Asystole- What is protocol?
Check in two leads, 2 Minutes CPR, IV/O2 (BVM 15 LPM), Epinephrine 1:10,000 1 mg IVP q 3-5 minutes, considier ET, capnography, CPR Continued, treat reversible causes
Asystole- What is first thing you do?
Check in two leads
Asystole- What is the first drug given?
Epinephrine- 1:10,000 1 mg IVP q 3-5 minutes
Asystole- what else should be occurring during 1st 2 min of CPR?
IV/IO Access, consider advanced airway, capnography
Asystole- What else should you be considering?
The causes of death...PATCH5MD
What is PATCH5MD?
P-Pulmonary Embolism, A-Acidosis, T-Tension Pneumo, C-Cardiac Tamponade, H-Hypovolemia, H-Hyper/hypokalemia, H-Hypoglycemia, Hypo/hyperthermia, H-Hypoxia, M-MI, D-Drug overdose
All dead people get what drugs?
Epinehrine 1:10,000 1 mg IVP q3-5 min Amiodarone 300 mg bolus, may repeat 150 mg
V-Fib/Pulseless V-Tach- What is first thing you do?
CPR and O2 (BVM 15 LPM) should be done before assessment, once Vfib known, defib biphasic 120J
V-Fib/Pulseless V-Tach- What is second thing you do?
2 min CPR, IV/IO Access
V-Fib/Pulseless V-Tach- What is third thing you do?
shockable rthythm? shock, o/w epi every 3-5 min
V-Fib/Pulseless V-Tach- What is first drug given?
Epinephrine 1:10,000 1mg IVP q 3-5 min
V-Fib/Pulseless V-Tach- What is another drug given other than Epi?
Vasopressin 40U IV
V-Fib/Pulseless V-Tach- What is the second drug given?
Amiodarone 300mg IVP
V-Fib/Pulseless V-Tach- What is another drug given for a second drug?
Lidocaine 1.5mg/kg IVP
V-Fib/Pulseless V-Tach- What do you shock at for joule setting?
120 - 200 Joule's for biphasic
V-Fib/Pulseless V-Tach- What is the protocol?
activate ems, CPR/O2,, attach monitor,Defib 120, CPR, IV Access, shock? CPR/Epi 1:10, 1mg q 3-5 min, Defib 360J, CPR, Amiodarone 300mg IVP, treat causes, Defib 360J, CPR, Amiodarone 150mg IVP, Defib 360J
PEA- What is it?
Any rhythm other than asystole, v-fib and pulseless v-tach. Pulseless Electrical Activity. The heart is not able to perfuse properly but has electrical conductivity.
PEA- What is the protocol?
CPR/IV/O2(BVM), Epi 1:10,000 1mg IVP q 3-5 min, consider advanced airway, shockable? cpr 2 min, treat PATCH5MD
PEA- What is another drug you can use as a casopressor other than Epi?
Vasopressin 40U IVP
V-Tach+pulse (stable)- What is the first thing you do for this?
iv access, 12 lead, consider adenosine if reg & monomorphic, consider antiarrthymic, consult
V-Tach+pulse (stable)- What is the first drug you give for this?
Amiodarone 150mg over 10 min
V-Tach+pulse (stable)- What is the drip for Amiodarone?
150mg infuse in 100cc w/10 gtts set = 100 gtts/min
V-Tach+pulse (stable)- What is the maint drip for Amiodarone?
900mg/500ml, set to receive 1mg/min, drip at 33ml/hr x 6hrs
V-Tach+pulse (unstable)- What is unstable protocol?
O2/IV, cardiovert 100J sync (if reg), Amiodarone, Procainamide (avoid if prolonged QT or CHF) or Sotalol (avoid if prolonged QT)
What makes a patient unstable vs. being stable?
Three things make a patient unstable: AMS, BP less than 90 systolic and Pumonary Edema
SVT+pulse (stable)- What is the first thing you do for this patient?
Have patient to vagal maneuvers
SVT+pulse (stable)- What is the second thing you do for this patient?
IV/O2, consider adenosine
SVT+pulse (stable)- What is the first drug given for this patient?
Adenosine 6mg RIVP
SVT+pulse (stable)- What is second drug given for this patient?
After 2 minutes Adenosine 12mg RIVP
SVT+pulse (stable)- What is third drug given for this patient?
After 2 minutes Adenosine 12mg RIVP
SVT+pulse (unstable)- What is the first thing you do for this patient?
SVT+pulse (unstable)- what are the recommended joule settings?
Narrow regular: 50 - 100J, Narrow irregular: 120 - 200J, Wide regular: 100J, Wide irregular: defib dose (not synchronized)
Brady+pulse (symptomatic)- What is the protocol for this rhythm?
