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ACLS
ACLS
128
Anatomy
Graduate
03/19/2012

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Term
CAB:
Definition
chest compressions
airway
breathing
Term
Order for CPR:
Definition
1. Check pt for responsiveness and breathing
2. Call for help and get AED
3. Check pulse
4. Give 30 compressions
5. Open airway and give 2 breaths
6. Resume compressions
Term
depth of compression for adults:
Definition
2 inches (5 cm)
Term
depth of compressions for children:
Definition
- at least 1/3 the depth of the chest, 2 inches or 5 cm
Term
depth of compressions for infants:
Definition
- at least 1/3 the depth of the chest, approximately 1.5 inches (4 cm)
Term
ACLS indications for continuous quantitative waveform capnography:
Definition
- Intubated patients through the periarrest period
- Confirming endotracheal tube placement
- Monitoring CPR quality and detecting ROSC based on ent-tidal carbon dioxide values
Term
best way to assess endotracheal tube placement:
Definition
Continuous Quantitive Waveform Capnography
Term
recommended initial biphasic energy dose for cardioversion of atrial fibrillation:
Definition
120-200J
Term
initial monophasic dose for defib of A. fib:
Definition
200 J
Term
defib dose for A. flutter or other supraventricular rhythms:
Definition
50-100 J (mono or biphasic)
Term
Defib dose for stable monomorphic VT:
Definition
100 J mono or biphasic
Term
symptomatic unstable bradycardia:
Definition
chronotropic drugs can be used to alternative to pacing
Term
stable, wide complex, undifferentiated, monomorphic tachycardia with regular rhythm:
Definition
adenosine
Term
are chronotropic drugs or transcutaneous pacing more effective for symptomatic unstable bradycardia?
Definition
equally effective
Term
Morphine is inidcated in __ when chest discomfort is unresponsive to nitrates. Morhpine should be used with cautin in pts with __ __ __ due to increased mortality in a large registry.
Definition
- STEMI
- unstable angina/NSTEMI
Term
During cardiac arrest, providers should administer a vasopressor every __ to __ minutes.
Definition
3 to 5
Term
what should be given for refractory VF or VT?
Definition
amiodarone
Term
first line for ALL symptomatic bradycardia:
Definition
Atropine (but atropine is NOT used for PEA or cardiac arrest)
Term
Critical Actions for Post-Cardiac Arrest Care:
Definition
HATMO
- Hemodynamic optimization, focus on treating hypotension
- Acquisition of 12 lead EKG
- Therapeutic hypothermia
- Monitioring advanced airway placement with quantitative waveform capnography in intubated patients
- Optimizing arterial oxygen saturation
Term
ACLS post-cardiac arrest care:
Definition
- Optimizing cardiopulmonary function and vital organ perfusion, esp heart and brain
- Transport out of hospital pts to facility with post cardiac arrest care including acute coronary interventions, neuro care, goal directed critical care, and hypothermia
- Transporting in hospital arrest pts to critical care units capable of provideing comprehensive post cardiac arrest care
- Identifying and treating causes of arrest and preventing recurrence
- Considering therapeutic hypothermia to optimize survival and neuro recovery and comatose pts
- Identifying and treating acute coronary syndromes
- Optimizing mechanical ventilation to minimize lung injury
- Gathering data for prognosis
- Assisting patiesn and families with rehab services if necessary
Term
adenosine does not convert:
Definition
- Atrial Fibrillation
- Atrial Flutter
- Ventricular Fibrillation

(ADENOSINE WILL NOT WORK ON THESE)
Term
indications for adenosine:
Definition
- stable narrow-complex SVT
- effective at terminated tachycardias due to reentry at the AV or sinus node
- may consider for unstable narrow-complex reentry tachycardia while prepping for cardioversion
- regular monomorphic wide complex tachycardia, previously known as reentry SVT
Term
stable narrow complex SVT;
Definition
adenosine
Term
Adenosine contraindications:
Definition
- poison/drug-induced tachycardia
- second degree heart block
- third degree heart block
Term
Adenosine side effects:
Definition
- Flushing
- Chest pain/tightness
- Brief asystole or bradycardia
- Ventricular ectopy
Term
Adenosine is less effective in pts taking __ or __ (these pts may need higher doses).
Definition
- theophylline
- caffeine
Term
Is adenosine safe and effective during pregnancy?
Definition
yes
Term
Adenosine is used to terminate SVT, what commonly occurs after this?
