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22 Cards in this Set
- Front
- Back
- 3rd side (hint)
Pulseless V-FIB/V-TAC, what is the treatment? |
Check LOC,A-open airway,b-ventilate,c-chest compressions,D-defib-shock-200-300-360,#2A-ETT,B-check placement-secure airway-ventilate,C-IV access-monitor-meds,D-differential DX,EPI 1mg IVq 3-5 mins or vasopressin 40u x1,Defib 360j,Antiarrhymics-Amio 300mg IV-Lido 1-1.5mg IV or ETT-Mag 2g in 10ml of NS-Procainamide 20mg/min-Consider HCO3 1mEq/kg,D/fib 360j after each drug D/fib, i.e.(epi,D/fib,lido,D/fib)
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What is the Tx for Asystole?
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Check LOC,1st-ABCD's,2nd-ABCD's,EPI 1mg IV or 2mg ETTq 3-5mins,Atropine 1mg IV or 2mg ETTq 3-5mins to a total of 0.04mg/kg,Consider treatable causes,Consider termination of code
REMEMBER!!! LOOK IN TWO LEADS, AND IF YOUR MONITOR LEADS ARE STILL CONNECTED!! |
Besides looking for the DNR!
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What does the A stand for in the first ABCD's of ACLS?
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AIRWAY- open the AIRWAY!!
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Air supply was a band in the 80's.
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What does the B stand for in the first ABCD'S?
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Breathing- Provide ventilation
BLS manuvers |
You do it everyday without knowing it.
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What does the C stand for in the first ABCD'S of ACLS?
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Circulation-
Chest Compressions 80-100 for adult |
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What does the D stand for in the first ABCD's of ACLS?
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Defibrillation-Either by quick look with the paddles, or with quick pads.
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What is the Tx for Pulseless Electical Activity, or PEA as some might know it as?
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Check LOC,1st ABCD's,2nd ABCD's,Consider treatable causes
H-Hypovolemia H-Hypoxia A-Acidosis H-Hyper- Hypokalemia H-Hypothermia T-Tablets (OD) T-Tamponade T-Tension pneumo T-Thrombosis (Coronary or Pulmonary) |
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What is the Tx for Narrow Complex Tachycardia?
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Evaluate Patient?
*stable or un-stable? Stable-IV,O2,Monitor Vagel manuvers, Adenosine 6mg RIVP ++Junctional Tach-Stable- NO DC Cardioversion,Amiodarone,B-Blockers,CA++channel blockers JUNCT TACH-UNSTABLE-With serious S/S NO DC Cardioversion Amiodarone-150mg in 250cc over 10mins ++PSVT-Stable- CA++channel blockers B-blockers Digoxin- DC Cardioversion-100j,200j,300j,360j Consider Procain or Cordarone PSVT-UNSTABLE- Digoxin Amiodarone Cardizem Cardiovert-100j,200j,300j,360j ++Ectopic-Multifocal Atrial Tach-Stable NO DC cardiovert Ca++channel blockers B-blockers Amiodarone E-Multifocal Atrial Tach-UNSTABLE- NO DC cardiovert Amiodarone Cardizem |
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What constitutes serious signs and symptoms per ACLS?
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Serious signs are:
Pulmonary Edema Rales Rhonci Hypotension Orthostasis JVD Peripheal Edema Ischemia ECG changes Symptoms: SHOB Chest pain Dyspnea on exertion AMS |
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What is the Tx for V-TAC with a pulse. (sustained)
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You can go directly to Sync-Cardiovert with serious signs and symptoms.
For Monomorphic V-TAC STABLE ABC'S IV,O2 MONITOR CONSIDER ONE: PROCAINAMIDE AMIODARONE LIDOCAINE THEN- SYNC-CARDIOVERT 100J,200J,300J,360J ++UNSTABLE V-TAC WITH SERIOUS S/S SYNC-CARDIOVERT 100J,200J,300J,360J (NOTE IF VF OCCURS WHILE SYNC-CARDIOVERT, TURN SYNC OFF AND DEFIB) CONSIDER ONE: AMIODARONE(150 OVER 10MINS) LIDOCAINE(0.5-0.75MG/KG IV) ++POLYMORPHIC(TORSADES)STABLE ABC'S,IV,O2,MONITOR CORRECT ELECTROLYTES CONSIDER ONE: B-BLOCKER LIDOCAINE AMIODARONE PROCAINAMIDE PRIOR TO CARDIOVERT ADMIN SEDATION WHENEVER POSSIBLE SYNC-CARDIOVERT 100J,200J,300J,360J ++UNSTABLE TORSADES(POLYMORPHIC V-TAC) SYNC-CARDIOVERT 100J,200J,300J,360J MAGNESIUM OVERDRIVE PACING(NOT DONE IN THE PREHOSPITAL SETTING) ISOPROTERONOL PHENYTOIN NOTE!!! HAVE YOUR ALS EQUIPMENT READY!! LIDOCAINE |
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What is the Tx for bradycardia per ACLS?
