ACLS Drugs dosages & uses
Sedatives that can be given before cardioversion (5):
-Diazepam -Midazolam -etomidate -methohexital -propofol
Treatment for causes of cardiac arrest related to hypotension:
-IV bolus: 1-2L NS or LR (for min SBP of 90 or a MAP of >65) -Norepinephrine: 0.1-0.5 mcg/kg/min -Epinephrine: 2-10 mcg/min IV -Dopamine: 5-20 mcg/kg/min iV
PEA includes these (5) rhythms:
-Idioventricular or Ventricular escape rhythms -Sinus rhythm -Afib -Aflutter -BBBs
For light sedation within the RN scope of practice give which 3 things should be given before TCP if the pt's condition allows for it?
-Parenteral narcotic -Parenteral benzodiazepine -Chronotropic infusion
Antiarrhythmic drugs for tachy-arrhythmias:
-Procainamide 20-50mg/min IV (max 17mg/kg IV) -Amiodarone 150mg IV over 10 minutes -Sotalol 100mg (1.5mg/kg) IV over 5 minutes
What roles does ECPR (ECMO) fill in the management of cardiac arrest?
-Provides vital organ support while treating reversible causes -Sevrves as a bridge for Left ventricular assist device implantation
What roles does ECPR fill in the management of cardiac arrest?
-Serves as a bridge for left ventricular assist device implantation -provides vital organ support while treating reversible causes
Pt has been experiencing dizziness and palpitations while exercising at home. This morning it has gotten worse and he is now in the ER.... The pt is conscious ans alert, has a HR of 180/min, a weak radial pulse, BP 110/78, and SpO2 of 96%. The most appropriate first interventions are attach a 12-lead EKG and Maintain a patent airway & monitor. What are the best next steps?
-Vagal Maneuvers -IV access -12-lead EKG
What is the therapy for a narrow QRS with regular rhythm (4)?
-Vagal maneuver -give Adenosine -give a B-blocker/calcium channel blocker -consider expert consultation
What are the shockable rhythms displayed on the AED?
-Ventricular Fibrillation (VF) -Pulseless Ventricular Tachycardia (pVT) -Monomorphic VT -Polymorphic VT
In a pt with VF/pVT from accidental moderate hypothermia, the treatment plan is:
-start CPR -attempt defibrillation -give medications -provide active rewarming
What is the recommended norepinephrine dose for hypotensive pts during the post-cardiac arrest phase?
0.1-0.5 mcg/kg/min
if the QRS complex is ----seconds or greater, consider expert consultation.
0.12 seconds
Maintenance dose for Amiodarone (antiarrhythmic)
1 mg/min IV for the 1st 6 hours
What is the first recommended IV/IO dose of Lidocaine for pts in cardiac arrest with VF/pVT that is unresponsive to defibrillation?
1-1.5 mg/kg IV
Lidocaine should be given as a first dose of _____. Then consider 1 additional doses of ____mg to ____mg IV at 5-10 minute intervals for shockable rhythms in VF/pVT
1-1.5 mg/kg IV 0.5-0.75 mg/kg IV (max dose 3mg/kg)
What is the recommended fluid bolus dose for pts who are hypotensive during the post-cardiac arrest phase?
1-2 L NS or lR
Maintenance dose for Procainamide (antiarrhythmic)
1-4 mg/min IV
What are the 7 rhythms associated with unstable tachycardia?
1. Sinus Tachycardia 2. Atrial fibrillation 3. Atrial Flutter 4. Superventricular Tachycardia (SVT) 5. Monomorphic Ventricular Tachycardia (giant shark teeth-looking) 6. Polymorphic Ventricular Tachycardia (Mutiple random shark teeth-looking) 7. Wide-complex tachycardia of uncertain type
After ROSC start a cycle of ____breaths/minutes.
10
To avoid access ventilation, vegin ventilation at a rate of ____ and adjust to achieve a PaCO2 of 35-45 mmHg.
