ACLS MEDS Flashcards
Adenosine is use for
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
Adenosine Precautions or contraindications
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
Adenosine dosage
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
When giving adenosine what monitored
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
Amiodarone is used for
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
Amiodarone precautions/contraindications
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.
Amiodarone dosing
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)
Atropine given for
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)
Atropine precautions/contraindications
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
Atropine doses
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
Dopamine is used for
Second line drug for symptomatic bradycardia (after atropine)
Use for hypotension (SBP <= 70 to 100 mm Hg AND SS shock
Dopamine precautions/contraindications
Correct hypvolemia before giving dopamine
CAUTION - cardiogenic shock AND accompanying CHF
May cause - tachyarrhythmias, excess vasoconstriction
DO NOT MIX WITH SODIUM BICARB
Dopamine dose
2-20 mcg/kg per minute
Titrate to patient response, taper slowly
Epinephrine given for
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
Epinephrine precautions/contraindications
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
Epinephrine dosing
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.
Lidocaine is used for
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
Lidocaine precautions/contraindications
CONTRAINDICATED
Prophylactic use in AMI
Liver disease or LV dysfunction - reduceoading dose
Discontinue with toxicity development
Lidocaine dose
Can be given endotracheal
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)
Magnesium sulfate used for
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.
Magnesium precautions/contraindications
Occasional fall in BP with rapid administration
Use caution with Renal disease
Magnesium dose
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)
When do we synchronize cardioversion
If using sticky pads - put defibrillator in syn mode
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
When do we use unsynchronized cardiovert
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
Cardiovert doses
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