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STABLE OR UNSTABLE?
ABC'S IF PT IS UNSTABLE AND HAS SERIOUS S/S THEN BEGIN IMMEDIATE PACING! STABLE PT's WITH HEART RATE LESS THAN 60. FOR BRADYCARDIA,JUNCTIONAL FIRST DEGREE HB, SECOND DEGREE HB TYPE 1(WENKEBACH) 1.ATROPINE 0.5-1.0MG IVQ 3-5 MINS TO A TOTAL DOSE OF 0.4MG/KG 2.PREMEDICATE TO SEDATE 3.TCP 4.DOPAMINE DRIP 2-20MCG/KG/MIN 5.EPI DRIP 2-10MCG/KG/MIN **NOTE THIS IS THE LAST STRAW** FOR SECOND DEGREE TYPE II(MOBITZ II)AND THIRD DEGREE HB 1.IMMEDIATE TCP(PACING) 2.MEDICATE FOR PAIN |
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How would you treat Ischemic chest pain per the ACLS liturature?
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Immediate(prehospital)evaluation
VITAL SIGNS O2 12 LEAD ECG(PARAMEDIC OR MD REVIEW) BRIEF H&P(FOCUS ON ANTITHROMBOLITIC ELIGIBILITY) INITIAL SERUM CARDIAC MARKERS(TRIPONIN I OR T) INITIAL LYTES AND COAG STUDIES GENERAL TX (PREHOSPITAL) MONA!! SHE IS GOOD FOR CHEST PAIN! MORPHINE- 2-10MG IV OXYGEN-2-15LPM NITROGLYCERIN- 0.4MG SUBLINGUAL SPRAY OR 1" PASTE ON CHEST OR IV BOLUS 12.5-25 MCG THEN INFUSE @ 10-20MCG/MIN TITRATE TO EFFECT. ASSESS 12 LEAD!! STEMI OR NEW OR PRESUMABLY NEW BBB WITH STRONG SUSPICION FOR INJURY 1.B-BLOCKERS,NTG IV,HEPARIN IV,ACE INHIBITORS(AFTER 6HRS OR STABLE) IF TIME IS LESS THAN 12 HRS SINCE ONSET CATH LAB TIME!! THEN THROMBOLITIC THERAPY. GOAL DOOR TO DRUG TIME 30MINS. DOOR TO CATH TIME 90+/-30MINS. |
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How does the Suspected stroke algorhythm go?
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PREHOSPITAL(EMS)
1.ASSESSMENT CINNCINATI STROKE SCALE, LOS ANGELES STROKE SCREEN, ALERT STROKE SCREEN, RAPID STROKE SCREEN 2.IV,O2,MONITOR,OBTAIN BLOOD(CBC,LYTES,COAG),CHECK FSBS,PERFORM STROKE SCREEN, ALERT STROKE TEAM 10MINS IS GOAL TIME FOR EMS IMMEDIATE NEURO ASSESSMENT PMH ESTABLISH ONSET(<3HRS REQUIRED FOR CLOT BUSTERS) GCS LEVEL OF STROKE SEVERITY(NIH OR HUNT/HESS SCALE) OBTAIN NON-CONTRAST CT(<25MINS) READ CT(<45MINS) X-RAY NECK(IF COMATOSE OR HX OF TRAUMA) DOES CT SHOW INTRACEREBRAL BLEED OR SUBARACNOID BLEED? NO! THEN 1. PROBABLE ACUTE ISCHEMIC STROKE(IF SUSPICION OF SUBARACNOID BLEED THEN PERFORM LP) IF NO BLOOD THEN PT GET THROMBOLYTIC WITH CONSULT OF RISKS WITH FAMILY. DOOR TO TREATMENT IS <60MINS |
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What is the Tx for A-FIB/A-Flutter per ACLS?
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CONTROL RATE!!
1.ABC'S, IV,O2,MONITOR ASSESS IN DURATION IS >48HRS. USE CAUTION WITH AGENTS TO CONVERT FOR POSSIBLE CLOTS TO FLOAT TO THE SQUASH OR LUNGS. 2. STABLE CA++CHANNEL BLOCKER B-BLOCKER, WITH WPW, THEN CHOOSE ONE: AMIODARONE,FLECANIDE,PROCAINAMIDE, PROPAFENONE 3. UNSTABLE WITH SERIOUS S/S CONSIDER ONE: DIGOXIN,CARDIZEM,AMIODARONE IF NO SUCCESS WITH MEDS THEN SYNCCARDIOVERT<48HRS 75J,100J,200J,300,360J CONTROL RYH!! DURATION <48HRS CONSIDER DC SYNC-CARDIOVERSION OR TRY ONE: AMIODARONE,IBUTILIDE,FLECINIDE, PROPAFENONE, PROCAINAMIDE DURATION >48HRS NO DC SYNC-CARDIOVERSION DELAYED CARDIOVERSION(ANTICOAG FOR 3 WEEKS,CARDIOVERT,ANTICOAG FOR 4 WEEKS) EARLY CARDIOVERSION(HEPARIN IV, TEE TO EXCLUDE ATRIAL CLOT, ANTICOAG FOR 4 WEEKS. |
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How do you treat wide-complex tachycardia?
