Advanced Cardiac Life Support (ACLS)
questions and answers
What is the first thing to do in the event of cardiac arrest?
Start CPR:
give oxygen, attach monitor/defibrillator
What would be the next step if Vfib or pulseless ventricular tachycardia was found as the patient's
rhythm?
Shock
What would be the next step if asystole or pulseless electrical activity was found as the patient's
rhythm?
Administer epinephrine
What should be done after shock or epinephrine is adminstered in the setting of ACLS?
Do CPR for 2 minutes, obtain IV/IO access
How often should epinephrine be given if rhythm is not shockable or a patient requires 2 or more
shocks?
every 3-5 minutes
When should amiodarone or lidocaine be considered in ACLS?
If a patient requires 3 or more shocks
What is ROSC?
Return of spontaneous circulation
Pulse and BP, abrupt sustained increased partial pressure of end-tidal CO2 (PETCO2), and sustained
arterial pressure waves with intra-arterial monitoring
What does ROSC mean in terms of the adult cardiac arrest algorithm?
You can begin post-cardiac arrest care
If no ROSC, you need to keep doing CPR with epinephrine and evaluate whether rhythm is shockable
What is the dose of epinephrine in adult cardiac arrest support?
1 mg IV/IO q3-5 minutes
What is the dose of amiodarone in adult cardiac arrest?
300 mg IV/IO bolus, then 150 mg second dose
, What is the dose of lidocaine in adult cardiac arrest?
First dose: 1-1.5 mg/kg
Second dose: 0.5-0.75 mg/kg
IV or IO
What are some reversible causes of adult cardiac arrest?
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
What is the recommended shock energy for defibrillation?
Biphasic: manufacturer recommended. If unknown, use max available
Monophasic: 360 J
When should intraosseous access be considered in adult cardiac arrest?
If intravenous access is unsuccessful or not feasible
Which is preferred in adult cardiac arrest: intravenous or intraosseous? Why?
IV is preferred if it's feasible because most drugs have been studied this way. Yields more predictable
drug response
How does drug PK differ when administered by peripheral vs central IV?
Central venous access achieves higher peak concentrations and more rapid circulation times than drugs
given by peripheral IV
What are some disadvantages to central venous access in adult cardiac arrest? When might you still
consider it?
Associated with higher morbidity, takes time to perform, may require interruption of CPR
May consider if IV and IO access are not successful or feasible
What is the least preferred drug adminsitration route in adult cardiac arrest? Why?
Endotracheal - associated with unpredictable drug concentrations and lower rates of ROSC and survival
What is the recommended vasopressor in cardiac arrest?
questions and answers
What is the first thing to do in the event of cardiac arrest?
Start CPR:
give oxygen, attach monitor/defibrillator
What would be the next step if Vfib or pulseless ventricular tachycardia was found as the patient's
rhythm?
Shock
What would be the next step if asystole or pulseless electrical activity was found as the patient's
rhythm?
Administer epinephrine
What should be done after shock or epinephrine is adminstered in the setting of ACLS?
Do CPR for 2 minutes, obtain IV/IO access
How often should epinephrine be given if rhythm is not shockable or a patient requires 2 or more
shocks?
every 3-5 minutes
When should amiodarone or lidocaine be considered in ACLS?
If a patient requires 3 or more shocks
What is ROSC?
Return of spontaneous circulation
Pulse and BP, abrupt sustained increased partial pressure of end-tidal CO2 (PETCO2), and sustained
arterial pressure waves with intra-arterial monitoring
What does ROSC mean in terms of the adult cardiac arrest algorithm?
You can begin post-cardiac arrest care
If no ROSC, you need to keep doing CPR with epinephrine and evaluate whether rhythm is shockable
What is the dose of epinephrine in adult cardiac arrest support?
1 mg IV/IO q3-5 minutes
What is the dose of amiodarone in adult cardiac arrest?
300 mg IV/IO bolus, then 150 mg second dose
, What is the dose of lidocaine in adult cardiac arrest?
First dose: 1-1.5 mg/kg
Second dose: 0.5-0.75 mg/kg
IV or IO
What are some reversible causes of adult cardiac arrest?
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
What is the recommended shock energy for defibrillation?
Biphasic: manufacturer recommended. If unknown, use max available
Monophasic: 360 J
When should intraosseous access be considered in adult cardiac arrest?
If intravenous access is unsuccessful or not feasible
Which is preferred in adult cardiac arrest: intravenous or intraosseous? Why?
IV is preferred if it's feasible because most drugs have been studied this way. Yields more predictable
drug response
How does drug PK differ when administered by peripheral vs central IV?
Central venous access achieves higher peak concentrations and more rapid circulation times than drugs
given by peripheral IV
What are some disadvantages to central venous access in adult cardiac arrest? When might you still
consider it?
Associated with higher morbidity, takes time to perform, may require interruption of CPR
May consider if IV and IO access are not successful or feasible
What is the least preferred drug adminsitration route in adult cardiac arrest? Why?
Endotracheal - associated with unpredictable drug concentrations and lower rates of ROSC and survival
What is the recommended vasopressor in cardiac arrest?
