Mrs Feilds ACLS
Terms
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- Pharmacological Goals
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Correct hypoxia
Establish spontaneous circulation
Promote optimal cardiac function
Pain relief
Correct acidosis
To treat congestive heart failure
Prevent/suppress arrhythmias - Pharmacology I
-
Drugs used for full arrest
Dysrythmics - Inotropic
- affects the force of the contraction
- Chronotropic
- affects the heart rate
- Drugs considered in ACLS only after
-
1)Correct identification of rhythm
2)Good airway management with 100% oxygen
3)CPR
4)Defibrillation, if indicated - Administration of Drugs:
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1)IV anticubital vein (or existing c-line)
2)IV fluids should be flushed with NS 20-30ml after each injection
3)Raise extremity (helps with speed circulation-gravity - ETT DRUGS
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A-Atropine
L-Lidocaine
O-Oxygen
N-Narcan
E-Epinephrine - ETT Drug Dose not including Oxygen
- 2.5 times IV dose diluted in 10cc NS and hyperventilate
- Oxygen as a “drug†corrects:
-
-Hypoxia (cardiac dysrhythmia’s need 02)
Necessary for cellular metabolism
-Corrects acidosis
Cells do not respond to catecholamines - Dose of oxygen
-
-Spontaneous breathers
-Whatever device to meet oxygen demands of patient (100% O2)
-Never withhold oxygen to a COPD patient that is hypoxic
-Resuscitation 100%
-Bag valve mask
-ETT -
Epinephrine
Action: - Increase everything (BP, O2 demand, blood flow, contractility)
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Epinephrine
Indication: - Indicated in all forms of cardiac arrest-aystole, PEA, V-fib, Pulseless V-tach)
-
Epinephrine:
Dose & Max -
Dose 1mg IV push q 3-5 min
Max dose : None -
Epinephrine
Precautions: -
1)cause of worsening myocardial ischemia
2)cause of ventricular ectopy -
Vasopressin
Action: -
Alpha
Vasoconstriction
Increase pressure in coronary arteries
Increase cerebral blood flow
Increase vital organ flow
No effect on myocardial oxygen consumption -
Vasopressin
Indications: - pulseless v-tach/v-fib refractory to defib
-
Vasopressin
Dose & Max -
40 units IV, single dose, 1 time only
½ life is 10-20 minutes
Vasopressin NOT used in ETT
Can be used as alternative to Epinephrine -
Vasopressin
Pressure drug - Pressure drugs- increase circulation, increase BP, Constrict of vessels
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Amiodarone(Cordorone)
Function/Indication -
The choice drug for:
(1)Refractory VF/pulseless VT
(2)Tachicardias in patients with impaired heart function-only drug that works for SVT & VT
(3)Narrow complex tachycardias that fail to Adenosine
(4)Stable monomorphic v-tach
HISTORY OF SICK HEART -
Amiodarone
Disadvantages -
1)Cost
2)Delay in administration
A)Stored in glass ampules (scoring files & glass filters required)
B)Motion causes bubbles
C)Mixed with 20-30ml saline or dextrose before administration -
Amiodarone
ECG Indications: - V fib/pulseless V Tach
-
Amiodarone
Dosing: -
300mg/20-30 cc D5W or NS IV (NO ETT)
MR 150 IVP in 3-5 min (max 2.2 grams 24 hour)
Maintance: 1 mg/min in x 6 hours
½ mg/min till 2.2 gms/24hours -
Lidocaine
Action -
Ventricular anti-arrhythmic
V-fib, pulseless V-fib(specific for ventricular ectopy) -
Lidocaine
Dosing: Look for Wide QRS -
Dosage 1.0-1.5 mg/kg IV bolus
May be given down ETT
Max: 3 mg/kg
Hang maintenance IV drip 2-4 mg/min if Lidocaine is successful in correcting dysrhythmia -
Lidocaine
Precautions: -
Decrease by 50% in patients with:
1)hepatic disease (excreted by liver)
2)> 70 years old (reduce volume distribution) -
Procainimide
Action -
Anti-arrhythmic
2nd line drug for ventricular
Dysrhythmias- except in lethal rhythms (VT &VF) -
Procainimide
Dosing: -
Not given as a bolus only continuous infusion
Dosage: 20-30 mg/min until
1 ectopy is suppressed
2)until BP drops (hypotension occurs)
3)QRS widens by 50%
4)17 mg/kg has been given -
Atrophine
Actions: -
1)systematic bradycardia
2)aystole
3)Slow PEA -
Atrophine
Dosing Look for skinny QRS -
Dosage: 0.5 mg-1.0 mg IV q 5 min
(<0.5 mg can cause bradycardia)
0.5-Bradycardia
1.0-Aystole
May be given ETT
Max 0.04 mg/kg (usually 2/3 kg) -
Atrophine
Precautions: -
1)use with caution on MI or Ischemia
2)Can cause ventricular tachydysrhythmias (PVCs, V-Tach, V-Vib) -
Adenosine
Action: -
1st line drug for SVT
Stable-(After vagal maneuvers)
Recommend for wide complex tach of unknown origin after Lidocaine -
Adenosine
Dosing -
Dosage: 6 mg IV push rapid
warn patient may be feel like they are having a heart attack -
Adenosine
Precautions -
Precautions: Flushing, dyspnea, chest pain
Side effect usually resolve within 1-2 min -
Verapamil
Action -
Calcium Channel Blockers
Make Sure it is a skinny QRS -
Verapamil
Dosing - 2.5-5mg IV over 1-2 min
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Magnesium Sulfate
Indications: -
1) Torsades de pointe
2)May reduce incidence of post-infarction dysrhythmias -
Magnesium Sulfate
Dosing -
Dosage: VT-1 or 2 gm in 10 ml D5W over 1-2 min
VF-give IV push -
Diltiazem (cardizem)
Dose - 15-20 mg IV Over 2 minutes
-
Diltiazem
Action - Slow HR, A-fib, A flutter
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Sodium Bicarbonate
Action -
Action: Corrects metabolic acidosis
(Code at least 10 minutes) -
Sodium Bicarbonate
Dosing -
Dosage: 1 meq/kg IV
MR with 0.5 meq/kg q 10 min -
Sodium Bicarbonate
As interventional -
Can be Class I of Class III interventional
In Class I (recommended) in
1)tricyclic antidepressant overdose
2)hyperkalemia
3)pre-existing metabolic acidosis -
Morphine Sulfate
Action -
1) Reduces vascular resistance
2)decrease myocardial oxygen requirements -
Morphine Sulfate
Indications - 1)Ischemia, chest pain 2) Pulmonary Edema 3)Relief of anxiety
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Morphine Sulfate
Dosage: - 1-3 mg IV over 15 min, titrated until pain is relieved
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Morphine Sulfate
Precautions: -
Severe respiratory depressant hypotension
(bottom out BP) -
Calcium Chloride
Indications -
1)hyperkalemia
2)hypocalemia
3)CA channel Blocker overdose