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ACLS
Paramedic: AHA ACLS
| Question | Answer |
|---|---|
| What 1st-line IV medication is used to treat Stable Adult Bradycardia? | Atropine |
| What is the Adult dose of Atropine for treating bradyarrhythmia’s? | 0.5mg bolus every 3-5mins |
| What is the Adult Max Total Dose of Atropine? | 3mg |
| What infusion dose and rate of Dopamine is used to achieve increased chronotropic and inotropic effects? | 2-5 mcg/kg/min |
| What infusion dose and rate of Dopamine is used to achieve increased chronotropy, inotropy, and increased BP? | 5-10 mcg/kg/min |
| What infusion dose and rate of Dopamine is used to achieve decreased cardiac output and decreased peripheral perfusion? | >10 mcg/kg/min |
| What is the Adult dose and rate of Epi 1:10,000 when used to treat bradycardia? | 2-10 mcg/min (titrate to effect) |
| The process of applying external pacemakers to a patient which allows adjustments to heart rate and current outputs is known as ____. | Transcutaneous Pacing |
| When selecting a desired pacing rate for Adult Unstable Bradycardia What is the acceptable demand rate range? | 60-80 |
| After selecting the rate, slowly increase the mA (milliamps) until you see ___ | Electrical Capture |
| Electrical capture occurs where there is a ___ before each QRS complex | Pacemaker Spike |
| After confirming electrical capture, ___ is confirmed by checking a radial and carotid pulse at the same time | Mechanical Capture |
| Once both mechanical and electrical capture are confirmed, increase the mA by ___ (or the smallest increment the monitor allows) to create a "safety margin" | 2 |
| What 3 signs indicate an increase is perfusion when pacing an Adult patient? | skin color, mental status, blood pressure increase |
| When pacing an Adult and their BP remains low, consider a ___ or Epinephrine infusion | Dopamine |
| What are the 5 S/S of an Unstable Arrhythmia? | Hypotension, Acute AMS, Signs of Shock, Ischemic Chest Discomfort, Acute Heart Failure |
| A bradyarrhythmia occurs when the HR is ____. | < 50bpm |
| What 1st-line medication is used to treat Stable Narrow-Complex Tachycardia? | Adenosine |
| What treatment should be attempted FIRST when trying to convert a Stable Narrow-Complex Tachyarrhythmia? | Vagal maneuver |
| Narrow-complex rhythms are ___ in origin. | Supraventricular |
| A rhythm with a rate 150bpm is known as a ___. | Tachyarrhythmia |
| What is the recommended treatment for Unstable Tachyarrhythmia's causing Hypotension, Acute AMS, S/S of Shock, Ischemic Chest Discomfort, and/or Acute Heart Failure? | Synchronized cardioversion |
| Vagal maneuvers stimulate the ___ nerve | Vagus |
| Vagus nerve stimulation causes a release of the neurotransmitter ___, which binds to muscarinic receptors and causes a decrease in cardiac action potential and rate. | Acetylcholine (Ach) |
| A type of vagal maneuver in which the patient "bears down like they are having a bowel movement." | Valsalva maneuver |
| When a patient performs the Valsalva maneuver, ___ pressure increases and causes a temporary drop in preload | Intrathoracic |
| A type of vagal maneuver in which the carotid is massaged at the level of the baroreceptors | Carotid sinus massage |
| When performing a carotid sinus massage, the ___ is stimulated via the vagus nerve, which causes a decrease in cardiac conduction. | Parasympathetic nervous system |
| An abnormal sound heard over an artery that typically reflects turbulent blood flow. This is caused by narrowing of the carotid artery, typically due to plaque build-up | Bruit |
| When performing a carotid sinus massage, the massage should be performed at the level of the ___ | Thyroid cartilage |
| A carotid sinus massage should NOT be performed for more than ___ | 15-20 seconds |
| What Class is Adenosine? | Nucleoside |
| What are the Actions of Adenosine? | Binds to A1 receptors which are coupled to GI-proteins. This binding causes potassium channels to open and hyperpolarize the cells, while calcium channels close and inhibits calcium influx |
| What are the Indications of Adenosine? | 1st-line medication for stable narrow-complex SVT that is refractory to vagal maneuvers. Also recommended for regular monomorphic wide-complex SVT thought to be supraventricular in origin |
| What are the Contraindications of Adenosine? | Not recommended for patients with Afib, Aflutter, Vtach, pre-excitation syndromes such as AVRT (WPW), a Hx of asthma/COPD, poison/drug-induced tachycardias, or 2nd and/or 3rd-degree AV blocks |
| What are the Adverse Effects of Adenosine? | May cause transient periods of bradycardia, asystole, and ventricular ectopy |
