ACLS

Question 1

best place to survive cardiac arrest

Answer 1

vegas

Question 2

Cardiac arrest rhythms

4

Answer 2

1. VF
2. pVT
3. PEA
4. Asystole

Question 3

immediate goal ACLS

Answer 3

return of spontaneous circulation (ROSC)

Question 4

Cardiac arrest survival dependens on

Answer 4

BLS +/- ACLS

Question 5

CPR cycle

Answer 5

Start CPR: give O2 + attach monitor (defib)
2 min cycle
End of cycle: pulse + rhythm check
Drug therapy:
* IV/IO EPI every 3-5 min
* Amio/Lido if refractor VF/pVT (try 2-3 shocks first)
Treat reversile causes

quality CPR: 100-120/min; 2cm deep

Question 6

Medication role in ACLS

Answer 6

No proven benefit
Only specific therapy proven to increase surivial to discharge = defib of VF/pVT

Question 7

Shockable rhythms

Answer 7

Ventricular Fibrilation
pulseless Ventricular Tachycardia

Question 8

Non-shockable rhythms

Answer 8

Asystole
Pulseless electrical activity

Question 9

VT/VF treatment

Answer 9

CPRx2min
Shock #1: CPR 2min + IV/IO access
Shock #2: CPR 2 min + EPI 3-5min
* Consider advanced airway capnogrpahy
Shock #3: CPR 2min + Amio/Lido+ treat reversible causes

if non-shockable rhythm - CPR+ EPI

Question 10

Asystole/PEA treatment

Answer 10

EPI ASAP
CPRx2 min + EPI 3-5 min
* Consider advanced airway capnogrpahy
CPRx2 min, treat reversible causes
If still no signs of ROSC: continue CPR/EPI

Question 11

Medication ROA

Answer 11

1. IV
2. IO
3. ET*

* NAVEL drugs

Question 12

NAVEL drugs

Answer 12

Naloxone
Atropine
Vasopressin
Epi
Lidocaine

Question 13

Endotracheal ROA considerations

Answer 13

give 2-2.5x of IV/IO dose down ET tube (lung absorption)
Requires dilution 5-10ml SWFI or NS

Question 14

Vasoactive agents role in ACLS

Epinephrine

Answer 14

vasoconstriction = organ perfusion (cerebral/coronary)
increases arterial/aortic diastolic pressures

Question 15

Epinephrine dose

Answer 15

1mg IV/IO every 3-5 min
Give ASAP for non-shockable rhythms for ROSC

Question 16

Antiarrythmics role in ACLS

Answer 16

Help cell re-establish electrical activity
normalize abnormally depolarizing/conducting heart cells
Poor evidence to suggest routine use = improve survival
Lido ≥ Amio
Magnesium: torsades (+) VF/pVT only

Question 17

Amiodarone dose

VF/pVT, stable VT with pulse

Answer 17

VF/pVT: 300 mg IV bolus
* may repeat 150 mg IV bolus in 3-5 min
* flush with 20 ml NS for circulation
if stable VT (pulse)
* 150mg IV over 10 min

Question 18

Amiodarone ADR

Answer 18

bradycardia, hypotension d/t diluent
* consider adding vasopressor to minimize hypotension

QTc prolongaiton - avoid use if hx, opt lidocaine instead

Question 19

Lidocaine dose

weight based dosing

VF/pVT, stable VT with pulse, ROSC

Answer 19

VF/pVT: 1-1.5 mg/kg IV or IO
* may repeat 0.5-0.75 mg/kg every 5-10 min
stable VT with pulse
* 0.5-0.75 mg/kg IV

with ROSC: give as drip to prevent arryhtmia
* infuse 1-4 mg/min

Question 20

Magnesium dose

Answer 20

dose not well established
generally: 2g IV bolus
flush with 10-20ml NS
if pulse: infuse
no pulse: bolus

wide complex QRS
Torsades (VF/pVT)

Question 21

reversible causes of arrest acronym

Answer 21

H & T

Question 22

H’s

reversible causes of arrest

Answer 22

hydrogen ion
hyperkalemia

hypothermia
hypoglycemia
hypovolemia
hypoxia

Question 23

T's | reversible causes of arrest

Answer 23

Tension pneumothorax Tamponade,cardiac Toxins Thrombosis * pulmonary * coronary

Question 24

Hypovolemia tx | loss of effective circulating volume * trauma, blood loss

Answer 24

restore volume: Lactated ringers Normal saline PRBC other blood factors

Question 25

Hypoxia tx | lack o2

Answer 25

give 100% O2 mask

Question 26

Hydrogen ion Tx | H+ acidosis, acidemia

Answer 26

Severe metabolic acidosis * No buffer/bicarb Pre-existing metabolic acidosis (pH <7.1-7.2) * consider bicarb

Question 27

Hypothermia Tx

Answer 27

CPR + restore body temp simultaneously Do not stop CPR until core temp reached

Question 28

Hyperkalemia tx

Answer 28

1. stabilize myocardial membrane * Calcium Cl or gluconate 2. intracellular K+ shift * Sodium bicarb * Insulin + dextrose if hypo * Albuterol neb not feasible 3. Excretion once ROSC * diuresis, kayexalate, dialysis, potassium binding resins | renal, dialysis, drug induced

Question 29

Toxin tx

Answer 29

Opioid: IV naloxone push Local anesthetic tox: lipid emulsion TCA: sodium bicarb etc

Question 30

What is the utility of bicarb in ACLS? | there are three

Answer 30

1. Hyperkalemia 2. TCA toxicity 3. Severe pre-existing metabolic acidosis - maybe

Question 31

Cardiac Tamponade tx

Answer 31

needle relieve pericardium fluid

Question 32

Tension pneumothroax tx | identified by ultrasound/CXR

Answer 32

Needle release air caused by lung injury, broke ribs, trauma, etc

Question 33

Thrombosis tx | pulmonary, cardiac

Answer 33

PE: alteplase/tenecteplase * ECLS, ECMO catheters MI: tenecteplase, alteplase, PCI