Definition
- transient periods of sinus bradycardia and ventricular ectopy
Term
Adenosine IV Rapid push dosing:
Definition
- Pt in mild reverse Trendelenburg position
- Initial bolus of 6 mg over 1-3 seconds followed by NS bolus of 20 mL, then elevate extremity
- A second dose of 12 mg can be given in 1 to 2 minutes if needed
Term
Injection technique for adenosine administration:
Definition
- Record rhythm strip during administration
- Draw up adenosine dose and flush in 2 separate syringes
- Attach both syringes to IV injection port closest to the patient
- Clamp IV tubing above the injection port
- Push IV adenosine as quickly as possible (1-3 seconds)
- While maintaining pressure on adensosine plunger, push NS flush as rapidly as possible after adenosine
- Unclamp IV tubing
Term
VF or VT unresponsive to CPR, shock, and vasopressor:
Definition
Amiodarone
Term
Recurrent hemodynamically unstable VT:
Definition
amiodarone
Term
rapid infusion of amiodarone may lead to ___.
Definition
hypotension
Term
With mulitple dosings of amiodarone, cumulative doses > __grams/24 hours are associated with significant __ in clinical trials.
Definition
- > 2.2 grams/24 hours
- hypotension
Term
Do NOT administer amiodarone with other drugs that prolong the __ __, such as __.
Definition
- QT interval
- Procainamide
Term
Terminal elimination of amiodarone is extremely long, the half life lasts up to _ __.
Definition
40 days
Term
indication for amiodarone:
Definition
VF/VT cardiac arrest unresponsive to CPR, Shock, and Vasopressors
Term
Dosing of amiodarone for refractory VT/VF:
Definition
- First dose: 300 mg IV/IO push
- Second dose if needed: 150 mg IV/IO push
Term
Rapid infusion dosing for amiodarone:
Definition
150 mg IV over first 10 minutes (15 mg/minute). May repeat rapid infusion of 150 mg as needed every 10 minutes.
Term
Slow infusion dosing of amiodarone:
Definition
360 mg IV over 6 hours (1 mg/minute)
Term
Maintenance infusion dose of amiodarone:
Definition
540 mg over 18 hours (0.5mg/minute)
Term
4 drugs that can be given via endotracheal tube:
Definition
- Atropine
- Epinephrine
- Lidocaine
- Vasopressin
Term
drug needed in large dosing with organophosphate poisoning:
Definition
Atropine sulfate
Term
Atropine may be effective for __ __ __ or __ __, but will NOT be effective for __ __ __ __ block.
Definition
- AV nodal block or ventricular asystole
- infranodal Mobitz Type II block
Term
this drug should be used with caution in myocardial ischemia and hypoxia because it increases the myocardial oxygen demand:
Definition
Atropine sulfate
Term
Avoid atropine with ___ __.
Definition
hypothermic bradycardia
Term
In pts with type II blocks or third degree blocks be prepared to:
Definition
- pace or give catecholamines
Term
Dosings of atropine less than ___mg may result in paradoxical slowing of the heart rate.
Definition
less than 0.5 mg
Term
Atropine dosing for bradycardia witho or without ACS:
Definition
0.5 mg every 3-5 minutes as needed, not to exceed total dose of 0.04mg/kg or a total of 3 mg
Term
Second line drug for symptomatic bradycardia:
Definition
Dopamine
Term
Indications for dopamine:
Definition
- 2nd line drug for symptomatic bradycardia after atropine
- Use for hypotension with signs and symptoms of shock
Term
Dopamine should be used with caution in __ shock with accompanying __.
Definition
- cardiogenic shock
- CHF
Term
do NOT mix dopamine with :
Definition
sodium bicarbonate
Term
SE of dopamine:
Definition
- tachyarrhythmias
- excessive vasoconstriction
Term
Dopamine dosing:
Definition
2-20 mcg/kg/minute
- titrate to patient response, taper slowly
Term
Indications for epinephrine:
Definition
- Cardiac arrest: VF, pulseless VT, asystole, PEA
- Symptomatic bradycardia after atropine as an alternative to dopamine
- Severe hypotension: can be used after pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesteraase enzyme inhibitor
- Anaphylaxis, severe allergic reactions: combine with large fluid volume, corticosteroids, and antihistamine
Term
symptomatic bradycardia:
Definition
1st: Atropine
2nd: Dopmamine or Epinephrine
Term
Severe hypotension and patient is on phosphodiesterase enzyme inhibitor:
Definition
epinephrine
Term
SE of epinephrine:
Definition
- Epi causes the blood pressure and heart rate to increase which may result in myocardial ischemia, angina, and increased myocardial oxygen demand
Term
What does evidence show about higher doses of epinehprine:
Definition
- do NOT improve survival or neurologic outcome
- may contribute to postresuscitation myocardial dysfunction

(higher doses may be needed with poising/drug induced shock)
Term
IV/IO dose of epinehprine for cardiac arrest:
Definition
- 1 mg (10mL of 1:10,000 solution) administered every 3-5 minutes during resuscitation.
