ACLS Stations

Question 0

Symptomatic Wide QRS Bradycardia

Answer 0

PDE
Pacing (transcutaneous) consider sedation
Dopamine infusion (2-10mcg/kg/min)
Epinephrine infusion (2-10mcg/kg/min)

Question 1

Symptomatic Narrow QRS Bradycardia

Answer 1

APDE
Atropine (0.5mg q 3-5min. Max 3mg total)
Pacing (transcutaneous) consider sedation
Dopamine infusion (2-10mcg/kg/min)
Epinephrine infusion (2-10mcg/kg/min)

Question 2

What are the three questions to determine treatment for symptomatic tachycardia?

Answer 2

1. Stable or unstable?
2. Wide or narrow?
3. Regular or irregular?

Question 3

Treatment for stable monomorphic V-Tach?

Answer 3

Amiodarone (150mg Mixed in 100cc NS infused over 10min)
Lidocaine (1-1.5mg/kg SIVP q 3-5min @ 0.5-0.75mg/kg, max 3mg/kg)
Procainimide (20-30mg/min until arrhythmia suppressed, hypotensive, QRS increases by >50% or 17mg/kg given)

Question 4

Treatment for unstable monomorphic V-Tach?

Answer 4

Synchronized Cardioversion (100j, 200j, 300j, 360j bi-phasic energy or manufacturer specs)

Question 5

Treatment for polymorphic V-Tach?

Answer 5

Magnesium Sulfate (2G IV infusion over 10min)
Un-synchronized Defibrillation (200j, 300j, 360j bi-phasic energy or check manufacturer specs)

Question 6

Treatment for stable, narrow QRS, regular tachycardia (SVT, A-Flutter)?

Answer 6

• Vagal maneuvers
• Adenosine (6mg RIVP followed by 20cc NS bolus, elevate extremity)
• if needed, after 1-2min, Adenosine (12mg RIVP followed by 20cc NS bolus, elevate extremity)
• if needed, after 1-2min, Adenosine (12mg RIVP followed by 20cc NS bolus, elevate extremity)
• Consider calcium channel blocker, Cardizem (0.25mg/kg SIVP max of 25mg single dose q 15min @ 0.35mg/kg max of 25mg)

Question 7

Treatment for unstable, narrow QRS, regular tachycardia (SVT, A-Flutter)?

Answer 7

• Synchronized cardioversion (50j, 100j, 200j, 300j, 360j bi-phasic energy or manufacturer specs); consider sedation prior to shock
• Consider Adenosine (6mg RIVP followed by 20cc NS bolus) while preparing cardioversion

Question 8

Treatment for stable, narrow QRS, irregular tachycardia (A-Fib)?

Answer 8

• Vagal maneuvers
• Calcium Channel Blocker: Cardizem (0.25mg/kg SIVP over 2min followed by 20cc NS bolus max 25mg single dose repeated @ 0.35mg/kg SIVP over 2 min max 25mg single dose every 15min)

Question 9

Treatment for unstable, narrow QRS, irregular tachycardia, no WPW (A-Fib)?

Answer 9

Synchronized cardioversion (120-200j, 300j, 360j bi-phasic energy or manufacturer specs); consider sedation prior to shock

Question 10

Treatment for unstable, narrow QRS, irregular tachycardia, with WPW (A-Fib)?

Answer 10

• Amiodarone (150mg mixed in 100cc NS infused over 10min)
• Synchronized cardioversion (100j, 200j, 300j, 360j bi-phasic energy or check manufacturer specs); consider sedation prior to shock