ACLS & drugs

• 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

Shock 200J then 5 cycles of CPR then check rhythm again

EPI & other meds prn & fluids

1mg q 3 to 5 min

check pulse

Before beginning CPR, after beginning bagging, & after intubation

Check placement by listening to the stomach first then the breath sounds

Place CO2 detector

after 3rd shock give 300mg then give 150mg

• 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

• 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

COPD, asthma

DKA, dialysis

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

amp of D50

tricyclic antidepressants, dysrhythmia meds

cardiac tamponade

chest tube

narcan 0.5-2mg IV - may be repeated in 2 to 3min intervals up to 10mg

after second shock

as soon as access is available IV

flush with 20mL of NS after all meds & elevate arm except with central lines

• 1. all types of  cardiac arrest
• 2. severe hypotension
• 3. bradycardia refractory to atropine
• 4. anaphylaxis

continuous drip 0.1-o.5mcg/kg/min

• 1. may be given as alternative to EPI - then give EPI 10 min later
• 2. hypotension

40u IV push (2 vials)

• 1. for SVT that does not respond to vagal maneuvers
• 2. rapid IV push 6mg then 12mg in 1 to 2 minutes

stops heart then starts it back normal

• 1. increase renal perfusion <5mcg/kg/min
• 2. symptomatic hypotension:  5-20mcg/kg/min

• 1. tachyarrhythmias
• 2. excessive vasoconstriction:  check pulses
• 3. extravasation

if dopamine doesn't work for symptomatic hypotension

vasoconstriction with occluded BF:  check pulses

extravasation

• 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

shunts blood to major organs

regitine

postivie ionotropic:  increases CO with low EF

2-20mcg/kg/min

tachyarrythmias

check compatibility

antiarrhytmics for arrest caused by VF/pulseless VT

also given for other arrhythmias:  frequent PVCs, VT with a pulse

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

toxicity is common:  monitor blood levels & d/c prn: confusion, n/v, seizures, bradycardia

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

150mg IV bolus over 10min - may repeat q10min prn

2.2g/24h

40 days

QT interval

• 1. prolonged QT
• 2. hypotension after initial dosing

1meq/kg IVP (amp/ half amp)

metabolic acidosis, hyperkalemia, tricyclic overdose, DKA

hyperventilate pt to blow off CO2 (BVM q4-5sec)

no

only compatible with NS - must flush very well before and after

first line drug for torsades

1-2g IV over 10-20min

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

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

fluid bolus or vasopressor

• dopamine 5-20mcg/kg/min
• levophed 0.5-1.0mcg/min

if rhythm was VF/VT hand drug that converted them:

• lidocaine 1/4mg/min
• amiodorone 1mg/min over 6h, then 0.5

pulse >/=150/min

• ID & Tx cause:
• 1. maintain patent airway & assist with breathing prn
• 2. O2 if hypoxemic
• 3. Cardiac monitor to ID rhythm, monitor BP & sats

persistent tachyarrhtymia with hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort or acute HF

consider sedation

if regular, narrow complex, consider adenosine

Check if QRS complex is >/= 0.12 then decide actions

• 1. IV access & 12-lead EKG
• 2. consider adenosine only if regular & monomorphic
• 3. Consider antiarrhythmics
• 4. consider expert consultation

• 1. IV access & 12-lead EKG
• 2. vagal maneuvers
• 3. adenosine if regular
• 4. B-blocker or Ca channel blocker
• 5. Consider expert consultation

Narrow regular - 50-100J

Narrow irregular:  120-200J

Wide regular:  100J

Wide irregular:  defibrillation dose:  NOT synchronized

first dose 6mg rapid IV push followed by NS flush

Second dose:  12mg if required