AHA ACLS Flashcards
1
Q
Cardiac Arrest
A
2
Q
pVT/VF) Repeated dos
A
Immediate Defib (initial 200J), CPR, Antiarrhythmic & EPI
3
Q
Stable vs Medical PT assessment
A
4
Q
ACS
A
5
Q
NCT stable vs unstable
A
Stable} Vagal, medicate, SVT (Adeno & Diltiazem) other NCT (Diltiazem, Verapamil, Beta-Blockers)
Unstable} Cardiovert SVT 50-100 (AFib RVR 120-200)
6
Q
WCT stable vs unstable
A
Stable} Med (Procain
Unstable} usually cardiovert 100-200
7
Q
ROSC
A
Dopamine, Infusion if needed, TCP probably
8
Q
Adult Bradycardia
A
Unstable) TCP
Stable) Medicate (atropine)
9
Q
Bradycardia stable vs unstable
A
Stable} medicate (Atropine)
Unstable} TCP
10
Q
Cardiovert dose
A
Inital 100J
200, 300, 360J
11
Q
TCP) doing
A
- Turn Pacer on
- 80BPM
- mA sync till capture
- check mechanical
- Increase 2-5mA
12
Q
Defib) Biphasic end max dose
Monophasic end max dose
A
= 120-200j
= 360j
13
Q
CPR) simple cycle
A
- Rhythm pulse check
- Defib if needed
- CPR 30:2
- Medicate appropriately
- RHYTHM/PULSE CHECK
- SHOCK IF NEEDED IF NOT CPR
14
Q
A
15
Q
L)
A
16
Q
L)
A
17
Q
L)
A
18
Q
L)
A
19
Q
L)
A
20
Q
L)
A
21
Q
L)
A
22
Q
L)
A
23
Q
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
A
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
24
Q
Defib) indication
Contra:
Rhythms
Initial & after doses:
A
= “Dead fibers” TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100J 200J 300J 360J
25
Pacing) indication
Rhythms
Initial & after:
= "pick up the pace" <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till' capture
26
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
27
Bradycardia Stable vs Unstable
28
Asystole & PEA 3 needs
CPR, NEVER SHOCK, EPI
29
ROSC
30
CPR tasks/delegating
2 people) 30:2, Airway, IO access, self scribe & timer
4-5 people) Pit crew, 2 rotating CPR, 1 BVM, partner checking pulse sites, Medicate, Self shock & admin
31
SVT treatment
32
Bradycardia treatment
33
AFib w/ RVR treatment
34
VT treatment
35
pVT/VF treatment
36
TCP
Defib
Cardiovert
= "pick up the pace" unstable bradycardias
= "for dead fibbers" pVT, VF, TdP
= "Convert to regular speed" Unstable Tachycardias
37
Defib initial dose:
Cardiovert initial dose:
TCP initial dose:
= 100-200
= 50-100 (120-200 AF RVR)
= 80BPM, mA till capture ~50 to 85mA (start 50mA like BP)
38
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
39
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
40
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose (17mg/kg)
41
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
42
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
43
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
44
Defib) indication
Contra:
Rhythms
Initial & after doses:
= "Dead fibers" TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100-200/300/360J
45
Pacing) indication
Rhythms
Initial & after:
= "pick up the pace" <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till' capture
46
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
47
Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
48
Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
49
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
1. Termination of rhythm
2. HypoBP
3. Widening QRS>50%
4. Meet the max total dose (17mg/kg)
50
Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
51
Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
52
L)
53
L)
54
L)
55
L)
56
L)
57
L)
58
L)
59
L)
60
