Advanced Cardiac Life Support

what is cardiac arrest

unable to generate adequate cardiac output to support oxygen demands of tissue

four types of rhythms in cardiac arrest

ventricular fibrillation (VF), pulseless ventricular tachycardia (pVT), pulseless electrical activity (PEA), and asystole

what is cardiac arrest survival dependent on

basic life support (BLS) and/or advanced cardiac life support (ACLS)

what is the immediate goal for patients in cardiac arrest

return of spontaneous circulation (ROSC)

how long are the cycles in cardiac arrest treatment

2 minutes

what should be checked at the end of each cycle

pulse and rhythm check

Which cardiac rhythms are shockable?

ventricular fibrillation and pulseless ventricular tachycardia

which cardiac rhythms are not shockable

pulseless electrical activity and asystole

describe ventricular fibrillation

a disordered electrical activity causing the ventricle to quiver rather than contract which prohibits the heart from pumping blood

describe pulseless ventricular tachycardia (pVT)

rapid and ineffective ventricular contractions leading to insufficient ventricular filling leading to near total decline in cardiac output such that a pulse is absent

describe pulseless electrical activity (PEA)

impalpable pulse in the presence of electrical discharge; may look like an organized rhythm but there is no pulse present

describe asystole

cessation of electrical and mechanical activity of the heart (aka flatline)

what should be done after each shock in VF and pVT

CPR for 2 minutes then determine if patient has a shockable rhythm

how many times do you shock a patient with VF or pVT before you administer drugs?

2 times

which drug can be given if Vf/pVT persists after two shocks and CPR?

A vasopressor such as epinephrine and can be given every 3-5 minutes

which drug can be given to VF or pVT patients after three shocks and epinephrine

Amiodarone or lidocaine (treat reversible causes)

Patients with PEA/asystole cannot be shocked so what is done immediately for them?

they are given a vasopressor such as epinephrine (continue giving every 3-5 minutes)

After administering epinephrine immediately for PEA/asystole what must be done

CPR for 2 minutes followed by a rhythm check to see if its shockable - continue process

routes of administration of drugs during cardiac arrest

IV, IO, and ET

T/F: intraosseous administration has higher doses of medications than IV

Falsee

what medications can be given through endotracheal

naloxone, atropine, vasopressin, epinephrine, and lidocaine

which doses are larger: IV/IO or ET tube

doses given via ET tube are 2-2.5 fold higher than the IV/IO dose

what do the ET administered drugs need to be diluted in

5-10 mL of sterile water or 0.9% saline.

what are vasoactive agents?

used to enhance organ perfusion by increasing arterial and aortic diastolic pressures resulting in increases in coronary and cerebral perfusion pressures

T/F: epinephrine is an example of a vasoactive agent

True - reasonable to administer as soon as feasible after onset of arrest due to initial non-shockable rhythms

indicatiosn for epinephrine

VF/pVT; PEA, asystole

dose of epinephrine

1 mg IV/IO every 3-5 minutes

T/F: There is no high-quality evidence to suggest that any antiarrhythmic drug given routinely during cardiac arrest increases survival to hospital discharge

true

antiarrhythmics used for cardiac arrest

amiodarone, lidocaine, and magnesium (only for TdP)

indication for amiodarone

VF/pVT, stable VT

dose for amiodarone in VF/pVT

300 mg iv bolus - may repeat with 150 mg iv bolus in 3-5 minutes

after administering amiodarone bolus what should be administered after

20 mL of normal saline flush

indications for lidocaine

VF/pVT, stable VT

dose for lidocaine in VF/pVT

1-1.5 mg/kg IV/IO - repeat 0.5-0.75 mg/kg every 5-10 minutes

when should lidocaine be considered for use?

if amiodarone is unavailable

with ROSC a lidocaine continuous infusion of what dose can be initiated?

1-4 mg/min

what does ROSC mean

return of spontaneous circulation

T/F: lidocaine should not be used in TdP

false - has minimal risk of QT prolongation :)

indications for magnesium

VF/pVT, associated with torsade de pointes

dose of magnesium for TdP

optimal dose is not established - give 1-2 grams IV bolus

in what scenario is magnesium not likely to be effective?

patients with VF/pulseless VT and normal QT interval

what should magnesium bolus be flushed with

10-20 mL of saline

what are some reversible causes of cardiac arrest

hypovolemia, hypoxia, hydrogen ion (acidosis), hypo-/hyperkalemia, hypothermia, hypoglycemia, tension pneumothorax, tamponade cardiac, toxins, thrombosis (pulmonary or coronary)

how to treat hypovolemia

since it is a loss of effective circulating volume - add fluids such as lactated ringers + treat any internal bleed/traumas <3333333

How to treat hypoxia

give 100% oxygen by mask

T/F: routine use of sodium bicarbonate is not recommended for patients in cardiac arrest due to acidosis

True …

how to treat hyperkalemia

give calcium chloride or calcium gluconate to stabilize myocardial membranes; giving sodium bicarbonate can be given to help shift potassium intracellularly

how to treat opioid induced respiratory depression and cardiac arrest

Naloxone 0.4 mg IV - but may require more (give IM/intranasally if out of the hospital)

how to treat cardiac tamponade and tension pneumothorax

take a big ass needle and draw out the excess blood/air/fluid

how to treat a pulmonary embolism

alteplase or tenecteplase

how to treat an MI

Tenecteplase, alteplase, or PCI