Medic ACLS Flashcards
Normal Sinus Rhythm
Rate: 60-100
Rhythm: Regular
P Wave: Before each QRS
Upright and uniform
PRI: 0.12-0.20
QRS: <0.12, alikeEpinephrine (infusion)
Dose (Brady): 1-10 mcg/min
(Post-arrest) 0.1-0.5mcg/kg/min
Supply: 1:10,000
Mix:1 mg/ 250ml (4:1)
2 mg/ 250ml (8:1)
Hint: Clock methodSinus Bradycardia
1) <0.12, alike
Sinus Tachycardia
1) 100-150
2) regular
3) before each QRS, upright
4) 0.12-0.20
5) <0.12, alike
Atrial Flutter
1) a-240-350, v-variable
2) regular
3) no p waves, f waves are present
(Sawtooth or picket fence)
4) n/a
5) <0.12, alike
Atrial fibrillation
1) a-350-700, v-variable
2) irregularly irregular
3) no p waves, f waves
4) n/a
5) <0.12, alike
(Any irregular narrow QRS rhythm is a-fib unless p-waves present)
Premature Atrial Complexes (PAC)
1) Usually Normal (underlying rhythm)
2) Regular mostly (except PAC)
3) Differs in shape, size and location
5) variable
5) similar, <0.12
Sinus Dysrhythmia
1) 50-100, frequently + inspiration,-expiration
2) Irregular (more than 0.08 variance)
3) Before each QRS, upright
4) 0.12- 0.20
5) Alike, <0.12
Sinus Arrest
1) Variable
2) Irregular
3) Present and upright if QRS is present
4) 0.12 - 0.20
5) Alike, 0.12-0.20
Normal Sinus Rhythm
1) 60-100
2) Regular
3) Before each QRS, Upright
4) 0.12 - 0.20
5) alike, <0.12
Superventricular Tachycardia
1) 160-240
2) Regular
3) Non-discernable
4) Non-discernable
5) alike, <0.12
Wandering Pacemaker
1) 60-100
2) May be slightly irregular
3) change in shape, size and location, but present
4) variable
5) yes, usually <0.12
Multifocal Atrial Tachycardia
1) >100
2) Irregular
3) At least 3 different forms
4) variable
5) variable
Procainamide Stop Points
1) Arrhythmia suppressed
2) Hypotension
3) QRS widens by >50%
4) Max dose 17mg/kg reached
Tachycardia Algorithm (unstable)
HR > 150 w/pulse ALS Sypmtomatic - Yes Sedation (ativan, versed) Syncronized Cardioversion SVT,Aflutter=50,all others 100,200,300,360
Tachycardia Algorithm (stable, wide QRS)
HR >150 w/pulse
ALS
Symptomatic - NO
QRS - wide
Consider Adenosine (6mg, 12mg, 20ml flush)
or
Procainamide (20-50 mg/min)
or
Amioderone (150mg,300mg/10min)]
or
Sotalol (100mg/5min)Tachycardia Algorithm (stable, narrow QRS)
HR >150 w/pulse
ALS
Symptomatic - NO
QRS - Narrow
Vagal Maneuvers
Adenosine (6mg, 12mg, 20ml flush)
or
Beta Blocker
or
Calcium Channel Blocker
Cardizem (15-20mg/kg/2min = .25mg/kg
20-25mg/kg/2min = .35mg/kg)Premature Junctional Complex (PJC)
1) Underlying Rhythm
2) Usually Regular except for PJC
3) Missing or inverted with PJC
4) 0.12-0.20
5) <0.12
Accelerated Junctional Rhythm
1) 60 - 100
2) Regular
3) Inverted/absent/retro
4) <0.12
Junctional Rhythm
1) 40-60
2) Regular
3) Absent/inverted,retro
4) None, short, retro
5) <0.12
Junctional Beat
1) underlying rhythm
2) Irregular when beat occurs
3) absent/inverted/retro in excape beat
4) None, short, retro
5) <0.12
Junctional Tachycardia
1) 100-180
2) Regular
3) Absent/inverted/retro
4) None, short, retro
5) <0.12
3rd degree block
1) 60-10
2) Regular
3) Extra - do not match QRS
4) inconsistent
5) normal
(consistent p-p and r-4, not same)
2nd Degree Type II (Mobitz II)
1) 60-100
2) Regular
3) Extra p waves
4) Consistently long
5) Present, <0.12
2nd degree type I (Mobitz I) (Wenckebach)
1) 60-100
2) Irregularly Irregular
3) Extra P-waves
4) Insonsistent
5) <0.12
1st degree block
