ACLS MEDS

Question 1

Adenosine is use for

Answer 1

1st drug for most STABLE NARROW complex SVT

Effective for terminating reentry involving the AV or sinus nodes

May use for UNSTABLE NARROW complex reentry tachycardia while preparing for cardioversion

Regular and monomorphic wide-complex tachy thought to be or previously defined reentry SVT

DOES NOT CONVERT a-fib, a-flutterm or VT

Diagnostic maneuver: stable narrow-complex SVT

Question 2

Adenosine Precautions or contraindications

Answer 2

Contraindicated
Poison or drug induced tachy
2nd or 3rd degree heart block

Transient side effects;
Flushing, chest pain, tightness, brief periods of asystole or bradycardia

Less effective and may require larger doses

If patient taking dipyridamole or carbamazepine, heart transplant or if giving by CVC - reduce dose to 3 mg

If given yo irregular or polymorphic WIDE COMPLEX tachy/VT - may cause deterioration (inc. hypotension)

Transient periods of sinus tachy and ventricular ectopy are common after termination of SVT

SAFE AND EFFECTIVE IN PREGNANCY

Question 3

Adenosine dosage

Answer 3

Rapid push
Initial bolus 6 mg over 1-3 secs
Place patient in mild reverse trendelenberg
Followed by 20 mL bolus
Elevate the extremity 

Repeat dose
12 mg in 1-2 minutes if needed

Question 4

When giving adenosine what monitored

Answer 4

Record rhythm strip during administration

Draw up second dose and flush in separate syringes

Attach vith syringes to luer locks

Clamp tubing above luer lock

Push IV adenosine as fast as possible 1-2 secs and while maintaining oressure on the drug syringe push NS rapidly after drug is given

Unclamp tubing

Question 5

Amiodarone is used for

Answer 5

VF/PULSELESS VT that is unresponsive to shock delivery and CPR and a vasopressor

Recurrent hemodynamic unstable VT

EXPERT CONSULTATION - may be used for some atrial and ventricular arrhythmias

Question 6

Amiodarone precautions/contraindications

Answer 6

Rapid infusion may cause low BP

Multiple doses (cumulative > 2.2 g over 24 hours not associated with hypotension

Do not give with other drugs that prolong QT interval (procainamide)

Terminal eliminations is very long - half life lasts up to 40 days.

Question 7

Amiodarone dosing

Answer 7

BG/pVT, arrest unresponsive to CPR, shock, and vasopressor

1st dose: 300 mg IV or IO push

2nd dose; 150 mg IV or IO push

LIFE THREATENING ARRHYTHMIAS
max cumulative dose = 2.2 g IV over 24 hours

Given as follows:

RAPID INFUSION
150 mg IV over 10 min (15 mg per min)
May repeat rapid infusion every 10 min

SLOW INFUSION
360 mg IV over 6 hours (1 mg per min)

MAINTENANCE INFUSION
540 mg IV over 18 hours (0.5 mg per min)

Question 8

Atropine given for

Answer 8

FIRST CHOICE for symptomatic bradycardia

May be beneficial for AV node block

NOT HELPFUL FOR
Type 2 second degree block or third degree AV block in non-nodal tissue

Not beneficial for PEA/asystole

May need HUGE doses for organophosphate poisoning (nerve agent)

Question 9

Atropine precautions/contraindications

Answer 9

CAUTION - Presence of myocardial oxygen demand

AVOID - hypothermic bradycardia

INEFFECTIVE - type 2 AB block, new 3° block with wide QRS. May cause paradoxical slowing

Be prepared to give catecholamines

Dose < 0.5 mg may result in paradoxical bradycardiaa

Question 10

Atropine doses

Answer 10

With or without ACS

0.5 mg IV every 3-5in ad needed

NTE 0.04 mg/kg (total 3 mg)

Use shorter interval dosing (3 minutes) and higher doses for severe clinical conditions

ORGANOPHOSPHATE POISONING 
HUGE doses (2-4 mg) may be needed

Question 11

Dopamine is used for

Answer 11

Second line drug for symptomatic bradycardia (after atropine)

Use for hypotension (SBP <= 70 to 100 mm Hg AND SS shock

Question 12

Dopamine precautions/contraindications

Answer 12

Correct hypvolemia before giving dopamine

CAUTION - cardiogenic shock AND accompanying CHF

May cause - tachyarrhythmias, excess vasoconstriction

DO NOT MIX WITH SODIUM BICARB

Question 13

Dopamine dose

Answer 13

2-20 mcg/kg per minute

Titrate to patient response, taper slowly

Question 14

Epinephrine given for

Answer 14

CARDIAC ARREST - VF, pVT, asystole, PEA

SYMPTOMATIC BRADYCARDIA - AFTER atropine as alternative to dopamine

SEVERE HTN - can be used when pacing and atropine fail when hypotension accompanying bradycardia OR with phosphodiesterase enzyme inhibitor

