ACLS Flashcards
(44 cards)
What is cardiovascular collapse?
A sudden loss of effective blood flow that is caused by cardiac or peripheral vascular factors that may revert spontaneously (e.g., syncope) or only with interventions (e.g., cardiac arrest)
Define Cardiac Arrest
The absence of cardiac mechanical activity as confirmed by the absence of a detectable pulse, unresponsiveness, and apnea or agonal gasping breathing
Define Sudden Cardiac Death
Sudden cardiac death is a natural death of cardiac cause that is preceded by an abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status.
What are the 2 shockable cardiac arrest rhythms?
V-Tach
V-Fib
What are the 2 non-shockable cardiac arrest rhythms?
Asystole
Pulseless Electrical Activity
What are the 2 types of electrical therapy?
Defibrillation and synchronous cardioversion
Define defibrillation (aka synchronized countershock)
Electrical energy (shock) is delivered without regard to the cardiac cycle
Define synchronous cardioversion
Electrical energy (shock) is delivered during ventricular depolarization (when the patient’s QRS complex is sensed)
What are the 3 indications for defibrillation?
Ventricular fibrillation
Pulseless monomorphic ventricular tachycardia
Sustained polymorphic ventricular tachycardia
What are the 4 indications for synchronous cardioversion?
Unstable atrial fibrillation
Unstable atrial flutter
Unstable monomorphic ventricular tachycardia
Unstable narrow-QRS tachycardia
V-Fib: What types of defibrillation do you use?
Yes. Use biphasic (120-200 J) monophasic (360 J), AED
V-Fib: What is the CPR protocol?
CPR for 2 minutes: 30 compressions + 2 breaths and repeat
V-Fib: What drugs do you give?
Epinephrine: 1 mg every 3-5 min
OR Vasopressin: 40 U (in lieu of 1st/2nd Epi dose)
Amiodarone: 300 mg IVP (may repeat IV bolus once in 5 min @ 150 mg)
Lidocaine (if no amiodarone): 1.5 mg/kg (max=3 mg/kg)
V-fib: What do you do between each step?
Defibrillation + CPR and recheck rhythm
What is the rate/rhythm for monomorphic V-tach?
100-250 bpm and regular
What does unstable monomorphic V-tach indicate and what are the accompanying Sx?
Indicates hemodynamic compromise
Sx: Lightheadedness, hypotension, SOB, diaphoresis, chest discomfort
What drugs do you give for stable (aka asymptomatic) monomorphic V-tach?
Give one of the following:
1. Amiodarone: 150 mg IV over 10 minutes
- Procainamide: 20-50 mg/min IV
- Sotalol: 100 mg over 5 minutes
What is the protocol for unstable monomorphic V-tach?
Sync. Cardioversion @ 100 J
What is the protocol for monomorphic V-Tach that is pulseless?
Same protocol as V-Fib
What is the rate/rhythm of polymorphic Vtach?
150-300 bpm. Can be regular or irregular.
What is almost always associated with polymorphic V-tach? What does this indicate in terms of Tx?
Indicates hemodynamic compromise, which means it should be treated with defibrillation, even if pt has a pulse
How does non-sustained polymorphic V-tach usually present?
Syncope and seizures
What is it called if there is polymorphic V-tach with a prolonged QT interval? How do you Tx it?
Torsade de pointe: Tx with 1-2 g IV magnesium sulfate
What is the first thing you do once you confirm ventricular asystole on an EKG?
CPR + IV access