10/min
First dose amount of Antiarrhythmic drug Sotalol: -dont give if prolonged QT is present
100mg (1.5mg/kg) IV over 5 minutes
What is the recommended follow-up dose of Adenosine for the management of SVT unresponsive to the first dose of Adenosine?
12mg IV
The HR that takes on clinical significance and is more likely to contribute to arrhythmia in tachycardia is what rate?
150/min or greater
What is the recommended first dose of Amiodarone for the management of stable wide-complex tachycardia?
150mg IV
First dose amount for Antiarrhythmic drug Amiodarone:
150mg IV over 10 minutes
Magnesium sulfate (treatment for Torsades de Pointes) has a loading dose of ___g IV in ____mL NS given IV typically over 20 minutes.
1g IV in 10mL NS
If the rhythm is analyzed as shockable on the defibrillator give ___mg of ____ IV during CPR after the 2nd shock.
1mg IV of Epinephrine
How much of a safety margin (energy above the dose at which consistent capture is observed) should you allow when using the transcutaneous pacemaker?
2 mA
What is the recommended starting IV infusion dose of epinephrine for pts in cardiac arrest who achieve ROSC and need vasopressor support?
2-10 mcg/min
Epinephrine should be given at what dose/rate for Bradycardia?
2-10mcg/min
First dose amount of Antiarrhythmic drug Procainamide:
20-50mg/min IV
Repeat giving Epinephrine when a shockable rhythm can be read, every ___ to ___ minutes.
3-5 minutes
What is the recommended first IV/IO dose of Amiodarone for pts in cardiac arrest with VF/pVT that is unresponsive to defibrillation?
300mg
When using amiodarone to treat ventricular fibrillation or pulseless ventricular tachycardia, the first dose should be _____mg IV/IO push. The second dose is delivered at _____mg IV/IO push.
300mg 150mg
pts should maintain a body core temp between ___ and ___ degrees Celsius for at elast 24 hours.
32 to 36 degrees Celsius
When adjusting ventilation rates, which PETCO2 value lies within the recommended range for a pt who achieves return of spontaneous circulation?
40mm Hg
How quickly should resuscitation team leaders consider perimortem cesarean delivery after beginning resuscitation efforts if return of spontaneous circulation has not been acheived?
5 minutes
Dopamine should be given at what dose/rate for Bradycardia?
5-20mcg/kg/min
What is the mean arterial pressure target when adminsitering epinephrinie to pts in cardiac arrest who achieve ROSC and need vasopressor support?
65 mmHg
What is the initial recommended dose of Adenosine for the management of SVT unresponsive to Vagal Maneuver?
6mg IV
Adenosine increased AV block and will terminate approx. ___% of reentry arrhythmias within ___ minutes.
90% 2 minutes
If SVT does not convert within 1-2 minutes after 1st dose of Adeosine 6mg, give _____.
A second dose of Adenosine 12 mg IV.
If SVT does not respond to Vagal maneuvers give _____ in a large vein over 1 second.
Adenosine 6mg IV
Amiodarone should be given as a bolus dose of _____. Then consider 1 additional ____mg IV for shockable rhythms in VF/pVT specifically.
Amiodarone 300mg IV bolus 150 mg IV
while doing CPR with a shockable rhythm (VF or pulseless VT), consider giving _____ or ____ to pull the pt out of the rhythm.
Amiodarone or Lidocaine
Pulseless Electrical Activity (PEA) is described as:
An organized rhythm consisting of QRS complexes that are similar in appearance from beat to beat and may have: -narrow or wide QRS complexes -rapid or slow rate -be regular or irregular and there will be No pulse.
Which therapy is not supported by evidence for use in pts with cardiac arrest secondary to hypothermia?
Antiarrhythmics (toxins can build up in the body more when it is hypothermic)
WHen is the recommended point to administer epinephrine to a pt with asystole?
As soon as IV access is available
When should resuscitation team leaders activate the protocol for perimortem cesarean delviery?