1) 60-100
2) Regular
3) Before each QRS
4) >0.20
5) <0.12
Brdycardia Algorithm
HR<50 ALS Symptomatic? No = Monitor Yes Atropine (0.5mg q 3-5min, max 3mg) ineffective Transcutaneous Pacing or Dopamine (2-20 mcg/kg/min) or Epinephrine (2-10 mcg/min
Epinephrine 1:1000
Dose: 0.3mg IV/IM
Supply: 1:1,000 (1mg/mL)
Indication: Allergic Reaction, Difficulty Breathing
Glucagon
Dosage: 1mg IM
Supply: 1 mg/1 ml
Indication: Hypoglycemia
Dosage: 3mg IV
Supply: 1mg/1ml
Indication: Reverse Beta Blocker Overdose
Morphine
Dosage: 1.0-10.0 mg IV w/o orders
Supply: 10mg/ml
Indications: extreme pain
Dosage: 1-2 mg/ 6-10min IV
Supply: 10mg/ml
Indications: Reduce venous return in AMI or PE
Sodium Bicarbonate
Dose: 1 mEq/kg IV
Supply: 50 mEq/50mL
Indications: TAD overdose, acidosis, hyperkalemia, long downtime
Haloperidol
Dose: 5mg < 60khg > 10mg IV/IM
Supply: 5mg/ 1ml
Indications: Acute psychotic disorders
Diazepam
Dose: 10mg 5mg IV/IM
Supply: 10mg/ 2ml
Indications: Stop seizure activity
(Valium)
Midazolam
Dose: 1mg/min 0.5mg/min Max: 5mg 3mg IV Supply: 5mg/ 5ml Indications: induce sedation/amnesia for cardioversion (versed)
Lorazepam
Dose: 1mg IV/IM Max: 2mg Supply: 1mg/ 1ml Indications: induce sedation for cardioversion (Ativan)
D-50
Dose: 25mg IV
Supply: 25mg/ 50mL
Indications: Hypoglycemia
Salvos
Series of 3 or more PVC’s
Ventricular Fibrillation (VFib)
1) Indeterminate
2) Chaotic
3) None
4) None
5) None
Idioventricular rhythm
1) 20-40
2) Regular
3) None
4) None
5) Wide, Bizarre appearance
Accelerated Idioventricular Rhythm
1) 41-100
2) Regular
3) None
4) None
5) Wide, bizarre appearance
Premature Ventricular Contraction (PVC)
1) Underlying Rhythm
2) Irregular when PVC occurs
3) None associated with PVC
4) None associated with PVC
5) Wide, bizarre appearance
Ventricular Bigeminy
PVC every 2nd beat
Ventricular Trigeminy
PVC every 3rd beat
Venticular Quadrigeminy
PVC every 4th beat
Couplets
Paired PVC’s
Torsades de Pointes
1) >100
2) Irregular
3) None
4) None
5) Wide, Polymorphic
Magnesium Sulphate
Dose: 2G/ 100ml/ 10min
Supply: 5G/10ml
Indications: Respiratory distress
Dose: 1-2 G IV q .5-1g/hr
Supply: 5G/10ml
Indications Torsades de pointes
Naloxone
Dose: >65yo = 2mg, .4mg
<65yo = .4mg
Max: 8mg
Supply: 2mg/ 2ml
Indications: respiratory depression due to OD of opiate, narcoticLasix
Dose: 1mg/kg
Supply: 100mg/10ml
Indications: acute pulmonary edema/ CHF
Albuterol
Dose: 2.5mg in 3.0ml NS via nebulizer
Supply: 2mg/3ml
Indications: Bronchospasm
Atrovent
Dose: 0.5mg/2ml via nebulizer
Supply: .5mg/2ml
Indications: bronchospasm
Nitroglycerin
Dosage: 0.4mg SL
Max: 3 doses or BP<90
Supply: 0.5mg tabs, spray
Indications: Chest pain associated with MI
Atropine
Dosage: 0.5mg IV
Max: 3mg or 0.04 mg/kg
Supply: 1mg/10ml
Indications: Brdycardia
Dose: 2-4 mg or higher
Indications: Organophosphate poisoning
Dopamine
Dose: 2-20 mcg/kg/min
Start at 5mcg/kg/min
Supply: 400mg/250ml or 800mg/500mll
Indications: Bradycardia
2mcg = Dopamanergic
5mcg = Beta 1
5-10 mcg = Alpha and Beta
10-20 mcg = Alpha
Adenosine
Dose: 6mg iv/ 12 mg IV followed by 20 ml NS
Supply: 6mg/2ml or 12mg/4ml
Indications: Tachycardia
Amioderone
Dose: 150mg/10min - 300mg
Supply: 150/3ml
Indications: Wide QRS Tachycardia
Cardizem
Dose: .25mg/kg/min (15-20mg/2min)
.35mg/kg/min (20-25mg/2min)
Supply: 25mg/5ml
Indications: narrow QRS tachycardia