- Follow each dose with a 20 mL flush
- elevate arm for 10-20 seconds after dose
Term
higher doses of epinephrine, __mg/kg, may be indicated for __ __ or __ __ __ overdose.
Definition
- 0.2mg/kg
- beta blocker
- calcium channel blocker
Term
continuous infusion dosing for epinephrine:
Definition
- 0.1-0.5mcg/kg/minute, titrate to response
Term
Trach tube dosing of epinephrine:
Definition
2-2.5 mg diluted in 10 mL NS
Term
Epinephrine dosing for profound bradycardia or hypotension:
Definition
- 2 to 10 mcg/minute, titrate to patient response
Term
Alternative to amiodarone for cardiac arrest from VT/VF:
Definition
Lidocaine
Term
Lidocaine indications:
Definition
- Alternative to amiodarone for VT/VF
- Stable monomorphic VT with preserved ventricular function
- Stable polymorphic VT with normal baseline QT inerval and preserved LV function when ischemia is treated and electrolyte balance is corrected
- Can be used for stable polymorphic VT when baseline QT interval is prolonged and torsades is suspected
Term
Lidocaine CI:
Definition
- CI as prophylactic use in AMI
Term
when should lidocaine MAINTENANCE dose be reduced:
Definition
- impaired liver/LV function
Term
lidocaine adult dosing for cardiac arrest from VT/VF:
Definition
Initial dose 1-1.5 mg/kg IV/IO
- For refractory VF may give addition 0.5-0.75 mg/kg IV push, repeat in 5-10 minutes, maximum of 3 doses or 3 mg/kg
Term
Lidocaine dose for stable VT, wide complex tachycardia of uncertain type, or significant ectopy (all perfusing arrhythmias):
Definition
- 0.5 to 0.75 mg/kg and up to 1 to 1.5mg/kg may be used
- Repeat 0.5 to 0.75 mg/kg every 5-10 minutes with max total dose of 3mg/kg
Term
Maintenance infusion of lidocaine:
Definition
1 to 4 mcg/minute (30-50 mcg/kg/minute)
Term
Magnesium sulfate indications;
Definition
- Torsades de pointes
- Hypomagensemia
- Digitalis toxicity
Term
SE of magnesium sulfate:
Definition
- occasional fall in blood pressure with rapid administration
- use with caution if renal failure is present
Term
Magnesium sulfate dosing for cardiac arrest from Torsades de pointes or Hypomagnsemia:
Definition
- 1-2 grams (2-4 mL of 50% solution) diluted in 10 mL of D5W IV/IO
Term
Magnesium sulfate dosing with Torsades with a pulse or AMI with hypomagensemia:
Definition
- Loading dose 1-2 g mixed in 50-100 mL of D5W, over 5-60 minutes
- Follow with 0.5 to 1 gram/hour IV (titrate to control torsades)
Term
Vasopressin indications:
Definition
- Alternative to epinephrine for adult shock- refractory VF
- Alternative to epinephrine for asystole, PEA
- May be used for hemodynamic support in vasodilatory shock (septic shock)
Term
Vasopressin is a potent __ __ which increases peripheral vascular resistance. This may provoke __ __ and __.
Definition
- peripheral vasoconstrictor
- cardiach ischemia and angina
Term
Vasopressin is NOT recommended for __ patients with coronary artery disease.
Definition
responsive
Term
IV dose administration of Vasopressin for cardiac arrest:
Definition
- One dose of 40 units IV/IO push may replace first or second epinephrine dose, epi can be administered every 3-5 minutes during cardiac arrest
Term
Vasodilatory (aka septic) shock dosing of vasopressin:
Definition
0.02-0.04 units/minute continuous infusion
Term
hypothermia:
Definition
potentially fatal condition when body temperature falls below 95F/35C
Term
mild hypothermia:
Definition
pts body temperature between 90 and 95F
Term
Moderate hypothermia:
Definition
86-90F
Term
Pulseless Electrical Activity (PEA) is continued __ __ of the heart in the absence of effective __ __.