As soon as cardiac arrest is identified in a pregnant patient
What are the 2 nonshockable rhythms displayed on the AED?
Asystole Pulseless Electrical Activity (PEA)
What rhythms will Adenosine not terminate?
Atrial Flutter and Atrial Fibrillation but it can slow down the HR so these rhythms can be identified.
For poor perfusion with Bradycardia Treat with which first line treatment?
Atropine 1mg IV (repeat to a total of 3mg IV)
What is the first line drug for acute stable bradycardia and how do you administer it?
Atropine given as 1mg IV q 3-5minutes (up to 3mg IV)
Pt has been experiencing dizziness and palpitations while exercising at home. This morning it has gotten worse and he is now in the ER.... The pt is conscious ans alert, has a HR of 180/min, a weak radial pulse, BP 110/78, and SpO2 of 96%. What are the most appropriate initial interventions?
Attach a 12-lead EKG Maintain a patent airway & monitor
What can be used if bradycardia is unresponsive to Atropine?
B-adrenergic infusions (dopamine or epinephrine)
PEA can present in which of the following organized rhythms?
BBB, Sinus rhythm, Afibrillation
When is it recommended to administer the first dose of epinephrine for a pt in a shockable rhythm?
Between the second and third shocks.
During the post-cardiac arrest care period, the 12-lead EKG reveals an ST-segment elevation MI. What is the next step/highest priority action?
Coronary Angiography
In addition to CPR with minimal interruptions in chest compressions, what is the most critical intervention during the first few minutes of arrest for a pt in Vfib?
Defibrillation
What can be given for bradycardia when vasoconstriction is not desired?
Dobutamine (b-adrenergic agonist)
During the management of a pt in cardiac arrest, you have initiated CPR, attached, the manual defibrillator, delivered the first shock, and immediately resumed CPR with chest compressions. What is your next intervention?
Establish IV or IO access
During the management of a patient in cardiac arrest, you have initiated CPR, attached the manual defibrillator, delivered the first shock, and immediately resumed CPR, beginning with chest compressions. What is your next intervention?
Establish IV/IO access
Pt has been experiencing dizziness and palpitations while exercising at home. This morning it has gotten worse and he is now in the ER.... The pt is conscious ans alert, has a HR of 180/min, a weak radial pulse, BP 110/78, and SpO2 of 96%. The most appropriate first interventions are attach a 12-lead EKG and Maintain a patent airway & monitor. After performing the set of 2nd interventions, Vagal Maneuvers, obtaning IV access, and getting antother 12-lead EKG, what would be the next best step? (updated vitals HR 178, BP 110/78, RR 24/min)
Give Adenosine 6mg IV
In addition to hypoxia, what is the most common underlying potentially reversile cause of pulseless electrical activity?
Hypovolemia
Depending on training and clinical circumstance, how can rescuers administer maloxone?
IV, Intranasally, IM
What is the first line treatment for unstable tachycardia?
Immediate Synchronized Cardioversion
If only 0.5mg of IV Atropine is given what consequence could it have?
It can further lower the HR
How does Transcutaneous Pacing (TCP) work and when should it be used?
It delivers pacing impulses to the heart through skin via cutaneous electrodes. for unstable bradycardia (hypotension, AMS, shock, ischemic chest pain)
What is an advantage of primary percutaneous coronary intervention in a catheterization lab for pts with cardiac arrest secondary to coronary artery occlusion once they achieve ROSC?
It restores blood flow in an infarction-related artery
You are assessing an unresponsive pt known to have an implanted left ventricular assist device (LVAD). The pt is not breathing, the pt's skin is pale and cool, and cap refill is inadequate. How do you assess whether the LVAD is functioning?
Listen for device hum
you are assessing an unresponsive pt known to have an implanted left Ventricular assist device (LVAD). The pt is not breathing, the pts skin is pale and cool, the cap refill is inadequate. How do you assess whether the LAD is functioning?
