Exam 1 ACLS Flashcards
What HR would be considered bradyarrhythmia?
Less than 50 bpm
What is the leading cause of bradycardia?
What are other causes of bradycardia?
Hypoxia
MI/infarction
Drugs/toxicities (CCB, BB, Dig)
Hyperkalemia
What can persistent bradyarrhythmia cause?
Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF
What do you do if someone is bradycardic but clinically stable?
Monitor and observe
What is the treatment for bradycardia?
1 mg Atropine every 3 to 5 minutes.
Max: 3 mg
What to do if atropine is ineffective for bradycardia?
Transcutaneous pacing and/or dopamine infusion or epinephrine infusion.
Dopamine infusion: 5-20 mcg/kg/min TTE
Epinephrine infusion: 2-10 mcg/min TTE
Why do you have to be cautious about when giving atropine for adult bradycardia?
A very low dose (0.1 mg) can actually worsen bradycardia. Make sure you give 1 mg.
How do you treat bradycardia secondary to calcium channel blockers?
Give Calcium
How do you treat bradycardia secondary to beta blockers?
Glucagon and give something for rate support while the glucagon kicks in
How do you treat bradycardia secondary to digoxin?
Digibind or Digifab
What is the rate for CPR?
100-120 compressions/min
Features of quality CPR?
Push hard (2 in) and fast (100-120/min)
Minimize interruptions in compressions
Avoid Excess ventilation
Change Compressors every 2 minutes or fatigued
30:2 compression: ventilation ratio if no airway
ETCO2 > 35-45 mmHg (normal)
ETCO2 of what level indicates perfusion.
15 mmHg
Shock Energy for Defibrillation
Biphasic:
Monophasic:
Shockable rhythms:
Non-shockable rhythms:
Biphasic: Manufacturer recommendation (120 to 200J)
Monophasic: 360J
Shockable rhythms: V-fib/ pulseless V-tach
Non-shockable rhythms: PEA/Asystole
Drug Therapy for Cardiac Arrest
Epinephrine IV/IO: 1mg every 3 to 5 minutes
Amiodarone IV/IO: first dose 300mg bolus, second dose 150mg
Lidocaine IV/IO: First dose 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg
Should you stop CPR to place an advanced airway?
No, oftentimes a supraglottic airway (LMA) will be placed during the code. Once the patient is stabilized, they will be intubated.
What is used to confirm and monitor ET tube placement?
Waveform capnography or capnometry
With an advanced airway, one breath will be delivered every ______ seconds.
6 seconds/ 1 breath
What are indications of Return of Spontaneous Circulation (ROSC).
Palpable Pulse
Blood Pressure, spontaneous atrial pressure wave
Abrupt sustained increase in ETCO2 (15 mmHg to 40 or 50 mmHg)
What are your reversible causes of cardiac arrest (H’s and T’s )
Hypovolemia - give blood, fluids
Hypoxia - oxygen and airway
Hydrogen Ion (acidosis)- bicarb and ventilation
Hypo/Hyperkalemia
Hypothermia- cold hearts are irritable
Tension Pneumothorax - can result in PEA, decompress chest
Tamponade, Cardiac- Pericardiocentesis
Toxins- use antidotes
Thrombosis (PE) -cannulation/ECMO/thrombectomy
Thrombosis (Coronary)-cannulation/ECMO/thrombectomy
How often do you defibrillate a shockable rhythm?
every 2 minutes
What HR is considered tachyarrhythmia?
HR greater than 150 bpm
What can persistent tachyarrhythmias cause?
Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF