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Flashcards in ACLS Deck (30):
0

What are the medications and their dosages you can give for Adult Bradycardia?

Atropine IV Dose: First dose, 0.5 mg bolus. Repeat every 3-5 minutes with max dose of 3 mg

Dopamine IV Infusion: 2-10 mcg/kg per minute

Epinephrine IV Infusion: 2-10 mcg per minute

1

On top of Atropine, Dopamine, and Epinephrine what other treatment can you provide for Adult Bradycardia?

Transcutaneous Pacing

2

What is the first step in the Adult Bradycardia Algorithm?

Assess appropriateness for clinical condition

3

After assessing clinical condition what is the next step in the Adult Bradycardia Algorithm?

Identify and treat underlying causes:

Maintain patent airway; assist breathing as necessary

Oxygen (if hypoxemic)

Cardiac Monitor to identify rhythm; monitor blood pressure and oximetry

IV Access

12 lead ECG if available; don't delay therapy

4

What do you do if persistent bradyarrhythmia is NOT causing hypotension, acutely altered mental status, shock, ischemic chest discomfort or acute heart failure?

Monitor and Observe

5

If persistent bradyarrhythmia IS causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what do you do next?

Atropine first dose: 0.5 mg bolus repeated every 3-5 minutes for a maximum of 3mg dose

6

If Atropine is ineffective for persistent bradyarrhythmia what are your other options for treatment?

Transcutaneous pacing
OR
Dopamine Infusion (2-10 mcg/kg per min)
OR
Epinephrine (2-10 mcg per min)

7

What is the first step in Adult Tachycardia algorithm?

Assess appropriateness for clinical condition

8

After assessing for appropriateness for clinical condition what is the next step in the Adult Tachycardia algorithm?

Identify and treat underlying causes:

Maintain patent airway; assist breathing if necessary

Oxygen (if hypoxemic)

Cardiac monitor to identify rhythm; monitor blood pressure and oximetry

9

If persistent tachyarrhythmia is causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what is the next step?

Synchronized cardioversion

Consider sedation

If regular narrow complex consider adenosine ( 1st dose: 6mg rapid IV push; follow with NS flush; 2nd dose 12mg if required)

10

If persistent tachyarrhythmia is NOT causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort and/or acute heart failure what is the next step?

Check QRS complex width

11

What medications are indicated for stable Wide-QRS Tachycardia?

Procainamide IV Doses: 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50%, or maximum dose 17mg/kg given. Maintenance Infusion: 1-4 mg/min, Avoid if prolonged QT or CHF

Amiodorane IV Dose: First dose 150 mg over 10 minutes, repeat as needed if VT recurs. Follow by maintenance infusion of 1mg/min for first 6 hours

Sotalol IV Dose: 100 mg (1.5mg/kg) over 5 minutes, avoid if prolonged QT

12

What treatment is indicated for stable narrow-QRS tachycardia?

IV Access and 12 lead ECG
Vagal maneuvers
Adenosine (If regular)
B-Blocker or calcium channel blocker
Consider expert consultation

13

What are the recommended dosages for Synchronized Cardioversion?

Narrow regular: 50-100J

Narrow Irregular: 120-200J biphasic or 200J monophasic

Wide Regular: 100J

Wide Irregular: Defribrillation dose (NOT synchronized)

14

Synchronized Cardioversion is in relation to which wave?

R Waves

15

True or False: Adenosine can be considered for unstable Tachycardia and stable tachycardia with wide QRS (if regular and monomorphic)

True

16

What is the first step in VF/Pulseless VT treatment algorithm?

Start CPR

Give Oxygen

Attach Monitor/defibillator

Check if Rhythm is shockable

17

In VF/Pulseless VT what are the two UNSHOCKABLE rhythms?

Asystole/PEA

18

What are the two shockable rhythms?

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

19

If there is unwitnessed or non-quality CPR on a cardiac arrest what should you do prior to shock?

2 min cycle of CPR

20

If you have a witnessed arrest would you begin CPR prior to shock?

No, shock immediately if you have a witnessed arrest with quality CPR

21

What are the two medications you give during cardiac arrest?

Epinephrine IV/IO: 1mg every 3-5 minutes

Amiodarone IV/IO: 300 mg bolus first dose, 150 mg ssecond dose

Cycle drugs between CPR cycles

22

If during cardiac arrest the patient is in Asystole/PEA what is the next step?

CPR cycle 2 min

IV/IO access

Epinephrine 1mg every 3-5 minutes

23

What are the H's and T's?

Correctable Causes:
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypothermia
Tension Pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary

24

Go through stable symptomatic bradycardia algorithm.

Vitals, 02, monitor, IV, Fluids, Transport

Atropine 0.5mg bolus repeat 3-5 minutes max dosage of 3 mg

25

Go through algorithm for unstable symptomatic.

Pacing at rate of 70-80 bpm
milliamps at 40 ma increase 5-10 until mechanical and electrical capture is achieved

Dopamine or epi drip
Dopamine: 5 mcg/kg/min drip
epi: 2-10 mcg/min drip

26

Go through treatment algorithm for Asystole/PEA.

CPR 30:2, BVM 100% O2 15 - 25 LPM, OPA

Every two minute cycle perform pulse/rhythm check and switch CPR roles.

Monitor with Defibrillator pads and 12 lead

Start IV with fluid, intubation with at least 2 confirmation devices, CPR changes to 100 compressions a minute continues with BVM breath every 5 - 6 seconds.

EPI 1:10,000 1mg repeat 3 - 5 minutes

27

What is the acronym MATCHED mean?

MI
Acidosis - 1mcg/kg sodium bicarbonate
Tension Pneumothorax - Needle decompress
Cardiac Tamponade - Nothing medic can do
Hypoxia - O2
Hypoglycemia - Check sugar, if needed push D50 25g
Hypothermia - Blankets, Take patient out of environment
Hypovolemia - Assess lung sounds, give fluids
Hypokalemia
Hyperkalemia
Embolism - Nothing medic can do
Drug overdose - Narcan 0.4 mg - 2 mg max 4 mg


28

Go through V-Fib/ V-Tach treatment algorithm.

Assess pulse, pulseless

Defibrillate immediately if witnessed with quality compressions

CPR 30:2 BVM 100% OPA 15 - 25 LPM after shock or unwitnessed arrest, Monitor with 12 lead and defib pads, IV large bore with fluid TKO

1 mg epi 1:10,000 repeat every 3 - 5 min

Defib after every 2 min cycle

CPR 30:2 with BVM 100% O2 and work on intubation at beginning of new cycles, once tube is confirmed switch CPR to continuous 100 bpm with breath every 5 - 6 seconds

Amiodarone 300 mg 1st dose

CPR, Defib

Epi 1:10,000

CPR Defib

Amiodarone 150 mg

CPR Defib

repeat

29

What is the dosage for Lidocaine?

1 - 1.5 mg/kg first dose

0.5 mg - .75 mg/kg second dose