ACLS/ Cardiac Drugs

Question 1

What is the Chain of survival?

Answer 1

• Early recognition & Call
• Early CPR
• Early defibrillation
• Early Advanced care

Question 2

What are the causes of cardiac arrest?

Answer 2

• heart disease
• trauma
• respiratory illness

Question 3

Assessing Rhythm:

What are the SHOCKABLE rhythms?

Answer 3

• VF Ventricular fibrillation
• VT Ventricular tachycardia (pulseless)

DRAW THEM

Question 4

Assessing Rhythm:

What are the NON SHOCKABLE rhythms?

Answer 4

• Asystole
• pulseless electrical activity (PEA)

DRAW THEM

Question 5

What is the COACHED acronym?

Answer 5

= Safe method for defibrillation

C: Compressions Continue
O: oxygen away
A: All others clear
C: Charging defibrillators
H: Hands Off
E: evaluating rhythm
D: defibrillate or disarm

Question 6

What is the defibrillation sequence?

Answer 6

• 1st shock, 2 mins CPR –> check rhythm
  
  • 2nd shock, 2 mins CPR –> check rhythm and then Adrenaline 1mg
  • 3rd shock, 2 mins CPR –> check rhythm and then amiodarone 300mg
  Continue Defib every 2 mins until no longer in a shockable rhythm
  ○ Adrenaline every 2nd defib cycle

Question 7

What are hazards during defibrillation?

Answer 7

• Water
• oxygen
• jewellery
• GTN patches
• Pacemakers

Question 8

What are the 4 Hs and 4Ts

Answer 8

= Reversible causes –> fix the cause or it will happen again

4H
- Hypoxia
- Hypovolemia
- Hyperkalemia
- Hyperthermia

4T
- Tension pneumothorax
- Tamponade (cardiac)
- Thrombosis
- Toxins

Question 9

What are the nurses roles during a cardiac arrest?

Answer 9

• Primary nurse usually knows the patient
  ○ Time of arrest –> call for help
  ○ Commence CPR
  ○ DRS ABC
  ○ Handover to cardiac arrest team
  ○ STAY WITH PT
  
  • Second nurse
    ○ Contact team
    ○ Brings trolley
  • Third nurse
    ○ Assists CPR, medications
    ○ Documents treatment
  • Scribe
    ○ Time
    ○ Actions and patients response to:
    § Defibrillation
    § Medications
    § Procedures
    § Intubation/ airway management
    ○ Vital signs
    ○ Team members present
    ○ End result

Question 10

What are the goals post resus?

Answer 10

• survival
• palliative
• organ donation
• family request

Question 11

Post resus respiratory support?

Answer 11

– oxygenation, high flow, definitive airway
— optimise cerebral perfusion
— treat & prevent cardiac arrhythmias
— determine & treat cause

Question 12

What are the 4 main cardiac arrest drugs?

Answer 12

1. Adrenaline
2. Atropine
3. Amiodarone
4. Lignocaine

Question 13

Adrenaline in cardiac arrest:

Answer 13

• Give in VF/ VT after initial counter shocks have failed
• Give in asystole and PEA in initial loop
• increases HR
• Recommended dose 1mg bolous Administered IV every three minuets

Question 14

Atropine in cardiac arrest

Answer 14

MOA: Acts on the conduction system of the heart and accelerates the transmission of electrical impulses through cardiac tissue
Uses: In cardiac arrest given to reverse asystole and severe bradycardia

Question 15

Amiodarone in cardiac arrest

Answer 15

Amiodarone
- Give VF/ pulseless VT (Between 3rd and 4th shock)
- Improves the rate of return of spontaneous circulation

Question 16

Lignocain in cardiac arrest

Answer 16

Lignocain
- Give in prolonged arrest
- weakens the force of muscular contractions
- Dose: 100mg bolus repeated 5-10 mins

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Question 17

Other drugs in cardiac arrest

Answer 17

Other drugs
- Potassium (give in persistant VF)
- Magnesium (digoxin toxicity)
- Calcium chloride