ACLS Flashcards
(96 cards)
in cardiac arrest when do you first introduce medical intervention? which drug?
after 2 rounds of CPR/shock
after 2nd shock give 1 mg epinephrine every 3-5 minutes
when do you introduce amiodarone during cardiac arrest?
after the 3rd shock give 300 mg bolus of amiodarone
if second dose is needed give 150mg as second dose
what rhythms are shockable in cardiac arrest
VF VT
what rhythms are not shockable in cardiac arrest
asystole PEA
if you are in an unshockable rhythm arrest when do you give epi
1mg epi every 3-5 minutes after 1st round of CPR
what do you do after return of spontaneous circulation
maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion
how do you treat non-symptomatic bradycardia
monitor and observe
what constitutes symptomatic bradycardia
hypotension altered mental status signs of shock chest pain acute heart failure
how do you treat symptomatic bradycardia
- give 0.5mg atropine every 3-5 mins to max of 3mg
if that doesn’t work try one of the following:
transcutaneous pacing
2-10mcg/kg / minute dopamine infusion
2-10mcg/minute epinephrine infusion
what is considered a tachycardia requiring treatment
over 150 per minute
when do you consider cardioversion
if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain acute heart failure
if persistent tachycardia does not present with symptoms what do you need to consider
wide QRS?
greater than 0.12 seconds
If persistent tachycardia without symptoms DOES have a wide QRS what to do you do?
IV access and 12 lead if available
6mg adenosine followed by NS flush only IF regular and monomorphic
consider anti-arrhythmic infusion:
- 20-50mg/min procainamide (max 17mg/kg)
- 150mg amiodarone over 10 minutes
- 100mg sotalol over 5 minutes
which anti-arrhythmic drugs can be used if prolonged QT
only amiodarone
150mg over 10 minutes, repeat if VT occurs
follow by maintenance infusion 1mg/min for first 6 hours
if persistent tachycardia without symptoms and without wide QRS what do you do
IV access and 12 lead EKG if available
vagal maneuvers
6mg adenosine followed by NS flush only IF regular
Beta blocker or calcium channel blocker
patient comes in with symptoms of ACS what do you do first
chew 325mg aspirin
O2
nitro
morphine
get 12 lead EKG
IV access
IF ACS patient has EKG showing ST elevation and symptoms are less than 12 hours then what
re-perfusion
door to balloon 90 minutes
door to needle 30 minutes
If ACS patient has EKG showing non ST elevation MI or high risk unstable angina then what
early invasive strategy? adjunctive treatment? -nitroglycerin -heparin -beta blockers -clopidogrel -glycoprotein IIb / IIIa inhibitor
what are the contraindications to fibrinolytics in ACS treatment
systolic > 180
diastolic > 100
right arm left arm systolic difference > 15
history of structural central nervous system disease
recent head/facial trauma
stroke more than 3 hours or less then 3 months ago
recent trauma, surgery or bleed
any history of intracranial hemorrhage
bleeding, clotting problem or on blood thinners
serious systemic disease
adenosine
used in tachy
6mg bolus followed by 20mL normal saline
12mg can be used after 1-2 minutes
amiodirone
In VF/VT arrest AFTER trying CPR shock and epi/vasopressin:
300mg then 150mg
In life threatening arrhythmias:
150mg over 10 minute infusion, every 10 minutes as needed
atropine sulfate
use as first line defense in sinus bradycardia
0.5mg every 3-5 minutes as needed MAX is 3mg ( think alive gets 0.5)
do not use if hypothermia
dopamine
2nd line drug for symptomatic bradycardia
use for hypotension with signs of shock
2-20 mcg/kg per minute
epinephrine
in cardiac arrest:
1mg every 3-5 minutes
in bradycardia or hypotension:
2-10mcg/minute infusion
