Acls

Front 1

epinephrine
iv/io dosage when used for cardiac arrest

Back 1

1 mg (10 ml of 1:10,000 soln) q 3-5 mins during resusc
each dose is followed by 20 mL flush, then raise arm 10-20 seconds after dose

Front 2

vasopressin
iv dosage when used for cardiac arrest

Back 2

40 U, can replace first or second dose of epi

Front 3

amiodarone
iv/io dosage when used in vf/vt/cardiac arrest unresponsive to cpr

Back 3

300 mg iv/io once, then one 150 mg iv push in 3-5 mins

Front 4

lidocaine
iv/io dosage when used in vf/vt/cardiac arrest unresponsive to cpr

Back 4

1-1.5 mg/kg (1st dose), then .5-.75 mg/kg at 5-10 min intervals

Front 5

indication for mgso4

Back 5

cardiac arreest only if torsades de pointes or suspected hypomagnesemia is present
digitalis toxicity

Front 6

mgso4
iv/io dosage in cardiac arrest

Back 6

1-2 g diluted in 10 mL of D5W, given over 5-20 mins

Front 7

when should an anti-arrhythmic be used during acls

Back 7

when vf/pulseless vt persists after 2-3 shocks, separated by cycles of cpr and administration of vasopressor, use anti-arrhythmic

Front 8

anti-arrhythmics used in persistent vt/vf

Back 8

amiodarone
lidocaine
mgso4

Front 9

indications for atropine

Back 9

first drug given for sx sinus brady
av block or ventricular asystole (bt not mobitz ii)
second drug (p epi/vasopressin) for asystole or bradycardic pea
organophosphate poisoning

Front 10

atropine
iv/io dose when given for asystole or pea

Back 10

1 mg, then repeat q 3-5 mins for max of 3 doses

Front 11

mnemonic for causes of PEA

Back 11

Hs (6) and Ts (5)
hypovolemia
hypoxia
h+ excess (acidosis)
hyper/hypokalemi a
hypoglycemia
hypothermia

toxins
tamponade
tension ptx
thrombosis (coronary or pulm)
trauma

Front 12

ekg findings of hyperkalemia

Back 12

tall, peaked t waves
wide qrs
sine-wave pea

Front 13

ekg findings of hypokalemia

Back 13

flattened t waves
prominent u waves
wide qrs
qt prolongation
wide complex tachy

Front 14

tx of hyperkalemia

Back 14

sodium bicarb
glucose + insulin
CaCl3
kayexelate/sorbitol
dialysis
albuterol (possibly)

Front 15

tx of hypokalemia

Back 15

K infusion
add Mg if cardiac arrest

Front 16

ekg findings of hypothermia

Back 16

j or osborne waves

Front 17

in general how long can you give a pt o2 during acs

Back 17

6 hrs

Front 18

what dosage of asa should be given in a pt with acs

Back 18

160 or 325mg

Front 19

dosing of nitroglycerin tabs

Back 19

up to 3 tablets sublingual, q 3-5 mins

Front 20

contraindications for nitro

Back 20

bp <90/30
bradycardia (<50 bpm)
tachycardia
recent pde-5 inhibitor use (viagra) --> refractory hypotension
inferior mi or rv infarction (venodilation will --> decreased rv pressure, and these pts esp need increased rv filling pressures to maintain co and bp)

Front 21

what is the time frame of reperfrusion in a pt with a stemi

Back 21

fibrinolytics within 30 mins of arrival
or pci within 90 mins of arrival

Front 22

what meds are generally given if cardiac ischemia is suspected

Back 22

MOAN
morphine (if pain not relieved by nitro)
o2
asa
nitro

Front 23

morphine
iv dosage in stemi

Back 23

2-4 mg
additional doses of 2-8 mg at 5-15 min intervals

Front 24

major contraindications to asa

Back 24

true asa allergy
active or recent gi bleed

Front 25

indication for administration of fibrinolytics

Back 25

>1 mm ST elevation in 2 contiguous ekg leads
can be given if sx occurred within 12 hrs of admin

