ACLS

Question 1

which rhythms are shockable

Answer 1

VF, pVT

Question 2

which rhythms are not shockable

Answer 2

asystole, PEA

Question 3

high quality CPR

Answer 3

rate 100-120 compressions/min, depth at least 2 inches, allow chest recoil, minimize interruptions

Question 4

what are the ABCs

Answer 4

airway, breathing, circulation

Question 5

which line is preferred

Answer 5

central line, meds reach the heart faster

Question 6

intraosseous

Answer 6

used when IV access not available, treat as a central line

Question 7

endotracheal

Answer 7

last line option for vascular access, absorption occurs in alveolar capillaries, doses often 2-2.5x higher than IV

Question 8

administer _____ after each med administered

Answer 8

NS flush 10-20 mL

Question 9

how does epinephrine work

Answer 9

increases coronary perfusion pressure

Question 10

negative side effects of epinephrine

Answer 10

tachycardia, dysrhythmias, increased myocardial oxygen demand

Question 11

IV/IO dose for epinephrine

Answer 11

1 mg q3-5 min

Question 12

endotracheal dose for epinephrine

Answer 12

2-2.5 mg q 3-5 min

Question 13

how does amiodarone work

Answer 13

antidysrhythmic properties through inhibition of sodium, potassium and calcium channels and alpha/beta adrenergic receptors

Question 14

IV/IO dose for amiodarone administration

Answer 14

300 mg push once followed by 150 mg push

Question 15

endotracheal dose for amiodarone

Answer 15

can’t be given via endotracheal tube.

Question 16

pearl for amiodarone

Answer 16

only give IV push if patient is pulseless, IV push can cause hypotension and bradycardia in patients with a pulse

Question 17

what is one alternative to amiodarone in ACLS algorithm

Answer 17

lidocaine

Question 18

how does lidocaine work

Answer 18

antidysrhythmic properties through inhibition of Na channels

Question 19

IV/IO dose for lidocaine

Answer 19

1-1.5 mg/kg once then 0.5-0.75 mg/kg if needed. may repeat for maximum total dose of 3 mg/kg

Question 20

endotracheal dose for lidocaine

Answer 20

2-4 mg/kg once then 1-2 mg/kg if needed

Question 21

what are the reversible causes

Answer 21

H’s and T’s

Question 22

H’s

Answer 22

hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia

Question 23

T’s

Answer 23

tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), thrombosis (cardiac)

Question 24

magnesium indication

Answer 24

cardiac arrest due to torsades or hypomagnesemia

Question 25

magnesium mechanism

Answer 25

inhibits calcium channels, suppressing early abnormal depolarizations responsible for arrhythmias

Question 26

magnesium dose

Answer 26

1-2 g diluted in 10 mL D5W or NS given over 5-20 minutes. rapid administration can cause hypotension in patients with a pulse

Question 27

sodium bicarbonate indication

Answer 27

acidosis or hyperkalemia

Question 28

mechanism of sodium bicarbonate

Answer 28

neutralizes acidosis; pushes K into cells via H/K exchange

Question 29

dose of sodium bicarbonate for acidosis

Answer 29

1 mEq/kg/dose IV/IO; repeat doses as needed guided by arterial blood gas

Question 30

dose of sodium bicarbonate for hyperkalemia

Answer 30

50 mEq once IVP/IO

Question 31

naloxone indication

Answer 31

suspected opioid overdose

Question 32

naloxone mechanism

Answer 32

opioid receptor antagonist

Question 33

naloxone dose IV/IM/SQ

Answer 33

0.4-2 mg

Question 34

naloxone dose intranasal

Answer 34

4-8 mg

Question 35

naloxone dose endotracheal tube

Answer 35

0.8-4 mg

Question 36

when should you give atropine for adult bradycardia

Answer 36

persistent bradyarrhythmia causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure

Question 37

what meds to give for adult bradycardia if atropine is ineffective

Answer 37

dopamine or epinephrine

Question 38

atropine mechanism

Answer 38

inhibits muscarinic acetylcholine receptors, increasing automaticity of SA & AV nodal cells

Question 39

atropine dose

Answer 39

0.5-1 mg q3-5 min, max total dose 3 mg

Question 40

dopamine mechanism

Answer 40

dopaminergic & beta-1 adrenergic receptor agonist

Question 41

dopamine dose

Answer 41

5-20 mcg/kg/min; titrate by 5 mcg/kg/min every 2 minutes

Question 42

epinephrine mechanism of action

Answer 42

beta1 receptor activation results in increased inotropy and chronotropy

Question 43

epinephrine dose

Answer 43

initial dose 2-10 mcg/min, max 40 mcg/min

Question 44

treatments for adult tachycardia

Answer 44

atropine (nonpharm: vagal maneuvers)

Question 45

what to do if persistent tachycardia causing: hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure

Answer 45

synchronized cardioversion, consider sedation; if regular narrow complex, consider adenosine

Question 46

if persistent tachycardia with no symptoms and wide QRS > 0.12 s

Answer 46

IV access & 12 lead ECG, consider adenosine only if regular & monomorphic, consider antiarrhythmic infusion

Question 47

if persistent tachycardia with no symptoms and no wide QRS

Answer 47

IV access & 12 lead ECG, vagal maneuvers, adenosine if regular, CCB or BB

Question 48

how do vagal maneuvers work

Answer 48

intended to stimulate vagal nerve, resulting in acetylcholine release and slowing of conduction through AV node

Question 49

examples of vagal maneuvers

Answer 49

bear down, blow through a syringe, immersion of face in ice water

Question 50

adenosine mechanism

Answer 50

slows conduction through AV node, 6 mg rapid IVP, can follow with 12 mg IVP if needed... MUST BE RAPID PUSH

Question 51

what to counsel patient before adenosine

Answer 51

may feel impending doom or feeling of dropping on a rollercoaster

Question 52

which line is preferred for adenosine

Answer 52

central line. if peripheral, raise extremity