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ACLS from July

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