AHA ACLS Flashcards
Cardiac Arrest
pVT/VF) Repeated dos
Immediate Defib (initial 200J), CPR, Antiarrhythmic & EPI
Stable vs Medical PT assessment
ACS
NCT stable vs unstable
Stable} Vagal, medicate, SVT (Adeno & Diltiazem) other NCT (Diltiazem, Verapamil, Beta-Blockers)
Unstable} Cardiovert SVT 50-100 (AFib RVR 120-200)
WCT stable vs unstable
Stable} Med (Procain
Unstable} usually cardiovert 100-200
ROSC
Dopamine, Infusion if needed, TCP probably
Adult Bradycardia
Unstable) TCP
Stable) Medicate (atropine)
Bradycardia stable vs unstable
Stable} medicate (Atropine)
Unstable} TCP
Cardiovert dose
Inital 100J
200, 300, 360J
TCP) doing
- Turn Pacer on
- 80BPM
- mA sync till capture
- check mechanical
- Increase 2-5mA
Defib) Biphasic end max dose
Monophasic end max dose
= 120-200j
= 360j
CPR) simple cycle
- Rhythm pulse check
- Defib if needed
- CPR 30:2
- Medicate appropriately
- RHYTHM/PULSE CHECK
- SHOCK IF NEEDED IF NOT CPR
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Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
Defib) indication
Contra:
Rhythms
Initial & after doses:
= “Dead fibers” TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100J 200J 300J 360J
Pacing) indication
Rhythms
Initial & after:
= “pick up the pace” <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till’ capture
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
Bradycardia Stable vs Unstable
Asystole & PEA 3 needs
CPR, NEVER SHOCK, EPI
ROSC
CPR tasks/delegating
2 people) 30:2, Airway, IO access, self scribe & timer
4-5 people) Pit crew, 2 rotating CPR, 1 BVM, partner checking pulse sites, Medicate, Self shock & admin
SVT treatment
Bradycardia treatment
AFib w/ RVR treatment
VT treatment
pVT/VF treatment
TCP
Defib
Cardiovert
= “pick up the pace” unstable bradycardias
= “for dead fibbers” pVT, VF, TdP
= “Convert to regular speed” Unstable Tachycardias
Defib initial dose:
Cardiovert initial dose:
TCP initial dose:
= 100-200
= 50-100 (120-200 AF RVR)
= 80BPM, mA till capture ~50 to 85mA (start 50mA like BP)
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose (17mg/kg)
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
Defib) indication
Contra:
Rhythms
Initial & after doses:
= “Dead fibers” TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100-200/300/360J
Pacing) indication
Rhythms
Initial & after:
= “pick up the pace” <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till’ capture
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose (17mg/kg)
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
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Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
Defib) indication
Contra:
Rhythms
Initial & after doses:
= “Dead fibers” TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100J 200J 300J 360J
Pacing) indication
Rhythms
Initial & after:
= “pick up the pace” <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till’ capture
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
Antiarrhythmics for pVT, TdP, VF
pVT/ TdP= Lidocaine & Aminodarone
Tdp= Mag-Sulfate
SVT shock dose
Cardiovert 50-100/200/300/360J
AFib w/ RVR shock dose
Cardiovert 120-200/300/360J
A-Flutter w/ RVR shock dose
Cardiovert 50-100/200/300/360J
VT with pulse &unstable shock dose
pVT & VF shock
cardiovert 100/200/300/360J
Defib 200J 300/360J
Tdp shock dose
defib 200/300/360J
SVT stable RX
Vagal, Adenosine 6mg 12mg, Diltiazem 0.25mg/kg (M20mg) 0.35/kg (M25mg)
AFib & Flutter w/ RVR, MAT, Junctional tachycardia stable RX:
= DONT VAGAL, Diltiazem 0.25mg/kg (M20mg) 0.35/kg (M25mg), Verapamil 2.5-5mg, Beta-Blockers
Bradycardia Stable Rx
Atropine 1mg/3-5mins
Diazepam/Versed) Adult Dose:
2.5-10 mg in 2.5 mg increments slow IV/IO/IM
Aspirin)
=160-325mg PO
Atropine) Bradycardia (w/ or w/o ACS) dose:
Severe dose:
Organophosphate poisoning:
=1 mg IVP 3-5mins as needed (Don’t exceed 0.04mg/Kg (total 3mg))
=1mg IVP (3mins) in severe clinical conditions
=2-4mg (or higher) IVP
Epinephrine 1:10,000): Cardiac arrest:
Bradycardia dose:
Normovolemic hypotension & severe anaphylaxis:
=1mg IVP/IOP every 3-5mins
=2-10mcg/min IV/IO infusion (0.002-
=2-10mcg per min—> mix 1mg of Epi 1:10,000 into a 1 liter bag of fluid
Fentanyl):
IN route:
=1mcg/kg to max of 100mcg (IV/IO/IN) → may repeat PRN in 5-10mins
=Max of 1mL per nare admin/ed IN
Labetalol):
10mg IV/IO push over 1-2mins & May repeat every 10mins to a max dose of 150mg
