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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
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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
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EPI dose & when can it be repeated?
1mg q 3 to 5 min
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What should be done after reading rhythm on the monitor?
check pulse
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When should respirations be checked?
Before beginning CPR, after beginning bagging, & after intubation
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Actions after intubation?
Check placement by listening to the stomach first then the breath sounds
Place CO2 detector
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When should amiodarone be given for VT/VF and what dose?
after 3rd shock give 300mg then give 150mg
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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
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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
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Pt who may be hypoxic?
COPD, asthma
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Pt who may be acidotic?
DKA, dialysis
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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
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Tx for hypoglycemia?
amp of D50
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Medication that can cause torsades?
tricyclic antidepressants, dysrhythmia meds
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What condition is likely to cause PEA?
cardiac tamponade
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Tx for tension pneumothorax?
chest tube
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Tx for opiate OD?
narcan 0.5-2mg IV - may be repeated in 2 to 3min intervals up to 10mg
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When should EPI be started for VF/pulseless VT?
after second shock
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When should meds be started for asystole/PEA?
as soon as access is available IV
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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
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Uses for EPI?
- 1. all types of cardiac arrest
- 2. severe hypotension
- 3. bradycardia refractory to atropine
- 4. anaphylaxis
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EPI dosage for hypotension & bradycardia?
continuous drip 0.1-o.5mcg/kg/min
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Use for vasopressin?
- 1. may be given as alternative to EPI - then give EPI 10 min later
- 2. hypotension
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Dosage of vasopressin if used in place of EPI?
40u IV push (2 vials)
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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
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What is the effect of adenosine?
stops heart then starts it back normal
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Use for dopamine?
- 1. increase renal perfusion <5mcg/kg/min
- 2. symptomatic hypotension: 5-20mcg/kg/min
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AE of dopamine?
- 1. tachyarrhythmias
- 2. excessive vasoconstriction: check pulses
- 3. extravasation
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When should levaphed be given?
if dopamine doesn't work for symptomatic hypotension
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AE of levophed?
vasoconstriction with occluded BF: check pulses
extravasation
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Actions r/t AE of dopamine & levophed?
- 1. watch for tachyarrhthmias with dopamine
- 2. check distal pulses
- 3. monitor for infiltration & document q2h
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Levophed dosage?
0.1-0.5mg/kg/min titrated to improve BP
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Effects of levophed?
shunts blood to major organs
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Tx for dopamine & levophed infiltration?
regitine
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Dobutamine?
Dosage?
AE?
postivie ionotropic: increases CO with low EF
2-20mcg/kg/min
tachyarrythmias
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Action before pushing more than one drug?
check compatibility
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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
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What should be done after lidocaine or amiodarone converts to normal rhythm?
hang continuous drip of the drug given
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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
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Consideration when giving lidocaine?
toxicity is common: monitor blood levels & d/c prn: confusion, n/v, seizures, bradycardia
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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
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Noncardiac arrest amiodarone dosage?
150mg IV bolus over 10min - may repeat q10min prn
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Max dose of amiodarone?
2.2g/24h
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Half-life of amiodarone?
40 days
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What should be monitored when amiodarone is given?
QT interval
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AE of amiodarone?
- 1. prolonged QT
- 2. hypotension after initial dosing
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Sodium bicarb dosage?
Uses for sodium bicarb?
1meq/kg IVP (amp/ half amp)
metabolic acidosis, hyperkalemia, tricyclic overdose, DKA
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Tx for respiratory acidosis?
Is bicarb used?
hyperventilate pt to blow off CO2 (BVM q4-5sec)
no
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Consideration with bicarb IV?
only compatible with NS - must flush very well before and after
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Use for magnesium?
Dosage?
first line drug for torsades
1-2g IV over 10-20min
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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
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If atropine is ineffective for bradycardia what med should be used?
chronotropic infusion: EPI or dopamine drip or external pacing
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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
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Tx for low BP during post-resuscitation?
fluid bolus or vasopressor
- dopamine 5-20mcg/kg/min
- levophed 0.5-1.0mcg/min
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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
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Tachyarrhythmia?
pulse >/=150/min
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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
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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
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Consideration for synchronized cardioversion?
consider sedation
if regular, narrow complex, consider adenosine
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If a patient has persistent tachyarrhythmia without s/s what actions are taken?
Check if QRS complex is >/= 0.12 then decide actions
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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
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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
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Recommended doses for synchronized cardioversion?
Narrow regular - 50-100J
Narrow irregular: 120-200J
Wide regular: 100J
Wide irregular: defibrillation dose: NOT synchronized
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Adenosine IV dose for tachyarrhthmias?
first dose 6mg rapid IV push followed by NS flush
Second dose: 12mg if required
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