Block 3 Flashcards
Chest compressions
Rate of _______ compressions per minute
100-120
30/2 – 30 compressions, 2 breaths
If an advanced airway is in place, __ breath every __ seconds
1 breath every 6 seconds
Which rhythms should you shock/not shock?
Pulseless vTac, VFib
Do not do on pulseless electrical activity (PEA) or asystole
Establish IV access (after/before) attempt of CPR and defibrillation
AFTER
Which drugs are absorbed in the trachea
NAVEL
Naloxone Atropine Vasopressin Epinephrine Lidocaine
Amiodarone class? MOA?
Class III antiarrhythmic agent
Inhibit ion flux through Na+, K+, Ca2+ channels
Has α- and β- blocking activities
Amiodarone dose in ACLS?
300 mg IVP/IO; may repeat 150 mg IVP/IO once; may start continuous infusion
Continuous infusion: 1 mg/min x 6 hrs followed by 0.5 mg/min x 18 hours
Max 2.2 grams in 24 hours
Lidocaine class? MOA?
Class IB antiarrhythmic agent
Inhibit ion flux through Na+ channels
Lidocaine dose in ACLS?
1 – 1.5 mg/kg IVP; may repeat if pVT/VF persists with 0.5 – 0.75 mg/kg IVP at 5- to 10-minute intervals
Can be given via ET tube at a dose of 2 – 4 mg/kg
Max dose: 3 mg/kg
Continuous infusion (after ROSC): 1 – 4 mg/min
Magnesium MOA in ACLS?
Facilitate prolongation of ventricular repolarization by enhancing intracellular myocardial K+ flux (a process that requires Mg2+)
Magnesium dose in ACLS?
1 – 2 gram (diluted in 10 mL D5W) IVP/IO
What are the H’s and T’s?
Hypothermia
Hypoxia
Hypovolemia
Hyper/hypokalemia
Hydrogen ions
Tablets (overdose, toxins)
Thrombosis, ACS
Thrombosis, PE
Tamponade, cardiac
Tension pneumothorax
In what situations should you give meds if a person is bradycardic? What meds can you give then?
Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
Atropine, dopamine, epi
Atropine MOA?
Blocks acetylcholine receptors; inhibit the action of the vagus nerve on the heart
Atropine dosing?
1 mg IV, may repeat
Max dose: 3 mg
Dopamine dosing?
Infusion (begin at 5 – 10 mcg/kg/min, titrate to response)
As you increase dose of dopamine, what receptors are affected?
It goes from mostly dopamine and beta to just alpha and beta
Epi dosing for bradycardia?
Infusion (begin at 2 – 10 mcg/min, titrate to response)
No maximum doses
If tachycardic and have these symptoms, what do you do?
Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure
Move on to synchronized cardioversion
What conditions are considered wide QRS? How is it treated
Anything ≥0.12 sec
Ventricular tachycardia
SVT with aberrancy
Pre-excited tachycardias (via accessory pathways)
Adenosine only if regular and monomorphic, Amiodarone Magnesium, and Procainamide
Anything else is narrow complex
How is narrow QRS treated?
Treated with vagal maneuvers, adenosine, BB, CCB
Adenosine dosing?
6 mg rapid IVP & 20-mL saline flush at the same time with elevation of the arm infused into
May repeat with 12 mg bolus x 2 if no conversion occurs within 1 – 2 min
Verapamil dosing?
Verapamil: 2.5 – 5 mg IV over 2 min, may repeat 5 – 10 mg Q 15 – 30 min (to a total dose of 20 mg)
Diltiazem dosing?
Diltiazem: 0.25 mg/kg (15 – 20 mg) IV over 2 min bolus; 0.35 mg/kg (20 – 25 mg) IV over 2 minutes (2nd bolus in 15 min); maintenance infusion 5 – 15 mg/hr (titrate to HR)
Metoprolol dosing?
Metoprolol: 5 mg slow IVP at 5-minute interval (to a total of 15 mg)
Atenolol dosing?
Atenolol: 5 mg slow IVP (over 5 minutes) may repeat x 1
Propranolol dosing?
Propranolol: 0.1 mg/kg slow IVP divided into 3 equal doses at 2- to 3-minute intervals (rate ≤ 1 mg/kg)
Esmolol dosing?
Esmolol: 500 mcg/kg bolus IVP (over 1 min), followed by a 4-minute infusion of 50 mcg/kg/min (total 200 mcg/kg)