Definition
- continued electrical rhythmicity
- absence of effective mechanical function
Term
rTPA stands for __ __ __ __, what is it?
Definition
- Recombinant Tissue Plasminogen Activator
- clot-dissolving substance produced naturally by cells in the walls of blood vessels
Term
severe hypothermia:
Definition
<86F
Term
sinus rhythm is produced by the __ node.
Definition
SA
Term
synchronized cardioversion uses a sensor to deliver a shock that is syncrhonized with a peak in the __ __.
Definition
QRS complex
Term
very rapid uncoordinated fluttering of ventricles:
Definition
Ventricular Fibrillation (VF)
Term
scan method for calculating rate:
Definition
R waves in 6 second strip x 10= bpm
Term
normal PR interval:
Definition
0.12-0.20 seconds
Term
normal QRS duration:
Definition
0.04-0.10 seconds
Term
P waves represent __ __.
Definition
atrial depolarization
Term
PR interval represents:
Definition
atrial depolarization and delay through the AV node
Term
QRS represents:
Definition
ventricular depolarization
Term
ST segment:
Definition
period b/w completion of ventricular depolariaztion and final ventricular repolarizatoin
Term
The T and P waves are normally upright in all leads except __. aVR
Definition
Term
T wave represents __.
Definition
recovery phase
Term
normal QT interval:
Definition
0.35-0.45 seconds
Term
PAC rate:
Definition
usually < 100
Term
Atrial flutter rate:
Definition
250-350
Term
Atrial fibrillation rate:
Definition
atrial: 400-700
ventricular: 160-180
Term
Junctional Escape Rhythm rate:
Definition
40-60
Term
Accelerated Junctional Escape Rhythm:
Definition
61-100
Term
Junctional tachycardia:
Definition
101-200
Term
With supraventricular tachycardia (SVT), the rhythm is __ __ and the rate is greater than __ bpm.
Definition
absolutely regular
> 150 bpm
Term
With Paroxysml Atrial Tachycardia the rate is usually ___. The onset is sudden and often initiated by a __.
Definition
- 160-220
Term
Ventricular tachycardia rate:
Definition
b/w 100-220 bpm
Term
rare PVC:
Definition
one on a strip
Term
Isolated PVC:
Definition
one in row
Term
Two PVCs in a row:
Definition
pair, couplet
Term
3 PVCs in a row:
Definition
Ventricular Tachycardia
Term
PVC Bigeminy:
Definition
Every other
Term
PVC trigeminy:
Definition
every third
Term
Ventricular tachycardia rate:
Definition
b/w 100 and 220, regular rhythm
Term
define V. tach:
Definition
- group of 3 PVCs in a row or more at a rate greater than 100 bpm
Term
rate of idioventricular rhythm:
Definition
20-40 bpm
Term
Accelerated Idioventricular Rhythm:
Definition
rate > 40
Term
asystole rate:
Definition
ventricular rate= 0

p waves may or may not be present
Term
each small box on an EKG is:
Definition
0.04 seconds
Term
each large box on an EKG is:
Definition
0.2 seconds
Term
First Degree AV Block has a prolonged __ __, it is between __ and __ seconds.
Definition
- PR interval
- 0.2 and 0.4 seconds
Term
With 2nd degree AV Block Type 1 Wenkebach, the __ interval __ __ until a __ is dropped.
Definition
- PR interval progressively increases until a QRS is dropped
Term
With Type 2 Second Degree AV block, the __ interval is __ and a __ suddenly drops.
Definition
- PR interval is consistent
- QRS suddenly drops
Term
With 3rd degree AV block, the __ interval __ __ and the __ waves are not related to the __ __.
Definition
- PR interval varies greatly
- P waves are not related to the QRS complexes
Term
difference b/w axis deviation b/w v. tachy and SVT with abberancy:
Definition
- V. tachy has extreme axis deviation b/w -90 and +180
- SVT with Aberrancy has normal axis except WPW syndrdome
Term
Valsalva maneuver does/does not slow V. Tachy, but does/does not slow SVT with abberancy.
Definition
- does NOT slow V. Tachy
- does slow SVT with aberrancy
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