ACLS

Question 1

types of rhythms in cardiac arrest

Answer 1

pulseless electrical activity (PEA), asystole, ventricle fibrillation (VF), pulseless ventricular tachycardia (pVT)

Question 2

non-shockable rhythms

Answer 2

asystole and PEA

Question 3

shockable rhythms

Answer 3

pVT and VF

Question 4

PEA and asystole treatment

Answer 4

1. EPInephrine ASAP
2. CPR 2 min cycles
   epi every 3-5 min (every pulse check)

Question 5

pVT and VF treatment

Answer 5

1. shock
2. cpr 2 min cycle
   epi every 3-5 min (every pulse check)
   repeat

Question 6

routes of admin pearl

Answer 6

Intraosseous (IO) equivalent to IV

Question 7

endotracheal tube (ETT) medications

Answer 7

NAVEL
-Naloxone
-Atropine
-Vasopressin
-Epinephrine
-Lidocaine

Question 8

NAVEL dosing

Answer 8

2-2.5x IV dose, repeat the dose when IV access is secured

Question 9

vasoactive agents goal

Answer 9

-increase BP and CO
-induce vasoconstriction and increase systemic vascular resistance, mean arterial pressure (MAP), and organ blood flow

Question 10

vasoactive agents

Answer 10

epinephrine and vasopressin (but removed from ACLS guidelines)

Question 11

epinephrine indications

Answer 11

VF, pVT, PEA, asystole

Question 12

epinephrine dosing and formulation

Answer 12

formulation: 1mg/10mL syringes
dosing: 1mg IVP/IO q3-5min
(high dose not shown improvement over standard dose)

Question 13

epinephrine after ROSC achieved and bradyarrythmias

Answer 13

start drip at 2-10 mcg/min

Question 14

epinephrine side effects

Answer 14

tachycardia, hypertension, tissue necrosis if extravasation

Question 15

anti arrhythmic agents

Answer 15

amiodarone, lidocaine, magnesium (torsades only)

Question 16

antiarrythmic use

Answer 16

VF or pVT unresponsive to defibrillation

Question 17

amiodarone formulation and dosing

Answer 17

formulation: 150mg/3mL vials
dosing: 300mg IV bolus
redose: 150mg IV bolus

Question 18

amiodarone after ROSC achieved

Answer 18

bolus: 150mg IV over 10min followed by 20mL NS flush
maintenance: 1mg/min for 6 hrs, then 0.5mg/min over 18hrs

Question 19

amiodarone side effects

Answer 19

hypotension and bradycardia

Question 20

lidocaine formulations and dosing

Answer 20

formulation: 2% 100mg/5mL syringe
dosing: 1-1.5mg/kg IV/IO
redose: 0.5-0.75 mg/kg q5-10min
stable VT: 0.5-0.75 mg/kg IV

Question 21

lidocaine after ROSC achieved

Answer 21

continuous infusion of 1-4 mg/min

Question 22

lidocaine side effects

Answer 22

hypotension, bradycardia, heart block

Question 23

magnesium (torsades) formulation and dosing

Answer 23

formulation: 50% 1g/2mL vial
dosing: 1-2g bolus flushed with 10-20mL NS

Question 24

reversible causes of cardiac arrest (H&T): H’s

Answer 24

hypovolemia, hypoxia, hydrogen ions, hyperkalemia, hypothermia

Question 25

reversible causes of cardiac arrest (H&T): T's

Answer 25

toxins, cardiac tamponade, tension pneumothorax, coronary thrombosis, pulmonary thrombosis

Question 26

hypovolemia

Answer 26

low fluids: blood loss, dehydration, urine, third spacing

Question 27

hydrogen ions (acidosis)

Answer 27

severe metabolic acidosis caused by increased H+ ions in the blood -bicarb not recommended

Question 28

hypoxia and hypothermia

Answer 28

hypoxia: 100% oxygen through mask hypothermia: heat

Question 29

hyperkalemia

Answer 29

K > 5.5mEq/L

Question 30

calcium chloride for hyperkalemia treatment

Answer 30

formulation: 10% 1g/10mL syringe dose: 1g IV

Question 31

calcium chloride indications

Answer 31

hyperkalemia, hypocalcemia, CCB/BB overdose

Question 32

sodium bicarbonate for hyperkalemia treatment

Answer 32

formulation: 8.4% 50mEq/50mL syringe dose: 1 mEq/kg IV (1 amp) *avoid co-admin with calcium

Question 33

sodium bicarbonate indications

Answer 33

hyperkalemia and TCA overdose

Question 34

naloxone use and dosing

Answer 34

indication: opioid overdose formulation: 0.4mg/mL vial dosing: 0.4mg IV (can repeat)

Question 35

thrombosis (PE and MI)

Answer 35

PE: thrombolytic (alteplase and tenecteplase) MI: PCI

Question 36

pharmacist responsibilities

Answer 36

draw up correct doses, recommend appropriate doses/meds, keep track of timing of epi, drug prep, documentation