Front 26

which is superior: fibrinolytics or pci

Back 26

pci if done at a skilled pci facility

Front 27

most commonly used fibrinolytics

Back 27

tpa
reteplase
tenecteplase

Front 28

what is the sequence of treating poor perfusion 2ndary to bradycardia

Back 28

prepare for transcutaneous pacing
give atropine while awaiting pacer
if atropine is not effective, give epi or da until pacer arrives

Front 29

epi
dose for bradycardia

Back 29

2-10 mcg/min

Front 30

dopamine
dose for bradycardia

Back 30

2-10 mg/kg/min

Front 31

indications for starting transcutaneous pacing

Back 31

bradycardia pts with sx who are unstable, esp if with type 2 2nd degree heart block or 3rd deg AV block
start immediately if no response to atropine, atropine will likely not work, or if pt is severely sx

Front 32

what to do if transcutaneous pacing is ineffective

Back 32

start transvenous pacing

Front 33

contraindications for tcp

Back 33

severe hypothermia
not rec for asystole

Front 34

recommended uses for tcp

Back 34

sx bradyarrhythmias
brady w escape rhythms
standby pacing

Front 35

rhythms for unstable tachy

Back 35

afib
a-flutter
svt
monomorphic and polymorphic vt
wide-complex tachy of uncertain type

Front 36

pathophysiology of unstable tachy

Back 36

heart is beating so fast that co is reduced --> pulm edema, coronary ischemia, and reduced blood flow to vital organs
heart is beating ineffectively so taht coordination between atrium and ventricles or b/l ventricles is ineffective

Front 37

tx of unstable tachy

Back 37

immediate cardioversion

Front 38

sx and si of unstable tachy

Back 38

altered ms, cp, sob, presyncope/syncope
hypotension
shock
rate usually >150

Front 39

if a pt has unstable tachy with ekg showing monomorphic vt, how to manage pt

Back 39

synchronized cardioversion, initial shock of 100J
if no response, then increase dose in stepwise fashion

Front 40

if a pt has unstable tachy with ekg showing polymorphic vt, tx?

Back 40

high energy unsynchronized shocks (defib doses)

Front 41

synchronized vs unsynchronized shock

Back 41

unsync: shock is delivered as soon as shock button is pushed, and can fall anywhere during cardiac cycle. must use HIGHER energy thank synch shock

sync: uses a sensor to deliver the shock so that it fires at peak of qrs complex; avoids shocking during t waves (that --> vf); lower energy required

Front 42

when is sync shock used

Back 42

sx stable pt w tachy

Front 43

when is unsync shock used

Back 43

pulseless tachy
pre cardiac arrest (severe shock or polymorphic vt)
when you are unsure which to use

Front 44

rhythms for stable tachy

Back 44

sinus tachy
a-fib
a-flutter
av block
vt

Front 45

if pt has stable tachy with narrow qrs and reg rhythm, next step?

Back 45

vagal maneuvers
give adenosine, if no conversion give again at increased dose x2

Front 46

dose for adenosine for cardioversion

Back 46

rapid iv push of 6 mg initially, then 12 mg through rapid iv push

Front 47

if pt has stable tachy with narrow qrs and irreg rhythm next step?

Back 47

control rate (likely afib or aflutter), use diltiazem or BB

Front 48

if pt has wide qrs and regular rhythm, next step?

Back 48

if vt or uncertain rhythm, amiodarone
synchronized cardioversion

if svt with aberrancy, give adenosine

Front 49

dose of amiodarone when given fro vtach

Back 49

150 mg iv over 10 mins, repeat as needed uuntil 2.2g/24 reached

Front 50

if pt has pre-excited a-fib, next step

Back 50

AVOID AV blocking agents
give anti-arrhythmic, suhc as amiodarone 150 mg

Front 51

how does adenosine work

Back 51

increases avv block and terminates 90% of all re-entrant rhythms