Listen for the device hum
what drug should you consider for treatment of Torsades de Pointes associated with a long OT interval?
Magnesium Sulfate
Which two AV block types will not respond to Atropine?
Mobitz type II second-degree AV block and third-degree AV block
What term best describes an organized rhythm without a pulse?
PEA
Pt has been experiencing dizziness and palpitations while exercising at home. This morning it has gotten worse and he is now in the ER.... The pt is conscious ans alert, has a HR of 180/min, a weak radial pulse, BP 110/78, and SpO2 of 96%. The most appropriate first interventions are attach a 12-lead EKG and Maintain a patent airway & monitor. After performing the set of 2nd interventions, Vagal Maneuvers, obtaning IV access, and getting antother 12-lead EKG, the pt was given 6mg IV of Adenosine. After admin of the Adenosine, the vitals are HR 184, BP 78/54, RR 26/min) what is your next action?
Perform synchronized cardioversion
A pt with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step?
Provide rescue breathing and give Naloxone
Venoarterial Extracorporeal Membrane Oxygenation, ECPR (ECMO), during cardiac arrest
Provides support to vital organs with perfusion gas exchange while reversible causes of cardiac arrest are treated.
ROSC stands for...
Return of spontaneous circulation
Hoe does Atropine work?
Reverses the cholinergic-mediated decreases in the heart rate and AV node conduction
Adenosine is safe or unsafe during pregnancy?
SAFE
Pt has been experiencing dizziness and palpitations while exercising at home. This morning it has gotten worse and he is now in the ER.... The pt is conscious ans alert, has a HR of 180/min, a weak radial pulse, BP 110/78, and SpO2 of 96%. Would you consider the pt to be stable or unstable?
Stable
What is the preferred treatment for Mobitz type II second-degree AV block and third-degree AV block?
TCP or B-adrenergic (dopamine, epinephrine) support until transcutaneous pacing can be achieved
How will the current generation of continuous-flow left ventricular assist devices complicate the BLS assessment?
The devices will not produce a pulse
What must you consider before giving B-adrenergic infusions in bradycardia?
The pt's BP/intravascular volume status for hypovolemia
For poor perfusion with Bradycardia Treat, if the first line of treatment is ineffective, what should be provided and what med should be given?
Transcutaneous pacing Dopamine 5-20mcg/kg/minute infusion OR Epinephrine 2-10mcg/min infusion
If the width of the ORs complex is 0.12 or less treat with what two things?
Vagal maneuvers and Adenosine
In a pt with VF/pVT from accidental hypothermia, it is reasonable to consider administering a ______ according to the standard ACLS algorithm while rewarming.
Vasopressor
Adenosine can cause ____ so you should not give it to pt's with asthma or COPD.
bronchospasm
what do you do with the pt immediately after giving Adenosine 6mg IV?
elevate the arm immediately
In addition to hypoxia, what is the most common underlying, potentially reversible cause of Pulseless Electrical Activity?
hypovolemia
Place a pregnant woman in cardiac arrest in which position to relieve possible compression of the inferior vena cava?
left-lateral decubitus position--lying on her L side with lower arm outstretched (using angled backs of 2-3 chairs or the angled thighs of several providers)
Which alteration to the standard ACLS algorithm is appropriate for pts whose cardiac arrest is caused by hypothermia?
medications spaced at longer intervals
What alterations are recommended for resuscitation drug administration to third-trimester gravid pts in cardiac arrest?
no dosing alterations are recommended
A patient with a ventricular assist device (VAD) is not breathing, has signs of inadequate perfusion, and is unconscious. You determine the VAD is functioning. After endotracheal intubation, the patient has a PETCO2 of 12mm Hg. What is your next action?
perform external chest compressions
In a pt with VF/pVT from accidental Severe hypothermia, treatment is:
rapid core rewarming
what is the recommended CPR position for a third-trimester gravid patient?
supine with manual left lateral uterine displacement