O2/monitor/IV/Atropine .5mg IVP Q3-5m up to 3mg;TCP 80 ma 80 bpm OR Dopamine 2-10 mcg/kg/min OR Epi 2-10 mcg/m
If Patient has Bradycardia & is showing signs of Poor perfusion, What might you see? (try to give 3-4 examples).
-Acute Altered Mental Status. -Ongoing chest pain. -Hypotension. -Other signs of shock.
If Patient has Bradycardia & is showing signs of Poor perfusion. What 2 rhythms call for immediate transcutaneous pacing (TCP).
2nd degree type II block & 3rd degree complete block (CHB)
In ACLS Bradycardia Algorithm Atropine is the 1st line drug. What is the dosage?
Atropine 0.5mg IV MR to max 3mg.
In ACLS Bradycardia Algorithm you might consider Epi or Dopamine. What dosage would be used for Epi and then for Dopamine?
Epi: 2-10 mics/ min Dopamine: 2-10 mics/kg per min.
Treat possible contributing factors. What are the 6 H,s & 5 T,s.
Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/ hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade-cardiac Tension pneumothorax Thrombosis (coronary or pulmonary) Trauma (hypovolemia, increased ICP).
In the ACLS secondary survey what does ABCD stand for?
Airway Breathing Circulation Differential Diagnosis
Give 2 reasons why you should avoid Hyperventilating a patient when assisting ventilations.
1) Aspiration risk 2) Increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output.
For patients with a likely asphyxial arrest, What is the sequence of actions for a Lone rescuer?
Perform 2 min (5 cycles) of CPR before leaving the patient to activate the emergency response system and get an AED. Then return to the patient, resume CPR, and use the AED if indicated.
What are the steps of closed-loop communication that a team leader should use?
1) Give assignment or order to team member. 2) Confirm it was heard and understood by receiving a clear response and good eye contact from the team member. 3) Listen for confirmation that the task was done before assigning another task.
When team resusitative efforts become ineffective what should the team then do?
go back to the basics and talk as a team.
What 3 things are going to be an essential role of the team leader to be monitoring and reevaluating?
1) The patients status 2) Interventions that have been performed. 3) Assessment findings.
ACLS guidelines state to typically limit suction attempts to...How many secounds?
10 seconds or less
With ET tube suctioning; How far or How do you measure the distance you can insert the suctioning catheter?
Insertion of the catheter beyond the tip of the ET tube is not recommended due to the chance that it may injure or stimulate cough and/or bronchospasm. To prevent this take note of the length of ET tube used and mark with thumb and forefinger.
If you are called on-scene to witnessed arrest in 6 min what should you do first?
If call-to-response time interval is longer then 4-5min perform 2min of CPR (5 cycles) before defibrillating patient. if under 4-5min shock first.
AED use; If a patient is lying on snow or in a small puddle...
Action: Ok to use the AED. (ACLS p. 39)
AED use; If a patient has an implanted pacemaker...
Not contraindicated as long as the electrode is not placed directly over the device. (at least 1in. to either side of the implanted device.
What ALS drugs are involved in cases of VF/Pulseless VT according to ACLS.
E.V.A ; Epi, Vasopressin, Amiodarone,
What are the energy doses of monopasic and biphasic defibrillator to effectively terminate VF.
monophasic=360joules. Biphasic=150-200joules (typically 200J)
VF/VT Epi dosage(s) are what? May replace with what other drug, include its dosage?
Epi=1mg IV/IO q 3-5min or may give 1 dose of Vasopressin= 40 U IV/IO to replace 1st or 2nd line Epi.
When should you consider giving Mag. Sulfate for? Dosage?
For torsades de pointes. Dose: 1-2 g IV/IO
CPR/ iv/io access
H's and T's
Vasopressin 40u or Epi 1mg
V-TACH (stable) Wide QRS
Amiodarone 150mg or
Vasopressin 40u or Epi 1mg
H's and T's
Epi drip 2-10mcg/min
Dopamine Drip 2-20mcg/kg/min
Diltiazem 0.25mg/kg over 2 mins
V-FIB / PULSELESS V-TACH
CPR/IV or IO access
CPR/ Vaso40u or Ep 1mg /intubate
Amiodarone 300mg / trx revers.
150mg over 10min, rpt as needed if VT recurs, maint dose 1mg/min,
20-50 mg/min until arrhy suppressed, decr BP, QRS widens > 50%, or max dose 17mg/kg given. Maint dose 1-4 mg/min. Avoid if prolong QT or CHF
100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.