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Flashcards in ACLS Deck (25)
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1
Q

Cardiac Arrest Rhythms (Pulseless):
Rhythm is NOT Shockable

Pulseless Electrical Activity (PEA)

Treatment for asystole and PEA consists of early identification and treatment of reversible causes and excellent CPR with vasopressor administration

A

Circulation (high quality, uninterrupted CPR immediately), Airway, Breathing

CPR for 2 minutes while establish IV access

Give epinephrine 1 mg IVP every 3-5 minutes OR
vasopressin 40 units IVP to replace 1st or 2nd dose of epinephrine

CPR for 2 minutes; check for shockable rhythm and give epinephrine or vasopressin

Check for shockable rhythm continue CPR
CORRECT UNDERLYING CAUSES

2
Q

Pulseless Electrical Activity (PEA)

A

The myocardium is exhibiting electrical activity but the ventricles are unable to contract

Results from a variety of causes (H’s and T’s)

Cardiac Arrest Rhythms (Pulseless):
Rhythm is NOT Shockable

3
Q

Asystole

Lack of electrical activity (flat line)

End stage terminal rhythm after treatment fails in prolonged VF or PEA

Poorest prognosis

A

Cardiac Arrest Rhythms (Pulseless):

Rhythm is NOT Shockable

4
Q

Underlying Reversible Causes of Asystole and PEA

Drugs

A

Opioids, B-Blockers, calcium channel blockers, digoxin, cocaine, tricyclic antidepressants, local anesthetics, carbon monoxide, and cyanide

OVERDOSE

5
Q

Underlying Reversible Causes of Asystole and PEA

H’s and T’s

A
H’s 
Hypovolemia***
Hypoxemia
Hydrogen Ion (Acidosis)
Hypokalemia/ Hyperkalemia***
Hypothermia
Hypoglycemia
T’s 
Toxin (drug overdose)*
Tamponade (cardiac)
Thrombosis (coronary and pulmonary)
Tension pneumothorax
Trauma
6
Q

Pulseless Cardiac Arrest Rhythms

Pulseless VT/VF -shocks should be delivered promptly

A

High-quality CPR is key!

7
Q

Pulseless Cardiac Arrest Rhythms

Shockable Rhythm

Pulseless VT

A

VT can also cause the heart to beat irregularly, causing the ventricles to “quiver.”
Pulseless VT/VF is considered a MEDICAL EMERGENCY

Circulation (high quality, uninterrupted CPR immediately), Airway, Breathing

  • 1 shock via defibrillator and continue CPR for 2 minutes while establish IV access
  • Immediately resume CPR for 2 minutes and check rhythm
  • 1 shock via defibrillator and continue CPR for 2 minutes
  • Identify and treat possible reversible causes f cardiac arrest
  • Give epinephrine 1 mg IVP every 3-5 minutes OR
  • vasopressin 40 units IVP to replace 1st or 2nd dose of epinephrine**
  • CPR for 2 minutes; check rhythm and give epinephrine or vasopressin
  • Consider amiodarone 300 mg IVP x 1 can repeat 150 mg IVP in 3- 5 minutes if patient remains in pulseless VT/ VF*
  • If torsades de pointes give magnesium 1-2 grams IVP**
8
Q

Defibrillation of Pulseless VT/ VF

Biphasic Technology:Dosing protocol should be:
200J-300J-360J

A

Biphasic waveform sends current one way at the start of the shock and then reverses it so the current flows in the opposite direction.

9
Q

Epinephrine

A

1 mg IV push or IO

Can also be given via ET tube 2–2.5 mg (diluted in 10 mL sterile water)

Repeat every 3 to 5 minutes

10
Q

Vasopressin

A

Dose:
40 units x 1 dose IV/IO (also can give via ET tube)
Half-life is 10- 20 minutes, therefore repeat dosing is not indicated

May replace either 1st or 2nd epinephrine dose

11
Q

Antiarrhythmics

If VF/pulseless VT exists after 2 –3 shocks plus CPR and administration of a vasopressor, consider antiarrhythmic medication

Amiodarone and Lidocaine

A

Amiodarone and Lidocaine

Amiodarone is considered 1st line -1st line antiarrhythmic agent for pulseless VT/ VF