| What are the Precautions of Adenosine? | Reduce initial dose in half in patients receiving dipyridamole or carbamazepine, heart transplant patients, or if giving this medication via central line access |
| What is the 1st dose of Adult Adenosine? | 6mg RIVP followed by 20mL flush of NS |
| What is the 2nd dose of Adult Adenosine? | 12mg RIVP followed by 20mL flush of NS |
| Larger doses of Adenosine may be required in patients taking ___ or caffeine | Theophylline |
| What Class of Antiarrhythmics are Beta Blockers? | Class II |
| What Class is Labetalol? | Beta Blocker |
| What are the Actions of Labetalol? | Blocks sympathetic stimulation of the heart which causes a slowing in heart rate |
| What Class of Antiarrhythmics are Calcium Channel Blockers? | Class IV |
| What Class is Diltiazem? | Calcium Channel Blocker |
| What are the Actions of Diltiazem? | Slows action potentials of autorhythmic cells in the heart by blocking Ca++ channels |
| What are the Indications of Diltiazem? | 1st-line medication for Afib and Aflutter with RVR, 2nd-line medication for SVT that is refractory to vagal maneuvers and Adenosine |
| What are the Contraindications of Diltiazem? | Not recommended for patients that have hypotension (< 90mmHg), CHF, cardiogenic shock, wide-complex tachycardias, WPW, AV blocks without a pacemaker, or hypersensitivity to medication |
| What are the Adverse Effects of Diltiazem? | May cause hypotension, severe CHF if given along with beta blockers, N/V, diarrhea, dizziness, and headache |
| To achieve Acute Rate Control, what is the 1st dose of Diltiazem? | 0.25mg/kg (max of 20mg) over 2 minutes |
| To achieve Acute Rate Control, what is the 2nd dose of Diltiazem? | 0.35mg/kg (max of 25mg) over 2 minutes |
| What are the Indications of Labetalol? | 2nd-line medication for patients with Afib and Aflutter with RVR or SVT that is refractory to vagal maneuvers and Adenosine. May also be used as an antihypertensive or to reduce ischemia in AMI patients with elevated HR's |
| What are the Contraindications of Labetalol? | Not recommended for patients experiencing a possible STEMI (signs of heart failure, low cardiac output) due to an increased risk of cardiogenic shock. Also not recommended for patients with hypotension and bradycardia |
| What are the Adverse Effects of Labetalol? | Concurrent administration of the medication with a calcium channel blocker may cause severe hypotension, bradycardia, heart blocks, and CHF |
| What is the dose of Labetalol? | 10mg IVP over 1-2 minutes. (max of 150mg) |
| How often can a follow-up dose of Labetalol be administered? | 10 minutes |
| How often can a follow-up dose of Diltiazem be administered? | 15 minutes |
| What is the Maintenance Infusion rate and dose of Diltiazem? | 5-15 mg/hr (titrate to effect) |
| Engage the synchronization mode of a cardiac monitor by pressing the ___ button. After each shock press this button to re-synchronize before delivering the next shock | Sync control |
| Markers should appear on the ___ when sync mode is operative during synchronized cardioversion | R waves |
| A shock that is timed with the R waves of the QRS complex to prevent shocking during the refractory period | Synchronized Cardioversion |
| What are the Indications for performing a synchronized cardioversion? | Unstable narrow or wide-complex tachyarrhythmias |
| How many Joules are used to treat SVT and Aflutter via synchronized cardioversion? | 50-100J |
| How many Joules are used to treat Afib via synchronized cardioversion when delivering the 1st shock? | 120J |
| How many Joules are used to treat Afib via synchronized cardioversion when delivering the 2nd shock? | 200J |
| How many Joules are used to treat Afib via synchronized cardioversion? | 120-200J |
| When delivering a synchronized cardioversion, you should ___ the shock button. The monitor will look for the optimal time to deliver the shock | press and hold |
| What is the 1st-line medication when treating stable, regular wide-complex and monomorphic tachyarrhythmias? | Adenosine |
| What are the Contraindications for giving Adenosine for wide-complex tachycardias? | Not recommended if rhythm is thought to be ventricular in origin (if administered for irregular, polymorphic wide-complex tachycardia or Vtach, may cause deterioration) |
| What Class of Antiarrhythmics are Sodium Channel Blockers? | Class I |
| What Class of Antiarrhythmics are Potassium Channel Blockers? | Class III |
| What is the 1st-line antiarrhythmic infusion for treating wide-complex tachyarrhythmias? | Amiodarone |
| What Class is Amiodarone? | Class III Antiarrhythmic with Class I, II, and IV properties |
| What are the Actions of Amiodarone? | Slows potassium efflux which delays repolarization |
