Advanced Cardiac Life Support Flashcards
(25 cards)
What medications are in the crash cart?
- Atropine
- Calcium Chloride
- Epinephrine
- Sodium Bicarbonate
- Amiodarone
- Dextrose
- Magnesium Sulfate
- Naloxone
- Norepinephrine
- Adenosine
- Digoxin
Epinephrine dosage
Adult:
* Asthma & allergic reaction - 0.3-0.5 mg of 1:1000 IM
* Cardiac arrest - 1 mg of 1:10,000 IV/IO every 3.5 minutes
* Bradycardia/Hypotension - 2-10 mcg/min (1mg in 250mL NS or D50) infusion titrated to respose.
Difference between Epi 1:1000 and Epi 1:10,000
1:100 is usually packaged in a vial and 1:10,000 is usually in the box. For ACLS algorithm, we use 1m/mL of epinephrine every 3-5 minutes.
So you can give one of the epinephrines from the brown box or take out one mL of saline from a flush, draw out the 1 mg of epinephrine in a vial, and give it that way.
We use saline to help dilute the epinephrine so the body can use it more effectively.
What is Epinephrine?
Common trade names: Adrenaline
Class: Sympathomimetic
Indications:
* Cardiac arrest
* Symptomatic bradycardia
* Allergic reaction
* Asthma
* Shock related hypotension, except hypovolemia
Contraindications:
* None in emergency setting
* Hypovolemic shock
* MI (due to increased myocardial O2 demand)
Adverse reactions:
* Restlesness, headache, nausea, vomiting, pulmonary edema
* Chest pain, tachycardia, hypertension, dysrhythmias
Steps:
1. Grab your code-cart epinephrine. It does not matter if its 1:1000 and 1:10,000 is no longer used and is replaced by mg/mL.
2. Inject the full 1 mg into a 1,000 mL normal saline bag (final concentration 1 mcg/mL)
3. Run wide open in your peripheral IV or IO until the patient’s hemodynamics stablize
Reasoning behind the “Dirty Epi Drip”
* The dirty epi drip is not perft, but it will buy you some time until your team can set up the pump, follow hopsital protocols, and perform double checks.
* The drug has been tested at such dilute concentrations and is stable.
* The maximum rate of infusion will vary with catheter size, IV bag height, and squeeze on the bag; however, with a wide-open 18-gauge IV, the patient will receive about 20-30 mL/min (or 20-30 mcg/min) of epinephrine, which is similar to the recommended push-dose epi (0.1 mg or 100 mcg over 5 minutes = 20 mcg per minute).
* Check pressures frequently and titrate (squeeze the bag, or roller-clamp the line) based on patient’s response.
Common trade names: None
Class: Electrolyte (Anion)
Mechanism of Action:
* Increases force of cardiac contractions (positive inotrope)
* Stabilizes cardiac cells in hyperkalemia
Pregnancy Class: C
Indications and Contraindications for Calcium Chloride
Indications:
* Hyperkalemia with ECG changes.
* Hypocalcemia
* Beta blocker and calcium channel blocker overdose
Contraindications:
* Ventricular fibrillation
* Digitalis toxicity
Adverse reactions:
* Bradycardia, dysrhythmia, hypotension, cardiac arrest.
* Vasodilation, nausea, vomiting, tissue necrosis at injection site.
Calcium Chloride: Drug Interactions and Duration of Effects
Drug interactions:
* Severe bradycardia in patients with digitalis.
* Potentiated by thiazide diuretics.
* Incompatible with other medications (Use separate IV or flush well between medications.)
Duration of effects:
* Onset: Immediate
* Peak effects: Immediate
* Duration: 30 minutes to two hours.
Calcium Chloride Dosage and Special Considerations
Dosage
* Adult: 500 mg - 1g IV/IO slow push
* Pediatric: 20mg/kg (0.2mL/kg) IV/IO slow push
Special Considerations
* Changes cardiac electrical threshold so that the heart doesn’t depolarize as easily.
* Three times more potent than calcium gluconate.
* Monitor for hypotension.
* Rapid injection can cause cardiac arrest.
Common trade names: None
Class:
* Alkalizing agent
* Systemic hydrogen ion buffer
Mechanism of Action:
* Interacts with hydrogen ions and converts to water and carbon dioxide.
* Raises blood pH, thereby reversing the clinical manifestations of acidosis
* Antacid: Reacts checmically to neutralize or buffer quantities of stomach acid but has no effect on its output.
Pregnancy Class: C
Indications:
* Metabolic acidosis in cardiac arrest.
* Tricyclic antidepressant overdose, aspirin, and phenobarbital overdoses
* Hyperkalemia
* Crush injuries
* Severe diarrhea
* Indigestion
Contraindications:
* Metabolic and respiratory alkalosis
* Hypokalemia
* Electrolye imbalance due to vomiting or diarrhea
Adverse Reactions:
* Hypernatremia, metabolic alkalosis, cellulitis, seizures
* Tetany, sodium retention, peripheral edema
Sodium Bicarbonate: Dosage and Drug Interactions
Dosage:
* Adult - 1 mEq/kg IV/IO (Overdoses may require higher dose)
* Pediatric - 1mEq/kg IV/IO (may dilute to 4.2% solution)
Drug Interactions:
* Increases effects of amphetamines
* Decreases effects of benzodiazepines, tricyclic antidepressants
* May deactivate sympathomimetics (flush IV well between medications)
The normal pH value for the human body: ? to ?
