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ACLS 2
| Question | Answer |
|---|---|
| Pt with tachycardia: what are the first 2 questions to determine? | Narrow vs wide; regular vs irregular |
| Narrow complex tach with regular QRS: the 4 most important: | Sinus tach, AVNRT, AVRT, A-flutter |
| Difference between AVRT and AVNRT | AVNRT is an SVT (paroxysmal or PSVT) due to a re-entry circuit confined to the AV node. AVRT is a re-entrant tachy having a circuit with 2 pathways: the normal conduction system and an AV accessory pathway. |
| Narrow complex tach with irregular QRS complexes. This could be (4): | A-fib, multifocal AT, focal AT (with variable AV block), A-flutter with variable AV block |
| Wide complex tach with regular QRS complexes. This could be (3): | Monomorphic VT, any SVT with aberrancy (meds, pacer, lytes), antidromic AVRT with antegrade conduction via accessory pathway (eg, WPW) |
| Wide complex tach with irregular QRS complexes: 3 most important: | A-fib/flutter; polymorphic VT & torsades; VF |
| Brady: first med and doses | atropine 1 mg, repeat every 3-5 min, max 3 mg |
| Brady: alternate meds (2) | Dopamine gtt 5-20 mcg/kg/min, titrate. Epinephrine gtt 2-10 mcg/min, titrate. |
| Persistent symptomatic tachycardia (>150), first consider: | synchronized cardioversion |
| Persistent symptomatic wide complex (>0.12 sec) tach, first med: | adenosine 6 mg rapid IV push; 2nd dose is 12 mg if required |
| Stable wide-QRS tachy, meds (3) | Procainamide, Amiodarone, Sotalol |
| Procainamide dose | 20-50 mg/min (max 17 mg/kg); maintenance dose 1-4 mg/min |
| Amiodarone doses | 1st dose 150 mg over 10 min; repeat prn if VT recurs. Maintenance dose of 1 mg/min for 1st 6 hours |
| Sotalol dose | 100 mg (1.5 mg/kg) over 5 min |
| Avoid sotalol if: | prolonged QT |
| Persistent symptomatic bradycardia (<50), if atropine ineffective, consider: | transcutaneous pacing |
| Persistent symptomatic bradycardia (<50), if atropine and transcutaneous pacing are ineffective, consider: | dopamine or epinephrine infusion |
| Persistent asymptomatic narrow complex (<0.12 sec) tachy, consider (4): | vagal maneuvers (if regular), adenosine (if regular), BB or CCB, expert consultation |
| BLS: ratio of compressions to breaths | Cycles of 30 compressions and 2 breaths |
| Narrow complex tach with regular QRS. the 3 less important: | focal AT, junctional tachy, SANRT |
| Wide complex tach with irregular QRS complexes: 2 less important: | antidromic AVRT; AF/flutter/AT with antegrade conduction pathway (eg, WPW) |
Created by:
Abarnard
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