Final study guide: ACLS

Question 1

Sinus Brady

Answer 1

P/R check 1
BP check 1
*Atropine Q4 minutes, max 3 mg (reflex brady) 1
P/R check 2
BP check 2
H&T
P/R check 3
BP check 3
*Atropine 1 mg 2
BP check 4
P/R check 4
BP check 5
~ 2 minutes ~
P/R check 5
BP check 6
Placer pads IMMEDIATELY
ROSC?

Question 2

In brady, what is the max for atropine

Answer 2

3 mg, so 3 rounds of 1mg boluses 3-5min apart

Question 3

Pulseless Asystole/PEA

Answer 3

P/R check 1
CPR 1
*Epi 1 mg Q2 min, no max 1
Call RT/intubate
P/R check 2
CPR 2
P/R check 3
CPR 3
*Epi 1 mg 2
P/R check 4
CPR 4
H&T
P/R check 5
CPR 5
*Epi 1 mg 3
ROSC?

Question 4

how long do you wait between epi doses? how big of dose? max?

Answer 4

1mg 3-5min apart, no max (but start to ask yourself if it’s really doing anything after a number of pushes)

Question 5

Tachy w/o Pulse AND Tachy w/Pulse

Answer 5

P/R check
Stable?
Cardiovert 100 J
Pulse?
Rhythm change? Go to that algorithm

Question 6

V-Fib/Pulseless V-Tach (kill me)

Answer 6

P/R check 1
Defib 120 J 1
CPR 1
P/R check 2
Defib 150 J 2
CPR 2
Epi 1 mg 1
Call RT/Intubate
P/R check 3
Defib 200 J 3
CPR 3
Amiodarone 300 mg OR Lidocaine 1-1.5 mg/kg 2
H&T
P/R check 4
Defib 200 J 4
CPR 4
Epi 1 mg 2
P/R check 5
Defib 200 J 5
CPR 5
Amiodarone 150 mg OR Lidocaine 0.5-0.75 mg/kg 2
P/R check 6
Defib 200 J 6
CPR 6
Epi 1 mg 3
P/R check 7
Defib 200 J 7
CPR 7
P/R check 8
Defib 200 J 8
CPR 8
Epi 1 mg 4
ROSC?

Question 7

ROSC

Answer 7

*Mange airway
- Start 10 breaths/min
- SpO2 92-98%
- PaCO2 35-45 mmHg
*Manage hemodynamic parameters
- Systolic BP > 90 mmHg
- MAP > 65 mmHg
*Obtain 12-lead EKG
*Consider for emergent cardiac intervention if:
- STEMI
- Unstable cardiogenic shock
- Mechanical circulatory support required
*Follows commands?
Yes:
- TTM
- Obtain brain CT
- EEG monitoring
- Other critical care management
No:
- Other critical care management
* Evaluate and tx rapidly reversible etiologies
*Involve expert consultation for continued management