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Whats the rate of V-Tach???
rate is usually greater than 180 beats per minute and the rhythm generally has a very wide QRS complex.http://acls-
Treatment with V-fib?
Ventricular fibrillation is always pulseless and must be confirmed by EKG or defibrillator monitor. Defibrillation is the treatment of choice and should occur as soon as possible.
PEA is treated by.....???
PEA is treated by assessing and correcting the underlying cause. These causes can be summed up in the 6 H’s and 6 T’s of ACLS. Use the link to review the H’s and T’s.
6 H's of ACLS???
- Hypovolemia, hypoxia, H-ions,
- Hypo/hyperkolemia, hypoglycemia, hypothermia
What is the most common cause of PEA?
Hypovolemia and hypoxia
If asystole is visualized on the monitor....?
If asystole is visualized on the monitor, you should ensure that all leads are connected properly. If all leads are properly connected, you should rapidly assess for any underlying causes for the asystole.
Second-Degree Heart Block (Type 1)
Second-Degree (AV) Heart Block (Type 2)
Supraventricular Tachycardia (SVT)
Characteristics of SVT ???
Classic Paroxysmal SVT has a narrow QRS complex & has a very regular rhythm. Inverted P waves are sometimes seen after the QRS complex. These are called retrograde p waves
Treatment of SVT ???
Unstable patients with SVT and a pulse are always treated with cardioversion
Monomorphic Ventricular Tachycardia
Normal ETCO2 in the adult ???
Normal ETCO2 in the adult patient should be 35-45 mmHg.
High quality chest compressions are achieved when the ETCO2 value is ???
High quality chest compressions are achieved when the ETCO2 value is at least 10-20 mmHg.
4 steps in the BLS Survey ???
- (1) Check responsiveness
- (2) Active emergency response system and obtain a AED
- (3) Circulation: Check for a carotid pulse. This pulse check should not take more than 5-10 seconds.
- (4) Defibrillation:
2 medications used in the PEA algorithm ??
epinephrine and vasopressin.1 milligram of epinephrine is given IV or IO every 3-5 minutes. 40 Units of vasopressin can be given IV or IO to replace the first or second dose of epinephrine.
Bradycardia Pharmacology ??
Atropine: The first drug of choice for symptomatic bradycardia. Dose in the Bradycardia ACLS algorithm is 0.5mg IV push and may repeat up to a total dose of 3mg.Dopamine:
Dopamine:-line drug for symptomatic bradycardia when atropine is not effective. Dosage is 2-10 micrograms/kg/min infusion.
Epinephrine: Can be used as an equal alternative to dopamine when atropine is not effective. Dosage is 2-10 micrograms/min.
Transcutaneous pacing (TCP)
For the patient with symptomatic bradycardia with signs of poor perfusion, transcutaneous pacing is the treatment of choice.
For patients with a perfusing rhythm deliver ???
1 breath every 5 to 6 seconds
Once an advanced airway is in place, chest compressions are no longer interrupted for ventilations.
1 breath should be given every 6-8 seconds (8-10 breaths per minute).
- 1. Maintain oxygen saturation >94%
- 2. Treat hypotension <90 mmHG
- 3. Follow commands; yes: coronary perfusion
- No: Hypothermia
Interventions for ROSC??
10-12 breaths/min; PETCo2 35-45mm HG
1-2 Liter bolus
- Epinephrine 0.1-0.5 mcg/kg/min
- Norepinephrine 0.1-0.5 mcg/kg/min
- Dopamine 5-10mcg/kg/min
Medications used in torsades de pointes?
Magnesium 1-2 gm IV over 5-10mins in D5W
Amiodorone dose in ventricular fibulation/ ventricular tachycardia?
Amiodorone 300mg IV first dose
Amiodorone 150mg IV 2nd dose in 3-5 minutes
interruption in CPR to conduct a rhythm should not exceed how many seconds ???
Physiologic monitoring during CPR ?
- Increase efforts in CPR if .....
- PETCO2 value <10mm Hg
- Arterial relaxation pressure is <20mm hg
- SVO2 is <30%
Lidocaine dose in VF/VT??
- 1-1.5 mg/kg IV or IO
- repeat dose of 0.5-0.75mg/kg
max dose of 3mg/kg
Therapeutic hypothermia temp ranges?
32-34 degrees for 12-24 hrs
Contraindication of nitroglycerin use?
Right ventricular MI, due to nitroglycerin decrease to preload.
- Systolic pressure <90mm Hg
- HR <60, or tachycardia
Use of sildenafil or vardenafil
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