Term
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Definition
sudden loss of spontaneous circulation & ventilation;
- no pulse or effective respiration;
- if untreated --> hypoxia --> loss of myocardium, brain cells, vital organs --> death;
In adults, usually caused by arrhythmia (VF, pulseless ventricular tachycardia);
In children, usually due to progressive shock or respiratory failure; |
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Term
| Basic Life Support (BLS) "ABCD Assessment" - Airway, Breathing, Circulation, Defibrillation |
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Definition
A: open airway if necessary;
B: look, listen, feel for adequate breathing;
- if not present, give 2 rescue breaths (not too quickly or with too much volume);
C: check carotid pulse for 5 sec;
- if NO PULSE, provide CPR until AED is available;
D: if not pulse, attach AED and analyze rhythm;
- if rhythm is "shockable", shock as indicated |
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Term
| provide 1 breath every 5-6 seconds (10-12 breaths/min) |
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Definition
| if pt HAS a pulse but inadequate respiration |
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Term
start chest compressions: push hard & fast (100/min), ensure full chest recoil, minimize interruptions;
Secure airway ASAP but avoid hyperventilation;
Once advanced airway is placed, DON'T pause compressions for breaths; |
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Definition
| If pt has NO pulse AND NO adequate respirations |
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Term
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Definition
effective BLS prior to ACLS is ESSENTIAL;
prompt CPR & defibrillation increases chances of survival;
Drug administration is 2ndary to ACLS |
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Term
| Possible Contributing Factors for Cardiopulmonary Arrest |
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Definition
| hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis, trauma |
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Term
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Definition
pulseless arrest;
symptomatic bradycardia;
symptomatic tachycardia; |
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Term
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Definition
VF or pulseless VT;
pulseless electrical activity (PEA) or asystole; |
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Term
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Definition
HR <60 bpm & inadequate for clinical condition;
Pt has altered mental status, ischemic chest pain, S/sx of HF, hypotension; |
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Term
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Definition
Narrow Complex (QRS <0.12 sec):
- regular rhythm: sinus tachycardia, SVT;
- irregular rhythm: Afib, AFL;
Wide Complex (QRS >0.12 sec) indicates ventricular origin:
- VT w/ pulse;
- SVT w/ aberrancy; |
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Term
| Routes of Administration for meds given during ACLS |
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Definition
Carpujects;
IV (preferred);
Intraosseous (IO);
endotracheal (ET); |
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Term
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Definition
preferred route of administration;
if peripherally placed, follow drug bolus by 20 mL IV fluid bolus to move drug to central circulation; |
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Term
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Definition
| easy-to-assemble, needleless, pre-filled syringes developed for crash carts to allow for rapid preparation of commonly used meds: Epi, atropine, NaHCO3, CaCl2, lidocaine; |
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Term
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Definition
use if IV is not possible;
injection in to bone marrow, delivery is similar to central IV, use same doses;
more commonly used in children; |
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Term
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Definition
use only if tube is in place and IV or IO access is not possible;
Doses are 2-2.5 x IV doses;
dilute in 5-10 mL water or saline;
Drugs that can be administered this route: naloxone, atropine, vasopressin, epi, lidocaine (NAVEL) |
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Term
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Definition
1st line sympathomimetic for CPR; vasopressor used for cardiac arrest in pts with ANY pulseless arrhythmia (VF, pulseless VT, asystole, PEA arrest);
MoA:
- alpha-adrenergic agonsim: increases coronary, cerebral perfusion;
- beta-adrenergic agonism: may increase myocardial work, reduce subendocardial perfusion; |
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Term
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Definition
vasopressor used for cardiac arrest;
used in any pulseless arrhythmia (VF, pulseless VT, asystole, PEA arrest);
MoA:
- non-adrenergic peripheral vasoconstriction, also causes coronary & renal vasoconstriction; |
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Term
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Definition
used in ACLS for: asystole, slow PEA arrest, symptomatic bradycardia;
MoA:
