ACLS/PALS Algorithms Flashcards
Unstable bradycardia and tachycardia S/S
hypotension
acutely ams
shock
ischemic chest discomfort
acute hf
If bradycardia is unstable what do we do.
Atropine
if atropine is ineffective try transcutaneous pacing and or dopamine infusion or epi infusion.
What should we consider while doing interventions for bradycardia
expert consultation
transvenous pacing
Atropine dose for bradycardia
1st dose; 1mg bolus
repeat every 3-5 min
max= 3mg
<0.5 mg-> worsen brady
Dopamine IV infusion rate for bradycardia
Usual infusion rate is 5-20 mg/kg/ min titrate to patient response; taper slowly
Epi infusion rate for bradycardia
2-10 mcg/ min infusion. titrate to patient response
Possible causes and treatment for bradycardia
MI
OD/ toxicity; CCB, BB/ DIG
hypoxia
Electrolyte abnormality (hyperK; 8-12 brady -> sinewaves)
BB-> glucagon
CCB-> ca+
Dig-> Digibind
HR less than what is a bradyarrhythmia
<50bpm
Tachyarrhthmia is hr of what
> 150 bpm
Treatment for unstable tachycardia
Synchronized cardioversion
if narrow complex consider adenosine
treatment for refractory tachycardia
find underlying cause
increase energy level for next cardioversion
additional anti-arrhythmic drug
expert consultation
Wide QRS tachycardia tx stable
adenosine only if regular and monomorphic
anti-arrhythmic infusion (procainamide, amio, sotalol)
expert consultation
> 0.12
Narrow QRS tachycardia tx stable
vagal maneuvers
adenosine
BB / CCB
expert consult
Adenosine dose for tachycardia
1st dose = 6mg IV push w/ flush
2nd dose = 12 mg if required
Procainamide dose for tachycardia
20-50mg/min until arrhythmia suppressed, hypotension ensues, qrs duration increased >50% or max dose 17mg/kg given.
maint infusion 1-4mg/min. avoid if prolonged qt or chf.
Amiodarone dose for tachycardia
first dose 150 mg over 10 min. repeat as needed if VT recurs. Folllow by maintenance infusion of 1mg/min for first 6 hours
Sotalol IV dose for tachycardia
100 mg (1.5mg/kg) over 5 min. avoid if prolonged QT.
characteristic of high quality cpr
2 inch depth and 100-120 bpm, allow recoil
no interruptions
if petco2 >15
Shock energy for defib
Biphasic; 120-200 J. if unknown use max available
monophasic; 360J
Epi dose for cardiac arrest
1mg every 3-5 min
Amio dose for cardiac arrest
first dose 300 mg. second dose 150 mg
lidocaine dose for cardiac arrest
first dose= 1-1.5mg/kg
second dose= 0.5-0.75mg/kg
Breaths per min after advanced airway placed for cardiac arrest
1 breath every 6 seconds
10 breaths/ min
ROSC s/s
pulse
bp
art line wave form
PETCO2 > 40 mmhg
H’s
Hypovolemia
hypoxia
hydrogen ions
hypo K
hyper K
Hypothermia
T’s
tension pneumothoax
tamonade
toxins
thrombosis; pulm or coronary
Post Rosc respiratory parameters
start 10 breaths. min
titrate spo2 to 92-98%
titrate CO2 35-45 mmhg
Post ROSC hemodynamic parameters
SBP > 90 mmhg
MAP >65
manage with cystalloids and or vasopressor or inotrope
Post rosc interventions for comatose patient
TTM- 32-36 for 24 hrs
Head CT
EEG
critical care
Maternal interventions for cardiac arrest
airway management (have to intubate)
admin 100% O2/ avoid excess ventilation
IV above the diaphragm
stop mag and give calcium chloride or gluconate
Perform OB interventions for cardiac arrest
lateral uterine displacement
detach fetal monitors
prep for perimortem c section (5 min post arrest)
Potential etiology of maternal cardiac arrest
anesthetic complications
bleeding
cardiovascular
drugs
embolic
fever
general nonOB causes (h and t)
Hypertension
When to start chest compressions on neonate
HR < 60bpm
intubate if not done already
If HR is persistently below 60 what other interventions can we do for neonate
epi
consider hypovolemia
consider pneumothorax
narcan?
unstable Pediatrics s/s
acutely ams
s/s of shock
hypotension
Interventions for neonate gasping/ apnea and HR <100
PPV
clear secretions
SPO2 monitor
ECG monitor
Pediatric compressions are initiated when hr is at?
60bpm
interventions if neonate hr <60/min
intubate
chest compressions
PPV
100% o2
ect monitor
consider emergency UVC (umbilical vein cannulation)
Persistent bradycardia for peds patients interventions
continue cpr if hr less than 60
iv/io
epi
atropine (for inc vagal tone/ primary av block)
transthoacic/ transvenous pacing
ID cause
Possible causes for peds bradycardia
hypothermia
hypoxia
medications
Epi dose for ped bradycardia and cardiac arrest
0.01mg/kg (0.1ml/kg of the 0.1mg/ml concentration)
repeat every 3-5 min
Atropine dose for peds bradycardia
0.02mg/kg. may repeat once
max dose 0.1mg and max single dose 0.5mg
Infant tachycardia rate
> 220
Child tachycardia rate
> 180
treatment for SVT (qrs <0.09) in unstable peds
adenosine
sychronized cardioversion
treatment for V tach (qrs > 0.09) in unstable peds
sychronized cardioversion
treatment for SVT (qrs <0.09) in stable peds
Vagal maneuvers
adenosine
treatment for V tach (qrs >0.09) in stable peds
regular and monomorphic qrs = adenosine
consult expert
Synchronized cardioversion dose in peds
Start with 0.5-1J/kg
if not effect, increase to 2 J/kg.
sedate if needed but dont delay cardioversion
Adenosine dose for peds tachycardia
first dose 0.1mg/kg rapid bolus (max; 6mg)
second dose; 0.2mg/kg rapid bolus (max 2nd dose; 12 mg)
Amio dose for kids cardiac arrest
5mg/kg during arrest
may repeat up to 3 doses
Lidocaine dose for peds cardiac arrest
1mg/kg loading dose
Defibrillation dose for peds cardiac arrest
First shock 2J/kg
Second shock 4J/Kg
Subsequent shocks > 4 J/kg
max 10 J/kg or adult dose
PEDS quality CPR characteristics
> 1/3 of anteroposterior diameter of chest
100-120bpm
allow recoil
no airway; 15;2 compression/ventilation ration
advanced airway; breath every 2-3 seconds
Amniotic fluid embolism treatment
atropine
ondansetron
ketorolac
APGAR score
0-10
activity
pulse
grimas
respiration
