ACLS Things to Remember

Question 1

Nicardipine

Answer 1

Ischemic Stroke

Candidate for reperfusion with BP >185/110:
5 mg/hr IV, titrate up by 2.5 mg/hr every 5-15 min, max 15 mg/h; when desired BP reached, adjust to maintain proper BP limits

Management of BP after reperfusion therapy to maintain BP ≤180/105 mm Hg:
5 mg/hr IV, titrate up to desired effect by 2.5 mg/hr every 5-15 min, max 15 mg/h

Question 2

Aspirin

Answer 2

Acute Coronary Syndromes:

160-325mg PO (chewed or non-coated) or 300mg PR (suppository)

Question 3

Pacing

Answer 3

Starting rate: 60-80bpm

Dose: 2mA above capture

Question 4

Nitroglycerin

Answer 4

Acute Coronary Syndrome:
SL q 3-5min (3 doses total)

*and normal dose is 0.4mg, but not mentioned in Provider eManual

Question 5

Magnesium Sulfate

Answer 5

Cardiac Arrest:
1-2g IV/IO diluted in 10ml IV/IO, typically over 20min

Perfusing Torsades or AMI with Hypomagnesemia:
1-2g loading dose over 5-60min, then 0.5-1g/hr

Question 6

Dopamine

Answer 6

Bradycardia & Post-Arrest Hypotension:

5-20mcg/kg/min IV

Question 7

Amiodarone

Answer 7

Arrest with Shockable Rhythm:
300mg IV/IO, then 150mg

Tachycardia, Stable Wide-QRS Tachycardia:
150mg IV over 10min, repeat as needed, then maintenance at 1mg/min x6hrs (followed by 0.5mg/min x18hrs)

*max cumulative dose 2.2g in 24hrs

Question 8

Procainamide

Answer 8

Tachycardia, Stable Wide-QRS Tachycardia: 20-50mcg/min (max 17mg/kg), then maintenance at 1-4mg/min

*stop when tachycardia suppressed, with QT prolongation or hypotension; avoid with existing long QT or CHF

Question 9

Clevidipine

Answer 9

Ischemic Stroke; as candidate for reperfusion with BP >185/110 & for management of BP after reperfusion therapy to maintain BP ≤180/105 mm Hg:
1-2 mg/hr IV, titrate by doubling the dose every 2-5 min until desired BP reached; maximum 21 mg/hr

Question 10

Atropine

Answer 10

Bradycardia:
1mg IV, repeat q3-5min (max 3mg or 0.04mg/kg)

Organophosphate Poisoning:
2-4mg or more

Question 11

Adenosine

Answer 11

Tachycardia with a Pulse:
6mg rapid IV push (followed by NS flush), repeat at 12mg

*consider 1/2 doses with heart transplant or central line administration, also with use of carbamazepine or dipyridamole; consider higher doses with theophylline, caffeine or theobromine

Question 12

Norepinephrine

Answer 12

Post-Arrest Hypotension:

0.1-0.5mcg/kg/min (for 70kg adult 7-35mcg/min)

Question 13

Epinephrine

Answer 13

Cardiac Arrest:
1mg IV/IO q 3-5min
or 2-2.5mg ETT diluted in 10ml NS
*higher doses (up to 0.2mg/kg) may be used for specific indications (B-blocker or Ca-channel blocker overdose)
*continuous infusion for cardiac arrest listed in eManual Appendix at 0.1-0.5 mcg/kg/min, but not discussed elsewhere

Bradycardia & Post-Arrest Hypotension:
2-10mcg/min IV

Question 14

Etiology of Maternal Cardiac Arrest

Answer 14

(ABCDEFGH)

Anesthetic complications

Bleeding

Cardiovascular

Drugs

Embolic

Fever

General non-obstetric causes of cardiac arrest (H’s and T’s)

Hypertension

Question 15

Endotracheal Route Considerations

Answer 15

IV and IO routes are preferred over ET, but if you consider administering drugs via the ET route during CPR, keep these concepts in mind:

The optimal dose of most drugs given by the ET route is unknown.

The typical dose of drugs administered via the ET route is 2 to 2½ times the IV route.

You will need to stop CPR briefly so that the drug does not regurgitate up the ET tube.

Drugs like epinephrine can negatively affect the colorimetric CO2 detector’s functionality.

Studies demonstrate that the circulatory system absorbs epinephrine, vasopressin, and lidocaine after administration via the ET route. When giving drugs via the ET route, dilute the dose in 5 to 10 mL of sterile water or normal saline, and inject it directly into the ET tube.

Question 16

Reversible Causes of Cardiac Arrest

Answer 16

(Hs & Ts)

Hypovolemia

Hypoxia

Hydrogen ion (acidosis)

Hypokalemia/hyperkalemia

Hypothermia

Tension pneumothorax

Tamponade, cardiac

Toxins

Thrombosis, pulmonary

Thrombosis, coronary

Question 17

Labetalol

Answer 17

Ischemic Stroke

Candidate for reperfusion with BP >185/110:
10-20mg IV over 1-2min, may repeat x1

Management of BP after reperfusion therapy to maintain BP ≤180/105 mm Hg:
10mg IV followed by continuous infusion 2-8mg/min IV

Question 18

Cardioversion

Answer 18

(synchronized shocks)

Indications: unstable SVT, unstable atrial fibrillation, unstable atrial flutter, unstable regular monomorphic tachycardia with pulses

Dose: “refer to your specific device’s recommended energy level to maximize first shock success”

Question 19

Lidocaine

Answer 19

Arrest with Shockable Rhythm:
1-1.5mg/kg IV/IO, then 0.5-0.75mg/kg at 5-10min intervals (max 3mg/kg)

Perfusing Arrythmia:
0.5-0.75mg/kg up to 1-1.5mg/kg (max 3mg/kg), then maintenance at 1-4mg/min or 30-50mcg/kg/min

Question 20

Sotalol

Answer 20

Stable Wide-QRS Tachycardia:
100mg (1.5mg/kg) over 5min

*avoid if prolonged QT

Question 21

Defibrillation

Answer 21

Monophasic: 360J
Biphasic: “use the manufacturer’s recommended energy dose (eg, initial dose of 120 to 200 J); if you do not know the effective dose range, deliver the maximal energy dose for the first and all subsequent shocks”