ACLS & drugs

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Author:
mthompson17
ID:
269945
Filename:
ACLS & drugs
Updated:
2014-04-09 17:40:22
Tags:
ACLS
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Description:
ACLS & drugs
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  1. Actions for any pt that needs ACLS?
    • 1. Check carotid pulse, airway, breathing
    • 2. Call for help (if you get the cart- unplug it!!)
    • 3. Start compressions, insert oral airway, attach BVM to O2
    • 4. attach defibrillator when available
    • 5. IVs
  2. Actions when 1st rhythm on monitor is VF/VT?
    Shock 200J then 5 cycles of CPR then check rhythm again

    EPI & other meds prn & fluids
  3. EPI dose & when can it be repeated?
    1mg q 3 to 5 min
  4. What should be done after reading rhythm on the monitor?
    check pulse
  5. When should respirations be checked?
    Before beginning CPR, after beginning bagging, & after intubation
  6. Actions after intubation?
    Check placement by listening to the stomach first then the breath sounds

    Place CO2 detector
  7. When should amiodarone be given for VT/VF and what dose?
    after 3rd shock give 300mg then give 150mg
  8. Actions for asystole/PEA?
    • 1. CPR
    • 2. EPI 1mg q 3 to 5 min
    • 3. Recheck rhythm after 5 cycles
    • 4. If rhythm is asystole repeat - If rhythm is anything else check carotid pulse and determine actions
  9. 6 H's & 5 T's?
    • 1. hypovolemia
    • 2. hypo/hyper kalemia
    • 3. hypothermia
    • 4. H+ - acidosis
    • 5. Hypoglycemia
    • 6. Hypoxia

    • 1. Toxins
    • 2. Tamponade:  cardiac
    • 3. Tension pneumothorax
    • 4. Thrombosis:  coronary/pulmonary
    • 5. Trauma
  10. Pt who may be hypoxic?
    COPD, asthma
  11. Pt who may be acidotic?
    DKA, dialysis
  12. Tx for hyperkalemia?

    Important consideration?
    10u regular insulin & amp of D50

    OR

    amp of bicarb

    Be sure to flush well after - if BG is high will not need the D50
  13. Tx for hypoglycemia?
    amp of D50
  14. Medication that can cause torsades?
    tricyclic antidepressants, dysrhythmia meds
  15. What condition is likely to cause PEA?
    cardiac tamponade
  16. Tx for tension pneumothorax?
    chest tube
  17. Tx for opiate OD?
    narcan 0.5-2mg IV - may be repeated in 2 to 3min intervals up to 10mg
  18. When should EPI be started for VF/pulseless VT?
    after second shock
  19. When should meds be started for asystole/PEA?
    as soon as access is available IV
  20. Actions that should be taken after the admin of a drug during ACLS?
    flush with 20mL of NS after all meds & elevate arm except with central lines
  21. Uses for EPI?
    • 1. all types of  cardiac arrest
    • 2. severe hypotension
    • 3. bradycardia refractory to atropine
    • 4. anaphylaxis
  22. EPI dosage for hypotension & bradycardia?
    continuous drip 0.1-o.5mcg/kg/min
  23. Use for vasopressin?
    • 1. may be given as alternative to EPI - then give EPI 10 min later
    • 2. hypotension
  24. Dosage of vasopressin if used in place of EPI?
    40u IV push (2 vials)
  25. Use & dosage for adenosine?
    • 1. for SVT that does not respond to vagal maneuvers
    • 2. rapid IV push 6mg then 12mg in 1 to 2 minutes
  26. What is the effect of adenosine?
    stops heart then starts it back normal
  27. Use for dopamine?
    • 1. increase renal perfusion <5mcg/kg/min
    • 2. symptomatic hypotension:  5-20mcg/kg/min
  28. AE of dopamine?
    • 1. tachyarrhythmias
    • 2. excessive vasoconstriction:  check pulses
    • 3. extravasation
  29. When should levaphed be given?
    if dopamine doesn't work for symptomatic hypotension
  30. AE of levophed?
    vasoconstriction with occluded BF:  check pulses

    extravasation
  31. Actions r/t AE of dopamine & levophed?
    • 1. watch for tachyarrhthmias with dopamine
    • 2. check distal pulses
    • 3. monitor for infiltration & document q2h
  32. Levophed dosage?
    0.1-0.5mg/kg/min titrated to improve BP
  33. Effects of levophed?
    shunts blood to major organs
  34. Tx for dopamine & levophed infiltration?
    regitine
  35. Dobutamine?

    Dosage?

    AE?
    postivie ionotropic:  increases CO with low EF

    2-20mcg/kg/min

    tachyarrythmias
  36. Action before pushing more than one drug?
    check compatibility
  37. Lidocaine & amiodarone?

