ACLS Flashcards
1
Q
Improvement in quality CPR is needed if PetCo2 is less than?
A
10 mm Hg
2
Q
Improvement in quality CPR is needed if relaxation phase/diastole (intra-arterial pressure) is less than?
A
20 mm Hg
3
Q
Monophasic shock energy for defibrillation:
A
360 J
4
Q
Biphasic shock energy for defibrillation should follow manufacturer recommendation (eg, initial dose of 120-200 J); if unknown, use:
A
maximum available
5
Q
Drug Therapy: Epinephrine IV/IO dose:
A
1 mg every 3-5 minutes
6
Q
Drug Therapy: Amiodarone IV/IO dose:
A
First dose: 300 mg bolus
Second dose: 150 mg
7
Q
Advanced airway placement: how many breaths/min?
A
1 breath every 6 seconds (10 breaths/min) - WITH CONTINUOUS CHEST COMPRESSIONS
8
Q
Advanced airway placement requires confirmation documentation with what device?
A
waveform capnography or capnometry
9
Q
ROSC is suspected with abrupt sustained increase in PETCO2, typically above?
A
40 mm Hg
10
Q
ROSC is suspected with identification of what in intra-arterial monitoring?
A
spontaneous arterial pressure waves
11
Q
Reversible causes (H’s):
A
Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-/Hyperkalemia Hypothermia
12
Q
Reversible causes (T’s):
A
Tension pneumo Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary
13
Q
Epi & Amiodarone used for shockable or non-shockable?
A
shockable
14
Q
Epi solo used for shockable or non-shockable rhythms?
A
non-shockable
15
Q
Acceptable depth and rate for CPR Quality?
A
at least 2 inches (5 cm) with full recoil
100-120/min
16
Q
Minimize __________________ in compressions.
A
interruptions
17
Q
Avoid excessive _________________.
A
Ventilation
18
Q
Rotate compressor every ___ minutes, or sooner if fatigued.
A
2
19
Q
If no advanced airway, _______ compression-ventilation ratio.
A
30:2
20
Q
Heart rate typically less than ______ in bradyarrhythmmias:
A
50
21
Q
Oxygen if _________.
A
hypoxemic
22
Q
Symptomatic signs & symptoms:
A
Hypotension Acutely AMS Signs of shock Ischemic chest discomfort Acute HF
23
Q
If Atropine ineffective in bradyarrhythmia:
A
TCP
24
Q
Alternatives to TCP in bradyarrhythmia:
A
Dopamine or Epinephrine
25
Atripine IV dose:
0.5 mg bolus
repeat every 3-5 minutes
Maximum dose: 3 mg (0.04 mg/kg)
26
Dopamine IV infusion dose:
2-20 mcg/kg/min
| Titrate to patient response; taper slowly.
27
Epinephrine IV infusion dose:
2-10 mcg/min
| titrate to patient response
28
Heart rate typically more than ___/min if tachyarrhythmia.
150
29
Unstable tachycardia ->
synchronized tachycardia
30
Consider ________ with synchronized cardioversion.
sedation
31
If regular narrow complex tachycardia, symptomatic, consider __________ in lieu of synchronized cardioversion.
adenosine
32
Wide QRS =
greater than/= 0.12 second
33
In wide QRS tachycardia, consider adenosine only if:
regular and monomorphic
34
In wide QRS tachycardia, consider:
antiarrhythmic infusion and/or expert consultation
35
In stable tachyarrythmia, begin with:
vagal maneuvers
adenosine (if regular)
B-Blocker or Calcium channel blocker
Expert consultation
36
Initial recommended dose for synchronized cardioversion of narrow regular:
50-100 J
37
Initial recommended dose for synchronized cardioversion of narrow irregular:
120-200 J biphasic
| 200 J monophasic
38
Initial recommended dose for synchronized cardioversion of wide regular:
100 J
39
Initial recommended dose for synchronized cardioversion of wide regular:
defibrillation dose (not synchronized)
40
Adenosive IV dose:
6 mg rapid IV push and flush
| 12 mg repeat dose if required
41
Procainamide (antiarrhythmic) infusion IV dose:
20-50 mg/min until arrhythmia suppressed, HoTN, QRS duration increases >50%, or max dose of 17 mg/kg given.
42
Procainamide maintenance infusion:
1-4 mg/min
43
Avoid procainamide if:
prolonged QT or CHF
44
Tachycardia amiodarone IV dose:
150 mg over 10 minutes
| repeat as needed if VT recurs
45
Tachycardia amiodarone maintenance infusion:
1 mg/min for first 6 hours
46
Sotalol IV dose:
100 mg (1.5 mg/kg) over 5 minutes
47
Avoid sotalol if:
prolonged QT
48
Sotalol brand name:
BetaPace
49
Procainamide brand name:
pronestyl
50
In ROSC, maintain oxygen saturation at or above 94% and do not:
hyperventilate
51
Treat HoTN (SBP<90 mm Hg) in ROSC with:
IV/IO bolus
vasopressor infusion
consider treatable causes
52
After ROSC, and 12-lead, treat STEMI OR high suspicion of AMI with:
coronary reperfusion
53
If a patient is unable to follow commands s/p ROSC, initiate:
Targeted temperature management
54
If a patient is able to follow commands s/p ROSC, initiate:
advanced critical care
55
Avoid excessive ventilation s/p ROSC. Start at 10 b/min and titrate to target PETCO2 of:
35-40 mm Hg
56
When feasible, titrate FIO2 to minimum necessary to achieve SpO2 of _______ in ROSC.
