lidocaine: - bolus dose: - drip dose:

- 100mg IV push - 2-4mg IV drip

10mcg/kg/min for hypotension SBP 70.

ACLS Flashcards by Mike Mah

Initial stabilizing/diagnostic measures for suspected MI?

VS, IV, O2, monitor

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dose of nitroglycerin

400 mcg q3-5min

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dose of morphine

2-4mg q5min

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Four diagnostic categories for EKG interpretation in setting of suspected MI:

normal
STEMI
ischemia
non-specific T wave changes

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EKG normal - next step?

trend trops

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EKG = non-specific T wave changes - next step?

repeat EKG in 20 min

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EKG = ischemia - next step?

O2, nitroglycerin

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Unstable angina Dx made, what 2 meds do you give continuously?

heparin drip, nitroglycerin

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Someone starts to code, what are initial steps?

Call 911/Code Blue
Start CPR
Assign roles
AED
Bag Valve Mask
monitor

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When should the first drug in every pulse-less arrest be given? What’s the drug, dose and interval?

2nd round or ASAP

-epi 1mg q3min

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Where do you place AED pads?

sternum and apex

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How do you manage airway for first 2 min?

Bag valve mask

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CPR - once pt has a pulse, what do you do?

3 steps:

BP check
500cc NS bolus
IV bicarb
* also do EKG/ABG/labs/CXR

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Pt recovers, how do you prevent another run of vfib?

amio 150mg

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Dose and drip rate for amio for pt with pulse:

150mg IV over 8-10 min loading dose

1mg/min x6 hrs
0.5mg/min x18hrs
avoid decrease in BP

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Refractory vfib: which drug do you give during 2nd cycle of CPR that will facilitate successful defib?

amio 300mg

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lidocaine:

bolus dose:
drip dose:

100mg IV push

- 2-4mg IV drip

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2nd round CPR

-which 2 additional airway management considered?

- larygneal mask airway

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First step after placing ETT or LMA?

listen to epigastrium for gurgles

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Gold standard for documenting ETT placement?

End Tidal CO2

*ETCO2

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ROSC

-why is pt tachy? 2 reasons:

- acidosis

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ROSC

-why hypotension? 2 reasons:

acidosis

- stunned mycocardio = CHF

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ROSC

-Sinus w/occasional PVCs. What to do?

amio drip

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ROSC

-What to do about hypotension? 2 things:

1-2L bolus

- dopamine drip: 10mcg/kg/min for hypotension SBP <90 but > 70.

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dopamine drip dose:

10mcg/kg/min for hypotension SBP <90 but > 70.

ROSC | -2 ways to treat metabolic acidosis:

- bicarb IV | - increase vent rate

ROSC | -even if it doesn't show STEMI - do you still take to cath lab?

yes

NRM - non rebreather | -how many L?

15L

In prep for ETT placement, what 3 things should you do?

1. pre-oxygenate 2. prepare suction 3. BVM assist

Causes of ACS: mnemonic:

6Hs and 5Ts

Causes of ACS: | -What are 6 H's?

- hypovolemia - hypoxia - hydrogen ion = acidosis - hyper/hypokalemia - hypothermia - hypoglycemia

Causes of ACS: | -What are the 5T's?

- tablets (drug OD) - tamponade - tension ptx - thrombosis (coronary) - thrombosis (PE) - trauma

First pressor to start?

levophed

No pulse: whats rate have to be to cardiovert?

150+

BP: 80/50 not responsive to fluids - which pressor do you start? - dose?

between SBP 90 and 70 use dopamine drip -10mcg/kg/min *SBP < 70 then levophed

PEA due to tamponade: | -resuscitation measures?

- IV x2 - dobutamine - pericardiocentesis - ETT/BVM - epi 1mg q3-5min

Pericardiocentesis - how much fluid to remove? - how should pt's vitals respond?

- 30cc | - BP increase

What does POLST stand for?

Physician's Orders for Life-Sustaining Treatment

aflutter | -3 characteristics:

- lack of normal P waves - x:1 = abnormal P waves : QRS - regular rhythym (vs afib which is irregular)

what limits aflutter and afib from transmitting every impulse to the ventricles?

refractory cells of the AV node

afib v aflutter | -which one is regular? which irregular?

afib = irregular aflutter = regular *regular means equal intervals btwn QRS complexes

AV nodal reentrant tachy - is every impulse sent to ventricles? - regular or irregular?

yes | -regular

Vtach - wide or narrow? - p waves present?

- wide | - no p waves

Vtach | -regular or irregular?

-regular

Vfib | -regular or irregular?

-irregular

Vtach vs Vfib | -which has varying amplitudes?

Vfib

1st deg AV block | -definition?

PR interval > 200ms

Symptomatic bradycardia | -atropine dose?