    Can they be given during same cardiac arrest?
    antiarrhytmics for arrest caused by VF/pulseless VT

    also given for other arrhythmias:  frequent PVCs, VT with a pulse
  38. What should be done after lidocaine or amiodarone converts to normal rhythm?
    hang continuous drip of the drug given
  39. Lidocaine dosage?
    initial dose 1mg/kg IV push

    may repeat 0.5mg/kg in 5-10min  up to max dose of 3mg/kg

    maintenance drip:  1-4mg/min
  40. Consideration when giving lidocaine?
    toxicity is common:  monitor blood levels & d/c prn: confusion, n/v, seizures, bradycardia
  41. Amiodarone dosage for cardiac arrest?
    300mg (2vials) mixed in 20mL D5W IV push then repeat 150mg in 30 to 5 min

    continuous drip 1mg/min X6h then o.5mg/min X18h
  42. Noncardiac arrest amiodarone dosage?
    150mg IV bolus over 10min - may repeat q10min prn
  43. Max dose of amiodarone?
    2.2g/24h
  44. Half-life of amiodarone?
    40 days
  45. What should be monitored when amiodarone is given?
    QT interval
  46. AE of amiodarone?
    • 1. prolonged QT
    • 2. hypotension after initial dosing
  47. Sodium bicarb dosage?

    Uses for sodium bicarb?
    1meq/kg IVP (amp/ half amp)

    metabolic acidosis, hyperkalemia, tricyclic overdose, DKA
  48. Tx for respiratory acidosis?

    Is bicarb used?
    hyperventilate pt to blow off CO2 (BVM q4-5sec)

    no
  49. Consideration with bicarb IV?
    only compatible with NS - must flush very well before and after
  50. Use for magnesium?

    Dosage?
    first line drug for torsades

    1-2g IV over 10-20min
  51. Use for atropine?

    Dosage?

    When should atropine not be used?
    symptomatic bradycardia - not arrest

    0.5mg IV initially then may repeat q3-5min up to max dose of 3mg

    does not work if pt has had a heart transplant - use inocor
  52. If atropine is ineffective for bradycardia what med should be used?
    chronotropic infusion:  EPI or dopamine drip or external pacing
  53. Post-resuscitation care?
    • 1.  Check responsiveness
    • 2. Airway:  ensure patent, assess respiratory rate & quality, SpO2
    • 3. Breathing:  provide O2/positive-pressure ventilations until ventilator
    • 4. Circulation:  check pulse, BP, labs
    • 5. Destination:  transfer to appropriate unit:  ICU, cath lab, etc
    • 6. Hang drip of lidocaine/amiodarone prn
    • 7. Tx any issues remaining:  BP
  54. Tx for low BP during post-resuscitation?
    fluid bolus or vasopressor

    • dopamine 5-20mcg/kg/min
    • levophed 0.5-1.0mcg/min
  55. When should drip be hung post-resuscitation?
    if rhythm was VF/VT hand drug that converted them:

    • lidocaine 1/4mg/min
    • amiodorone 1mg/min over 6h, then 0.5
  56. Tachyarrhythmia?
    pulse >/=150/min
  57. Actions for tachycardia with a pulse?
    • ID & Tx cause:
    • 1. maintain patent airway & assist with breathing prn
    • 2. O2 if hypoxemic
    • 3. Cardiac monitor to ID rhythm, monitor BP & sats
  58. When should synchronized cardioversion be done for tachyarrhythmias?
    persistent tachyarrhtymia with hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort or acute HF
  59. Consideration for synchronized cardioversion?
    consider sedation

    if regular, narrow complex, consider adenosine
  60. If a patient has persistent tachyarrhythmia without s/s what actions are taken?
    Check if QRS complex is >/= 0.12 then decide actions
  61. Actions if pt has a persistent tachyarrhythmia with QRS complex >/= 0.12?
    • 1. IV access & 12-lead EKG
    • 2. consider adenosine only if regular & monomorphic
    • 3. Consider antiarrhythmics
    • 4. consider expert consultation
  62. Actions if pt has persistent tachyarrhythmia and QRS is not >/= 0.12?
    • 1. IV access & 12-lead EKG
    • 2. vagal maneuvers
    • 3. adenosine if regular
    • 4. B-blocker or Ca channel blocker
    • 5. Consider expert consultation
  63. Recommended doses for synchronized cardioversion?
    Narrow regular - 50-100J

    Narrow irregular:  120-200J

    Wide regular:  100J

    Wide irregular:  defibrillation dose:  NOT synchronized
  64. Adenosine IV dose for tachyarrhthmias?
    first dose 6mg rapid IV push followed by NS flush

    Second dose:  12mg if required

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