ACLS

What ACLS medication dosages should you know for exams?

ACLS and PALS medication dosages

Why are ACLS and PALS medication dosages important?

They are AHA guidelines and are nationally recognized, accepted, and practiced

What should you know about medications besides dosages?

Indications, contraindications, and other key information

What are the four ACLS rhythm categories?

Slow, normal, fast, or dead

What heart rate range is considered the ACLS normal category?

60–150 bpm

What rhythms fall into the ACLS normal category?

Normal Sinus Rhythm, Sinus Tachycardia, Atrial Fibrillation, Atrial Flutter, Accelerated Junctional, Junctional Tachycardia

What heart rate defines the ACLS slow category?

< 60 bpm

What additional criterion is required before treating a slow rhythm?

The patient must be symptomatic

What rhythms fall into the ACLS slow category?

Sinus Bradycardia, Junctional Escape, Second Degree Type I, Second Degree Type II, Third Degree, Idioventricular

Which slow rhythms are typically responsive to Atropine and pacing?

Sinus Bradycardia, Junctional Escape, Second Degree Type I

What is the Atropine dose for symptomatic bradycardia?

1 mg, up to a maximum of 3 mg

What is the ACLS transcutaneous pacing rate recommendation?

60 bpm, increase as needed

What milliamps are typically used to begin transcutaneous pacing?

50+ mA until electrical and mechanical capture are achieved

What indicates electrical capture during pacing?

A captured pacer spike followed by a QRS complex

What indicates mechanical capture during pacing?

A pulse corresponding to the paced rhythm

What is the Dopamine infusion dose for symptomatic bradycardia?

5–20 mcg/kg/minute

What is the Epinephrine infusion dose for symptomatic bradycardia?

2–10 mcg/minute

Which slow rhythms are typically not responsive to Atropine?

Second Degree Type II, Third Degree, Idioventricular

Why is Atropine often ineffective in high-degree heart blocks?

AV conduction is blocked and the SA node cannot effectively regulate the ventricles

What heart rate defines the ACLS fast category?

150 bpm

How are fast rhythms further classified?

Stable or unstable

What fast rhythms are commonly addressed in ACLS?

Supraventricular Tachycardia (SVT) and Ventricular Tachycardia with a pulse

What defines a stable tachycardic patient?

Alert and oriented, hemodynamically stable, no significant complaints, may have mild weakness or lightheadedness

What defines an unstable tachycardic patient?

Disoriented, hemodynamically unstable, chest pain, or difficulty breathing

What is the first treatment for stable SVT?

Vagal maneuvers

What is the first Adenosine dose for stable SVT?

6 mg rapid IV push

What is the second Adenosine dose for stable SVT?

12 mg rapid IV push

What additional Adenosine dose may be considered for stable SVT?

A second 12 mg dose

What is the treatment for unstable SVT?

Synchronized cardioversion

What cardioversion energies are used for unstable SVT?

50–100 J, 200 J, 300 J, 360 J

What may be considered before cardioversion in unstable SVT?

Sedation

What is the Amiodarone dose for stable Ventricular Tachycardia?

150 mg over 10 minutes

What is the Procainamide dose for stable Ventricular Tachycardia?

25–50 mg/minute

What is the Sotalol dose for stable Ventricular Tachycardia?

100 mg (1.5 mg/kg) over 5 minutes

What is the treatment for unstable Ventricular Tachycardia with a pulse?

Synchronized cardioversion

What cardioversion energies are used for unstable Ventricular Tachycardia?

100 J, 200 J, 300 J, 360 J

What may be considered before cardioversion in unstable Ventricular Tachycardia?

Sedation

What rhythms are considered shockable cardiac arrest rhythms?

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

What rhythms are considered non-shockable cardiac arrest rhythms?

Asystole and Pulseless Electrical Activity

What is the immediate treatment for shockable rhythms?

CPR, defibrillation, IV/IO access, Epinephrine, and consideration of H’s and T’s

How often is Epinephrine given during cardiac arrest?

Every 3–5 minutes

What Epinephrine dose is used during cardiac arrest?

1 mg of 1:10,000 concentration

What is the first Amiodarone dose for refractory VF/pVT?

300 mg IV push

What is the second Amiodarone dose for refractory VF/pVT?

150 mg IV push

What should always be considered during cardiac arrest management?

H’s and T’s

What is the immediate treatment for Asystole and PEA?

CPR, IV/IO access, Epinephrine, and consideration of H’s and T’s

What is the key ACLS principle for cardiac arrest medications?

Push Epi Always

What are the shockable rhythms?

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

What are the non-shockable rhythms?

Asystole and Pulseless Electrical Activity

What are the H’s and T’s used for in ACLS?

Identifying and treating reversible causes of cardiac arrest