Acls Study

Front 1

Adenosine (endogenous nucleoside)

Indicated for?

IV Bolus Dosage?

Back 1

PSVT or Narrow Complex Tachycardia

6mg - 1st dose
12 mg - 2nd dose
12 mg - 3rd dose
(1-2 min intervals between)

Front 2

Amiodarone (antiarrhythmic)

Indicated for?

IV Bolus Dosage?

Infusion Dosing?

Back 2

V-Fib/Pulseless V-Tach
300 mg - 1st dose
150 mg - 2nd dose

Infusion dosing:
Loading: 150 mg over 10 minutes, then
360 mg IV over 6 hours
540 mg IV over 18 hours

Front 3

Aspirin (NSAID)

Indicated for?

PO dose?

Suppository Dose?

Back 3

Chest Pain/ACS

PO Dose: 160-325 mg

Suppository dose: 300 mg

Front 4

Atropine (parasympathetic blocker)

Indicated for?

IV Bolus Dosage?

Back 4

Bradycardia
0.5 mg q 3-5 min as needed

PEA, Asystole
1 mg q 3-5 min

Front 5

Atropine special considerations

Back 5

Only used in bradycardias for *symptomatic* patients. Only used in PEA if rate is *slow*. The maximum dosage is 3 mg. Doses of Atropine < .5 mg may result in paradoxical slowing of the heart. NOT indicated in 2nd degree type I or third degree heart block.

Front 6

Adenosine considerations

Back 6

Doses are followed by a saline flush. Two subsequent doses of 12 mg each may be administered at 1 - 2 min intervals. Use the port closest to cannulation. The AHA recommends that the dose be cut by half if administering through a central line, or in the presence of Dipyridamole or Carbamazepine. Larger doses are required in the presence of caffeine or Theophylline.

Front 7

Amiodarone considerations

Back 7

Cumulative doses > 2.2 g/24 hours are associated with significant hypotension. Do not administer with other drugs that prolong QT interval (ie, Procainamide). Terminal elimination is extremely long - half life lasts up to 40 days.

Front 8

Digoxin (cardiac glycoside antiarrhythmic)

Indicated for?

IV Bolus Dosage?

Back 8

A-Fib/ A-Flutter

10 - 15 mics/kg lean body weight

Front 9

Digoxin considerations

Back 9

Reduce Digoxin dose by 50% when initiating Amiodarone due to drug interaction. Toxicity may cause serious arrhythmias.

Front 10

Diltiazem (calcium channel blocker)

Indicated for?

IV Bolus Dosage?

Back 10

A-Fib/A-Flutter

15-20 mg over 2 minutes

Front 11

Diltiazem considerations

Back 11

Do not use in wide-QRS tachycardias of uncertain origin. May cause hypotension.

Front 12

Dopamine (catecholamine)

Indicated for?

IV dosage?

Back 12

Symptomatic Bradycardia, Hypotension

1-5 mic/kg/min - renal perfusion
5-15 mic/kg/min - cardiac dose
10 - 20 mic/kg/min - vasopressor dose

Front 13

Dopamine considerations

Back 13

Titrate to patient response. Correct hypovolemia with volume replacement BEFORE initiating Dopamine. May cause tachyarrhythmias. Do not mix with Sodium Bicarbonate.

Front 14

Epinephrine (catecholamine)

Indicated for?

IV dosage?

Infusion dosage?

Back 14

V-Fib/Pulseless V-Tach, PEA, Asystole, Symptomatic Bradycardia
1 mg every 3-5 minutes

Infusion dosage 1 mg in 500mL of D5W or NaCl at 1 mic/min titrated to effect

Front 15

Epinephrine considerations

Back 15

First line drug in all pulseless rhythms. Bolus given in 10mL of a 1:10,000 solution. May cause myocardial ischemia, angina, and increased myocardial oxygen demand. ET route is discouraged, but if used 2-2.5 mg diluted in 10 mL NaCl.

