CARDIO FINAL TSU ACLS

BLS intial assessment

• verify scene safety

• check responsiveness

• 911/AED

• look for no breathing / only gasping + check pulse

no breathing / only gasping + no pulse

• Start CPR

  • 30 compressions + 2 breaths

  • use ADE if shockable rhythm

abnormal breathing (gasping) + pulse felt

• provide 1 breath every 6 secs (10 breaths/min)

• check pulse very 2 mins

• no pulse → CPR

normal breathing + pulse felt

monitor

opioid overdose suspicion

administer opioid antagonist (naloxone)

chest compressions

• purpose

• rate

• depth

• purpose

  • create blood flow by increasing intrathroacic pressure

• rate

  • 100 - 120 compressions/min

• depth

  • adult: 2 in (5 cm)

  • peds: 1/3 of anteroposterior chest diameter

• allow complete recoil

• minimize interruptions

heart attack vs cardiac arrest

• heart attack = plumbing problem

• cardiac arrest = electrical problem

cardiac arrest

• definition

• causes

• survival

• definition

  • cessation of cardiac mechanical activity, absence of signs of circulation

  • code blue

• causes

  • adults: arrhythmias

  • peds: respiratory failure

• survival

  • best to worst survival: Vfib > PEA > asystole

Defibrillation

• treatment

• impact of delay

• shock energy

• treatment

  • preferred for shockable rhythyms (VF or VT)

• impact of delay

  • every 1 min delay in defib, survival rate decreases by 7 - 10%

• shock energy

  • biphasic: 120 - 200 J ( if unknown → use max)

  • monophasic: 360 J

T or F: all meds administered by rapid IV push and should not stop CPR

true

epinephrine

• goal

• pharmacology

• effects

• indications

• dose

• increases

• goal

  • augment low coronary and cerebral perfusion pressures

• pharmacology

  • alpha 1, alpha 2, beta 1, beta 2 agonist

• effects

  • vasoconstriction

  • increased inotropic/chronotropic activity

• indications

  • all pulseless rhythyms (VF, pulseless Vtach, PEA, asystole

• dose

  • 1mg IV/IO every 3 - 5 mins

• increases

  • return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge

amiodarone

• purpose

• class

• IV admin

• dose (pulseless arrest, shockable)

• purpose

  • raise fibrillation threshold and help heart stat in normal ryhtmym

• class

  • class III anti-arryhtmic, but possesses all 4 classes

• IV admin

  • cause hypotension and bradycardia

• dose (pulseless arrest, shockable)

  • 300 mg bolus, then 150 mg

lidocaine

• purpose

• dose

• class

• PK

• monitoring

• purpose

  • alternative to amiodarone

• dose

  • 1 - 1.5 mg/kg, then 0.5 - 0.75 mg/kg

• class

  • class Ib antiarryhthmic

• PK

  • prolongedt ½ in HF, liver disease, low muscle mass

• monitoring

  • elevated → increased risk of seizures

Vasopressin

• pharmacology

• effects

• pharmacology

  • V1 receptors

• effects

  • vasoconstriction

alternative ACLS Meds

• magnesium

  • for TdP

  • dilute in 10 mL of D5W or NS

  • can cause hypotension and asystole

• sodium bicarbonate

  • if acidosis present

• thrombolytics

  • for MI or PE

IV route

• preferred

• central line preferred

• peripheral line: 1 attempt; above diaphragm preferred

• peak concentration: 1.5 - 3 mins

  • shortened by 40% if followed by flush

Intraossesous (IO) route

• into bone marrow

• used for all ACLS drugs

• peak concentration similar to IV

• placement times < 1 min

endotracheal (ET) route

• last resort

• lower and delayed peak concentration

• Naloxone, Atropine, Vasopressin, Epi, Lidocaine