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ACLS

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dinosaur1234's version from 2016-08-23 21:43

ACLS

Question Answer
Shockable rhythmsVF and pVT
Not shockable rhythm asystole, PEA
VF/pVT algorithm1 CPR, 2 shock, 3 CPR for 2 min and establish IV/IO access; 4 check again to see if you can shock; if yes, then 5 shock, 6 CPR for 2 min and give epi q3-5min, 7 check to see if shockable, if yes 8 shock, 9 CPR and give amio, go back to step 5 and repeat…. If rhythm no shockable after step 4, give epi and cont CPR
Asystole/PEA algorithmstart CPR, establish IV/IO access, give epi q3-5 min, check to see if rhythm is shockable every 2 min during CPR
Epi dose1 mg q3-5 min
Amiodarone dose in VF/pVTfirst dose is 300 mg bolus, second dose is 150 mg
Biphasic shock energy120 – 200 jolts
Monophasic shock energy360 J
Atropine dosefirst dose 0.5 mg bolus; repeat q3-5 min; max dose of 3mg
Dopamine IV infusion rateusual infusion rate is 2-20 mcg/kg/min; titrate to pt response and taper slowly
Epi IV infusion2-10 mcg/min; titrate to patient response
Bradycardia with a pulse algorithmidentify cause, get 12-lead EKG and IV access; if persistent bradyarrhythmia causing (hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute HF) then give atropine; if atropine fails do transcutaneous pacing or dopamine infusion, or epi infusion; then consider expert consultation or transvenous pacing
Tachycardia with a pulse algorithmif causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute HF, then give synchronized cardioversion; if none of the above, assess QRS; if QRS wide (>0.12), get IV access, 12 lead EKG, consider adenosine if monophasic and regular, consider antiarrhythmic infusion (procainamide, amiodarone, sotalol); if narrow QRS, IV access, 12 lead EKG, vagal maneuvers, adenosine (if regular); BBL or CCB, expert consultation
Narrow regular synchronized cardioversion dose50-100 J
Narrow irregular synchronized cardioversion dose120-200 J biphasic or 200 J monophasic
Wide regular synchronized cardioversion100 J
Wide irregulardefibrillation dose
Adenosine dosefirst dose 6mg rapid IV push, follow with NS flush, second dose 12 mg if required
Amiodarone IV dosefirst dose 150 mg over 10 min. repeat as needed if VT recurs; follow by maintenance infusion of 1mg/min for first 6 hrs
Sotalol IV dose100 mg (1.5 mg/kg) over 5 min
Return of spontaneous circulation algorithmoptimize ventilzation and oxygenation -> treat hypotension with either IV/IO bolus (1-2 L NS or LR) or vasopressor (epi infusion, dopamine, NE infusion) -> 12 lead EKG -> if STEMI, coronary reperfusion; if not, initiate targeted temp management
Epi IV infusion0.1-0.5 mcg/kg/min (in 70 kg adult, 7-35 mcg/min)
Dopamine infusion5-10 mcg/kg/min
NE infusion0.1-0.5 mcg/kg/min (in 70 kg adult, 7-35 mcg/min)
Reversible causeshypovolemia, hypoxia, H+ ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade (cardiac), toxins, thrombosis (coronary or pulmonary)
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