| What are the Indications for Amiodarone? | Used to treat life-threatening arrhythmias, VF/pulseless VT unresponsive to shock delivery, CPR, and vasopressors, and recurrent, hemodynamically unstable VT. Can also be used for some atrial and ventricular arrhythmias with expert consultation |
| What are the Contraindications of Amiodarone? | Not recommended if patient has hypersensitivity to medication, bradycardia with AV blocks, breastfeeding mothers, in concordance with drugs that prolong QT interval (procainamide), 2nd and 3rd-degree AV blocks without a pacemaker, SA node origin brady |
| What are the Adverse Effects of Amiodarone? | May cause severe hypotension, bradycardia, and prolong the QT interval (can lead to Torsade de Pointes) |
| What is the rapid infusion dose and rate of Amiodarone? | 150mg over 10 minutes |
| How often can an Amiodarone rapid infusion be repeated? | 10 minutes |
| What is the max dose of Amiodarone in a 24 hour period? | 2.2g |
| What is the slow infusion dose and rate of Amiodarone? | 360mg over 6 hours |
| What is the maintenance infusion dose and rate of Amiodarone? | 540mg over 18 hours |
| What is the half-life of Amiodarone? | 40 days |
| What is the 1st dose of Amiodarone used to treat cardiac arrest unresponsive to CPR, shock, and vasopressors? | 300mg IVP |
| What is the 2nd dose of Amiodarone used to treat cardiac arrest unresponsive to CPR, shock, and vasopressors? | 150mg IVP |
| What Class is Procainamide? | Class Ia Antiarrhythmic |
| What are the Actions of Procainamide? | Blocks sodium channels in cardiac cells which causes depolarization to slow and a decrease in automaticity |
| What are the Indications for Procainamide? | Used to treat stable Vtach with a pulse and pre-excitation syndromes such as WPW |
| What are the Contraindications for Procainamide? | Not recommended for patients who have received IV calcium channel blockers or patients who have 2nd and/or 3rd-degree AV blocks without a pacemaker. Avoid if prolonged QT or CHF |
| What are the Adverse Effects of Procainamide? | May cause drowsiness, slurred speech, confusion, seizures, and hypotension |
| What are the 4 Ending Points when using Procainamide? | Termination of the rhythm, hypotension, widening of the QRS by more than 50%, or the max dose has been met |
| What is the dose and rate of Procainamide for recurrent VF/pVT? | 20mg/min |
| What is the max dose of Procainamide for recurrent VF/pVT? | 17mg/kg |
| What is the dose and rate of Procainamide for urgent situations when treating VF/pVT? | 50mg/min |
| What is the maintenance infusion rate of Procainamide? | 1-4mg/min |
| If a patient has cardiac or renal dysfunction, what is the dose and rate of Procainamide for recurrent VF/pVT? | 12 mg/kg |
| If a patient has renal or cardiac dysfunction, what is the maintenance infusion rate of Procainamide? | 1-2mg/min |
| What Class is Lidocaine? | Class Ib Antiarrhythmic |
| What are the Actions of Lidocaine? | Blocks sodium channels in cardiac cells which causes depolarization to slow and a decrease in automaticity |
| What are the Indications for Lidocaine? | Alternative to Amiodarone in cardiac arrest from VF/pVT. May also be used to treat stable monomorphic VT with preserved LV function. |
| What are the Contraindications for Lidocaine? | Not recommended if AMI is present, signs of toxicity develop, concurrent treatment with Class I antiarrhythmics, hypersensitivity to medication, or 2nd and 3rd-degree AV blocks without a pacemaker |
| What are the Adverse Effects of Lidocaine? | Bradycardia, hypotension, and reduce the maintenance dose in the presence of impaired liver function or LV dysfunction |
| What is the dose of Lidocaine for treating cardiac arrest due to VF/pVT? | 1-1.5mg/kg |
| What is the dose of Lidocaine for treating refractory VF? | 1.5-2.25mg/kg |
| How often can Lidocaine be administered? | 5-10 minutes |
| What is the max dose of Lidocaine? | 3mg/kg (3 doses max) |
| What is the dose and rate of Lidocaine for treating a perfusing arrhythmia? | 0.5-0.75mg/kg (up to 1-1.5 mg/kg) |
| What Class is Sotalol? | Class III Antiarrhythmic |
| What are the Actions of Sotalol? | Blocks potassium efflux channels to delay repolarization. Also has beta-blocker effects resulting in negative chronotropic and dromotropic effects |
| What are the Indications of Sotalol? | Used to treat supraventricular and ventricular arrhythmias in patients that do not have a structural heart disease |
| What is the maintenance infusion dose and rate of Lidocaine? | 1-4mg/min |
| What are the Contraindications of Sotalol? | Not recommended for patients with poor perfusion, renal impairment (may cause toxicity), and 2nd and 3rd-degree heart blocks without a pacemaker |
