Acls review 2009
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ACLS Review 2009. Emory Family Medicine. Phone first ABCs 30:2 cycles 100/min 1 ½ - 2 inches Check rhythm after 5 cycles. Adult CPR. Name this rhythm Ventricular Fibrillation What drugs can you use initially? Epi 1 mg q 3-5 min Vasopressin 40 U x 1 What other drugs can you try?

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ACLS Review 2009

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Acls review 2009

ACLS Review 2009

Emory Family Medicine


Adult cpr

Phone first

ABCs

30:2 cycles

100/min

1 ½ - 2 inches

Check rhythm after 5 cycles

Adult CPR


Acls review 2009

  • Name this rhythm

    • Ventricular Fibrillation

  • What drugs can you use initially?

    • Epi 1 mg q 3-5 min

    • Vasopressin 40 U x 1

  • What other drugs can you try?

    • Amiodorone 300 mg once, then 150 mg once, or

    • Lidocaine 1 – 1.5 mg/kg initially, then 0.5 – 0.75 mg/kg to max of 3 mg/kg

    • Mag 1-2 g for torsades


  • Acls review 2009

    • What should you check with this rhythm?

      • Pulse

  • What is this rhythm?

    • PEA

  • What are the 6 H’s and 5 T’s?

    • Hypoxia, Hypovolemia, Hypo/Hyperkalemia, Hydrogen ions, Hypothermia, Hypoglycemia

    • Toxins, Trauma, Tamponade, Thrombosis, Tension Pneumo

  • What drugs can you use?

    • Epi 1 mg q 3-5 min

    • Vasopressin 40 U x 1

    • Atropine 1 mg for PEA with slow rate


  • Acls review 2009

    • What is this rhythm?

      • Asystole

  • Do you shock this pt?

    • NO

  • What do you do?

    • CPR, O2, IV, Monitor

    • R/O and fix 6 H’s/ 5 T’s

    • Check DNR status

  • What drugs can you use?

    • Epi 1 mg q 3-5 min

    • Vasopressin 40 U x 1

    • Atropine 1 mg


  • Acls review 2009

    Name these rhythms?

    1st degree AV Block

    2nd degree AV Block Type I

    (Mobitz I-Wenkenbach)

    2nd degree AV Block Type II

    Which rhythm needs TC pacing?


    Acls review 2009

    What does this patient need?

    Transcutaneous/transvenous pacing

    What drugs can you use?

    Atropine 0.5 – 1 mg, to max of 3 mg

    Epi 2 - 10 mcg/min

    Dopamine 2 - 20 mcg/kg/min


    Acls review 2009

    • What is this rhythm?

      • PSVT

  • What can you try first?

    • Vagal manuevers

  • What drug do you use?

    • Adenosine 6 mg IV push

    • Repeat with 12 mg x 2

  • What if patient becomes unstable?

    • Synchronized cardioversion with 50 Joules


  • Acls review 2009

    • What are these rhythms?

      • A Fib and A flutter

  • What do you need to ask?

    • Is patient stable or unstable?

    • Has rhythm been present for > 48 hrs?

    • Is systolic function impaired < 40%

    • Does pt have WPW?


  • Treatment focus of a fib a flutter

    Treatment Focus of A Fib/A Flutter

    • Treat unstable patients with cardioversion

      • 50 - 100 J

  • Rate control

    • Normal LV fx – Ca (Diltiazem) or Beta blocker

    • Impaired LV fx – Digoxin, Amiodarone

  • Rhythm control

    • < 48 hrs – Cardioversion or Amiodarone

    • > 48 hrs – Anticoagulate x 3 wks, then cardiovert, then anticoagulate for 4 more weeks


  • Acls review 2009

    • What is the rhythm?

      • Wolff-Parkinson-White Syndrome

  • What drugs must you NOT use?

    • Adenosine

    • Ca or Beta Blockers

    • Digoxin

  • What drugs can you use?

    • Amiodarone

    • Flecainide

    • Procainamide

    • Sotalol

    • Propafenone


  • Acls review 2009

    • What is the rhythm?

      • Monomorphic Ventricular Tachycardia

  • First question to ask?

    • Is pt stable or unstable?

  • What drugs can you use?

    • Amiodarone 150 mg IV over 10 min, to max of 2.2 g/ 24 hrs

    • Lidocaine 0.5 – 0.75 mg/kg IV push

    • Procainamide

    • Sotalol


  • Acls review 2009

    • What is this rhythm?

      • Polymorphic Ventricular Tachycardia

  • What is your first question?

    • Is pt stable or unstable

  • What drugs can you use?

    • Amiodarone

    • Beta blocker

    • Lidocaine

    • Procainamide

    • Sotalol


  • Acls review 2009

    • Name the rhythm?

      • Torsades de pointes

  • What can help you determine this?

    • Baseline QT interval prolonged

  • What drugs can you use?

    • Magnesium 1-2 g load

    • Lidocaine

    • Isoproteronol

    • Phenytoin

    • Overdrive pacing


  • Tachycardia

    Tachycardia


    Name that rhythm

    Name that rhythm

    Normal Sinus Rhythm


    Acls review 2009

    Sinus Tachycardia


    Acls review 2009

    Junctional Tachycardia


    Acls review 2009

    Multifocal Atrial Tachycardia


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