Mag-Sulfate)Cardiac arrest due to suspected hypomagnesemia/ Tdp:
Tdp w/ pulse:
Maintenance infusion:
= 1-2grams diluted in 10mL
= 1-2grams mixed in 50-100mL admin/ over 5-60mins
=0.5-1gram per hour
Morphine): STEMI:
NSTEMI-ACS:
= 2-4mg IV/IO (slow); may give + doses of 2-8mg IV at 5-15min intervals
=0.1mg/kg IV/IO (slow) or IM up to 10mg
Nitroglycerin):
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
NORepinephrine):
= 0.1-0.5mcg/kg/min IV/IO infusion
Ondansetron (Zophran):
= 4-8mg IV (slow), IM, PO
Procainamide): Recurrent VF/VT:
Maintenance Infusion:
Urgent situationships:
= 20mg/min (max total dose: 17mg/kg)
= 1-4mg/min
= up to 50mg/min may be admin/ to total dose of 17mg/kg
Verapamil): 1st:
2nd:
Max dose:
=2.5-5mg IV/IO bolus over 2-3mins
= 5-10mg over 2-3 mins
=20mg
Etomidate (Amidate) IVP:
= 0.2-0.4 mg/kg (limit to 1 dose) Onset w/in 30 secs. Duration: 5-10 mins
Ketamine (Ketalar): IVP:
= 1-2mg/kg, Onset 1 min, Durations 10-20 mins
Diltiazem) 1st dose:
2nd dose:
= 0.25 mg/kg (max dose 20 mg)
= 0.35 mg/kg (max dose 25 mg)
Dopamine) Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= 2–20 mcg/kg/min Titrate to patients response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
Epi 1:10,000) Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
Mag-Sulfate) Bronchodilation or TdP arrest Adult Dose:
Bronchodilation Pedi Dose:
= 1-2G IV/IO over 10-20 mins (Infusion)
= 25-50 mg/kg IV/IO (max 2G) over 15-30 mins (Infusion)
NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
(Labetalol) Max dose:
Adult Dose:
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
Dobutamine) adult dose:
PEDI dose:
= 2-20mcg/kg/min- titrate so HR cant rise>10% baseline (pt HR arrival)
= 2-20mcg/kg/min
Aspirin)
=160-325 mg PO of nonenteric coated ASA.
ketamine) Sedation Dose:
Pain dose:
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
(Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
(Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)
(Amiodarone) Contra:
Effects:
Caution b/c:
= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP
(Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
(Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
(Atropine) indications:
Contraindications:
Avoid:
= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace
(Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
(Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
(Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
(Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
(Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
(Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til’ vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
(Fentanyl) effects:
dose:
Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V
= 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN
= Chest wall rigidity so admin slowly, Depresses every- thing/where
(Furosemide) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
(Furosemide) indications:
Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies
= Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
(Glucagon) class:
pharmacodynamics:
= Hormone
= Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
(Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
(Glucagon) effects
Dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia
= 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
(Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
(Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
(Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
(Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
(Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
(Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
(Nitroglycerin) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP, RVI
(Nitroglycerin) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
(NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
(NORepi) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
(Ondansetron) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
(Ondansetron) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
(Ondansetron)effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
(Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
(Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med
Titrate to effect & CONSTANTLY check BP & HR:
= NORepi, Epi 1:10, Dopamine, Dobutamine
