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What rhythms require unsynchronized high-energy shocks?
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Which rhythms are not shockable?
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ADULT CARDIAC ARREST
ACLS V/F/PULSELESS VT, ASYSTOLE/PEA
| Question | Answer |
|---|---|
| What rhythms require unsynchronized high-energy shocks? | VF and VT |
| Which rhythms are not shockable? | PEA and Asystole |
| An adult collapses from cardiac arrest. What do you do? | Shout for help/Activate the Emergency Response System |
| Your patient is unconscious. Help is on the way. What do you do in the meantime? | . Start CPR, Give oxygen, Attach monitor/defibrillator |
| The Rhythm is VF or pulseless VT. What do you do? | Deliver shock |
| Give an example of how the person delivering the shock should alert team members. | “Clear. I am going to shock on three.” “One, two, Three. Shocking” |
| One shock has been delivered. No ROSC. What’s next? | CPR for 2 minutes (5 cycles) and IV/IO access. No pulse check. Then check rhythm. Deliver shock if indicated. |
| Two shocks have been delivered without return of ROSC. What’s next? | CPR for 2 minutes. Epinephrine 1 mg every 3-5 minutes (Vasopressin 40 units can replace 1st or 2nd dose of epi) followed by 20 ml flush. Elevate limb to aid in distribution of drug. Consider advanced airway and capnography |
| Name and explain the relevant values when using capnography. | <10mm Hg – attempt to improve CPR quality; 35-40mm Hg – target range; > 40 mm Hg sustained indicates ROSC |
| At what rate should breaths be delivered to the patient with an advanced airway and compressions in progress? | one breath every 6-8 seconds, ideally during chest recoil, no need to interfere with compressions, to equal 8-10 breaths per minute |
| Two shocks have been delivered. Epinephrine has been administered. CPR is in progress. What’s next? | Check Rhythm. Deliver shock if indicated. |
| Third shock has been delivered. Patient is in refractory VF. What’s next? | Administer Amiodarone 300mg bolus followed by 20ml flush. Look for and treat reversible causes |
| What is the second dose of Amiodarone? | 150mg |
| What are the H’s and T’s? | Hypovolemia, Hypoxia, Hydrogen Ions (Acidosis), Hypo-HyperKalemia, Hypothermia, Tension pneumothorax, Tamponade-cardiac, Toxins, Thrombosis-pulmonary or coronary |
| What is the initial and following energy levels when delivering shock for VF and pulseless VT? | Biphasic 120-150 j, second and third doses should be equivalent or higher; Monophasic 360 j |
| What energy level should be used to shock a patient who recovers from VF then goes back into the arrhythmia after displaying an organized rhythm? | Deliver subsequent doses at the previously successful energy level. |
| What if a nonshockable rhythm is found? | Give CPR for 2 minutes. Gain IV/IO access and give epinephrine 1 mg every 3-5 minutes (1st or 2nd dose may be replaced by Vasopressin 40 units) consider advanced airway and capnography |
| Patient is in Asystole or PEA. CPR has been in progress for 2 minutes, epinephrine administered, airway intact. What’s next? | Analyze Rhythm |
| The rhythm remains nonshockable. What’s next? | Check for and treat reversible causes. Then check for shockable rhythm. |
| Describe the appropriate timing for pulse checks in order to avoid prolonged interruptions in compressions. | Check pulse only when an organized rhythm is observed, preferably during rhythm analysis. |
| What course of actions follows a palpable pulse and organized rhythm? | Proceed to post cardiac arrest care. |
| What course of action follows a questionable pulse and organized rhythm? | Immediately resume CPR |
| What is the appropriate dose of the antiarrhythmic amiordarone? | 300mg IV/IO bolus, then consider an additional 150mg IV/IO once |
| If Amiodarone is not available lidocaine is an acceptable option. What is the appropriate dosing of lidocaine? | 1-1.5mg/kg IV/IO first dose, then 0.5-.75mg/kg IV/IO at 5-10 minute intervals to a maximum dose of 3mg/kg |
| When is magnesium sulfate indicated? | only for torsades de pointes associated with a long QT interval |
| What is the appropriate dosing for magnesium sulfate? | 1-2g IV/IO diluted in 10mL of d5w given as a IV bolus typically over 5-10 minutes |
| What action is necessary if intra-arterial diastolic pressure is <20mm Hg? | attempt to improve quality of CPR |
| If Petco2 is less than 10, what actions can be taken? | Improve chest compressions and vasopressor therapy |
| What actions can be taken of arterial relaxation pressure is < 20 mm Hg? | Improve chest compressions and vasopressor therapy |
| Describe how ACLS would differ for the hypothermic patient. | Reduce the rate of drug administration to allow for slowed metabolism and avoid toxic drug levels. Vasopressors are appropriate. Antiarrhythmics have not been proven effective for hypothermia. Re-warm the patient. |
| Severe hypothermia is defined as 30 degrees Celsius. What’s that in Fahrenheit? | 86 |
| Describe proper drug administration using a peripheral IV during CPR. | Give by bolus unless otherwise indicated, Follow with 20mL normal saline bolus, Elevate extremity for 10-20 seconds to promote delivery to central circulation |
| How long does it take for drugs administered via peripheral IV during CPR to take full effect? | It will take several cycles of CPR for the drug to take effect. |
| What drugs can be given the ET tube? How are they administered? | Epinephrine, Vasopressin, and Lidocaine, Dose is 2-2.5 times the IV dose, dilute the dose in 5-10 mL of sterile water or NS and inject the drug directly into the trachea |
| What are the limitations to drug administration via ET tube? | Results are variable and unpredictable in drug absorption and blood levels. |
| What is the function of vasopressors in CPR? | Vasopressors are used to optimize cardiac output and blood pressure |
| What vasopressors are utilized during CPR? | Epinephrine 1 mg IV/IO q 3-5 minutes, Vasopressin 1 dose of 40 units can replace the first or second dose of epinenphrine, follow each dose with 20 ml of flush and elevation of the limb for 10-20 seconds |
| How does epinephrine work to improve chances of ROSC? | Epinephrine acts on andrenergic receptors causing vasoconstriction resulting in increased blood pressure and heart rate and improving perfusion pressure to the heart and brain |
| How does vasopressin work improve the chances of ROSC? | Vasopressin causes peripheral vasoconstriction and increase in arterial blood pressure |
| When should amiordarone be used? | Consider amiordarone for VF or Pulseless VT unresponsive to shock, CPR and vasopressor. |
| What kind of drugs are amiodarone, lidocaine, and magnesium sulfate? | antiarrhythmics |
| What is the proper dosing for amiodarone? | 300mg IV/IO push for the first dose. If VF/VT persist consider giving a second dose of 150 mg in 3-5 minutes. |
| When is it advisable to use Lidocaine in CPR? | when amiodarone is not available |
| What is the proper dosing for lidocaine? | 1 -1.5 mg/kg repeat if indicated at 0.5 -0.75mg/kg over 5-10 minute intervals to a maximum dose of 3mg/kg |
| What is the proper dosing for lidocaine via ET? | 2-4mg/kg |
| What are the indications for magnesium sulfate? | Torsades de Pointes in which pre-arrest rhythm was associated with prolonged QT interval. Magnesium is adjunctive to primary tx of high energy shock. Malnutrition/alcoholism can lead to hypomagnesic states and may be the cause of refractory VF/VT. |
Created by:
Perseverandovercome
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