Pharm Quiz #2 > ACLS > Flashcards

ACLS Flashcards

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1
Q

If Adult Cardiac Arrest what do you do 1st?

A

Shout for help/activate emergency response

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2
Q

After you Shout for help/activate emergency response, what do you do next?

A

Start CPR

  • Give oxygen
  • Attach monitor/defibrillator
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3
Q

After you started CPR what do you do?

A
  • Check rhythm
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4
Q

What if the patient is in VF/VT?

A

Shock

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5
Q

After check rhythm…

A
  • Give continuous CPR, and monitor CPR quality for 2 minutes
  • Drug Therapy
    1. IV access
    2. Epinephrine every 3-5 minutes
    3. Amiodarone for refractory VF/VT
  • Consider Advanced Airway: quantitative waveform capnography
  • Treat reversible causes
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6
Q

After you shock 1st time, what do you do?

A

CPR 2 min with IV/IO acces

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7
Q

After shocked 1st time and 2nd round CPR, then what?

A

Is rhythm shockable?

  1. Yes: so shock, then CPR 2 min, Epinephrine every 3-5 minutes, Consider Advanced Airway
  2. NO: no signs of return to spontaneous circulation, either do
    a.) CPR 2 min with IV/IO acces, Epinephrine every 3-5 minutes, Consider Advanced Airway
    OR
    b.) CPR 2 min, Treat reversible causes
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8
Q

After shocked 2nd time and 3rd round CPR, then what?

A

Is rhythm shockable?

  1. Yes: so shock, then CPR 2 min, Amiodarone, Treat reversible causes
  2. NO: no signs of return to spontaneous circulation, either do
    a.) CPR 2 min with IV/IO acces, Epinephrine every 3-5 minutes, Consider Advanced Airway
    OR
    b.) CPR 2 min, Treat reversible causes
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9
Q

After initial start of CPR and Rhythm is not shockable (asytole/PEA) then what?

A

CPR 2 min with IV/IO access, Epinephrine every 3-5 minutes, Consider Advanced Airway

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10
Q

If Persistent Tachycardia IS causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Synchronized Cardioversion

  • consider sedation
  • if narrow complex, consider adenosine
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11
Q

If Persistent Tachycardia IS NOT causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Look at if there is a Wide QRS (greater than 0.12 seconds)

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12
Q

Yes Persistent Tachycardia has a Wide QRS (greater than 0.12 seconds)

A
  • IV access and 12-lead EKG
  • Consider adenosine only if regular and monomorphic
  • Consider antiarrhythmic infusion
  • Consider expert consultation
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13
Q

NO Persistent Tachycardia has a Wide QRS (greater than 0.12 seconds)

A
  • IV access and 12-lead EKG
  • Vagal Maneuvers
  • adenosine (if regular)
  • Beta blocker or calcium channel blocker
    • Consider expert consultation
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14
Q

If Persistent Bradycardia IS NOT causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A

Monitor and observe

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15
Q

If Persistent Tachycardia IS causing Hypotension, acutely altered mental status, signs of shock, or ischemic chest discomfort, or acute heart failure?

A
  • Atropine IV dose:
    1st dose: 0.5mg bolus
    repeat every 3-5 mins
    max = 3 mg

OR
- Dopamine IV infusion:
2-10 mcg/kg per min

OR
- Epinephrine IV infusion:
2-10 mcg/kg per min

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16
Q

Epinephrine Dose

A

o 1 mg every 3 5 minutes in adult cardiac arrest; follow each dose with 20 ml flush
o Intraosseous administration
o ET capable- 2 to 2.5 mg

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17
Q

Epinephrine MOA

A

o May restore electrical activity in asystole
o During resuscitation causes heart to contract faster and more forcefully due to beta stimulation
o Vasoconstriction due to alpha stimulation
o Bronchodilation due to beta2 effect

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18
Q

Epinephrine Indications

A

o All types of cardiac arrest, anaphylaxis, acute asthmatic attacks

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19
Q

Watch for with Epinephrine

A

o Use with caution in angina, hypertension, hyperthyroidism

o Patients over 40 years old with heart rate greater than 120/min.

