ACLS RENEWAL STUDY SET 2023.

ACLS RENEWAL STUDY SET 2023 Therapeutic Hypothermia cooling goals post ROSC VF Cardiac Arrest - 32C-34C or 89.6F - 93.2F for 12 -24 hours in order to protect brain and other organs. May be >24 hrs. Pt core temp taken via esophageal thermometer or bladder catheter in non anuric pts or pulm artery catheter. Ventilation Optimization goals - PETCO2 35 -40 PACO2 40 -45 If PETCO2 <10 mm Hg attempt to improve CPR quality Post cardiac arrest MAP goal - >65 mmHG Glycemic Control post ROSC w/ cardiac arrest - 144-180 mg/dL no titrating to 80 -110 d/t risk of hypoglycemia RRT criteria - -threatened airway -RR <6 or >30 bpm -HR <40 or >140 -SBP <90 -symptomatic HTN -dec. LOC -unexplained agitation -seizure -low UO -subjective concern for pt Ventilation Rates - -Bag Mask: 2 ventilations every 30 c ompressions -Advanced Airway: 1 ventilation every 6 -8 seconds (8 -10 breaths per min) -Resp. Arrest w/ pulse present: 1 ventilation every 5 -6 seconds (10 -12 breaths/min) Monitoring to improve CPR quality - Quantitative waveform capnography -PETCO2 < 10mmHg (improve CPR QUALITY) Intra-arterial pressure <20mmHg diastolic pressure (improve CPR quality and implement vasopressor therapy) PaCO2 40 -45 mmHg ScvO2 norm 60 -80%... <30% improve chest compression and vasopressor therapy PETCO2 determinant - End t idal CO2 is the conc. of carbon dioxide in exhaled air at end of expiration. PETCO2 determines blood delivery to the lungs during CPR. partial pressure of end -tidal CO2, a measure of the amount of carbon dioxide present in the exhaled air 35-40mmHg = ROSC Most reliable method of confirming and monitoring correct placement of ET tube - waveform capnography Nasopharyngeal Airway sizing guide - distance from the tip of the nose to the earlobe Quality CPR - compress center of chest (lower half of sternum) 1 00 compressions/min depth of 2 inches Allow complete chest recoil after each compression avoid excessive ventilation PEA - Pulseless electrical activity Biphasic Shock energy - 120-200 J - if unknown use max available Monophasic Shock energy - 360 J Cardiac Arrest ACLS Drug Therapy - -Epinephrine IV/IO Dose 1mg Q3mins -Vasopressin IV/IO dose (40U can replace 1st or 2nd dose of epinephrine) -Amiodarone IV/IO Dose - 1st dose: 300mg bolus 2nd dose 150mg bolus... if amio is not available providers may admin lidocaine Epinephrine hydrochloride - used during resuscitation for its alpha -adrenergic effects, ie, vasoconstriction. Vasoconstriction increases cerebral and coronary blood flow during CPR by increasing MAP and aortic diastolic pressure Vasopressin - nonadrenergic peripheral vasoconstrictor that increases arterial blood pressure. amiodarone - first line anti -arrythmic agent given in cardiac arrest for refractory VF/VT... Used in tx o f VF or pulseless VT unresponsive to shock delivery, CPR and vasopressors -Amio is a complex drug that affects na, k, and ca channels. also has alpha -adrenergic and beta -adrenergic blocking properties Lidocaine - used if amio is not available 1-1.5mg/kg I V/IO first dose 0.5-7.5mg/kg at 5 -10 min intervals max dose of 3 mg/kg if no iv/io available ET dose 2 -4mg/kg Mag Sulfate - is an adjunctive agent used to prevent recurrent or treat persistent VT assoc. w/ torsades de pointes indicated for pts with known/ suspected low serum mag. -alcoholism or other conditions assoc. w/ malnutrition/hypomag states loading dose 1 -2g IV/IO diluted in 10mL typically over 5 -20mins Reversible Causes H's and T's - Hypovolemia Hypoxia Hydrogen Ion (acidosis) Hypo/Hyperkalemia Hypotheria Tension Pneumothorax Tamponade (Cardiac)