaneous pacing
Initial treatment for patient in unstable SVT?
Synchronized cardioversion
How often to give epi and at what dose in adult cardiac arrest?
1mg Epi every 3-5 min
What are the common reversible causes “H’s” for cardiac arrest?
Hypovolemia **
Hypoxemia**
(H+) acidosis
Hypothermia
Hyper/Hypo -kalemia
What are the common reversible causes “T’s” for cardiac arrest?
Tension PTX
Tamponade (cardiac)
Toxins
Thrombosis (pulm/coronary)
What is the primary way to treat acidosis?
Good ventilation to blow off CO2 **
Bicarb
Why do you want to warm core before extremities for hypothermia protocol?
If warm extremities first then just having cold blood moving from extremities to the core
Treatments for hyperkalemia?
Calcium, Insulin, D50, Bicarb
Albuterol
What is the treatment for beta blocker OD?
Glucagon 3-5mg–if unstable need to pace
Antidote for TCD OD:
Bicarb
What are the main causes for PEA/ Asystole in the OR?
Hypoxia or Hypovolemia
What is the adult dose for atropine? Why do you want to make sure to give the full dose?
1mg
too small of a dose could cause reflex bradycardia
If a patient is bradycardic, has low BP and mental status changes and there isnt an AED available what should you do?
Need to start epi infusion until you can pace
What is the dose for Epi infusion?
2-10 mcg/min
How many joules should be used to cardiovert and adult?
1-2 J/kg
What can be given for adult stable narrow rhythm tachycardia?
Adenosine–6mg with rapid flush
can follow with 12mg if needed
What med can be given for wide or narrow adult tachy rhythm?
Amiodarone–followed by continuous infusion if you give amio or lido
amio continuous gtt: 1mg/min for first 6 hours then decrease to 0.5mg/min
What meds can you give for stable wide rhythm adult tachycardia? what dose?
Procainamide: 20-50mg/min until arrhythmia goes away or you get to 17mg/kg, QRS widens, or hypotension
Amio 150mg bolus followed by continuous infusion
Sotalol 100mg (1.5mg/kg)
If tachycardia is stable what are some non medication therapies you can try?
Vagal stimulation:
Carotid massage
Bearing down
Ice (for kids)
What is a common reason for Vfib/Vtach in kids?
Underlying heart defect
Electrocution
What is the pediatric dose for epi?
0.01 mg/kg repeat every 3-5min
Max dose 1mg
What is the pedi dose for atropine?
0.02 mg/kg max single does 0.5mg
What is the pedi dose for amiodarone?
5 mg/kg
What is the pedi dose for lidocaine?
1 mg/kg
What is the defib joule amount for kids?
2 J/kg intially
Subsequent 4 J/kg
At what HR do you start doing chest compressions in kids?
Less than 60bpm
What is the initial treatment for pediatric bradycardia?
Epi
If a pedi patient has stable bradycardia what med can be given?
Atropine–faster onset than glyco
Why do you want to have atropine close by when giving succinylcholine to a pediatric patient?
2nd dose can commonly cause bradycardia in kids
What is considered tachycardia for kids 1-8 y/o?
180 bpm
What is considered tachycardia for infants?
220 bpm
What is the biggest cause of tachycardia in pedi popualation?
Fever
Hypovolemia
Treat underlying issue (not usually cardiac problem)
If a pedi patient has unstable tachycardia how many Joules should you cardiovert with?
0.5 J/kg then move up to 2J/kg
When should a neonate start being ventilated?
HR less than 100 probably not adequately oxygenation–start ventilating
What is common with BMV in neonates?
Abd distension–would be good idea to have gastric compression with NGT
Potential etiology for maternal cardiac arrest:
Anesthetic complications
Bleeding
Cardiovascular
Drugs
Embolic
Fever
General nonobstetric causes of cardiac arrest (H/Ts)
Hypertension
What is targeted preductal SpO2 after birth?
1 min: 60-65%
2 min: 65-70%
3 min: 70-75%
4 min: 75-80%
5 min: 80-85%
10 min: 85-95%
What is the max shock energy for defib in pediatric population?
10 J/kg or adult dose
What is the endotracheal dose of epi in peds if no IV/IO access?
0.1mg/kg
Pedi CPR with ETT vs without:
Change compressor every
2 minutes, or sooner if fatigued
- If no advanced airway, 15:2
compression-ventilation ratio - If advanced airway, provide
continuous compressions and
give a breath every 2-3 seconds
How many times can pediatric amiodarone be repeated for refractory VF/pulseless VT?
5mg/kg repeated up to 3 total doses
What happens during the initial stabilization phase for adult post cardiac arrest?
Manage respiratory parameters
Start 10 breaths/min
Spo2 92%-98%
Paco2 35-45 mm Hg
SBP >90
DBP > 65
administer crystalloids and/or vasopressor
obtain 12 lead
Steps in adult post cardiac arrest care if patient if comatose:
- TTM: 32-36 degrees for 24 hours
- Obtain brain CT
- EEG monitoring (continuous or intermittent)
- Other critical care
management
When is adenosine used in kids? What is the pedi dose for adenosine?
Unstable Narrow QRS(<0.09 sec), Stable wide/narrow QRS infant rate >220 child rate >180, Fixed RR interval
First dose: 0.1 mg/kg (max 6mg)
Seconds dose: 0.2mg/kg (max 12mg)
What treatment may be indicated for cardiopulm compromised wide QRS (>0.09 sec) with pulse in kids?
Synchronized cardioversion
How to respond to kid with HR 200 bpm narrow QRS, absent p waves, RR interval fixed with normal mental status and BP:
SVT
Consider vagal maneuvers
Give adenosine
9 year old patient is alert/oriented with stable BP. HR is 190bpm QRS is 0.1sec. Whats the next move?
Possible V tach
regular rhythm QRS monomorphic consider adenosine
What is the probable rhythm in kids when rate is elevated, P waves are present, and RR interval is variable?
Sinus tachycardia
Treatment for adult normal QRS tachycardia w/ pulse and without hypotension/AMS/cardio issues:
Vagal maneuvers
Adenosine (if regular)
Beta blocker/ CCB
Expert consult
How does treatment differ for adult wide complex (>0.12sec) tachycardia with pulse/hypotension/AMS vs same rhythm that is asymptomatic?
Synchronized Cardioversion for unstable persistent tachycardia
Adenosine/anti-arrhythmic infusion for wide complex “stable” tachycardia (procainamide, amio, sotolol)
How often can atropine be given in adults?
1mg every 3-5 minutes
max 3mg
What do you do if adult pt has unstable (hypotensive, AMS, shock) persistent bradycardia?
pace
Atropine
What can you try if atropine doesnt work and adult pt still has unstable bradycarda?
Transcutaneous Pace
and or
Dopamine or Epi infusion
What is Dopamine IV infusion rate?
5-20mcg/kg/min
Depth/rate for pediatric chest compressions:
≥⅓ of anteroposterior
diameter of chest) and fast
(100-120/min)
Reasons for bradycardia in kids:
Hypothermia
Hypoxia
Medications
How often do you check pulse in kids with persistent unstable bradycardia?
check pulse Every 2 min and continue CPR as long as HR <60