No effect on survival to hospital discharge

12
Q

Amiodarone

AE

A

Hypotension, bradycardia, AV block, QT prolongation

Polyvinyl chloride bags absorb amiodarone

Concentrations > 2 mg /mL require a central line for administration (phlebitis)

13
Q

Amiodarone

A

Initial bolus dose: 300 mg IVP

Additional bolus (if required): 150 mg IVP if pulseless VT/ VF continues

Continuous IV Infusion: return of spontaneous circulation and once stable rhythm occurs

14
Q

Lidocaine

A

Alternative to amiodarone if not available

15
Q

Treatment of Torsades de Pointes

Remove and correct underlying causes (i.e. medications which increasing QT interval)

(2)Treat electrolyte abnormalities (i.e. magnesium and potassium repletion

Potassium Chloride

Normal potassium level
(3.5- 5.0 mEq/L)

A

CODE situation can administer 10 mEq IVP of potassium over 5 minutes

Potassium IV continuous infusion: only

Potassium IV continuous infusion: only
–>Rate should NOT exceed 10 mEq/hour when administering it via PERIPHERAL line and 20 mEq/hour when administered via CENTRAL line

Maximum:Generally check potassium levels after giving 40 mEq IV

16
Q

Magnesium Sulfate

Effective for TdP, even in the absence of hypomagnesemia

A

Dose: 1-2 grams IV

17
Q

CPR Quality

A

If no advanced airway, 30:2
compression-ventilation ratio

If advanced airway (i.e. endotracheal tube), continuous compressions (100 compressions/minute) and ventilate 8-10 times/minute or 1 breath every 6-8 seconds

18
Q

Tachycardia with a Pulse

NO CPR

A

Stable narrow QRS complex tachycardia (with a pulse and hemodynamically stable) Supraventricular Tachycardia (SVT)

Airway, Breathing, Circulation**

Attempt vagal maneuvers

Adenosine 6 mg IVP (repeat dosing in 1-2 minutes) flush with IV bolus of NS
Repeat with Adenosine 12 mg IVP
Continuous IV β- blockers (i.e. esmolol IV infusion) OR

Continuous IV calcium channel blockers (i.e. diltiazem IV infusion)

Treat underlying causes

19
Q

Tachycardia with a Pulse

Special orders

A

Attempt vagal maneuvers

Vagel maneuuvers– slows down the conduction of AV nerve. Bare down like your having a bowel movement.

20
Q

Adult Tachycardia with Pulse

Adenosine

A

Dose: 6 mg IVP followed by IV bolus of NS flush; repeat with 12 mg IVP after 1-2 minutes if needed

Adverse effects (common and transient): chest pain, flushing, headache, and dyspnea

21
Q

Adult Tachycardia with Pulse

Consider continuous IV β- blocker (i.e. esmolol) or IV calcium channel blocker (i.e. diltiazem)

A

Esmolol

Diltiazem

22
Q

Arrhythmia Management

ACLS chain of survival: Interventions to PREVENT cardiac arrest:

Bradycardia

Tachycardia: Supraventricular Tachycardia (SVT)

A

Atropine

Drug of choice for acute symptomatic bradycardia
i.e. altered mental status, chest pain, hypotension

Dose: 0.5 mg IV bolus, repeat every 3- 5 minutes (max 3 mg)

Atropine doses

23
Q

Adult Bradycardia with a pulse:

A

Adult Bradycardia with a pulse:

HR

24
Q

Endotracheal Tube (ET)

LAST LINE

A

NAVEL- medications absorbed by trachea

Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine

Doses required are 2- 2.5 times of IV dose

25
Q

IV Push (IVP)

Peripheral Line
Central Line

A

Preferred route of administration–CENTRAL

Central line preferred but must hold CPR for insertion

Fast and convenient-PERIPHERAL-Elevate the arm for 10- 20 seconds (i.e. peripheral line)

After administration of medication must flush with a IV bolus of normal saline(NS) (10- 20 mL) and elevate arm for 10- 20 seconds for peripheral line administration

Use IV and IO routes if possible

Continue CPR while medications are being administered