ACLS NOTES
8/9/10
Analyzing EKG:
1. are there P waves to every QRS cmplex
2. is rhythm regular or irregular, fast or slow
3. are waves Narrow/Atrial or Wide/Ventricular
Pulseless VT: wide complex
Asystole: Flat line, NO SHOCK
PEA/pulseless electrical activity: No P wave, No T wave, no pulse, NO SHOCK
2nd degree Type 1/wiekenbach: PR interval changes/getting shorter, then drops QRS
cmplex
2nd degree Type 2/mobitz: same PR interval, then drops QRS
V.Tachy w/pulse: cardiovert, synch, charge, clear, fire
SVT: Narrow complex, valsalva maneuver, give adenosine, CARDIOVERT
V.Tachy: Wide complex, NO ADENOSINE
Defibrillator Machine:
Leads: White/RUQ, Black/LUQ, Red/LLQ (of chest)
Monophasic AED: 360J
Biphasic AED: 200J
Cardiovert: Machine on, lead select, 50-100J, SYNCH, LOCKS ON R WAVE,
Charge, ALL CLEAR/PUSH RED BUTTON
Pt w/pulse: CARDIOVERT
Pt w/o pulse: DEFIB
Pace: 3rd degree, is most common/place pads Front to Back,
bradyrhythm/symptomatic/ non responsive
Pace: 30 bpm, set rate 76-80, select mili-amps 0-1-2-3-4, check heart rate, pt will
get small shocks and will see spikes, NEEDS QRS to capture beat
V.FIB AND PULSELESS V.TACHY------AED SHOCK ONLY
1st INDICATION FOR USE OF AED:
1. unconscious
2. not breathing
3. pulseless
CPR: 30 compressions 2 breaths
Rescue Breathing: 1 breath q 5-6sec
Advanced airway: 1 breath q 6-8 sec and 100 compressions
Anti-arrhythmic Drugs:
Epinephrine or Vasopressin
Lidocaine or Amiodarone in Cardiac Arrest, V.Tach, V.Fib
EPINEPHRINE: IV/IO/ET, like adrenaline
Indications: cardiac arrest, VF, pulseless VT, asystole, pulseless electrical activity/PEA
1mg (10ml 1:10,000 soln) q 3-5min
NO MAX DOSE, Continue CPR---ONCE HAVE PULSE—STOP giving
Endotracheal Tube: give 2-2.5mg diluted in 10ml NS
Atropine Sulfate: IV/IO/ET, given after Epinephrine
Indications: cardiac arrest, PEA, SYMPTOMATIC SINUS BRADY <60bpm, asystole
1mg q 3-5min, MAX 3 DOSES (3mg)
Bradycardia: 0.5mg IV q 3-5 min, DO not exceed 0.04mg/kg (3mg)
Endotracheal Tube: 2-3mg diluted in 10ml NS
Treats----Organophosphate Poisoning-----Given in large dose 2-4mg
Amiodarone: IV/IO, Treats life threatening arrhythmias that have not responded to other
interventions (CPR, Shock, Vasopressin)
Indications: RECURRENT V.FIB, Recurrent hemodynamically unstable V.Tachy
300mg PUSH, dilute in 20-30ml D5W
Give 150mg ONCE IV PUSH, 3-5min.
Recurrent Life threatening V.Arrhythmia: give
150mg q 10min, repeat 150mg q 10min prn
160 mg q 6hrs
540 mg q 18hrs
Adenosine: short ½ life
Indications: Treats PSVT >150-200bpm
IV RAPID PUSH
1. 6mg 1-3sec, then 20ml NS flush, elevate arm
2. 12mg-----20ml NS, 1-2min
3. 12mg-----20ml NS, 1-2min
MAX DOSE 30mg
IF UNRESPONSIVE-------NEED CARDIOVERSIONLidocaine: IV/IO/ET
1-1.5mg/kg
Indication: REFACTORY V.Fib 0.5-0.75mg/kg IV PUSH, repeat 5-10min, MAX 3
DOSES TOTAL 3mg/kg
ET: 2-4mg/kg
Vasopressin: IV/IO/ET
Indications: REFACTORY V.FIB, asystole, PEA
40 UNITS 1 DOSE ONLY
CAN REPLACE 1ST OR 2ND DOSE OF EPINEPHRINE
Diltiazem: Acute Rate Control
Indications: controls Vent. Rate in A. Fib, A. Flutter, Terminated re-entrant arrhythmia
that requires AV nodal conduction
15-20mg (0.25mg/kg) IV over 2min
May give other dose in 15min at 20-25mg (0.35mg/kg) over 2min
USE AFTER ADENOSINE--------2ND LINE TREATMENT TO TREAT SVT
Do not use with Ca+ channel blockers, or WPW syndrome, or w/Beta Blockers (drop Bp)
Dopamine: 2nd line Tx for Symptomatic Bradycardia----after ATROPINE
Indications: use in Hypotension, BP systole 70-100 w/signs of shock
Can cause excess vasoconstriction
IV: 2-20ug/kg per min, Titrate to pt response, taper slowly
Precaution: correct hypovolemia, volume replacement
Sodium Bicarbonate:
Indications: treat hyperkalemia, bicarb acidosis (DKA, aspirin/TCA overdose, Cocaine,
diphenyhydramine-OD)
Not used in hypercarbic acidosis
1mEq/kg IV bolus
Use ABG analysis to guide bicarb therapy
ABG not reliable indicator of acidosis in Cardiac Arrest
Example questions:
Can be given ET: atropine, lidocaine, epinephrine, NO ADENOSINE
Pt awake, alert, rapid heart beat, SVT-narrow, 172 HR, BP 108/69:
Action=ADENOSINE 6mg
Vasopressin Administer: can be given as 1st or 2nd dose of epinephrine (replaces
administration of epinephrine)
Pt w/CP, confused, sinus brady, 40bpm: ATROPINE, 0.5mg IV q 3-5min