ACLS HEARTCODE
• IF ACS patient has EKG showing ST elevation and symptoms are less than12 hours then
what
Answer: re-perfusion
door to balloon 90 minutesdoor to needle 30 minutes
• If ACS patient has EKG showing non ST elevation MI or high risk unstableangina then
what
Answer: early invasive strategy?
adjunctive treatment?
-nitroglycerin
-heparin
-beta blockers
-clopidogrel
-glycoprotein IIb / IIIa inhibitor
• what are the contraindications to fibrinolytics in ACS treatment
Answer:
systolic >180
diastolic > 100
right arm left arm systolic difference > 15
history of structural central nervous system diseaserecent head/facial trauma
stroke more than 3 hours or less then 3 months agorecent trauma, surgery or bleed
any history of intracranial hemorrhage bleeding, clotting problem or on blood thinnersserious
systemic disease
• adenosine
Answer: used in tachy
6mg bolus followed by 20mL normal saline
12mg can be used after 1-2 minutes
,• amiodarone
Answer: 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
Answer: 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
Answer: 2nd line drug for symptomatic bradycardiause for hypotension with signs of shock
2-20 mcg/kg per minute
• epinephrine
Answer: in cardiac arrest:
1mg every 3-5 minutes
in bradycardia or hypotension:
2-10mcg/minute infusion
• lidocaine
Answer: alternative to amiodirone in cardiac arrest:
1-1.5 mg/kg IV
for stable VT, wide complex VT:
0.5 - 0.75 mg.kg every 5-10 minutes max of 3mg/kg
• magnesium sulfate
Answer:
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
Answer: cardiac arrest:
40 units can replace either 1st or 2nd dose of epi
• what meds can go down the endotrachial tube
Answer: atropineepinephrine
lidocaine vasopressin
• hyperkalemia
Answer: 1mEq of sodium bicarb
• hypokalemia
Answer: 10-20 mEq of potassium
• hypomagnesemia
Answer: give mag sulfate 1-2g
• The five links in the adult Chain of Survival
Answer:
1- Immediate activation of EMS
2- Early CPR
3- Rapid defibrillation (not in peds)
4- Effective advanced life support
5- Integrated post-cardiac arrest care
• in cardiac arrest when do you first introduce medical intervention? whichdrug?
Answer:
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?
Answer:
after the 3rdshock give 300 mg bolus of amiodarone
if second dose is needed give 150mg as second dose
• what rhythms are shockable in cardiac arrest
Answer: VFVT
• what rhythms are not shockable in cardiac arrest
Answer: asystolePEA
• IF ACS patient has EKG showing ST elevation and symptoms are less than12 hours then
what
Answer: re-perfusion
door to balloon 90 minutesdoor to needle 30 minutes
• If ACS patient has EKG showing non ST elevation MI or high risk unstableangina then
what
Answer: early invasive strategy?
adjunctive treatment?
-nitroglycerin
-heparin
-beta blockers
-clopidogrel
-glycoprotein IIb / IIIa inhibitor
• what are the contraindications to fibrinolytics in ACS treatment
Answer:
systolic >180
diastolic > 100
right arm left arm systolic difference > 15
history of structural central nervous system diseaserecent head/facial trauma
stroke more than 3 hours or less then 3 months agorecent trauma, surgery or bleed
any history of intracranial hemorrhage bleeding, clotting problem or on blood thinnersserious
systemic disease
• adenosine
Answer: used in tachy
6mg bolus followed by 20mL normal saline
12mg can be used after 1-2 minutes
,• amiodarone
Answer: 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
Answer: 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
Answer: 2nd line drug for symptomatic bradycardiause for hypotension with signs of shock
2-20 mcg/kg per minute
• epinephrine
Answer: in cardiac arrest:
1mg every 3-5 minutes
in bradycardia or hypotension:
2-10mcg/minute infusion
• lidocaine
Answer: alternative to amiodirone in cardiac arrest:
1-1.5 mg/kg IV
for stable VT, wide complex VT:
0.5 - 0.75 mg.kg every 5-10 minutes max of 3mg/kg
• magnesium sulfate
Answer:
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
Answer: cardiac arrest:
40 units can replace either 1st or 2nd dose of epi
• what meds can go down the endotrachial tube
Answer: atropineepinephrine
lidocaine vasopressin
• hyperkalemia
Answer: 1mEq of sodium bicarb
• hypokalemia
Answer: 10-20 mEq of potassium
• hypomagnesemia
Answer: give mag sulfate 1-2g
• The five links in the adult Chain of Survival
Answer:
1- Immediate activation of EMS
2- Early CPR
3- Rapid defibrillation (not in peds)
4- Effective advanced life support
5- Integrated post-cardiac arrest care
• in cardiac arrest when do you first introduce medical intervention? whichdrug?
Answer:
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?
Answer:
after the 3rdshock give 300 mg bolus of amiodarone
if second dose is needed give 150mg as second dose
• what rhythms are shockable in cardiac arrest
Answer: VFVT
• what rhythms are not shockable in cardiac arrest
Answer: asystolePEA
