ACLS & drugs
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. What would you like to do?
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
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
EPI dose & when can it be repeated?
1mg q 3 to 5 min
What should be done after reading rhythm on the monitor?
When should respirations be checked?
Before beginning CPR, after beginning bagging, & after intubation
Actions after intubation?
Check placement by listening to the stomach first then the breath sounds
Place CO2 detector
When should amiodarone be given for VT/VF and what dose?
after 3rd shock give 300mg then give 150mg
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
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
Pt who may be hypoxic?
Pt who may be acidotic?
Tx for hyperkalemia?
10u regular insulin & amp of D50
amp of bicarb
Be sure to flush well after - if BG is high will not need the D50
Tx for hypoglycemia?
amp of D50
Medication that can cause torsades?
tricyclic antidepressants, dysrhythmia meds
What condition is likely to cause PEA?
Tx for tension pneumothorax?
Tx for opiate OD?
narcan 0.5-2mg IV - may be repeated in 2 to 3min intervals up to 10mg
When should EPI be started for VF/pulseless VT?
after second shock
When should meds be started for asystole/PEA?
as soon as access is available IV
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
Uses for EPI?
- 1. all types of cardiac arrest
- 2. severe hypotension
- 3. bradycardia refractory to atropine
- 4. anaphylaxis
EPI dosage for hypotension & bradycardia?
continuous drip 0.1-o.5mcg/kg/min
Use for vasopressin?
- 1. may be given as alternative to EPI - then give EPI 10 min later
- 2. hypotension
Dosage of vasopressin if used in place of EPI?
40u IV push (2 vials)
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
What is the effect of adenosine?
stops heart then starts it back normal
Use for dopamine?
- 1. increase renal perfusion <5mcg/kg/min
- 2. symptomatic hypotension: 5-20mcg/kg/min
AE of dopamine?
- 1. tachyarrhythmias
- 2. excessive vasoconstriction: check pulses
- 3. extravasation
When should levaphed be given?
if dopamine doesn't work for symptomatic hypotension
AE of levophed?
vasoconstriction with occluded BF: check pulses
Actions r/t AE of dopamine & levophed?
- 1. watch for tachyarrhthmias with dopamine
- 2. check distal pulses
- 3. monitor for infiltration & document q2h
0.1-0.5mg/kg/min titrated to improve BP
Effects of levophed?
shunts blood to major organs
Tx for dopamine & levophed infiltration?
postivie ionotropic: increases CO with low EF
Action before pushing more than one drug?
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
What should be done after lidocaine or amiodarone converts to normal rhythm?
hang continuous drip of the drug given
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
Consideration when giving lidocaine?
toxicity is common: monitor blood levels & d/c prn: confusion, n/v, seizures, bradycardia
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
Noncardiac arrest amiodarone dosage?
150mg IV bolus over 10min - may repeat q10min prn
Max dose of amiodarone?
Half-life of amiodarone?
What should be monitored when amiodarone is given?
AE of amiodarone?
- 1. prolonged QT
- 2. hypotension after initial dosing
Sodium bicarb dosage?
Uses for sodium bicarb?
1meq/kg IVP (amp/ half amp)
metabolic acidosis, hyperkalemia, tricyclic overdose, DKA
Tx for respiratory acidosis?
Is bicarb used?
hyperventilate pt to blow off CO2 (BVM q4-5sec)
Consideration with bicarb IV?
only compatible with NS - must flush very well before and after
Use for magnesium?
first line drug for torsades
1-2g IV over 10-20min
Use for atropine?
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
If atropine is ineffective for bradycardia what med should be used?
chronotropic infusion: EPI or dopamine drip or external pacing
- 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
Tx for low BP during post-resuscitation?
fluid bolus or vasopressor
- dopamine 5-20mcg/kg/min
- levophed 0.5-1.0mcg/min
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
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
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
Consideration for synchronized cardioversion?
if regular, narrow complex, consider adenosine
If a patient has persistent tachyarrhythmia without s/s what actions are taken?
Check if QRS complex is >/= 0.12 then decide actions
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
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
Recommended doses for synchronized cardioversion?
Narrow regular - 50-100J
Narrow irregular: 120-200J
Wide regular: 100J
Wide irregular: defibrillation dose: NOT synchronized
Adenosine IV dose for tachyarrhthmias?
first dose 6mg rapid IV push followed by NS flush
Second dose: 12mg if required
What would you like to do?
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