ACLS Questions and Answers 100% Pass

ACLS Questions and Answers 100% Pass in cardiac arrest when do you first introduce medical intervention? which drug? after 2 rounds of CPR/shock after 2nd shock give 1 mg epinephrine every 3-5 minutes when do you introduce amiodarone during cardiac arrest? after the 3rd shock give 300 mg bolus of amiodarone if second dose is needed give 150mg as second dose what rhythms are shockable in cardiac arrest VF VT what rhythms are not shockable in cardiac arrest asystole PEA if you are in an unshockable rhythm arrest when do you give epi 1mg epi every 3-5 minutes after 1st round of CPR what do you do after return of spontaneous circulation maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion what are the 5 h's and 5 t's hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary how do you treat non-symptomatic bradycardia monitor and observe what constitutes symptomatic bradycardia hypotension altered mental status signs of shock chest pain acute heart failure how do you treat symptomatic bradycardia 1. give 0.5mg atropine every 3-5 mins to max of 3mg if that doesn't work try one of the following: transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2-10mcg/minute epinephrine infusion what is considered a tachycardia requiring treatment over 150 per minute when do you consider cardioversion if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain acute heart failure if persistent tachycardia does not present with symptoms what do you need to consider wide QRS? greater than 0.12 seconds If persistent tachycardia without symptoms DOES have a wide QRS what to do you do? IV access and 12 lead if available 6mg adenosine followed by NS flush only IF regular and monomorphic consider anti-arrhythmic infusion: - 20-50mg/min procainamide (max 17mg/kg) - 150mg amiodarone over 10 minutes - 100mg sotalol over 5 minutes which anti-arrhythmic drugs can be used if prolonged QT only amiodarone 150mg over 10 minutes, repeat if VT occurs follow by maintenance infusion 1mg/min for first 6 hours if persistent tachycardia without symptoms and without wide QRS what do you do IV access and 12 lead EKG if available vagal maneuvers 6mg adenosine followed by NS flush only IF regular Beta blocker or calcium channel blocker patient comes in with symptoms of ACS what do you do first chew 325mg aspirin O2 nitro morphine get 12 lead EKG IV access IF ACS patient has EKG showing ST elevation and symptoms are less than 12 hours then what re-perfusion door to balloon 90 minutes door to needle 30 minutes If ACS patient has EKG showing non ST elevation MI or high risk unstable angina then what early invasive strategy? adjunctive treatment? -nitroglycerin -heparin -beta blockers -clopidogrel -glycoprotein IIb / IIIa inhibitor what are the contraindications to fibrinolytics in ACS treatment systolic > 180 diastolic > 100 right arm left arm systolic difference > 15 history of structural central nervous system disease recent head/facial trauma stroke more than 3 hours or less then 3 months ago recent trauma, surgery or bleed any history of intracranial hemorrhage bleeding, clotting problem or on blood thinners serious systemic disease adenosine used in tachy 6mg bolus followed by 20mL normal saline 12mg can be used after 1-2 minutes amiodirone In VF/VT arrest AFTER trying CPR shock and epi/vasopressin: 300mg then 150mg In life threatening arrhythmias: 150mg over 10 minute infusion, every 10 minutes as needed atropine sulfate use as first line defense in sinus bradycardia 0.5mg every 3-5 minutes as needed MAX is 3mg ( think alive gets 0.5) do not use if hypothermia dopamine 2nd line drug for symptomatic bradycardia use for hypotension with signs of shock 2-20 mcg/kg per minute epinephrine in cardiac arrest: 1mg every 3-5 minutes in bradycardia or hypotension: 2-10mcg/minute infusion lidocaine alternative to amiodirone in cardiac arrest: 1-1.5 mg/kg IV for stable VT, wide complex VT: 0.5 - 0.75 every 5-10 minutes max of 3mg/kg magnesium sulfate use in cardiac arrest only if hypomagnesemia or torsades: 1-2g diluted in 10mL of D5W use in torsades with a pulse or AMI with hypomagnesia: 1-2g in 50 to 100 mL of D5W maintenance with 0.5g per hour infusion vasopressin cardiac arrest: 40 units can replace either 1st or 2nd dose of epi what meds can go down the endotrachial tube atropine epinephrine lidocaine vasopressin reentry supraventricular tachycardia polymorphic ventricular tachycardia - aka torsades atrial fibrilation sinus tachycardia reentry supraventricular tachycardia sinus bradycardia coarse ventricular fibrillation atrial flutter second degree AV block type 1 (wenckenbach) reentry supraventricular tachycardia sinus bradycardia monomorphic ventricular tachycardia fine ventricular fibrillation second degree AV block mobitz type 2 second degree AV block mobitz type 2 coarse ventricular fibrillation asystole normal sinus rhythm third degree AV block hyperkalemia 1mEq of sodium bicarb hypokalemia 10-20 mEq of potassium hypomagnesemia give mag sulfate 1-2g