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BCPS study guide

arrhythmias and ACLS

QuestionAnswer
meds used in the pulseless VT/Vfib algorithm in ACLS epinephrine 1 mg or vasopressin 40 mg alternate with amiodarone 300 mg x1 f/b 150 mg x1 or lidocaine in a pinch.
meds used in asystole/PEA algorithm in ACLS epinephrine 1 mg or vasopressin 40 mg
meds used in symptomatic bradycardia algorithm in ACLS atropine 0.5 mg, may repeat Q3-5 mins up to 3 mg. if not effective may try transcutaneous pacing dopamine 2-10 mcg/kg/min or epinephrine 2-10 mcg/min,
meds used in tachycardia in ACLS. specifically narrow complex with regular ventricular rhythm typically SVT or sinus tach. use vagal maneuvers or adenosine. 6 mg f/b 12 mg up to two doses. decrease to 3 mg if pt on CBZ or dipyrimadole or post heart transplant. increase dose if pt on theophylline or caffeine
meds used in tachycardia in ACLS. specifically narrow complex with irregular ventricular rhythm typically afib or flutter. use rate control. non-DHPs or beta blockers or digoxin.
meds used in tachycardia in ACLS. specifically wide complex that is VT or of unknown mechanism adenosine. alternatively can try amiodarone. can use procainamide or sotalol if pt does NOT have prolonged QTc.
meds used in tachycardia in ACLS. specifically wide complex with confirmed SVT adenosine
meds used in tachycardia in ACLS. specifically wide complex with polymorphic VT typically QTc >500 ms. torsades. if stable use mag 1-2 g boluses. up to 16 g in 24 hours. if unstable defibrillate. correct electrolytes specifically mag and potassium.
Class Ia antiarrhythmics Sodium channel blockers. disopyramide, quinidine, procainamide (double quarter pounder) intermediate
Class Ib antiarrhythmics Sodium channel blockers. lidocaine, mexilitine, phenytoin (lettuce mayo pickles) fast
Class Ic antiarrhythmics Sodium channel blockers. flecainide, propafenone (fries please) slow
Class II antiarrhythmics beta blockers - specifically metoprolol, esmolol and atenolol
Class III antiarrhythmics potassium channel blockers. amiodarone, dronedarone, dofetilide, sotalol, ibutilide
Class IV antiarrhythmics calcium channel blockers. NON DHPS diltiazem, verapamil
mainstay of therapy for chronic treatment of ventricular arrhythmias beta blockers. only drug with mortality benefit. amiodarone and sotalol also occ. used but no mortality benefit. typically only for altering threshold of ICD firing.
Which antiarrhythmics should be avoided in HF pts Class Ia and Ic (intermediate and slow sodium channel blockers)
Which antiarrhythmics should be avoided in acute MI pts Class Ia and Ic (intermediate and slow sodium channel blockers) increases mortality in this population.
Created by: mjuhlin