ACLS Rhythms with Pulses

Question 1

Narrow QRS Bradycardia

Answer 1

All Puppy Dogs Eat

• A - Atropine
• P - Pacing
• D - Dopamine
• E - Epinephrine (Infusion)

Question 2

Narrow QRS Bradycardia

Atropine Dose

Answer 2

Atropine

1 mg q 3-5 in

(Max 3 mg)

Question 3

Narrow QRS Bradycardia

Pacing (transcutaneous)

Answer 3

Pacing

70 ppm consider sedation/analgesia

Question 4

Narrow QRS Bradycardia

Dopamine Dose

Answer 4

Dopamine Infusion Dose

2-10 mcg/kg/min (common 5 mcg/kg/min

Question 5

Narrow QRS Bradycardia

Epinephrine Dose

Answer 5

Epinephrine Infusion

2 - 10 mcg/min

Question 6

Narrow QRS Bradycardia

Answer 6

All Puppy Dogs Eat

• A - Atropine
  
  • 1 mg q3-5m (max 3mg)
• P - Pacing
  
  • 70 ppm
• D - Dopamine
  
  • 5 mcg/mg/min
• E - Epinephrine (Infusion)
  
  • 2 - 10 mcg/min

Question 7

Wide Complex Bradycardia

Answer 7

Puppy Dogs Eat

• P - Pacing
• D - Dopamine
• E - Epinephrine (Infusion)

Question 8

Wide QRS Bradycardia

Pacing (transcutaneous)

Answer 8

Pacing

70 ppm consider sedation/analgesia

Question 9

Wide QRS Bradycardia

Dopamine Dose

Answer 9

Dopamine Infusion Dose

2-10 mcg/kg/min (common 5 mcg/kg/min

Question 10

Wide QRS Bradycardia

Epinephrine Dose

Answer 10

Epinephrine Infusion

2 - 10 mcg/min

Question 11

Wide Complex Tachycardia - Stable Patient

(Unknown Origin)

When do you consider Adenosine?

Answer 11

Rhythm is Regular & Monomorphic

Question 12

Wide Complex Tachycardia - Stable Patient

(Unknown Origin)

If possibly Monomorphic V-Tach, consider

Answer 12

Amiodarone OR Lidocaine

Question 13

Wide Complex Tachycardia - Stable Patient (Unknown Origin)

If possibly Monomorphic V-Tach, consider

Amiodarone Dose

Lidocaine Dose

Answer 13

• Amiodarone Infusion - 150 mg in 50-100 NS over 10 min

OR

• Lidocaine - 1 - 1.5 mg/kg ……. Repeat in 5 - 10 min @ 0.5 -0.75 mg/kL
  
  • Max 3 mg/kL
  • If coverts with Lidocain = Lidocaine Infusion
    
    • 1 mg/kL > than total dose (2-4 mg/min)

Question 14

Monomorphic Ventricular Tachycardia

Stable Patient

Answer 14

Amiodarone OR Lidocaine

Question 15

Monomorphic Ventricular Tachycardia

Stable Patient

Answer 15

• Amiodarone Infusion - 150 mg in 50-100 NS over 10 min

OR

• Lidocaine - 1 - 1.5 mg/kg ……. Repeat in 5 - 10 min @ 0.5 -0.75 mg/kL
  
  • Max 3 mg/kL
  • If coverts with Lidocain = Lidocaine Infusion
    
    • 1 mg/kL > than total dose (2-4 mg/min)

Question 16

Monomorphic Ventricular Tachycardia

UNSTABLE Patient means

Answer 16

Unstable

Shock, Hypotension

ALOC

Ischemic Chest Discomfort

Acute CHF

Question 17

Monomorphic Ventricular Tachycardia

UNSTABLE Patient Tx

Answer 17

• Synchronized Cardioversion (Bi-Phasic)
  
  • 100-200 J
  • 300 J
  • 360 J
• Magnesium Sulfate
• UnSynchronized Cardioversion (Bi-Phasic)
  
  • 200 J
  • 300 J
  • 360 J

Question 18

Monomorphic Ventricular Tachycardia

UNSTABLE Patient Tx

Magnesium Sulfate Dose

Answer 18

Magnesium Sulfate

2 Gm in 50-100 NS over 5 minutes

Question 19

Narrow QRS Tachycardia

Stable Patient

Answer 19

Vagal

Adenosine

Calcium Channel Blocker

Consider Beta Blockers

Question 20

Narrow QRS Tachycardia - Stable Patient

Adenosine Dose

Answer 20

Adenosine

6 mg RIVP with 20mL Flush

q1-2m @ 12 mg RIVP with 20mL Flush

Question 21

Narrow QRS Tachycardia - Stable Patient

Calcium Channel Blocker Dose

Answer 21

Cardizem

• 0.25 mg/kg SIVP over 2 min
  
  • Repeat if needed, 0.35 mg/kg in 15 min
• (max single dose 25 mg)

Question 22

Narrow QRS Tachycardia

UNStable Patient w/ WPW Tx

Answer 22

Amiodarone

Synchronized Cardioversion

Question 23

Narrow QRS Tachycardia - UNStable Patient w/ WPW Tx

Amiodarone Dose

Answer 23

Amiodarone

150 mg in 50-100 mL NS over 10 min

Question 24

Narrow QRS Tachycardia - UNStable Patient w/ WPW Tx

Synch Cardioversion Settings

Answer 24

Synch Cardioversion

120 J

200 J

300 J

360 J

Question 25

Narrow QRS Tachycardia

UNStable Patient NO WPW Tx

Answer 25

Synch Cardioversion

120 J

200 J

300 J

360 J