ACLS 2024
Sinus bradycardia rate
Treatment - answers <60
may or may not be needed (ie. BP) - atropine, pacing, epinephrine, dopamine
Sinus tachycardia rate
Treatment - answers >100
• Normal response to stress
• Infection, hypoxemia, hypovolemia, MI, drugs
• Can impair cardiac output
Atrial fibrillation
Treatment - answers -P waves not present - atria are not depolarizing - they are
fibrillating - chaotic wavy baseline
QRS looks normal but is irregular (irregular ventricular
reponse
-Treat with anticoagulation, digoxin, beta blockers - may need to cardiovert
Ventricular fibrillation (V-fib)
2.TREATMENT - answers =P waves and PR Interval are absent
=QRS complexes are absent
-Electrical activity consists of low (fine) or high (coarse) amplitude undulations from the
baseline that vary in shape
-There is no rate
-There is no pulse
2. EPI 2-3MIN
AMIODARONE- 300mg
1. Ventricular tachycardia (V-tach)
2. Treatment - answers -No P waves
P-R Interval can't be measured
-QRS complexes are wide and bizarre looking
=QRS may be similar (unifocal)
• QRS complexes may vary (multifocal)
-Rate 150-250 per minute
-May occur with or without a pulse
2.
-Deliver unsynchronized shock 120-200 joules
-Epinephrine 1 mg IV/IO (1:10,000) Q3-5 minutes during compressions
-Amiodarone 300 mg IV/IO, 2nd dose 150 mg in 5-10 min - if conversion set up drip
OR
, -Lidocaine 1.0-1.5 mg/kg IV/IO, 2nd and 3rd doses .5 to .75 mg/kg in 5-10 min (x 2
ifneeded) MAX 3 mg/kg - if conversion set up drip
-optimize oxygenation and ventilation, treat hypotension, treat STEMI if needed, fluid
bolus
monomorphic vs. polymorphic v tach - answers
SVT - answers
Ist Degree Heart Block - answers PR Interval is longer than .20 sec but are generally
equal
This rhythm looks a lot like normal sinus rhythm, but it has a subtle secret. The PR
intervals will be prolonged ( >0.20 seconds) regularly throughout the rhythm
Type 1 second degree heart block - answers -P waves are present and all look similar,
there are more P waves than QRS complexes
-PR Interval progressively lengthens until one P wave isn't conducted (no QRS)
-QRS Complexes are normal
The key with this rhythm is that the PR interval follows a pattern where they gradually
lengthen. Therefore, you will see that the p wave is getting further and further away from
the QRS complex, and then all of the sudden there is a p wave without a QRS complex.
Then this pattern will repeat itself again.
Type 2 second degree heart block - answers -P waves are present and all look similar,
there are more P waves than QRS complexes (some P waves are not conducted)
-PR intervals may be normal or prolonged, but it stays the same
-QRS Complexes are normal
The key with differentiating this rhythm from Second-Degree Type I is that with Second-
Degree Type II the PR Intervals don't progressively lengthen like with Type I, but stay
constant, and then at some point a QRS complex is dropped. Furthermore, the PR
interval can normal or prolonged.
-PR interval constant (the same throughout)...may be prolonged or normal
3rd degree heart block - answers -P waves are present and all look similar
-PR Interval is variable and is of no consequence
-QRS Complexes may be normal or wide
P waves are completely unrelated to QRS complexes
P-P intervals are regular, R-R intervals are regular - they just don't have anything to do
with each other. Atrial rate 60-100, ventricular rate 40-60
What you will see?
Sinus bradycardia rate
Treatment - answers <60
may or may not be needed (ie. BP) - atropine, pacing, epinephrine, dopamine
Sinus tachycardia rate
Treatment - answers >100
• Normal response to stress
• Infection, hypoxemia, hypovolemia, MI, drugs
• Can impair cardiac output
Atrial fibrillation
Treatment - answers -P waves not present - atria are not depolarizing - they are
fibrillating - chaotic wavy baseline
QRS looks normal but is irregular (irregular ventricular
reponse
-Treat with anticoagulation, digoxin, beta blockers - may need to cardiovert
Ventricular fibrillation (V-fib)
2.TREATMENT - answers =P waves and PR Interval are absent
=QRS complexes are absent
-Electrical activity consists of low (fine) or high (coarse) amplitude undulations from the
baseline that vary in shape
-There is no rate
-There is no pulse
2. EPI 2-3MIN
AMIODARONE- 300mg
1. Ventricular tachycardia (V-tach)
2. Treatment - answers -No P waves
P-R Interval can't be measured
-QRS complexes are wide and bizarre looking
=QRS may be similar (unifocal)
• QRS complexes may vary (multifocal)
-Rate 150-250 per minute
-May occur with or without a pulse
2.
-Deliver unsynchronized shock 120-200 joules
-Epinephrine 1 mg IV/IO (1:10,000) Q3-5 minutes during compressions
-Amiodarone 300 mg IV/IO, 2nd dose 150 mg in 5-10 min - if conversion set up drip
OR
, -Lidocaine 1.0-1.5 mg/kg IV/IO, 2nd and 3rd doses .5 to .75 mg/kg in 5-10 min (x 2
ifneeded) MAX 3 mg/kg - if conversion set up drip
-optimize oxygenation and ventilation, treat hypotension, treat STEMI if needed, fluid
bolus
monomorphic vs. polymorphic v tach - answers
SVT - answers
Ist Degree Heart Block - answers PR Interval is longer than .20 sec but are generally
equal
This rhythm looks a lot like normal sinus rhythm, but it has a subtle secret. The PR
intervals will be prolonged ( >0.20 seconds) regularly throughout the rhythm
Type 1 second degree heart block - answers -P waves are present and all look similar,
there are more P waves than QRS complexes
-PR Interval progressively lengthens until one P wave isn't conducted (no QRS)
-QRS Complexes are normal
The key with this rhythm is that the PR interval follows a pattern where they gradually
lengthen. Therefore, you will see that the p wave is getting further and further away from
the QRS complex, and then all of the sudden there is a p wave without a QRS complex.
Then this pattern will repeat itself again.
Type 2 second degree heart block - answers -P waves are present and all look similar,
there are more P waves than QRS complexes (some P waves are not conducted)
-PR intervals may be normal or prolonged, but it stays the same
-QRS Complexes are normal
The key with differentiating this rhythm from Second-Degree Type I is that with Second-
Degree Type II the PR Intervals don't progressively lengthen like with Type I, but stay
constant, and then at some point a QRS complex is dropped. Furthermore, the PR
interval can normal or prolonged.
-PR interval constant (the same throughout)...may be prolonged or normal
3rd degree heart block - answers -P waves are present and all look similar
-PR Interval is variable and is of no consequence
-QRS Complexes may be normal or wide
P waves are completely unrelated to QRS complexes
P-P intervals are regular, R-R intervals are regular - they just don't have anything to do
with each other. Atrial rate 60-100, ventricular rate 40-60
What you will see?