The normal pH value for the human body is 7.34 - 7.45
Common trade names: Atropine
Class:
* Anticholinergic
* Parasympatholytic
Mechanism of Action: Inhibits acetylcholine at parasympathetic nerve sites which causes increase in heart rate.
It increases:
* Parasympatholytic (Vagolyic Action)
* Heart rate
* Sinus Node Discharge
* Increased AV Conduction
Pregnancy class: C
Atropine: Indications, Contraindications, and Adverse Reactions
Indications:
* Symptomatic bradycardia
* Organophosphate poisoning or nerve agent exposure
* Premedication with RSI in pediatrics (blunts vagal nerve stimulation)
* Beta blocker or calcium channel blocker overdose
Contraindications:
* Narrow angle glaucoma
* Hypothermic bradycardia
Adverse reactions:
* Tachycardia, palpitations, headache
* Nausea, vomiting, dry mouth, dilated pupils
* Paradoxical bradycardia if pushed too slowly or low dose (<0.1 mg)
Atropine: Dosage and Special Considerations
Bradycardia dosage:
* Adult: 1 mg IV/IO every 3-5 minutes, 3 mg total max dose.
* Pediatric: 0.02 mg/kg IV/IO up to 0.5 mg max single dose. May repeate dose once in 3-5 minutes. Maximum total dose for child is 1 mg; for adolescent is 3 mg.
Organophospate poisoning:
* 2 to 4 mg or higher
Special considerations:
* May be ineffective in heart transplants or infranodal AV blocks.
* Ineffective in 3rd degree heart blocks.
Atropine: Drug Interactions and Duration of Effects
Drug Interactions:
* Adverse effects if given with digitalis, cholinergics, physostigmine.
* Potentiated by antihistamines, procainamide, quinidine, antipsychotics, benzosdiazepines, antidepressants.
Duration of Effects:
* Onset: Immediate, Peak Effects: 2-4 minutes, Duration: 4-6 hours
What routes can we give Atropine in?
- Intravenous
- Intramuscular
- Subcutaneous
- Inhalation
- Oral
- Opthalmic
LifePak 15: How to
Best place to check for a pulse is the femoral.
It is recommended to give an initial shock between 150 and 200 joules for adults. In children, the initial shock is usually 2 joules/kg. Stryker recommends a dosing protocol of 200-300-360 joules.
Common trade names: Cordarone, Pacerone
Class: Antidysrhythmic (Class III)
Mechanism of Action:
* Blocks sodium (Na), potassium (K), and calcium (Ca) channels.
* Prolongs action potential and repolarization
* Decreases sinoatrial node function and atrioventricular node conduction
Pregnancy Class: D (lactating women should not breastfeed following use.
Amiodarone: Indications, Contraindications, and Adverse Reactions
Indications:
* Cardiac arres with ventricular tachycardia or ventricular fibrillation.
* Tachycardias (Heart rate > 150)
Contraindications:
* Cardiogenic shock
* Sinus node disease including sick sinus, 2nd & 3rd degree AV blocks, unless a functioning pacemaker is present.
Adverse Reactions:
* Dizziness, fatigue, tremor, ataxia, pulmonary edema, nausea, vomiting.
* Bradycardia, hypotension, prolonged QT interval
* Stevens-Johnson Syndrome
Amiodarone: Dosage and Drug Interactions
Dosage:
Adult:
* Cardiac arrest: 300 mg IV/IO push, followed by 150 mg over 10 minutes if necessary.
* Tachycardia with a pulse, 150 mg over 10 minutes.
Pediatric:
* Cardiac arrest: 5 mg/kg IV/IO push. May repeat with an infusion up to a max of 15 mg/kg in 24 hours.
Drug Interactions:
* Beta-blockers and calcium channel blockers may potentiate bradycardia, sinus arrest, and AV blocks.
* If used in conjuction, digitalis may cause digitalis toxicity.
What is Magnesium Sulfate?
Class: Electrolyte
Mechanism of Action:
* Corrects Torsades by increasing blood serum magnesium levels
* Reduces striated muscle contractions and peripheral neuromuscular transmission by reducing the release of acetylcholine.
* Can relax bronchial smooth muscles and relax uterus.
Pregnancy Class: D
Magnesium Sulfate: Indications, Contraindications, and Adverse Reactions
Indications:
* Eclamptic seizures
* Torsades de pointes, hypomagnesemia
* Life threatening dysrhythmias due to digitalis toxicity
* Status asthmaticus and bronchoconstriction refractory to beta agonists and anticholinergics
Contraindications:
* Heart blocks
* Myocardial damage
Adverse Reactions:
* CNS depression, hyporeflexia, respiratory paralysis
* Vasodilation, abnormal ECG changes, heart blocks
