Advanced Cardiac Life Support (ACLS)
questions and answers
Time is Brain
Death can occur within minutes of cardiac arrest. Brain damage occurs within 4-6 minutes after the
heart stops pumping. CPR and early defibrillation can prevent death.
Emergency Cardiac Care
1) Immediate recognition, 2) Early CPR with emphasis on good, quality compressions, 3) Rapid
defibrillation, 4) Effective ACLS, 5) Integrated post-cardiac arrest care.
Advanced Cardiac Life Support (ACLS)
Consists of 1) basic life support (BLS), 2) ECG monitoring, arrhythmia recognition, 3) IV access, 4)
Medications for cardiac arrest, 5) Defibrillation, and 6) Post-resuscitation care.
Pharmacist's Role
Understand algorithms and treatment strategies. Most common jobs during a code: 1) Medication
preparation, 2) Drug information, and 3) Calculating doses.
Rhythms to Recognize
1) Sinus bradycardia, 2) Sinus tachycardia, 3) Torsades de Pointes, 4) Ventricular tachycardia (VT), 5)
Ventricular fibrillation (VF), 5) Pulseless electrical activity (PEA), 6) Asystole, and 7) AV blocks of all
degrees. Shockable. Not shockable.
Start CPR
When a patient presents in cardiac arrest, the first thing to do is _____, give oxygen, and attach a
monitor/defibrillator. Then assess if the rhythm is shockable.
Epinephrine
Medications administered in non-shockable rhythms (PEA and Asystole): _____ 1 mg IV/IO q3-5
min followed by CPR for two minutes then check for a pulse.
Epinephrine
After administration of epinephrine and CPR for 2 minutes, reassess for shockable rhythm. If no
shockable rhythm is detected and no signs of return of spontaneous circulation (ROSC), repeat
administration of ______. Consider appropriateness of continued resuscitation.
defibrillation
For patients with non-shockable rhythms (PEA and Asystole), after administration of epinephrine and
CPR for 2 minutes, reassess for shockable rhythm. If shockable rhythm is detected, administer _____
and continue CPR for 2 minutes.
, Epinephrine
Medications Administered in shockable rhythms (VF and VT): Shock patient then perform CPR for two
minutes. If the rhythm is still shockable, shock and administer _____ 1mg IV/IO q3-5min followed by
CPR for 2 minutes.
Amiodarone; Lidocaine
If administration of epinephrine has not gotten the patient to return of spontaneous circulation (ROSC)
and the rhythm is still shockable, shock and administer _____ 300mg IV/IO bolus OR _____ 1-1.5 mg/kg
IV/IO and perform CPR for 2 minutes.
PEA and Asystole
If at any point during the treatment of shockable (VF and VT) the patients rhythm become non-
shockable, begin treatment for ______ with epinephrine ASAP followed by CPR. Consider
appropriateness of continued resuscitation.
VF and VT
If at any point during the treatment of non-shockable (PEA and asystole) the patient's rhythm
becomes shockable, begin treatment for ______ with defibrillation followed by CPR.
Causes of cardiac arrest: H's
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, and Hypothermia.
Causes of cardiac arrest: T's
Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary), and Thrombosis (coronary).
Magnesium Sulfate
Adjunctive medication indicated for Torsades de Pointes. 1-2g IV bolus.
Dextrose 50%
Adjunctive medication indicated for hypoglycemia. 1 amp = _____ in 50mL (25g).
Calcium Chloride
Adjunctive medication indicated for hypo/hyperkalemia. 1g/10mL
Sodium Bicarbonate
Adjunctive medication indicated for severe acidosis, toxidromes, hyperkalemia. 1 amp = 50 mEq/50mL
(8.4%).
Tracheal Administration (NAVEL)
Narcan, atropine, vasopressin/valium, epinephrine, and lidocaine. Give higher doses (2-3x amount of IV
dose). Used with no IV or IO access.