- inhibits cholinergic-mediated cardiovascular effects: increases HR, increases systemic vascular resistance (increases BP); |
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Term
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Definition
may increase survival to hospital admission if cardiac arrest occurs out of hospital;
- 1st line tx for refractory VF or pulseless VT (unresponsive to defibrillation, CPR, & vasopressors);
MAY increase response to defibrillation; |
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Term
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Definition
| 2nd line tx to amiodarone for refractory VF or pulseless VT that is unresponsive to defibrillation, CPR, vasopressors; |
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Term
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Definition
| can terminate Torsades de Pointes (TdP) |
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Term
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Definition
| possible use if known cause is embolic |
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Term
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Definition
limited by slow infusion;
NOT RECOMMENDED; |
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Term
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Definition
| may worsen neurologic outcomes in comparison with epi |
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Term
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Definition
| give CaCl2, insulin, and dextrose --> causes shift of K from extracellular to intracellular spaces, it also prevents hypoglycemia; |
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Term
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Definition
| give sodium bicarbonate (can be given IV push) |
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Term
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Definition
"shockable" rhythms --> attach a defibrillator & shock ASAP while allowing minimal interruptions in CPR;
- after shock, access established, continue to provide CPR, then give vasopressors:
- epinephrine, vasopressin if 1st or 2nd doses of epi DON'T work;
- continue CPR between shocks, don't stop CPR for drug administration; |
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Term
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Definition
1st line: amiodarone;
2nd line: lidocaine;
If TdP:
- give Mg |
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Term
| Pulseless Electrical Activity (PEA)/Asystole |
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Definition
NOT SHOCKABLE!!!
- CPR is ESSENTIAL!
- give vasopressors: epinephrine, vasopressin;
- if asystole or slow PEA, consider atropine |
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Term
| PEA (Pulseless Electrical Activity) |
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Definition
| ECG shows disorganized activity that is not VF, VT, or other arrhythmia; |
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Term
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Definition
| ECG shows NO discernable activity, pt is "flatlining" |
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Term
| Management of Symptomatic Bradycardia |
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Definition
ensure adequate airway & breathing, supplemental O2 if needed;
establish IV access;
Attempt to identify potential reversible causes;
Determine if perfusion is adequate;
If perfusion is INADEQUATE:
- prepare for transcutaneous pacing;
- use medications while awaiting pacing:
atropine (1st line), or continuous infusions of epi & dopamine (2nd line) |
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Term
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Definition
regular narrow-complex tachycardia;
HR >100 bpm;
Tx or remove underlying cause;
Drug therapy usually not necessary; |
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Term
| Tx of Supraventricular Tachycardia |
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Definition
regular narrow-complex tachycardia;
- caused by re-entry, HR >120 bpm;
Management:
- Vagal Manuevers: hold breath, dip face in cold water, coughing, tense stomch muscles, carotid sinuse massage;
- if vagal maneuvers fail: give adenosine;
- if adenosine fails: give diltiazem, verapamil, or beta-blockers; |
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Term
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Definition
irregular narrow-complex tachycardia;
Management:
- control ventricular rate: diltiazem, beta-blockers;
- if unstable, attempt cardioversion: electric (direct current, DC) or pharmacological (amiodarone, ibutilide); |
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Term
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Definition
QRS complex >0.12 sec;
if unstable, immediately cardiovert;
VT or Uncertain Rhythm:
- amiodarone
- synchronized cardioversion;
Polymorphic VT:
- may quickly progress to pulseless arrest;
Tx depends on QTc:
- if long QTc --> TdP: Mg, correct electrolytes, stop QTc-prolonging meds;
- if unsynchronized --> cardioversion; |
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Term
| Role of Pharmacist in ACLS |
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Definition
prepare medications;
record medication administration;
provide drug information; |
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