ACLS & PALS (Sing)

Difference between MI and Cardiac arrest?

not the same thing!!!

• MI – death/dysfunction of myocardial tissue due to ischemia

• Cardiac Arrest – cardiac electrical system malfunction

"Five H's and T's" is a mnemonic used in advanced cardiac life support (ACLS) to remember the causes of cardiac arrest.

What are the Five H’s and T’s?

1. Hypovolemia

2. hypoxia

3. hydrogen ion (acidosis)

4. hyper/hypokalemia

5. hypothermia

6. toxins

7. tamponade, cardiac

8. tension pneumothorax

9. thrombosis (coronary MI)

10. thrombosis (pulmonary PE)

What is the #1 complication of cardiac arrest?

anoxic brain injury (neurological deficits)

What is the out-of-hospital chain of survival?

1. activation of emergency response

2. high-quality CPR

3. defibrillation

4. advanced resuscitation (note: main difference from in-hospital)

5. postcardiac arrest care

6. recovery

What is the in-hospital chain of survival?

1. early recognition and prevention

2. activation of emergency response

3. high-quality CPR

4. defibrillation

5. postcardiac arrest care

6. recovery

When giving chest compressions…

• compression rate should be:

• compression depth should be:

• compression-to-ventilation ratio should be:

• compression rate should be: 100-120/min

• compression depth should be: at least 2 inches

• compression-to-ventilation ratio should be: 30:2

defibrillation is used in…

v-fib and pulseless v-tach

recheck rhythm every __ minutes after shock delivery

2

For CPR in ACLS it’s the same technique as in BLS, but…

• rotate compressor every ___ minutes

• for defibrillation, biphasic is recommended and ___-___J

• rotate compressor every 2 minutes

• for defibrillation, biphasic is recommended and 120-200J

Once an advanced airway is established, with continuous chest compressions, you should do ___ breath every ___ seconds.

1 breath every 6 seconds

Epi dose for ACLS

1mg IVP q3-5 min → 0.1mg/ml

What is given after the 1st round of EPI for VF or pVT?

amiodarone (alternative: lidocaine)

Tx for torsades de pointes in cardiac arrest?

Mg sulfate 1-2g IVP over 1-2 minutes (may repeat)

Adenosine is used for what?

narrow complex tachyarrhythmias (SVT)

What are some other medications used for tachycardia in adults?

• procainamide

• amiodarone

• sotalol

• b-blockers (metoprolol)

• Non-DHP CCBs (diltiazem)

What medications are used for adult bradycardia?

• atropine

  • anticholinergic

  • for persistent bradyarrhythmia (HR <50 bpm) causing sx

• dopamine

• EPI

nonpharm for bradycardia?

TCP or TVP