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT's w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
61
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
62
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
63
Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
64
Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
65
Cardioversion/vert) Indication
Rhythms
intial & after Doses:
= UNSTABLE} SBP <90 & AMS
= Bradycardia, AF w/ SVR,
= 50-100J then 200J 300J 360J
66
Defib) indication
Contra:
Rhythms
Initial & after doses:
= "Dead fibers" TdP (only rhythm defib awake)
= Asystole VT w/ Pulse stable
= pVT, VF, TdP
= 100J 200J 300J 360J
67
Pacing) indication
Rhythms
Initial & after:
= "pick up the pace" <50BPM UNSTSBLE} SBP <90 & AMS
= BPM <50
= 80BPM mA till' capture
68
Monophasic monitor Jules max
Biphasic monitor Jules max
360J
200J
69
Antiarrhythmics for pVT, TdP, VF
pVT/ TdP= Lidocaine & Aminodarone
Tdp= Mag-Sulfate
70
SVT shock dose
Cardiovert 50-100/200/300/360J
71
AFib w/ RVR shock dose
Cardiovert 120-200/300/360J
72
A-Flutter w/ RVR shock dose
Cardiovert 50-100/200/300/360J
73
VT with pulse &unstable shock dose
pVT & VF shock
cardiovert 100/200/300/360J
Defib 200J 300/360J
74
Tdp shock dose
defib 200/300/360J
75
SVT stable RX
Vagal, Adenosine 6mg 12mg, Diltiazem 0.25mg/kg (M20mg) 0.35/kg (M25mg)
76
AFib & Flutter w/ RVR, MAT, Junctional tachycardia stable RX:
= DONT VAGAL, Diltiazem 0.25mg/kg (M20mg) 0.35/kg (M25mg), Verapamil 2.5-5mg, Beta-Blockers
77
Bradycardia Stable Rx
Atropine 1mg/3-5mins
78
Diazepam/Versed) Adult Dose:
2.5-10 mg in 2.5 mg increments slow IV/IO/IM
79
Aspirin)
=160-325mg PO
80
Atropine) Bradycardia (w/ or w/o ACS) dose:
Severe dose:
Organophosphate poisoning:
=1 mg IVP 3-5mins as needed (Don't exceed 0.04mg/Kg (total 3mg))
=1mg IVP (3mins) in severe clinical conditions
=2-4mg (or higher) IVP
81
Epinephrine 1:10,000): Cardiac arrest:
Bradycardia dose:
Normovolemic hypotension & severe anaphylaxis:
=1mg IVP/IOP every 3-5mins
=2-10mcg/min IV/IO infusion (0.002-
=2-10mcg per min—> mix 1mg of Epi 1:10,000 into a 1 liter bag of fluid
82
Fentanyl):
IN route:
=1mcg/kg to max of 100mcg (IV/IO/IN) → may repeat PRN in 5-10mins
=Max of 1mL per nare admin/ed IN
83
Labetalol):
10mg IV/IO push over 1-2mins & May repeat every 10mins to a max dose of 150mg
84
Mag-Sulfate)Cardiac arrest due to suspected hypomagnesemia/ Tdp:
Tdp w/ pulse:
Maintenance infusion:
= 1-2grams diluted in 10mL
= 1-2grams mixed in 50-100mL admin/ over 5-60mins
=0.5-1gram per hour
85
Morphine): STEMI:
NSTEMI-ACS:
= 2-4mg IV/IO (slow); may give + doses of 2-8mg IV at 5-15min intervals
=0.1mg/kg IV/IO (slow) or IM up to 10mg
86
Nitroglycerin):
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
87
NORepinephrine):
= 0.1-0.5mcg/kg/min IV/IO infusion
88
Ondansetron (Zophran):
= 4-8mg IV (slow), IM, PO
89
Procainamide): Recurrent VF/VT:
Maintenance Infusion:
Urgent situationships:
= 20mg/min (max total dose: 17mg/kg)
= 1-4mg/min
= up to 50mg/min may be admin/ to total dose of 17mg/kg
90
Verapamil): 1st:
2nd:
Max dose:
=2.5-5mg IV/IO bolus over 2-3mins
= 5-10mg over 2-3 mins
=20mg
91
Etomidate (Amidate) IVP:
= 0.2-0.4 mg/kg (limit to 1 dose) Onset w/in 30 secs. Duration: 5-10 mins
92
Ketamine (Ketalar): IVP:
= 1-2mg/kg, Onset 1 min, Durations 10-20 mins
93
Diltiazem) 1st dose:
2nd dose:
= 0.25 mg/kg (max dose 20 mg)
= 0.35 mg/kg (max dose 25 mg)
94
Dopamine) Dosing:
Adult & Pedi Cardiac dose:
