Anesthesia ACLS, Bradycardia, Power Outage Flashcards
(34 cards)
Most recent changes to anesthesia-specific ACLS:
- CAB versus ABC
- removed Vasopressin
- includes opioid-associated algorithm
- more attn to post-arrest care
Perioperative cardiac arrest is…
- uncommon
- variable causes
- usually witnessed
- frequently anticipated
- rescuer knowledgeable
Frequency of intraoperative cardiac arrest
5-7 per 10,000 anesthetics
Sources of intraoperative cardiac arrest
- hypoxia
- emergency surgery
- intraop cardiac events
- hemorrhage, hypovolemia
- PO resp depression
- auto-PEEP
- vagal response
- human factor related complications
Predictors of intraop cardiac arrest
- # of RBC transfusions
- ASA >=3
- poor preop fxnl status
- type of sx
- emergency sx
Top 3 causes of cardiac arrest in perioperative setting
- vasovagal events
- hypovolemia
- hypoxia
Most common presenting rhythm associated with intraop cardiac arrest
bradycardia
(then asystole, tachy/VT/VF)
Treatment for stable bradycardia
Ephedrine 5mg
Glycopyrrolate 0.2mg
Treatment for unstable bradycardia
Epi 10-100mcg up to 1mg
Atropine 0.5-1mg up to 3mg
- prepare to TCP
- begin Epi/Dopamine infusions
Treatment for overdose of a BB
Glucagon 2-5mg IVP
Treatment for overdose of CCB
Calcium chloride 1g IV
Treatment for overdose of Digoxin
Digoxin immune FAB - ask pharmacy for pt-specific dosing
Frequency of delayed defibrillation
1 out of 7 pts with VT/VF in perioperative setting
EtCO2 value associated with successful ROSC
EtCO2 = or > 20mmHg
EtCO2 value associated with failure of ROSC
EtCO2 < 10mmHg after 20mins ACLS
Anesthesia ACLS calls for continuing resuscitative efforts for…
at least 45-60 mins
(60-75 mins?)
Diastolic pressure and CVP associated with higher rate of ROSC?
Diastolic 30-40mmHg via art line
CVP >15mmHg
Epi dose for LAST
<1mcg/kg
Drugs to avoid in treatment of LAST
- Vasopressin
- CCB
- BB
- other LA
When treating LAST, CPR should be continued for…
60-75 mins
Failing RV is best managed by 2 things:
1) pulm vasodilators
2) positive inotropes
What electrolyte imbalance should be considered for any new wide complex tachycardiac?
hyperK+
First treatment for hyperk+ should involve cardiac protection. What drug should be administered?
calcium chloride or calcium gluconate 1-2g IV
ACLS modifications for MH treatment include…
treating the underlying disorders (hyperK+ and acidosis)