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20
Q

ADR of Epinephrine

A

o Tachycardia

o Increased blood pressure

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21
Q

Vasopressin Dose

A

o 40 Units IV push one time (vial)

o Intraosseous administration

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22
Q

Vasopressin MOA

A

o Potent vasoconstrictor effect

o Increases contractility of smooth musculature especially of coronary arteries

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23
Q

Vasopressin indications

A

o Alternative vasoconstrictor to epinephrine

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24
Q

Vasopressin ADR

A 
o	Arrhythmias
o	Myocardial ischemia
o	Angioedema
o	Bronchoconstriction
o	Anaphylaxis
•
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25
Amiodarone Dosing
o Cardiac arrest- 300 mg IV push, consider repeat doses of 150 mg in 3-5 minutes o Wide-Complex Tachycardia- 150 mg IV over first 10 minutes (repeat every 10 minutes PRN); slow infusion 360 mg IV over 6 hours o Intraosseous administration
26
Amiodarone MOA
o Affects sodium, potassium and calcium channels which contributes to slowing of conduction and prolongs refractoriness in the AV node o Alpha and beta blocking properties o Lengthens cardiac action potential
27
Amiodarone Indications
o Wide variety of atrial and ventricular tachyarrhythmias
28
Amiodarone ADR
o Vasodilation o Hypotension o Negative inotropic effects
29
Atropine Sulfate Dosing
o 500 mcg to 1 mg IV push in bradycardia o 1 mg IV push in asystole or PEA o Dose may be repeated at 3 5 minute intervals o Give dose rapidly (slow administration causes transient decrease in heart rate) o Intraosseous administration
30
Atropine Sulfate MOA
o Enhancement of conduction through AV junction by parasympathetic blockade
31
Atropine Sulfate Indications
o Sinus bradycardia with a pulse less than 60/min o When accompanied by PVCs, systolic pressure less than 90 mm Hg or other signs of decreased perfusion o Asystole o Bradycardic PEA
32
Avoid Atropine Sulfate if
o Atrial flutter/fibrillation with rapid ventricular response
33
Watch for these if on Atropine Sulfate
o Increased myocardial oxygen demand trigger of tachycardias
34
Atropine Sulfate ADR
o Flushing of skin o Dryness of mouth o Tachycardia o Pupillary dilation
35
Adenosine dose
o 6 mg rapid IV push (over 1 3 seconds) | o Follow each bolus immediately with 20 ml flush of 0.9% sodium chloride
36
Adenosine MOA
o Decreases conduction of electrical impulse through AV node
37
Adenosine Indications
``` o PSVT (narrow complex) refractory to normal vagal maneuvers o Tachycardia (wide complex) of uncertain type post lidocaine administration ```
38
Watch for with Adenosine
o in 2nd/3rd degree heart block o Sick sinus syndrome o Dysrhythmias other than PSVT
39
Adenosine ADR
o Facial flushing, headache, dizziness, nausea, chest pain or tightness, brief episodes of bradycardia, asystole
40
Diltiazem dose
o 0.25 mg/kg actual body weight as a bolus administered over 2 minutes  20 mg is a reasonable dose for the average patient o Second bolus dose should be 0.35 mg/kg actual body weight administered over 2 minutes  25 mg is a reasonable dose for the average patient).
41
Diltiazem MOA
o Inhibits the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle o Ability to slow AV nodal conduction time and prolong AV nodal refractoriness
42
Diltiazem Indications
o Atrial fibrillation or atrial flutter | o Paroxysmal supraventricular tachycardia
43
Watch for with Diltiazem
o Refractoriness that may rarely result in second- or third-degree AV block in sinus rhythm o Caution should be exercised when using the drug in severe heart failure o Occasionally result in symptomatic hypotension o VPBs may be present on conversion of PSVT to sinus rhythm