94%
57
HoTN fluid bolus s/p ROSC dose:
1-2 L NS or LR
58
ROSC epinephrine IV infusion:
0.1-0.5 mcg/kg/min
59
ROSC dopamine IV infusion:
5-10 mcg/kg/min
60
ROSC Norepinephrine IV infusion:
0.1-0.5 mcg/kg/min
61
First drug for most forms of stable narrow-complex SVT.
Adenosine
62
Effective in terminating stable narrow-complex SVT's due to reentry involving AV node or sinus node.
Adenosine
63
This drug may be considered for unstable narrow-complex reentry tachycardia while preparations are made for cardioversion.
Adenosine
64
This drug may be used for regular and monomorphic wide-complex tachycardia, thought to be or previously defined to be reentry SVT.
Adenosine
65
This medication does NOT convert atrial fibrillation, atrial flutter, or VT.
Adenosine
66
This drug is used as a diagnostic maneuver: stable narrow-complex SVT.
Adenosine
67
This drug is contraindicated in poison/drug-induced tachycardia or second- or third-degree heart block.
Adenosine
68
Transient side effects of this drug include flushing, chest pain or tightness, brief periods of asystole or bradycardia, or ventricular ectopy.
Adenosine
69
This drug is less effective (larger doses may be required) in patients taking theophylline or caffeine.
Adenosine
70
Reduce the initial dose of Adenosine to _______ in patients receiving dipyridamole or carbamazepine, in heart transplant patients, or if given by central venous access.
3 mg
71
If administered for irregular, polymorphic wide-complex tachycardia/VT, this drug may cause deterioration (including hypotension).
Adenosine
72
This drug commonly causes transient periods of sinus bradycardia and ventricular ectopy after termination of SVT.
Adenosine
73
Adenosine is _____ and _________ in pregnancy.
safe; effective
74
Adenosine Adult Dosage; Rapid IV Push
Initial Bolus of 6 mg given rapidly over 1-3 s followed by NS bolus of 20 mL (extremity elevated)
75
Prior to adenosine administration, place patient in mild reverse ________________ position before administration of drug.
Trendelenburg
76
Second dose of Adenosine:
12 mg
77
How soon after 1st dose of Adenosine should 2nd dose be given?
1-2 m
78
During administration of adenosine, begin recording ______________.
rhythm strip
79
Because its use is associated with toxicity, ______________ is indicated for use in patients with life-threatening arrhythmias when administered with appropriate monitoring (VF/pulseless VT unresponsive to shock delivery, CPR, and a vasopressor or recurrent, hemodynamically unstable VT)
Amiodarone
80
With EXPERT CONSULTATION, this drug may be used for treatment of some atrial and ventricular arrhythmias.
Amiodarone
81
This drug has multiple, complex drug interactions!
Amiodarone
82
Rapid infusion of amiodarone may lead to:
hypotension
83
With multiple dosing, cumulative doses of this drug >2.2 b over 24 hours are associated with significant hypotension in clinical trials.
Amiodarone
84
Do not administer this drug with other drugs that prolong QT interval (eg, procainamide)
Amiodarone
85
Terminal elimination of this drug is extremely long (half-life lasts up to 40 days).
Amiodarone
86
Amiodarone dose for VF/pVT Cardiac Arrest unresponsive to CPR, Shock, and Vasopressor
First dose: 300 mg (IV/IO push)
| Second dose: 150 mg (IV/IO push)
87
Amiodarone dose for Life-Threatening Arrhythmias, Rapid Infusion:
150 mg IV over first 10 minutes (15 mg/min).
| May repeat every 10 min as needed.
88
Amiodarone dose for Life-Threatening Arrhythmias, Slow infusion:
360 mg IV over 6 hours (1 mg/min)
89
Amiodarone dose for Life-Threatening Arrhythmias, Maintenance infusion:
540 mg IV over 18 hours (0.5 mg/min)
90
What is the first drug for symptomatic sinus bradycardia?
