Critical Care: Advanced Cardiac Life Support

Question 1

IV/IO dose conversion to ET

Answer 1

2-2.5x IV dose = ET dose

Question 1

cardiac arrest

Answer 1

pt unale to generate aadquate cardiac ouput o support O2 demands

Question 2

types of rhythms in cardiac arrestg

Answer 2

• v. fib (VF)
• pulseless v tach (pVT)
• asystole
• pulseless electrical activity (PEA)

Question 3

when do we admin meds when treating cardiac arres

Answer 3

• if initially non-shockable rhythm (PEA, asystole): admin epiniphrine ASAP
• if initially shockable (VF or pVT): admin epiniphrine after the 2nd shokc and antiarrhythmics after 3rd

• epinephrine is 1 mg Q4min (2 CPR cycles) - do NOT use high dose
• antiarrhythmics: usually amio or lidocaine

Question 4

general treatment for cardiac arrest

Answer 4

1. start with CPR/O2 and attatch heart monitor/defibrillator
2. 2 min cycles
3. if after2 min of CPR, pt has shockable rhythm, shock and then CPR; if they do NOT have shockable rhythm, CPR + epi
4. reassess in 2 min
5. Whenever pt hits ROSC, swtich to post caidac arrest acre

for more specific directions on med admin, see med admi card

Question 5

ROSC

Answer 5

treatment goal for cardiac arrest
- return of spontaneous circulation

Question 6

epinephrie MOA in treatment of cardiac arrest

Answer 6

increase coronary and cerebral perfusion pressure -> enhance orang pefusion
- can help achieve ROSC faster but doesn’t necessarily mean better neuro utcomes

Question 7

antiarrhythmic agents in treatment of cardiac arrrest

Answer 7

• amio
• lidocaine
• Mg - ONLY if pt has torsadews

Question 7

antiarrhythmics MOA in treatment of cardiac arrest

Answer 7

potnetially normalzie abnormlaly depolarizing and conducting myocardial cell

Question 8

amio considerations in cardiac arrest

Answer 8

• do NOT bolus if pt has pulse
• DO bolus if pt is pulseless
• follow admin with 10-20 mL of NS to help get it into circulatoin
• diluent can cause hypotension and bradycardia, consider giving with vasopressor to reduce
• ADR: QT prolongatio risk

remeber that it’s not even used until after 3rd shock

Question 9

when to consider lidocaine in treatment of cariac arres

Answer 9

• ONLY after 3 shocks
• if amio unavailable
• torsades (dt lower QT prolognation risk than amio)

Question 10

reversible causes of cardiac arrest: Hs

Answer 10

• hypovolemia
• hypoxia
• hydrogen ion (acidosis) - do NOT treat with bicarb
• hyperkalemia
• hypothermia
• hypoglyceia

Question 11

reversible causes of cardiac arrest: Ts

Answer 11

• tension pneumothorax
• tamonade, cardiac
• toxins (opioids, local anesthetics, TCAs)
• thrombosis (pulmonary or ardiac)

Question 12

How to handle hyperkalemia induced cardiac arrest

Answer 12

• treat cardiac arresy (duh)
• treat hyperkalemia
  1. give Ca - stabilzes myocardial membrane
  2. give temporary measure (bicarb or insulin w/dextrose)
  3. once ROSC, consider long term measuers: dialyses, kayexelate, diuresis

Question 13

what treatment decreases mortality in cardiac arrest

Answer 13

• high qualtiy compressions and appropriate defib
• limited to no med efficacy