| What are the Adverse Effects of Sotalol? | May cause bradycardia, hypotension, and arrhythmias (torsades de pointes) |
| What is the dose and rate of Sotalol? | 1-1.5mg/kg over 5 minutes |
| A distinctive form of polymorphic Vtach in which the amplitude and twisting of the QRS complexes around the isoelectric line causes a "ribbon-like" appearance | Torsade de Pointes |
| What is the drug of choice when treating Torsades de Pointes? | Magnesium sulfate |
| What Class is Magnesium Sulfate? | Antidysrhythmic |
| What are the Actions of Magnesium Sulfate? | Reduces early after depolarization (EAD) in patients with prolonged QT syndrome |
| What are the Indications of Magnesium Sulfate? | Used to treat cardiac arrest due to hypomagnesmia or Torsades de Pointes and life-threatening ventricular arrhythmias due to digitalis toxicity. Use caution if given to patients with renal failure |
| What are the Contraindications of Magnesium Sulfate? | Not recommended for patients with hypersensitivity to medication, 2nd and 3rd-degree Av blocks, shock, dialysis, hypocalcemia, Vfib or pVT |
| What are the Adverse Effects of Magnesium Sulfate? | May cause flushing, sweating, bradycardia, respiratory depression, and hypothermia |
| What is the loading dose and rate of Magnesium Sulfate for treating Torsades de Pointes with a pulse or AMI with Hypomagnesemia? | 1-2g mixed in 50-100 mL of diluent (administer over 5-60 mins) |
| What is the follow-up dose and rate of Magnesium Sulfate for treating Torsades de Pointes with a pulse or AMI with Hypomagnesemia? | 0.5-1g/hr (titrate to effect) |
| What is the dose and rate of Magnesium Sulfate for treating Cardiac Arrest as a result of Torsades de Pointes or Hypomagnesmia? | 1-2g diluted in 10 mL NS |
| How many Joules are used to treat regular and monomorphic wide-complex tachyarrhythmias via synchronized cardioversion? | 100J |
| How many Joules are used to treat irregular and unstable polymorphic VT via a monophasic defibrillator? | 360J |
| How many Joules are used to treat irregular and unstable polymorphic VT via a biphasic defibrillator? | 120-200J (or manufacturer recommendation if known); if unknown, use maximum available |
| How many Joules should be delivered via monophasic defibrillators when treating cardiac arrest? | 360J |
| How many Joules should be delivered via biphasic defibrillators when treating cardiac arrest? | 120-200J |
| After giving the patient O2 therapy and attaching them to the monitor, What is the 1st intervention you should perform when treating pulseless Vtach? | Give 1 unsynchronized shock at 120-200J |
| After delivering your initial shock to a patient in cardiac arrest, what should your next treatment be? | Perform 5 cycles of CPR |
| After completing 5 cycles of CPR, the rhythm is unchanged. You shock a second time with 200 J and resume CPR. While completing the cycle of CPR what else should be done? | Administer 1 mg RIVP Epinephrine |
| The third shock is delivered and you restart CPR (5 cycles). What medication should be given after the 3rd shock during CPR? | Amiodarone |
| What is the initial dose of Amiodarone during cardiac arrest? | 300mg |
| What is the follow-up dose of Amiodarone during cardiac arrest? | 150mg |
| What is the maximum cumulative dose of Amiodarone in a 24 hour period? | 2.2g |
| What medication can be used as an alternative to Amiodarone during cardiac arrest? | Lidocaine |
| How often should Epinephrine be administered during cardiac arrest? | every 3-5 minutes |
| What is the 1st dose of Lidocaine given during cardiac arrest? | 1-1.5mg/kg IVP |
| What is the 2nd dose of Lidocaine given during cardiac arrest? | 0.5-0.75mg/kg IVP |
| After obtaining ROSC, you should maintain SpO2 saturation ≥ ___ | 94 |
| After obtaining ROSC, you should treat hypotension with an SBP < __ | 90mmHg |
| After obtaining ROSC, administer an IV/IO fluid bolus of ___ or ___ | Normal Saline; Lactated Ringer's |
| To treat hypotension after obtaining ROSC, how much fluid should you administer? | 1-2L |
| After administering a fluid bolus to treat hypotension post-arrest, you should administer a ___ | Vasopressor infusion |
| What is the dose and rate of administration for an Epinephrine or Norepinephrine IV infusion when treating post-arrest hypotension? | 0.1-0.5mcg/kg/min |
| What is the dose and rate of administration for an Epinephrine or Norepinephrine IV infusion when treating post-arrest hypotension in a 70-kg adult? | 7-35mcg/min |
| What is the dose and rate of administration for a Dopamine IV infusion when treating post-arrest hypotension? | 5-10mcg/kg/min |
Created by:
sarah.thomas32
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