Atropine
91
Atropine may be beneficial in the presence of:
AV nodal block
92
Atropine is not likely to be effective for:
type II second-degree or third-degree AV block or a block in nonnodal tissue
93
Routine use of this medication during PEA or asystole is unlikely to have a therapeutic benefit
Atropine
94
Extremely large doses of atropine may be needed in nerve agent poisoning such as:
organophosphate
95
Use atropine with caution in the presence of MI and hypoxia. Atropine increases:
myocardial oxygen demand
96
Avoid this drug in hypothermic bradycardia
atropine
97
Atropine may not be effective for infranodal (type II) AV block and new third-degree block with wide QRS complexes. In these patients, may cause
paradoxical slowing
98
In the event of paradoxical slowing after atropine administration, be prepared to pace or give
catecholemines
99
Doses of atropine <0.5 mg may result in
paradoxical slowing of heart rate
100
Atropine dose in Bradycardia with or without ACS
0.5 mg IV
every 3-5 minutes as needed
max dose 0.04 mg/kg (total 3 mg)
101
Use shorter dosing intervals (3 minutes) and higher doses of atropine in severe
clinical conditions
102
Atropine in organophosphate poisoning (extremely large doses may be needed)
2-4 mg
103
Second drug for symptomatic bradycardia
Dopamine
104
Use this drug for hypotension (SBP <70-100 mm Hg) with signs and symptoms of shock
dopamine
105
When using dopamine, correct ________________ with volume replacement before initiating dopamine
hypovolemia
106
Use with caution in cardiogenic shock with accompanying CHF
dopamine
107
may cause tachyarrhtyhmias, excessive vasoconstriction
dopamine
108
do not mix this drug with sodium bicarbonate
dopamine
109
Dopamine IV administration dose
2-20 mcg/kg/min
| titrate to patient response, taper slowly
110
Epinephrine can be considered after atropine as an alternative infusion to dopamine in:
symptomatic bradycardia
111
This drug can be used in severe hypotension when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase enzyme inhibtor
epinephrine
112
Combine epinephrine with large fluid volume, corticosteroids, and antihistamines for
anaphylaxis, severe allergic reactions
113
By raising blood pressure and increasing heart rate, this drug may cause myocardial ischemia, angina, and increased myocardial oxygen demand
epinephrine
114
High doses of epinephrine do not improve survival or neurologic outcome and may contribute to postresuscitation:
myocardial dysfunction
115
Higher doses of epi may be required to treat poison or
drug induced shock
116
Cardiac Arrest Epinephrine Dose (1:10,000)
1 mg (10 mL of 1:10,000 solution)
q 3-5 mins during resuscitation
chase with 20 mL flush, elevate arm for 10-20 secs
117
Cardiac Arrest Epinephrine Higher Dose:
up to 0.2 mg/kg may be used for specific indications (beta/calcium channel blocker overdoses)
118
Continuous infusion epinephrine dose:
Initial rate: 0.1 - 0.5 mcg/kg/min
| titrate to response
119
Epinephrine dose ETT route:
2 - 2.5 mg diluted in 10 mL NS
120
Epinephrine dose for profound bradycardia or hypotension
2-10 mcg/min infusion
| titrate to response
121
_____________ is an alternative to amiodarone in cardiac arrest from VF/pVT.
Lidocaine
122
This drug can be administered for monomorphic VT with preserved ventricular function
lidocaine
123
This drug can be administered for polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected
lidocaine
124
This drug can be used for stable polymorphic VT with baseline
lidocaine
125
This drug is indicated if QT-interval prolongation is torsades is suspected
lidocaine
126
Lidocaine is contraindicated for prophylactic use in _____
AMI
127
Reduce maintenance dose of lidocaine (not loading dose) in presence of impaired liver function or
LV dysfunction
128
Discontinue lidocaine infusion immediately if signs of _______________ develop
toxicity
129
Adult dosage of lidocaine in cardiac arrest
Initial dose: 1-1.5 mg/kg IV/IO
Refactory VF re-bolus: 0.5-0.75 mg/kg IV push, repeat in 5-10 mins
Max 3 doses or total of 3 mg/kg
130
Adult dosage of lidocaine in perfusing arrhythmia (stable VT, wide-complex tachycardia of uncertaine type, significant ectopy)
Dose range 0.5-0.75 mg/kg and up to 1-1.5 mg/kg may be used.
Repeat 0.5-0.75 mg/kg every 5-10mins
Max total dose 3 mg/kg
131
Lidocaine maintenance infusion (adult)
1-4 mg/min (30-50 mcg/kg/min)
132
Recommended for use in cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present
magnesium
133
life-threatening ventricular arrhythmias due to digitalis toxicity
magnesium
134
routine administration in hospitalized patients with AMI is not recommended
magnesium sulfate
135
An occasional fall in blood pressure with rapid administration
magnesium
136
Use with caution with this ACLS med if renal failure is present
magnesium sulfate
137
Magnesium dose in cardiac arrest (hypomagnesemia or Torsades de Pointes)
1-2 g (2-4 mL of a 50% solution diluted in 10 mL [eg, D5W, NS] given IV/IO)
138
Magnesium dose for Torsades de Pointes with a pulse or AMI with hypomagnesemia
Loading dose: 1-2g mixed in 50-100mL of diluent (eg, D5W, NS) over 5-60 mins.
Follow with 0.5-1g per hour IV (titrate to control torsades)