Adult & Pedi Vasopressor dose:
= 2–20 mcg/kg/min Titrate to patients response
= 5-10mcg/kg/min
= 10-20 mcg/kg/min
95
Epi 1:10,000) Admin via:
(Adult) Cardiac Arrest dose:
(Adult) Bradycardia dose:
(PEDI) Bradycardia/Cardiac Arrest dose:
(PEDI) Hypoperfusion & Severe anaphylaxis dose:
= IV infusion drip
= 1mg IVP/IOP every 3-5 mins
= 2-10 mcg/min IV/IO infusion
= 0.01 mg/kg or 0.1 mL/kg
= 0.1-1 mcg/kg/min infusion by Mixing 1mg of Epi 1:10 into 1L IV bag
96
Lidocaine) Max dose:
Cardiac Arrest from VF/pVT dose:
Refractory VF dose:
Perfusing Arrhythmia dose:
Maintenance Infusion dose:
= 3 mg/kg
= 1-1.5 mg/kg IV/IO
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= may give additional 0.5-0.75 mg/kg IV/IO in 5-10 mins
= 1-4mg/min (30-50 mcg/kg/min)
97
Mag-Sulfate) Bronchodilation or TdP arrest Adult Dose:
Bronchodilation Pedi Dose:
= 1-2G IV/IO over 10-20 mins (Infusion)
= 25-50 mg/kg IV/IO (max 2G) over 15-30 mins (Infusion)
98
NORepi) Adult Dose:
Pediatric Dose:
= 0.1–0.5 mcg/kg/min IV/IO infusion
= 0.1–2 mcg/kg/min IV/IO infusion
99
(Labetalol) Max dose:
Adult Dose:
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
100
Dobutamine) adult dose:
PEDI dose:
= 2-20mcg/kg/min- titrate so HR cant rise>10% baseline (pt HR arrival)
= 2-20mcg/kg/min
101
Aspirin)
=160-325 mg PO of nonenteric coated ASA.
102
ketamine) Sedation Dose:
Pain dose:
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
103
(Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
104
(Amiodarone) Class:
Dynamics:
Indi:
B/c its toxicity indi:
W/ expert consultation may be used for:
Terminal elimination:
= Class III antiarrhythmic
= Slows K+ efflux delaying repolarization on all of heart
= VF/Pulseless VT-no/response to shock CPR & Epi, Recurrent hemodynamically unstable VT w/ pulse
= PT w/ life-threatening arrhythmias w/ monitoring
= some atrial & ventricular rhythms w/ life-threatening hypoBP
= Extremely long (half-life lasts max 40 days)
105
(Amiodarone) Contra:
Effects:
Caution b/c:
= Allergic, Bradycardias w/ AV blocks, Breastfeeding mothers
= Severe hypotension, Bradycardia, Prolong QT which can lead to TdP
= Toxicity, Causes severe BP drop, Prolong QT which can lead to TdP
106
(Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
107
(Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
108
(Atropine) indications:
Contraindications:
Avoid:
= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace
109
(Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
110
(Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
111
(Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
112
(Dobutamine) class:
Dynamics:
= synthetic sympathetic agonist
= A&B agonist w/ inotropic prop/s > Chronotropic prop/s
113
(Dopamine) class:
pharmacodynamics
= sympathetic agonist
= A/B agonist rate dependent vasopressor +chron/in/Drom/otropic
114
(Dopamine) indications:
Contraindications:
= CHF, HypoBP w/ shock signs, 2nd med for sympathetic Bcardia (after Atropine)
= hypovolemic PTs til' vol/ replaced, pheochromocytoma, Dont mix w/ sodium bicarb
115
(Fentanyl) effects:
dose:
Admin notes:
= Resp/ arrest/depres/, AMS, Bcardia & Prolong of QT interval, +vagal tone b/c suppress/ sympathetic path/s, HypoBP, N/V
= 1mcg/kg IV/O(max 100mcg) may repeat PRN in 5-10mins (Max 1mL per nare) if admin/ed IN
= Chest wall rigidity so admin slowly, Depresses every- thing/where
116
(Furosemide) class:
pharmacodynamics:
= Loop diuretic