Post-Cardiac Arrest Care
questions and answers
Time is Brain
Death can occur within minutes of cardiac arrest. Brain damage occurs within 4-6 minutes after the
heart stops pumping. CPR and early defibrillation can prevent death.
Emergency Cardiac Care
1) Immediate recognition, 2) Early CPR with emphasis on good, quality compressions, 3) Rapid
defibrillation, 4) Effective ACLS, 5) Integrated post-cardiac arrest care.
Advanced Cardiac Life Support (ACLS)
Consists of 1) basic life support (BLS), 2) ECG monitoring, arrhythmia recognition, 3) IV access, 4)
Medications for cardiac arrest, 5) Defibrillation, and 6) Post-resuscitation care.
Pharmacist's Role
Understand algorithms and treatment strategies. Most common jobs during a code: 1) Medication
preparation, 2) Drug information, and 3) Calculating doses.
Rhythms to Recognize
1) Sinus bradycardia, 2) Sinus tachycardia, 3) Torsades de Pointes, 4) Ventricular tachycardia (VT), 5)
Ventricular fibrillation (VF), 5) Pulseless electrical activity (PEA), 6) Asystole, and 7) AV blocks of all
degrees. Shockable. Not shockable.
Start CPR
When a patient presents in cardiac arrest, the first thing to do is _____, give oxygen, and attach a
monitor/defibrillator. Then assess if the rhythm is shockable.
Epinephrine
Medications administered in non-shockable rhythms (PEA and Asystole): _____ 1 mg IV/IO q3-5
min followed by CPR for two minutes then check for a pulse.
Epinephrine
After administration of epinephrine and CPR for 2 minutes, reassess for shockable rhythm. If no
shockable rhythm is detected and no signs of return of spontaneous circulation (ROSC), repeat
administration of ______. Consider appropriateness of continued resuscitation.
defibrillation
For patients with non-shockable rhythms (PEA and Asystole), after administration of epinephrine and
CPR for 2 minutes, reassess for shockable rhythm. If shockable rhythm is detected, administer _____
and continue CPR for 2 minutes.
, Epinephrine
Medications Administered in shockable rhythms (VF and VT): Shock patient then perform CPR for two
minutes. If the rhythm is still shockable, shock and administer _____ 1mg IV/IO q3-5min followed by
CPR for 2 minutes.
Amiodarone; Lidocaine
If administration of epinephrine has not gotten the patient to return of spontaneous circulation (ROSC)
and the rhythm is still shockable, shock and administer _____ 300mg IV/IO bolus OR _____ 1-1.5 mg/kg
IV/IO and perform CPR for 2 minutes.
PEA and Asystole
If at any point during the treatment of shockable (VF and VT) the patients rhythm become non-
shockable, begin treatment for ______ with epinephrine ASAP followed by CPR. Consider
appropriateness of continued resuscitation.
VF and VT
If at any point during the treatment of non-shockable (PEA and asystole) the patient's rhythm
becomes shockable, begin treatment for ______ with defibrillation followed by CPR.
Causes of cardiac arrest: H's
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, and Hypothermia.
Causes of cardiac arrest: T's
Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary), and Thrombosis (coronary).
Magnesium Sulfate
Adjunctive medication indicated for Torsades de Pointes. 1-2g IV bolus.
Dextrose 50%
Adjunctive medication indicated for hypoglycemia. 1 amp = _____ in 50mL (25g).
Calcium Chloride
Adjunctive medication indicated for hypo/hyperkalemia. 1g/10mL
Sodium Bicarbonate
Adjunctive medication indicated for severe acidosis, toxidromes, hyperkalemia. 1 amp = 50 mEq/50mL
(8.4%).
Tracheal Administration (NAVEL)
Narcan, atropine, vasopressin/valium, epinephrine, and lidocaine. Give higher doses (2-3x amount of IV
dose). Used with no IV or IO access.
Post-Cardiac Arrest Care