ANAPHYLAXIS - combine with large fluid volume, corticosteroids, antihistamines

Question 15

Epinephrine precautions/contraindications

Answer 15

Elevated BP and increased HR. May cause myocardial ischemia, angina, and increased myocardial oxygen needs

High doses DO NOT improve survival or neurological outcomes AND MAY contribute to postresuscitstion myocardial dysfunction

Higher doses may be required when treating poison/drug-induced shock

Question 16

Epinephrine dosing

Answer 16

CARDIAC ARREST
IV/IO 1 mg (10 mL of 1:10,000 solution) given every 3-5 minutes during resuscitation. Each dose followed by 20 mL NS flush. Elevate arm after for 10-20 secs

HIGHER DOSES - up to 0.2 mg/kg per minute for specific indications: Beta blocker or calcium channel blocker overdose)

CONTINUOUS INFUSION
0.1-0.5 mcg/kg per min
For 70-kg pt: 7-35 mcg per min
Titrate to response

ENDOTRACHEAL ROUTE
2-2.5 mcg per min infusion. Titrate to response.

PROFOUND BRADYCARDIA
2-10 mcg per min infused. Titrate to response.

Question 17

Lidocaine is used for

Answer 17

Alternate to amiodarone in cardiac arrest from VT/pVT

Stable monomorphic VT with preserved ventricular function

Stable polymorphic VT with normal baseline QT interval and preserved LV function with ischemia treated and electrolyte balance correct

Can be used with polymorphic VT with QT prolonged if torsades expected

Question 18

Lidocaine precautions/contraindications

Answer 18

CONTRAINDICATED
Prophylactic use in AMI
Liver disease or LV dysfunction - reduceoading dose
Discontinue with toxicity development

Question 19

Lidocaine dose

Can be given endotracheal

Answer 19

CARDIAC ARREST FROM VT/pVT
1-1.5 mg/kg IV or IO

Refractory VF - give additional 0.5-0.75 mg/kg IVP, repeat in 5-10 min

Max dose - 3 doses or total of 3mg/kg

PERFUSING ARRHYTHMIA
stable VT, wide complex tachy of uncertain type, significant ectopy

O.5.-0.75 mg/kg and up to 1-1.5 mg/kg may be used

Repeat 0.5-0.75 mg/kg every 5-10 min

Max dose: 3mg/kg

MAINTENANCE INFUSION
1-4 mg per min (30-50 mcg/kg per minute)

Question 20

Magnesium sulfate used for

Answer 20

Cardiac arrest if torsades or low mag suspected

Use for arrest ONLY if tirades do pointed or suspected hypomagnesemia

Life threatening ventricular arrhythmias r/t digitalis toxicity

Routine admin in hospitals with AMI NOT recommended.

Question 21

Magnesium precautions/contraindications

Answer 21

Occasional fall in BP with rapid administration

Use caution with Renal disease

Question 22

Magnesium dose

Answer 22

CARDIAC ARREST
1-2 g (2-4 mL of 50% solution diluted in 10 mL (D5W or NS) and given IV/IO

TORSADES
Loading: 1-2 g in 50-100 mL (D5W or NS) over 5 min to 60 min IV

Follow with 0.5-1 g per IV (titrate to control torsades)

Question 23

When do we synchronize cardioversion

If using sticky pads - put defibrillator in syn mode

Answer 23

Unstable SVT

Unstable A-fib

Unstable A-flutter

Unstable regular monomorphic tachy with pulses

Reentry SVT or VT With Pulses

NOT FOR
Junctional tachy or ectopic or multifocal atrial tachy

Question 24

When do we use unsynchronized cardiovert

Answer 24

Pulseless patients
Demonstrating clinical deterioration (severe shock, polymorphic VT when delay could result in arrest)

When u clear if mono or polymorphic VT in an unstable patient

I’d shock causes VF - defibrillate immediately

Question 25

Cardiovert doses

Answer 25

SYNCHRONIZED

MONOPHASIC
initial 200 Jules

BIPHASIC
Initial 120-200 jules

Repeat doses:
Increase in stepwise for any subsequent attempts

A FLUTTER
50-100 J with monomorphic or biphasic waveform

MONOMORPHIC VT
Regular form and rate with pulse. Synchronize shocks
Initial: 100 J

No response: increase dose stepwise