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ACLS
| Question | Answer |
|---|---|
| Tachy in stable pt: do what 1st? | IV access, 12 lead EKG; Is QRS narrow (<0.12 sec)? |
| Tachy in stable pt: Narrow QRS & regular rhythm: tx | Vagal maneuvers; adenosine 6mg rapid IVP. If no conversion, 12mg rapid IVP (may repeat 12mg x1) |
| Tachy in stable pt: Narrow QRS & regular rhythm: rhythm not converting with adenosine: tx | Possible A-flutter, ectopic A-tach, or junctional tach. Rate ctrl (dilt, BB), tx underlying cause, call Cards |
| Tachy in stable pt: Narrow QRS & IRREGULAR rhythm: tx | Irreg narrow complex tach (prob AF, poss flutter or MAT): call Cards; Rate ctrl (dilt, BB) |
| Tachy in stable pt: Narrow QRS & regular rhythm: rhythm converts with adenosine: dx/tx | Prob reentry SVT; tx recurrence with adenosine or LA AVN blocking agents (dilt, BB) |
| Tachy in stable pt: Wide QRS (>0.12 sec) & regular rhythm: If VT or uncertain rhythm: tx | Amiodarone 150mg IV over 10 min, repeat prn (max 2.2gm/24 hr); prepare for sync cardioversion |
| Tachy in stable pt: Wide QRS (>0.12 sec) & regular rhythm: If SVT w/aberrancy: tx | Adenosine 6mg rapid IVP. If no conversion, 12mg rapid IVP (may repeat 12mg x1) |
| Tachy in stable pt: Wide QRS (>0.12 sec) & IRREGULAR rhythm: If AF w/aberrancy: tx | Tx like narrow complex tach: call Cards; Rate ctrl (dilt, BB) |
| Tachy in stable pt: Wide QRS (>0.12 sec) & IRREGULAR rhythm: If pre-excited AF (AF + WPW): tx | Call Cards; AVOID AVN blockers (adenosine, dig,dilt, verapamil); consider antiarrhythmics (amiodarone 150mg IV over 10 min) |
| Torsades: mgmt | Give Mg: load with 1-2 gm over 5-60 min, then infusion |
| Brady (<60 bpm): initial mgmt | Maintain patent airway, assist breathing prn. Give O2. EKG/ telemetry to ID rhythm. IV access |
| Brady & sxs poor perfusion 2/2 the brady (AMS, persistent CP, hotn / shock): Mgmt if ADEQUATE perfusion: | Observe & monitor |
| Brady & sxs poor perfusion 2/2 the brady (AMS, persistent CP, hotn / shock): Initial Mgmt if INADEQUATE perfusion: | Atropine 0.5mg IV bolus, repeat Q3-5min (max 3mg) |
| Brady & sxs poor perfusion 2/2 the brady (AMS, persistent CP, hotn / shock): Mgmt if Atropine is ineffective: | Dopamine (2-10mcg/kg/min) OR epinephrine (2-10/mcg/min). Consider transvenous pacing & Cards consult |
| ACLS algorithm | 911/EMS. CPR. O2. Attach monitor/defibrillator; check rhythm. Shock if VT/VF. CPR. IV/IO access. |
| CPR | >2 inches, >100/min. If no advanced airway, 30:2. Rotate compressor Q2 min. |
| Arrest: shockable rhythm (VT/VF): give shock, then: | CPR x2 min. Establish IV/IO access. Check rhythm: shock if VT/VF: CPR 2 min. Epi 1mg Q3-5min. PETCO2 if poss. Check rhythm: shock if poss; Amiodarone 300mg bolus (2nd dose 150mg) |
| Arrest: rhythm NOT shockable (PEA/ asystole): mgmt | CPR 2 min. IV/IO. Epi 1mg Q3-5min. Consider adv airway, PETCO2. Check rhythm: if shockable, start shockable algorithm. If not, resume CPR & meds |
| The H's (causes of cardiac problems) include (6): | hypovolemia, hypoxia, H+ (acidosis), hyper / hypokalemia, hypoglycemia, hypothermia |
| The T's (causes of cardiac problems) include (5): | toxins, tamponade, tension PTX, thrombosis (coronary and pulmonary), trauma |
| To rule out tension PTX: | No pulse with CPR (if pulse: not PTX) |
| To rule out cardiac tamponade: | No pulse with CPR (if pulse: not PTX) |
| To rule in toxins as cause: | bradycardia; abnormal pupils |
| Shocking: dosages | SVT: 50J. pVT/VF: 100J or more |
| When to use pressors | Secondline tx for symptomatic bradycardia (aftre atropine). Epinephrine 2-20 mcg/kg/min (may also use norepinephrine). May try after fluid challenge |
| Post-arrest care | Labs + ABG. VS. 12-lead ECG. Cardiac consult |
| Definitive tx for SVT | radiofrequency ablation |
| Reversible causes: 5 H's | Hypothermia, hypo/hyperkalemia, hypovolemia, hypoxia, H+ (acidosis) |
| Reversible causes: 5 T's | Tension PTX, tamponade, toxins, pulmo Thrombosis, coronary Thrombosis |
| When to use synchronized cardioversion | Unstable (symptomatic) re-entry SVT; or VT with pulses; or ? A-fib/flutter (unstable) |
| Tachyarrhythmias: wide and regular = | SVT with aberrancy (give adenosine) (may need ablation); or VT (give amiodarone) |
| Tachyarrhythmias: narrow and regular = | Re-entry SVT (try vagal maneuvers; give adenosine; if not converting, likely AF/flutter, AVNRT) |
| Tachyarrhythmias: wide and irregular = | ?A-fib/flutter |
| Tachyarrhythmias: narrow and irregular = | A-fib/flutter (tx with BB, CCB, Cards consult) |
| STEMI mgmt: start O2 at: | 4 LPM |
| STEMI mgmt: reperfusion time goals for (a) door to balloon and (b) door to needle | (a) 90 minutes; (b) 30 minutes |
| Goal TV (tidal volume) in respiratory arrest | 500-600 L (6-7 mL/kg) |
| TCP (transcutaneous pacing) when? | Some bradycardia (refractory to meds) |
| TCP (transcutaneous pacing): avoid atropine in: | AVB type II (Mobitz) or 3rd degree block (or 3rd degree with new wide complex) |
| TCP (transcutaneous pacing) is contraindicated in patients with: | worsening hypothermia |
| Synchronized cardioversion dose for unstable AF | 200 J |
| Synchronized cardioversion dose for unstable monomorphic VT | 100 J |
| Synchronized cardioversion dose for unstable SVT/flutter | 50-100 J |
| Synchronized cardioversion dose for polymorphic VT | Tx as VF (give defib dose, increased energy) |
| Airway that may be used in conscious patient | NPA (nasopharyngeal) |
| Airway that may NOT be used in unconscious patient | OPA (oropharyngeal) |
Created by:
Abarnard
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