ACLS/etc Flashcards
Test 1
What is my best indication and 3 other indicators that my pt is not perfusing & in cardiac arrest?
End tidal CO2
Art line
BP
Ultrasound on heart/artery
What is the fastest indicator that the patient is not perfusing?
End tidal CO2
If we get a pulse back, what do we do immediately after?
Get BP
What is your role in CPR, as an anesthesiologist?
Head of code: I am doing meds and directing
Need to delegate:
Compressions
Bagging
Get code cart
Recorder/time keeper
All unstable/symptomatic patients get ___________
shockeddddddd
Zapp
Please read the questions on the test dummy. Keep looking at this flashcard. If it says unstable –> shock the patient. PERIODDDD
What rhythms do we shock during CPR? No shock?
Shock: V-fib
pulseless V-tach
No shock: asystole
PEA
How much energy do we use to shock an adult in cardiac arrest?
Biphasic: Initial = 200 J
subsequent = increase doses
Monophasic: 360 J
In ACLS, we do a rhythm check every ________ and give epi every ________
2 minutes
3-5 minutes
After ____ rounds of CPR, what other types of medications can we consider?
3
amio/lidocaine
What is the dose for Epi in ACLS?
1 mg every 3-5 mins
1:10,000
What is the amio dose in ACLS?
1st: 300 mg bolus
2nd: 150 mg
What is the lidocaine dose in ACLS?
1st: 1 - 1.5 mg/kg
2nd: 0.5 - 0.75 mg/kg
ACLS requires 1 breath every ____ seconds
6
What are my H&Ts? Which 2 are the most common?
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade
Toxins
Thrombosis, pulmonary/ coronary
What medications can I give down the ET tube?
LEAN
Lidocaine
Epi
Atropine
Narcan
How can we treat acidosis?
Good ventilation and bicarb
What can I use during CPR instead of intubating?
LMA
T/F: I use lidocaine/amio in nonshockable rhythms
F
Only use these in ventricular rhythms
Cardiac tamponade presents with _______. What are the symptoms of this?
Beck’s triad
Decreased BP
Narrowing PP
JVD
tension pneumothorax causes what symptoms?
JVD
tracheal deviation
What is an easy way to Dx Cardiac tamponade or tension pneumothorax?
ultrasound
What is the antidote for tricyclic antidepressants overdose?
Bicarb
How do you Tx symtomatic bradycardia?
Transcutaneous pacing
How do you treat non-symptomatic bradycardia or ineffective Tx of symptomatic bradycardia?
1st: Atropine
2nd: Epi drip
3rd: Dopamine drip
What is the dose for atropine in bradycardia?
1mg
repeat 2 times every 3-5 mins
(max 3mg)
What is the dose for epi drip in bradycardia?
2 - 10 mcg/min
What is the dose for dopamine drip in bradycardia?
5 - 20 mcg/kg/min
What is the dose for Adenosine w/ stable narrow tachycardia (SVT)?
1st: 6mg rapid IVP followed by flush
2nd: 12 mg if required
What is the dose for Amio w/ stable wide complex tachycardia?
1st: 150 mg over 10 mins (repeat as needed if VT occurs)
Maintenance: 1mg/min for 6 hours
What is the dose for Sotalol w/ stable wide complex tachycardia? What considerations should I have?
100 mg (1.5mg/kg) over 5 mins
Avoid w/ long QT
What is the dose for Procainamide w/ stable wide complex tachycardia? What considerations should I have?
1st: 20-50mg/min until arrhythmia suppressed; hypotension; QRS duration increases >50%; at max dose 17mg/kg
Maintenance: 1-4 mg/min
Avoid with prolonged QT or CHF
What are the medications used in the tachycardia algorithm?
Adenosine
Procainamide
Amiodarone
Sotalol
Beta blockers
CCB
What non-pharmacological intervention can be used to treat stable narrow complex tachycardia? How do we do this?
Vagal maneuvers:
-rub on carotid
-Bear down
-ice/cold water on face
Why do we put increased emphasis on ventilation in pediatrics in cardiac arrest?
Respiratory issues are the main reason pediatrics code
What causes vFib/Vtach in pediatrics?
Underlying cardiac issues
Electrocution
If a patient is in a nonshockable rhythm, what do we want to do 1st?
give Epi asap!!!!!!
Even before compressions if only you
What is the compression-ventilation ratio in pediatric CPR?
15:2
How often do we give a breath in pediatric CPR?
Every 2-3 secs
At what J do we shock in pediatrics CPR?
1st: 2J/kg
2nd: 4J/kg
subsequent: > 4J/kg
max 10J/kg or adult dose
What is the dose for Epi in pediatric CPR?
0.01 mg/kg
Max dose 1mg
ET tube: 0.1 mg/kg
What is the pediatric dose for Amio in CPR?
5 mg/kg bolus
May be repeated up to 3 times
What is the dose for lidocaine in pediatric CPR?
1 mg/kg
What is my main focus in pediatric CPR?
Getting an airway early on these patients
What is the pediatric dose for atropine w/ stable bradycardia?
0.02 mg/kg
min dose of 0.1 mg
max dose of 0.5 mg
What is a very common T (reversible cause) in pediatrics?
Toxins
When do we start CPR in a pediatrics?
HR < 60
What drug do we give initially in bradycardia in pediatrics? Why would we give any other medication? What would that medication be?
Epi
Atropine: if we believe that the bradycardia is due to increased vagal tone or AV block
What does glycopyrrolate do? What does it treat?
Increases HR
Bradycardia
If we give pediatrics succs, what mediation do I need to have close by? Why?
Atropine
Succs has a byproduct that causes bradycardia in pediatrics
When do we start treating tachycardia in pediatrics?
Infant: HR < 220
Child: HR < 180
What are the main reasons for tachycardia in pediatrics?
fever
volume deletion
What J do we use to cardiovert a pediatric patient with unstable tachycardia?
0.5 - 1.0 J/kg
increase to 2 J/kg
What is the dose for Adenosine in pediatrics with tachycardia?
1st: 0.1 mg/kg
(max 6mg)
2nd: 0.2 mg/kg
(max 12mg)
Why do we only use vagal maneuvers in narrow complex tachycardia?
It’s originating from the atria, which is influenced by the vagus
Wide complex is originating in the ventricles and is not influenced by the vagus
What happens if you bag a neotate for a long time? How do we treat this?
Gastric distention
Gastric tube to decompress
What do we do if a neonate HR drops below 100, apnea/gasping?
ventilate
Consider intubation/LMA in persists
What do we do if neonate has labor breathing or is blue?
position
suction
O2/CPAP
What are the main H/T in neonates?
Hypovolemia
Tension pneumothorax
What volume do we use to bag in neonates?
6 ml/kg
What can cause hypovolemia in neonates?
Raising the baby higher than the placenta before they cut it.
What are the main considerations with pregnancy & CPR?
- Provide continuous lateral uterine displacement
- If receiving magnesium, STOP. Give Calcium instead
- Perform perimortem C-section in 5 mins if no ROSC
Able to treat mom & baby separately bc it lowers mortality