44
Diltiazem ADR
``` o Asymptomatic hypotension o Symptomatic hypotension o Site reactions o Vasodilation o Arrhythmia ```
45
Verapamil dose
o 2.5 to 5 mg IV Push over 2 minutes o Repeat doses of 5 to 10 mg every 15 minutes to a total maximum of 20 mg  Alternative- 5 mg bolus every 15 minutes for a total of 30 mg
46
Metoprolol dose
o 5 mg by slow intravenous or intraosseous push at 5 minute intervals to a total of 15 mg
47
Metoprolol MOA
o Beta-adrenergic receptor blocking agent | o Preferential effect on beta1 adrenoreceptors, chiefly located in cardiac muscle
48
Metoprolol indications
o Rate control in narrow-complex tachycardias that originate either from a reentry mechanism (reentry SVT) or an automatic focus uncontrolled by vagal maneuvers and adenosine in the patient with preserved ventricular function o Rate control in atrial fibrillation and atrial flutter in the patient with preserved ventricular function
49
Metoprolol ADR/watch for
o Decrease in sinus heart rate in most patients o May produce significant first- (P-R interval greater than or equal to 0.26 sec), second-, or third-degree heart block o Hypotension o Patients with bronchospastic diseases should, in general, not receive beta blockers
50
Magnesium Sulfate Dose
o 1 to 2 g IV push (diluent of 10 ml 5% dextrose injection) over 5 to 20 minutes o Doses may go as high as 6 g in torsades with pulses  1 -2 g mixed in 50-100 ml 5% dextrose as loading dose o Infusion:  500 mg to 1 g per hour infusion in torsades
51
Magnesium Sulfate MOA
o Unknown mechanism although may involve inhibition of acetylcholine release
52
Magnesium Sulfate Indications
o Torsades, VF/VT associated with known or suspected hypomagnesemia and severe refractory VF
53
watch for with Magnesium Sulfate
o Rapid administration may cause mild bradycardia, hypotension, flushing, sweating
54
Magnesium Sulfate ADR
o Circulatory collapse, respiratory paralysis, decreased reflexes, flaccid paralysis
55
Lidocaine (syringe) Dose
``` o Cardiac Arrest:  1 1.5 mg/kg IV push o Refractory VF:  See above starting dose the subsequent doses of 0.5 0.75 mg/kg every 5 10 minutes to 3 mg/kg maximum o ET Tube Capable:  2-4 mg/kg ```
56
Lidocaine MOA
o Decrease automaticity, depolarization and excitability in ventricles during diastolic phase by direct action on nerve tissue
57
Lidocaine Indications
o PVCs associated with acute myocardial infarction | o Prevention of recurrence of ventricular fibrillation and to treat ventricular tachycardia and ventricular fibrillation
58
Watch for with Lidocaine
o Known allergy to lidocaine/”caines” o 2nd or 3rd degree heart block o Sinus bradycardia/ sinus arrest
59
Lidocaine ADR
o Decrease in cardiac output and blood pressure o Drowsiness, slurred speech, altered consciousness o Rare seizures o Respiratory depression
60
Sodium Bicarbonate (syringe) dose
o 1 mEq/kg IV push followed by 0.5 mEq/kg every 10 minutes depending on results of arterial blood gas values
61
Sodium Bicarbonate MOA
o Restores the body’s buffering capacity and neutralizes excess acid
62
Sodium Bicarbonate Indications
o Metabolic acidosis, hyperkalemia, drug overdose
63
Sodium Bicarbonate Watch for's
o Inactivation of dopamine (acidic) infusion | o Induction of intracellular acidosis with resulting negative inotropic effect
64
Sodium Bicarbonate ADR
o Local pain and irritation at injection site o Hyperosmolarity o Hypernatremia
65
POISONING basic steps
- Establishment of an airway - Ventilation - Maintenance of adequate vital signs - Measure often and accurately - Accurate temperatures - Respiratory rate carefully counted - Unconscious: Naloxone, Oxygen, Dextrose?
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