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ACLS
ACLS from July
| Question | Answer |
|---|---|
| 5 rhythms and immediate steps | 1. VF/VT with no pulse = shock 2. VT/SVT & pulse = stable --> meds, unstable --> shock 3. PEA = reversible 4. Asystole = Epi 5. Bradycardia = stable? |
| 5 main steps to tx VF | 1. Shock (CPR x 2 if prolonged downtime/unwitnessed) 2. CPR 3. Epi (1 mg adult, 0.01 mg/kg peds) 4. Amiodarone (300mg adult, 10 mg/kg peds) 5. Amiodarone (150mg adult, 5 mg/kg peds) or lidocaine |
| PEA Reversible causes | A, B - Hypoxia, PTX C - Hypovolemia, Tamponade D - Toxic metabolic (think hyperK) |
| PEA Tx | 1. O2, ventilate, intubate if have help 2. IV access & small fluid bolus 3. Look at 3: ECG for hyperK, temp by touching (really hot or cold?), volume status (US IVC if available) 4. Epi - 1mg q3-5min 5. Look & r/o all 5 reversible causes |
| When not to give atropine for bradycardia | Can cause VF 1. Hypoxia 2. High ICP 3. Hypothermia 4. Wide complex |
| Tx for SVT (step 0 & 1) | Unstable = sync & cardiovert Stable & not old 1. Vagal maneuvers - valsalva 5 sec & release --> R sided carotid massage (push hard) 5 sec --> both --> ice water if young kid |
| Tx for SVT (step 2-5) | 2. Adenosine - 12g IVP through proximal IV (3mg through central line) 3. Adenosine - 18g IVP 4. Diltiazem - wt based at 0.25mg/kg (~ 20mg) over 1-2min 5. BB (Esmolol - 0.5 mg/kg loading, then 0.05 mg/kg infusion) or Procainamide (50 mg/min) |
| Who should you not give adenosine to (1-3) | 1. HR < 150 (= not PSVT) 2. HR that slows to vagal stim but returns to tachy (= not PSVT, PSVT will stop or not be affected, likely ST) 3. Irregular (PSVT = regular) |
| Who should you not give adenosine to (4-5) | 4. Hx of a-fib/a-flut/MAT - don't give to a-fib with aberrant conduction b/c slows AVN so bypass tract speeds up 5. Hx CHF or COPD (these ppl don't often get PSVT) Generally - don't give to sick older pts b/c they don't do well with AVN pause |
| Tx VT (steps 1-3) | No pulse --> shock & tx like VF 1. Unstable --> sedate & shock, then load with amio (150mg/10 min) or procainamide (35-100mg/min to max of 17mg/kg) 2. Stable --> can try lidocaine 1.5mg/kg over 15 sec (acts quickly) |
| Tx VT (steps 3) | 3. Amio (150mg/10 min) or procainamide (35-100mg/min to max 17mg/kg) - Procainamide 100mg/1st min --> 100mg/2nd min --> 50 --> 50 --> 50 --> 35mg/min |
| Tx VT (steps 4-5) | 4. Mg 2g over 30 sec 5. Sedate & cardiovert |
| What % is VT vs SVT with aberrancy | 85% = VT, always assume & tx like VT |
| What to worry about with procainamide | 1. Can inc QTc (never give for arrhythmia caused by inc QT) 2. Can widen QRS = stop this if widens QRS more (given for wide QRS rhythms but stop if gets wider) 3. Can cause hypotension from dec myocardial contractility (same as amiodarone) |
| What are symptoms in symptomatic bradycardia | 1. AMS 2. Hypoxia 3. Pulm edema 4. CP or ECG evidence of ischemia 5. Dec peripheral perfusion |
| Tx symptomatic bradycardia or AVB (steps 1-2) | 1. Atropine 0.5mg IVP or TC Pacer - atropine preferred for SB & 1st deg AVB, pacer for other AVBs --> wait 1 min 2. Atropine 1.0 mg IVP or max TC Pacer energy |
| Tx symptomatic bradycardia or AVB (steps 3-5) | 3. Epi infusion - start at 2mcg/min & titrate to HR 70-80 4. Inc Epi as needed & request transvenous pacer 5. TV pacing |
| Asystole Tx | 1. Confirm - check monitor & leads (pt not breathing or moving) 2. Oxygenate/Ventilate & begin CPR 3. Begin Tx - Epi 1mg (0.01mg/kg in peds) 4. Cont Tx - Epi q3min 5. Re-evaluate |
| When to stop resuscitation in asystole | 1. 10 min ACLS with intubation and 2. 3 doses of Epi 3. 3 min apart 4. in pt with continued asystole 5. if ETCO2 shows no expired CO2 |
| What energy levels should be used for defibrillation & sync cardioversion | VF, aFib, & anyone dying = 200 J VT, A-flut, PSVT, & anyone stable = 100 then 200J |
| What are reversible causes of symptomatic PVCs to tx or r/o | 1. Hypoxia 2. Ischemia 3. HypoK - hypoMg 4. Profound alkalosis/acidosis 5. Hypersympathetic state (EtOH w/d, cocaine, hyperthyroid) |
| Tx for run of VT or multifocal ectopy | Amio (150mg/10min) |
| Tx for PVCs during acute ischemia | Metoprolol (5mg IV q5min x 3) OR Esmolol (0.5 mg/kg IVP - if successful --> 0.05mg/kg/min) |
| Tx for PVCs with prolonged QT or HypoK/Mg | Mg (2g / 5 min) |
| Tx for PVCs with EtOH w/d or cocaine | Ativan 1mg q5-10min AND Mg (2g / 5 min) |
| Tx for refractory ectopy not due to long QT | Procainamide as per VT |
Created by:
wamberge
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