= Blocks absorption of Na, Cl, & water from kidney thus +urinination
117
(Furosemide) indications:
Contraindications:
= Acute pulmonary edema in PTs w/ SBP >90-100mmHg (w/o signs of shock) Hypertensive emergencies
= Hypovolemia Hypotension Hypokalemia or other suspected electrolyte abnormalities
118
(Glucagon) class:
pharmacodynamics:
= Hormone
= Binds to Glucagon receptors & stim/s adenyl cyclase & +cAMP thus an up-reg/ Ca channels in SA & AV nodal cells
119
(Glucagon) cardiac indications:
Contraindications:
= Bradycardia suspected from Beta-Blocker or Ca-Channel Blocker OD
= Bradycardia from etiology (disease origin), Known hypersensitivity
120
(Glucagon) effects
Dose:
= Anxiety, Chest palp/s, H/A, N/V, Hyperglycemia
= 3-10mg IV slowly over 3-5 mins Followed w/ infusion 3-5mg per hour
121
(Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
122
(Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
123
(Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
124
Lidocaine) Class:
Dynamics:
= Ib Antiarrhythmic
= Blocks Na channels in cardiac cells thus depolarization slows & decreases automaticity in ventricles
125
(Lidocaine) Ind:
Contra:
Effects:
= Stable monomorphic VT w/ preserved LVF & Alternative to Amiodarone in cardiac arrest by VF/pVT
= Shouldn’t use if PT already received IV Ca channel blockers, Not given prophylactically in AMI setting
= Drowsiness, Slurred Speech, Confusion, Seizures, Hypotension
126
(Mag-Sulfate) Class:
Dynamics:
= Misc. Airway med, Mineral, powerful noradrenergic bronchodilator
= Organic Salt act as a physiologic Ca-channel blocker Bronchodilator
127
(Nitroglycerin) class:
pharmacodynamics:
= nitrate
= Potent vasodilator opens coronary vessels to improve blood flow to myocardium thus Decreases overall workload of heart/afterload
128
(Nitroglycerin) indications:
Contraindications
= Symptoms suggestive of Myocardial ischemia CHF
= HypoBP (SBP<90 or >30 below baseline BP) Severe Bcardia<50bpm, Tcardia>100bpm, Use of phosphodiesterase inhibitors (Boner pills) in last 48 hours, Increased ICP, RVI
129
(Nitroglycerin) effects:
dose:
=H/A, Dizziness, Weakness, Tcardia, HypoBP (tablets lose effectiveness after exposed to sun/air)
= 0.4mg SL (pill or spray) → repeat 3x (Q5 mins) for total dose of 1.2mg
DONT SHAKE SPRAY B/C AFFECTS DOSE
130
(NORepi) Class:
dynamics:
= Synthetic hormone Vaso-pressor “Sepsis med”
= A/B-adrenergic agonist (A effects > B effects)
131
(NORepi) Indi:
Contra:
Effects:
= Normovolemic hypotension, Septic shock, Cardiogenic shock
= hypovolemia PTs til’ Vol/replacement occurred
= Hypertension, Organ ischemia, Cardiac arrhythmia, Tissue necrosis w/ extravasation, Palpitations, Anxiety, N/V
132
(Ondansetron) class:
pharmacodynamics:
= selective Seratonin 5-HT3 receptor blocker/antagonist
= Serotonin 5-HT3 receptors @the vagal-N. Can initiate the gag reflex when stim/ed; Zofran is antiemetic/antag/ of 5-HT3 receptors inhibiting serotonin release on central/peripheral vagal nerve
133
(Ondansetron) indi/s:
Contra:
= Prevent/control N/B
= Known hypersensitivity to med
134
(Ondansetron)effect:
dose:
= HypoBP, Tcardia, Extrapyramidal reaction (=impaired motor control), Prolong QT
= 4-8mg IV (slow), IM, PO
135
(Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
136
(Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med
137
Titrate to effect & CONSTANTLY check BP & HR:
= NORepi, Epi 1:10, Dopamine, Dobutamine