Front 16

Lidocaine (antiarrhythmic)

Indicated for?

IV dosage?

Infusion dosage?

Back 16

V-Fib/Pulseless V-Tach, Stable V-Tach
1-1.5 mg/kg

Infusion dosage: 1-4 mg/min (30-50 mic/kg/min)

Front 17

Lidocaine considerations

Back 17

May repeat at 0.5-0.75 mg/kg every 5-10 minutes to maximum dose 3mg/kg. Prophylactic use in AMI is contraindicated. Use with caution in presence of impaired liver. Discontinue infusion if signs of toxicity develop.

Front 18

Magnesium sulfate (electrolyte)

Indicated for?

IV dosage?

Back 18

Cardiac arrest if torsades or Hypomagnesemia

1-2g in 10 mL D5W over 20 minutes

Front 19

Magnesium sulfate considerations

Back 19

occasional fall in blood pressure with rapid administration. Use with caution in renal patients.

Front 20

Morphine sulfate (opiate analgesic)

Indicated for?

IV dosage?

Back 20

Chest pain
Pulmonary edema

2-4 mg every 5-30 minutes

Front 21

Naloxone (opiate antagonist)

Indicated for?

IV dosage?

Back 21

Narcotic overdose

0.4-2mg

Front 22

Naloxone considerations

Back 22

If needed, can administer up to 10mg in 10 minutes. Monitor for recurrent respiratory depression. May cause opiate withdrawal. ET route discouraged, but can be used if IV/IO access not available.

Front 23

Nitroglycerine (vasodilator)

Indicated for?

IV dosage?

Back 23

Chest pain/ACS

12.5-25 mics

Front 24

Nitroglycerine considerations

Back 24

Most commonly given sublingually as a tablet or spray. The dose is 0.3-0.4 mg. Repeat up to 3 doses at 5 minute intervals. Hypotension or bradycardia may occur. Do not use with Viagra and similar drugs.

Front 25

Nitroprusside (vasodilator)

Indicated for?

IV dosage?

Back 25

Hypertensive crisis

0.1 mic/kg/min, titrate upward to effect

Front 26

nitroprusside considerations

Back 26

May cause hypotension. Use with catution with Viagra and similar drugs. Light-sensitive--bag and tubing must be covered with opaque material.

Front 27

Procainamide (antiarrhythmic)

Indicated for?

IV dosage?

Infusion dosage?

Back 27

Wide variety of arrhythmias

IV drip dosage - 20mg/min

Infusion dosage: 1-4 mg/min

Front 28

Procainimide considerations

Back 28

Maximum dosage is 17mg/kg. In presence of cardiac or renal dysfunction, reduce max dose to 12mg/kg. Can cause arrhythmias in presence of AMI, hypokalemia, or hypomagnesemia. Use with caution with other drugs that prolong the QT interval such as Amiodarone.

Front 29

Sodium Bicarbonate (buffer)

Indicated for?

IV dosage?

Back 29

Acidosis, hyperkalemia

1 mEq/kg

Front 30

Sodium bicarbonate considerations

Back 30

Not recommended for routine use in cardiac arrest patients. If available, use arterial blood gas analysis to guide bicarbonate therapy.

Front 31

Vasopressin (hormone)

Indicated for?

IV dosage?

Back 31

V-fib/V-Tach
PEA, Asystole

10 U IV/IO

Front 32

Vasopressin considerations

Back 32

Only given one time. May cause cardiac ischemia and angina. May replace first or second dose of Epi. Not recommended for responsive patients with coronary artery disease.

Front 33

Verapamil (calcium channel blocker)

Indicated for?

IV dosage?

Back 33

A-Fib/A-Flutter
PSVT

2.5-5 mg over 2-5 minutes

Front 34

Verapamil considerations

Back 34

Alternative drug after Adenosine to terminate PSVY with adequate blood pressure and preserved LV function. Can cause peripheral vasodilation and hypotension. Use with extreme caution in patients receiving oral beta blockers.