ACLS Protocols

Question 1

reversible causes of adult cardiac arrest - H’s and T’s

Answer 1

*hypovolemia
*hypoxia
*hydrogen ion (acidosis)
*hypo/hyperkalemia
*hypothermia
*tension pneumothorax
*tamponade (cardiac)
*toxins
*thrombosis (pulmonary)
*thrombosis (coronary)

Question 2

stable vs. unstable patients - adult ACLS

Answer 2

*“unstable” means that the patient has one or more of the following:
-hypotension
-acutely altered mental status
-signs of shock
-ischemic chest discomfort
-acute heart failure

Question 3

adult ACLS cardiac arrest algorithm - shockable rhythm

Answer 3

1. BLS - start CPR, give oxygen, attach monitor/defibrillator
2. identify a shockable rhythm: ventricular fibrillation or pulseless ventricular tachycardia
3. SHOCK
4. CPR 2 min & obtain IV/IO access
5. recheck rhythm; if shockable, SHOCK
6. CPR 2 min & epinephrine IV/IO 1 mg every 3-5 min; consider advanced airway
7. recheck rhythm; if shockable, SHOCK; administer amiodarone or lidocaine
8. repeat steps 5-7 until ROSC is returned or efforts are finished

Question 4

adult cardiac arrest ACLS algorithm - non-shockable rhythm

Answer 4

1. BLS - start CPR, give oxygen, attach monitor/defibrillator
2. identify a NON-shockable rhythm: asystole or pulseless electrical activity (PEA)
3. administer epinephrine IV/IO 1 mg ASAP and every 3-5 min
4. continue CPR and epinephrine pushes, and keep rechecking rhythm to see if its shockable

Question 5

adult tachycardia ACLS algorithm - STABLE narrow QRS complex (SVT)

Answer 5

STABLE patient with persistent, regular, narrow (< .12 sec) QRS tachyarrhythmia:
1. attempt vagal maneuvers
2. adenosine IV 6 mg
3. beta-blocker or CCB

Question 6

adult tachycardia ACLS algorithm - UNSTABLE tachyarrhythmia

Answer 6

*UNSTABLE patient with persistent tachyarrhythmia: SYNCHRONIZED CARDIOVERSION
*note - this is applicable to BOTH narrow QRS and wide QRS tachyarrhythmias

Question 7

adult tachycardia ACLS algorithm - STABLE wide (> .12 sec) QRS complex

Answer 7

1. consider adenosine (only if regular and monomorphic)
2. ANTIARRHYTMIC INFUSION: procainamide, amiodarone, sotalol, or lidocaine
   -procainamide IV 20-50 mg/min
   -amiodarone IV 150 mg over 10 min
   -sotalol IV 100 mg over 5 min

Question 8

adult bradycardia ACLS algorithm

Answer 8

1. if patient is STABLE, monitor and observe or administer atropine 1 mg bolus
2. if UNSTABLE, transcutaneous pacing
   -then start an epinephrine infusion IV 2-10 mcg/min (or a dopamine IV infusion)

Question 9

AV nodal reentrant tachycardia - overview

Answer 9

*most common cause of paroxysmal SVT
*etiology: reentrant pathway in or around the AV node
*sx: palpitations, dizziness, dyspnea
*ECG: narrow QRS complexes, tachycardia, P waves often buried within or fused with QRS complex, retrograde P waves
*tx options:
-hemodynamically STABLE: (1) vagal maneuvers; (2) adenosine; (3) non-dihydropyridine CCBs (verapamil, diltiazem) or beta blockers
-hemodynamically UNSTABLE (hypotension, declining mental status): synchronized electrical cardioversion