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SVT-CONFIRMED
SEE NARROW COMPLEX TACHYCARDIA SYNC- CARDIOVERT OR PROCAINAMIDE OR AMIODARONE V-TAC-CONFIRMED SEE STABLE VT SYNC-CARDIOVERT OR AMIODARONE OR ANY OF THE OTHER ANTIARRYHMICS IN THAT ALGORITHM |
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What are the indications, dosages, and administration pearls for Adenosine?
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1. Indications
Narrow PSVT 2. Dosage 6mg,12mg,and a 3rd dose of 12mg can be give 3. Administration Rapid IV push(RIVP) |
Look it up! There are no hints here!
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What is the indications, dosage, and administration pearls for Amiodarone?
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1. Indications
V-FIB/Pulseless VT, VT with a pulse, and may be given for rate control in A-FIB 2. Dosage 300mg IV(never ETT)for cardiac arrest. Repeat dose at 150mg in 3-5 mins VT w/pulse 150 mg over 10mins(150mg in 250cc), and repeat if ectopy is not abolished at 150mg Slow drip 360mg IV over 6 hrs, maintenance 540mg over 18hrs Not to exceed 2.2g in 24hrs 3. Admin It is a soapy solution, and if shaken will take a few mins to settle. Never give this med in the ETT. It will eat the surfactent away. |
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Atropine?
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1. Indications
Symptomatic sinus brady, second drug after epi and vasopressin for treatment of asystole, or brady PEA. 2. Dosage Asystole and brady PEA 1mg IV or 2mg ETTq 3-5mins not to exceed 0.04mg/kg Bradycardia 0.5mg-1.0mg every 3-5mins not to exceed 0.04mg/kg 3. Admin Will not be effective in 2nd degree hb type II or 3rd degree hb use pacing or dopamine or epi drips Don't give less than 0.5mg IV Does not work with transplant pt's |
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What are the indication, dosage, and administraion pearls for Calcium Cloride?
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1. Indications
Known or suspected hyperkalemia(renal failure). Hypocalcemia(after multiple blood transfusion. Antidote for Calcium Channel Blockers or Beta blocker overdoses. 2. Dosage 8-16mg/kg for hyoerkalemia and CCB overdoses. 3. Admin DON"T GIVE WITH HCO3(bicarb) |
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What are the indication, dosage, admisitration pearls for Dopamine?
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1. Indications
Second drug for symptomatic bradycardia after Atropine. Used for hypotension with signs and symptoms of shock. 2. Dosage Mixed 400mg in 250cc NS Consentration of 1600mcg/ml Renal dose- 1-5mcg/kg/min Moderate dose- 5-10mcg/kg/min High dose- 10-20mcg/kg/min An easy way to figure out the drop/min is. If the patient weighs 100kg, and you want to give 5mcg/kg/min. The drops/min will be will be 19gtt/min. For every kg the Pt is above 100kg add 2gtt's. For every kg the Pt is under 100kg subtract 2gtt's. An example of this is, the Pt weighs 110kg's. (19gtt's for a 100kg pt + 2gtt's for every kg above 100kg's= 39gtt/min) 3. Admin IV MUST BE GOOD!!!!! DON'T MIX WITH HCO3(bicarb) NEVER RUN DOPAMINE IN TILL YOU GET THE DESIRED EFFECT!!! |
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What are the indications, dosage, and administration pearls for Epinephrine?
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1. Indications
Cardiac Arrest, VF, pulseless VT, asystole, PEA, symtpmatic bradycardia, severe hypotension, anaphylaxis 2. Dosage Cardiac Arrest- 1mg of 1:10q 3-5mins ETT dose- Double down Bradycardia and hypotension- 2-10mcg/min- add 30mg of EPI to 250cc NS Anaphylaxis- .3-.5mg 1:1 SQ 3. Admin May be given IO,ET,and IV. 1mg in 250cc= 1mcg/min= 15cc/hr |
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What are the indications, dosage, and administration pearls for Lidocaine?
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1. Indications
Cardiac Arrest- VF,pulseless VT,stable VT, Wide complex Tachycardia 2. Dosage- Cardiac Arrest- 1.0-1.5mg/kg IVP ETT- Double Down q 3-5mins to a total dose of 3mg/kg 3. Admin Mix either 1gm is 250cc NS, or 2gm in 500cc NS. Then infuse at 1-4mg/min Can be given IO,ET,IV |
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