ACLS Drugs dosages & Uses Questions with Complete Solutions, A+

For poor perfusion with Bradycardia Treat with which first line treatment? - Atropine 1mg IV (repeat to a total of 3mg IV) For poor perfusion with Bradycardia Treat, if the first line of treatment is ineffective, what should be provided and what med should be given? - Transcutaneous pacing Dopamine 5-20mcg/kg/minute infusion OR Epinephrine 2-10mcg/min infusion What is the first line drug for acute stable bradycardia and how do you administer it? - Atropine given as 1mg IV q 3-5minutes (up to 3mg IV) Hoe does Atropine work? - Reverses the cholinergic-mediated decreases in the heart rate and AV node conduction Which two AV block types will not respond to Atropine? - Mobitz type II second-degree AV block and third-degree AV block What is the preferred treatment for Mobitz type II second-degree AV block and third-degree AV block? - TCP or B-adrenergic (dopamine, epinephrine) support until transcutaneous pacing can be achieved If only 0.5mg of IV Atropine is given what consequence could it have? - It can further lower the HR What can be used if bradycardia is unresponsive to Atropine? - B-adrenergic infusions (dopamine or epinephrine) What must you consider before giving B-adrenergic infusions in bradycardia? - The pt's BP/intravascular volume status for hypovolemia What can be given for bradycardia when vasoconstriction is not desired? - Dobutamine (b-adrenergic agonist) Epinephrine should be given at what dose/rate for Bradycardia? - 2-10mcg/min Dopamine should be given at what dose/rate for Bradycardia? - 5-20mcg/kg/min How does Transcutaneous Pacing (TCP) work and when should it be used? - It delivers pacing impulses to the heart through skin via cutaneous electrodes. for unstable bradycardia (hypotension, AMS, shock, ischemic chest pain) For light sedation within the RN scope of practice give which 3 things should be given before TCP if the pt's condition allows for it? - -Parenteral narcotic -Parenteral benzodiazepine -Chronotropic infusion How much of a safety margin (energy above the dose at which consistent capture is observed) should you allow when using the transcutaneous pacemaker? - 2 mA The HR that takes on clinical significance and is more likely to contribute to arrhythmia in tachycardia is what rate? - 150/min or greater What are the 7 rhythms associated with unstable tachycardia? - 1. Sinus Tachycardia 2. Atrial fibrillation 3. Atrial Flutter 4. Superventricular Tachycardia (SVT) 5. Monomorphic Ventricular Tachycardia (giant shark teeth-looking) 6. Polymorphic Ventricular Tachycardia (Mutiple random shark teeth-looking) 7. Wide-complex tachycardia of uncertain type What is the first line treatment for unstable tachycardia? - Immediate Synchronized Cardioversion if the QRS complex is ----seconds or greater, consider expert consultation. - 0.12 seconds If the width of the ORs complex is 0.12 or less treat with what two things? - Vagal maneuvers and Adenosine What is the therapy for a narrow QRS with regular rhythm (4)? - -Vagal maneuver -give Adenosine -give a B-blocker/calcium channel blocker -consider expert consultation If SVT does not respond to Vagal maneuvers give _____ in a large vein over 1 second. - Adenosine 6mg IV what do you do with the pt immediately after giving Adenosine 6mg IV? - elevate the arm immediately If SVT does not convert within 1-2 minutes after 1st dose of Adeosine 6mg, give _____. - A second dose of Adenosine 12 mg IV. Adenosine increased AV block and will terminate approx. ___% of reentry arrhythmias within ___ minutes. - 90% 2 minutes What rhythms will Adenosine not terminate? - Atrial Flutter and Atrial Fibrillation but it can slow down the HR so these rhythms can be identified. Adenosine is safe or unsafe during pregnancy? - SAFE Adenosine can cause ____ so you should not give it to pt's with asthma or COPD. - bronchospasm What is the initial recommended dose of Adenosine for the management of SVT unresponsive to Vagal Maneuver? - 6mg IV Sedatives that can be given before cardioversion (5): - -Diazepam -Midazolam -etomidate -methohexital -propofol Antiarrhythmic drugs for tachy-arrhythmias: - -Procainamide 20-50mg/min IV (max 17mg/kg IV) -Amiodarone 150mg IV over 10 minutes -Sotalol 100mg (1.5mg/kg) IV over 5 minutes Maintenance dose for Procainamide (antiarrhythmic) - 1-4 mg/min IV Maintenance dose for Amiodarone (antiarrhythmic) - 1 mg/min IV for the 1st 6 hours What is the recommended follow-up dose of Adenosine for the management of SVT unresponsive to the first dose of Adenosine? - 12mg IV