0.5 mg IV q3-5min

Diltiazem (AV nodal blocking drug) - 1st dose: - 2nd dose:

- 20mg IVP | - 30mg ivp

Adenosine (AV nodal blocking drug) - 1st dose: - 2nd dose:

- 6mg IVP | - 12mg IVP

AV nodal blocking drugs | -name 3

diltiazem, adenosine, metoprolol

Metoprolol (AV nodal blocking drug) | -doses:

5mg IVP | -up to 3 doses

O2 | -how many liters NC for ACS?

4-6L

Morphine - dose - rate

2mg IVP q3-5min for chest pain unrelieved by NTGx3 and SBP > 100.

Following STEMI Dx: | -Clopidogrel dose:

600mg PO

Following STEMI Dx: | -Heparin dose:

1) 60 units/kg IV bolus for acute ischemia - max 4000 units 2) then 12 units/kg/hr - max 1000units/hr

Procainamide - dose: - drip:

- 17mg/kg IV load over 40 min | - drip: 1-4mg/min

Lidocaine - dose: - drip:

- 100mg IVP in cardiac arrest or symptomatic vtach | - drip: 2-4mg IV

Dopamine | -drip:

10mcg/kg/min for hypotension SBP btwn 70 and 90

Norepi | -drip:

2-20mcg/kg/min for hypotension SBP < 70

Epi | -drip:

2-10mcg/min

Sodium bicarb - when to administer? - dose?

-50 meq IVP after ROSC

IV Fluids in cardiac arrest | -how much?

1 liter wide open to start cardiac arrest resuscitation, 500cc IV bolus for hypotension.

Cardioversion - when to use? - sequence of voltages?

- when you have perfusing rhythm with a pulse | - 100J biphasic => 150J => 200J if no cardioversion.

Mnemonic for organs first damaged by hypotension:

SLK BH - SLK in Beverly Hills - Skin, Lungs, Kidneys, Brain, Heart.

Symptomatic bradycardia - whats your goal HR when first treating? - what device do you grab next?

60 bpm | -transcutaneous pacer

Transcutaneous pacer | -rate/energy/mode:

60-70 20-200J demand mode

Which benzos to use before trans-cutaneous pacer (which hurts).

valium or versed

How to determine if transcutaneous pacer is successful?

mechanical capture - pulse/BP - vital organ perfusion

Electrical capture - look for what? | Mechanical capture - look for what?

- QRS | - pulse

contraindications to adenosine use: - which 2 drugs? - what could happen if you used?

tegretol (carbamazepine) dipyramidole -asystole

What do you expect to see on monitor after giving adenosine?

asystole

What is considered a "wide" QRS?

120ms

Narrow QRS complexes always have origin from where?

supraventricular | -you know bc you know its going through proper conduction pathway from atria down through AV node.

Before cardioversion, what drugs should you give pt? | -be cautious about what?

valium/versed, fentanyl | -watch for decreasing BP.

Two common causes of Vtach:

ischemia, electrolyte probs

Evaluation method for stroke:

Cincinnati stroke scale

3 components of Cincinnati stroke scale

face, arms, speech

Time frame for thrombolytic therapy?

4.5 hrs

Contraindications to tPa therapy?

1. trauma 2. hx of hemorrhagic stroke 3. ischemic stroke last 3 mo. 4. aneurysm 5. avm 6. INR >1.7 7. active bleeding 8. metastatic tumor 9. melena

Acute stroke: if you decide not to give tPa, which med should you give?

ASA

Rate of symptomatic intracranial hemorrhage with tPA is used for stroke?

6.4% in literature

What % improvement in neuro outcomes if tPa given?

30%

BP necessary to give tPa? | -how to reach if over? which drugs?

< 185/110 | -metop or nicardipine

Where is transvenous pacer placed?

apex of R ventricle

do "unstable" pts have a pulse?

yes but w/poor circulation.

Is there ever a pulse w/vfib?

is FB(+) contra to tPa?

no but melena is.

rhythm strips: Inverted P wave w/rate of ~50 Normal QRS

junctional rhythm

If you see QRS w/o preceding P wave, what should you think?

ectopic rhythm

sinus brady w/unifocal pvc vs. ventricular bigeminy

Ventricular bigeminy there is a PVC following every sinus beat.

rhythm strips: | A sinus beat is shortly followed by a PVC, a pause, another normal beat, and then another PVC.

Ventricular bigeminy,

rhythm strips: | Rate of 30 - whats first thing to think of?

3rd degree block | -ventricular escape rhythm is 30 bpm.

valium dosage

5mg

versed dosage

2mg

Cardioversion | -sequence of doses:

100J biphasic => 150J => 200J

ACLS Flashcards

(96 cards)