OnlineMedEd: Cardiology - "ACLS Easy"

Question 1

Why is synchronous rhythm important?

Answer 1

If you shock during a T wave, it will send the person into torsades.

Question 2

Give Dustyn’s protocol for working up ACLS rhythms when the patient has a pulse.

Answer 2

• First: is it an arrhythmia?
- If no (e.g., normal sinus rhythm, SVT, or bradycardia), then this is not an ACLS problem.

•Second: if it is an arrhythmia, is the person symptomatic?
- If no (i.e., absence of SOB, angina, AMS), then give O2, IVF, and monitor on the telemetry unit.

•Third: if they are symptomatic, are the unstable?

• If they are unstable (given by new-onset SBP less than 90, SOB, AMS, or angina), then shock fast rhythms or pace slow rhythms.
• If they are stable, then use medical management.

Question 3

Go through the three types of medical management for stable, symptomatic arrhythmias.

Answer 3

• Fast with wide QRS complexes: amiodarone
• Fast with narrow QRS complexes: adenosine (unless it is atrial fibrillation or flutter in which case see that card)
• Slow: atropine (prepare to pace)

Question 4

Review the treatments for atrial fibrillation/flutter.

Answer 4

•It depends on if they have CHF:

• If yes, then amiodarone and digoxin.
• If no, then beta-blockers and CCBs.

Question 5

What are the two categories of pulseless cardiac issues?

Answer 5

• VT/VF: identifiable by ECG

* Pulseless electrical activity / asystole: PEA is any electrical activity not VF/VT and asystole is a flat line

Question 6

How should you treat the two type of pulseless presentations?

Answer 6

• VT/VF:

• CPR for two minutes
• Shock
• Epinephrine and amiodarone

• PEA/asystole:

• CPR
• Epinephrine