ACLS PALS

Question 1

BLS Compressions depth adult

Answer 1

At least 2 inches

Question 2

BLS Compression rate adult

Answer 2

100-120 compressions per minute

Question 3

Treatment for stable SVT

Answer 3

Adenosine 6-12-12

Rapid push with NS flush

Question 4

SVT EKG characteristic

Answer 4

Narrow complex tachycardia

No p waves

Question 5

Narrow complex tachycardia
No p waves
dx?

Answer 5

SVT
Tx if stable: Adenosine 6-12-12
Tx if unstable: immediate synchronized cardioversion

Question 6

Treatment for unstable SVT

Answer 6

Immediate synchronized cardioversion

Question 7

In BBB, look for R-R’ only in these leads

Answer 7

V1, V2, V5, V6

Question 8

Widened QRS is >

Answer 8

0.12 seconds (120 ms)

Question 9

Persistent unstable bradycardia steps

Answer 9

1. Atropine
2. If 1 doesn’t work, epinephrine or dopamine or transcutaneous
   After, transvenous pacing

Question 10

Atropine IV doses for bradycardia

Answer 10

1st dose 0.5 mg bolus
Repeat every 3-5 min
Up to 3 mg

Question 11

Dose for epinephrine IV infusion for bradycardia

Answer 11

2-10 mcg per minute

Question 12

Unshockable rhythms

Answer 12

PEA

Asystole

Question 13

Shockable rhythms

Answer 13

VF

VT

Question 14

Dose of synchronized cardioversion for narrow regular tachycardia

Answer 14

50-100 J

Question 15

Dose of synchronized cardioversion for narrow irregular tachycardia

Answer 15

120-200 J biphasic or

200 J monophasic

Question 16

Dose of synchronized cardioversion for wide regular tachycardia

Answer 16

100 J

Question 17

Persistent tachycardia causing instability, next step:

Answer 17

Synchronized cardioversion

Question 18

Persistent stable tachycardia, next step in management

Answer 18

Is QRS wide?

Question 19

Stable, wide QRS tachycardia chemical cardioversion options

Answer 19

Adenosine if regular and monomorphic;
Procainamide
Amiodarone
Sotalol

Question 20

Sotalol dose for stable wide QRS tachycardia

Answer 20

100 mg (1.5 mg/kg) over 5 minutes. Do not use in prolonged QT

Question 21

Amiodarone dose for stable wide QRS tachycardia

Answer 21

1st dose: 150 mg over 10 minutes; repeat as needed in VT returns
Maintenance infusion 1mg/min for first 6 hours

Question 22

Procainamide dose for stable wide QRS tachycardia

Answer 22

20-50 mg/min until: arrhythmia is suppressed, hypotension ensues, QRS duration increases by 50%;
Max dose 17 mg/kg
Maintenance dose 1-4mg/min
Do not use with long QT or pregnant

Question 23

Avoid procainamide if:

Answer 23

Long QT

Pregnant

Question 24

Avoid sotalol if

Answer 24

Long QT

Question 25

5H Reversible causes of cardiac arrest

Answer 25

``` Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypothermia Hypo/hyperkalemia (H for hypoglycemia added in kids) ```

Question 26

5T Reversible Causes of adult cardiac arrest

Answer 26

``` Tension PTX Tamponade Toxins Thrombosis, pulmonary Thrombosis, coronary ```

Question 27

Amiodarone IV/IO dose for adult cardiac arrest

Answer 27

1st dose 300 mg bolus | 2nd dose: 150 mg bolus

Question 28

Epinephrine IV/IO dose for adult cardiac arrest

Answer 28

1 mg every 3-5 min

Question 29

Monophasic shock dose for adult cardiac arrest (VF/VT)

Answer 29

360 J

Question 30

Biphasic shock dose for adult cardiac arrest (VF/VT)

Answer 30

120-200 J | Subsequent doses can be the same or higher

Question 31

Vasopressin dose for adult cardiac arrest

Answer 31

40 units can replace first or second dose of epi

Question 32

Tx pediatric bradycardia first step

Answer 32

``` IV/IO O2 Airway EKG Vitals ```

Question 33

If HR <60 in peds with poor perfusion despite oxygenation/ventilation, next step

Answer 33

CPR

Question 34

If CPR does no improve pediatric bradycardia, next step

Answer 34

Epinephrine Atropine - for increased vagal tone or primary AV block Consider transthoracic or transvenous pacing Treat underlying causes

Question 35

Epinephrine dose in pediatric bradycardia

Answer 35

0.01 mg/kg (0.01 ml/kg of 1:10,000 [ ] ) Repeat q 3-5 min If no IV/IO access, can give in ET tube 0.1 mg/kg or 0.1 ml/kg of 1:1000

Question 36

Atropine dose in pediatric bradycardia

Answer 36

0.02 mg/kg May repeat once Maximum single dose 0.5 mg

Question 37

Adult chest compressions: breathing ratio if no advanced airway

Answer 37

30:2

Question 38

Pediatric chest compressions: breathing ratio if no advanced airway

Answer 38

15:2

Question 39

Shock energy for defibrillation in PALS

Answer 39

1st shock 2 J/kg 2nd shock 4 J/kg Subsequent shocks 4 or more J/kg Maximum 10 J/kg or adult dose

Question 40

Epinephrine dose in PALS for cardiac arrest

Answer 40

0.01 mg/kg (0.01 ml/kg of 1:10,000 [ ] ) Repeat q 3-5 min If no IV/IO access, can give in ET tube 0.1 mg/kg or 0.1 ml/kg of 1:1000

Question 41

Amiodarone bolus in PALS for cardiac arrest

Answer 41

5 mg/kg bolus | May repeat up to 2 times for refractory VF/pulseless VT

Question 42

Cutoff for wide QRS complex in kids

Answer 42

0.09s (90 ms)

Question 43

Adenosine dose for SVT in PALS

Answer 43

1st dose 0.1 mg/kg bolus (max 6 mg) 2nd dose 0.2 mg/kg (max 12 mg) 0.1-0.2-0.2 mg/kg

Question 44

Tx for SVT in PALS

Answer 44

1. Adenosine | 2. If not IV/IO access, or no response to adenosine, synchronized cardioversion

Question 45

Treatment for probable sinus tachycardia in PALS

Answer 45

Find and treat underlying cause

Question 46

Tachycardia rates in PALS

Answer 46

< 220 infant | < 180 kiddo

Question 47

Probable VT in kiddo, unstable, next step

Answer 47

Synchronized cardioversion

Question 48

Probable VT in kiddo, stable, next step

Answer 48

Consider adenosine if regular rhythm and monomorphic QRS | Followed by expert consultation, amio OR procainamide (not both)

Question 49

Synchronized cardioversion doses for PALS

Answer 49

Begin with 0.5-1 J/kg Then increase to 2 J/kg +/- sedation but do not delay cardioversion

Question 50

Procainamide dose for PALS VT

Answer 50

15 mg/kg over 30-60 min

Question 51

Assessing hypotension in peds

Answer 51

SBP < 70 + 2 x age in years

Question 52

Racemic epi dose

Answer 52

0.5 mL of 2.25% soln