A4 Acls

Front 1

Pulseless arrest: shockable rhythms

Back 1

V fib, V tach

Front 2

Pulseless arrest: non-shockable rhythms

Back 2

PEA, asystole

Front 3

Pulseless arrest: elements of PRIMARY ABCD survey

Back 3

A: open airway with head-tilt or jaw thrust
B: listen for breathing, give 2 breaths
C: CPR 30:2
D: DEFIBILLATION

Front 4

What is the proper rate of CPR?

Back 4

100 per minute

Front 5

Pulseless arrest: What is the proper setting of the defibrillator?

Back 5

200 J biphasic
360 J monophasic

this contrasts with lower energy levels used for synchronized cardioversion of unstable tachycardia

Front 6

Pulseless arrest: after the first shock, how long do you continue CPR? What else do you do?

Back 6

5 cycles of 30:2 = 2 minutes
Get IV access and deliver vasopressors

Front 7

Pulseless arrest: after first shock, what drugs are delivered at what dose?

Back 7

Vasopressors:
Epinephrine 1 mg IV/IO or 2 mg ETT, repeat q 3-5 minutes
Vasopressin 40 U IV can be substituted once

Front 8

Pulseless arrest:after second shock, what drugs are delivered at what dose?

Back 8

Antiarrhythmics:
amiodarone 300 mg IV push first time,
150 mg repeat doses at q 3-5 minutes
lidocaine 1.0-1.5 mg/kg, (avg 100 mg) first dose, then
0.5-0.75 mg/kg (avg 50 mg) q5-10 min, max 3 mg/kg

Front 9

Pulseless arrest: What is the mnemonic for v fib/ v tach?

Back 9

SCRREAM
Shock as soon as possible 200 biphasic/360 monophasic
CPR immediately for 2 minutes
Rhythm check, Repeat shock
Epinephrine 1 mg IV/IO or 2 mg ETT
Antiarrhythmic Meds: after 2nd shock;
Any Legitimate Medication:
Amiodarone 300 mg then 150 mg IV
Lidocaine 1.0-1.5 mg/kg first time (avg 100 mg), then 0.5-0.75 (avg 50 mg)
Magnesium sulfate 1-2 g IV/IO diluted in 10mL D5W
(5-20 min. push) for torsades de pointes or suspected/ known hypomagnesemia.

Front 10

Pulseless arrest: What is the dose for magnesium sulfate if torsades is suspected?

Back 10

1-2 GRAMS IV (the only dose in grams in the algorithm)

Front 11

Pulseless arrest: What are the elements of the secondary survey?

Back 11

ABCD
Airway: remove obstructions; should you bag or intubate?
Breathing: check airway placement and CO2 detector, breath q 6-8 seconds
Circulation: IV access
D: DIFFERENTIAL DIAGNOSIS (Patch4MDs or 7H&6T)

Front 12

Pulseless arrest: What is the difference between the "D" in primary survey and secondary survey?

Back 12

primary: defibrillate
secondary: differential (PATCH4MDs or 7H & 6T)

Front 13

Pulseless arrest: PATCH4MDS
quick version

Back 13

P: PE
A: Acidosis
T: Tension PTX
C: Cardiac tamponade
H: Hyperkalemia
H: Hypokalemia
H: Hypovolemia
H: Hypoxia
M: MI
D: Drugs
S: Shivering (hypothermia)

Front 14

Tachycardia: What is the acls.net mnemonic for tachycardia intervention?

Back 14

SNR: Yes 1-2-3 Think SVT, Do VAC
Stable? If no, cardiovert
Narrow? If no, consult
Regular? If no, consult
If yes to 1-2-3, assume SVT:

Vagal stimulation
Adenosine 6 mg RAPID first time, IV push, followed by bolus of 20 cc normal saline,
12 mg IV push second time q minutes
Cardizem (diltiazem): 15-20 mg IV over 2 minutes, 20-25 mg 15 minutes later if needed

Front 15

Tachycardia: What is the mnemonic for equipment for cardioversion?

Back 15

Oh Say It Isn't So
O2 sat monitor
suctioning equipment
IV line
Intubation equipment
Sedation/analgesics

Front 16

"Oh say it isn't so" is mnemonic for what?

Back 16

equipment to have ready if you are cardioverting an unstable tachycardia

Front 17

Cardioverting an unstable tachycardia is rarely needed if ?

Back 17

heart rate is below 150

Front 18

What is an alternative to diltiazem for rate control of tachycardia?

Back 18

metoprolol

Front 19

Tachycardia: if narrow complex and regular, what are the likely rhythms?

Back 19

AVNRT or AVRT

Front 20

Tachycardia: if narrow complex and irregular, what are the likely rhythms?

What is likely the best intervention if stable?

Back 20

A fib, A flutter, MAT

Rate control with BB (metroprolol) or CCB (diltiazem)
Cardiovert if unstable of course

Front 21

Tachycardia: if wide complex and regular, what are the likely rhythms?

What is likely the best intervention?

Back 21

V tach or SVT with aberration

This is tricky. If VT, you need cardioversion / amiodarone; if SVT, you need adenonsine

Front 22

**Tachycardia: if wide complex and irregular, what are the likely rhythms?

Back 22

1. A fib with aberration (rate control with diltiazem)
2. A fib with WPW (amiodarone, procainamide, ibutilide, but avoid anything that blocks AV node like adenosine, BB, CCB, digoxin)
3. PMVT (amiodarone, defibrillate)
4. Torsades (Mg 2 g IV, pacing)

Front 23

Tachycardia: if rhythm is stable irregular and WIDE, what is your primary CAUTION in intervening?

Back 23

You need to avoid any AV blocking meds (digoxin, CCB) because WPW may be in picture.

Consider amiodarone.

Front 24

What is the mnemonic for bradycardias?

Back 24

PAED
Pacing Always Ends Danger
Pacing: transcutaneous
Atropine 0.5 mg IV/IO q3-5 min. (max. 3mg)
Epinephrine 2-10 mcg/minute
Dopamine 2-10 mcg/kg/minute

Front 25

Bradycardia: Pacing should be used without delay for what conditoins?

Back 25

type II secondary heart block
type III heart block

Front 26

Pulseless arrest: PATCH4MDS
long version -- signs and treatments
PATC

Back 26

PE - JVP, no pulse with CPR; tx = thrombolytics
Acidosis - DM or renal pt; tx = bicarb, hyperventilation; tx
Tension PTX: JVD, no pulse with Cpr, no breath sounds, trach deviation; tx= needle thoracostomy
Cardiac tamponade: JVD, no pulse with CPR, pulsus paradoxus; tx = pericardiocentesis

Front 27

Pulseless arrest: PATCH4MDS
long version -- signs and treatments
H4

Back 27

Hyperkalemia: renal pt, EKG, labs; tx = C BIG K, calcium gluconate, BB, insulin, kayexelate
Hypokalemia: EKG, labs; tx=consider K+, but very cautiously
hypovolemia: collapsed vasculature; tx= fluids
hypoxia: clinical, ABGs; O2, vent

Front 28

Pulseless arrest: PATCH4MDS
long version -- signs and treatments
MDS

Back 28

MI - EKG, hx, tx= ACS protocol
Drugs
Shivering - hypothermia - warm