Questions and Answers
What is your next intervention for a patient with narrow complex SVT (160) after placing O2 at 2L by NC?
Attempt vagal maneuvers
What is your next step if vagal maneuvers show no change on the monitor?
Give adenosine 6mg rapid IV push. If no conversion, give 12mg rapid IV push
After administering 12mg Adenosine and the patient develops severe chest pain and changes in rhythm, what should be your next step?
Perform immediate synchronized cardioversion
What should you do if synchronized cardioversion fails and the patient has pulseless ventricular tachycardia?
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What is your next intervention after performing defibrillation with 120 J?
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What should be done while completing the cycle of CPR after 5 cycles with unchanged rhythm?
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What will be your defibrillator setting for the third defibrillation attempt after two unsuccessful shocks?
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What medication should be given after the third shock during CPR?
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What is the correct dosing for amiodarone in the Cardiac Arrest Algorithm?
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What is the proper dosing of lidocaine used as an alternative to amiodarone during cardiac arrest?
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What is the maximum cumulative dose for amiodarone in a 24 hour period during post-resuscitation?
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What would be the most important intervention in the post-cardiac arrest phase for an unresponsive patient?
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Study Notes
Patient Presentation and Initial Assessment
- A 40-year-old man presents to the ER with palpitations after outdoor work.
- Assessment highlights:
- Skin: Hydrated, pale, warm, and dry
- Cardiovascular: Strong peripheral pulses, BP 125/80
- CNS: Fully intact
- Respiratory: RR of 22, lungs clear to auscultation
Initial Intervention
- Administer 2L O2 via nasal cannula and start an IV.
- Monitor shows narrow complex SVT at 160 BPM.
- Next step: Attempt vagal maneuvers to reduce heart rate.
Medication Administration
- After failed vagal maneuvers, administer adenosine:
- First dose: 6 mg rapid IV push.
- If no conversion, follow with 12 mg rapid IV push.
Patient Response to Adenosine
- After administering 12 mg adenosine, the patient develops severe chest pain and presents with weak pulses and LOC changes.
- Immediate response: Perform synchronized cardioversion, typically starting at 100 J for unstable VT.
Defibrillation Protocol
- If synchronized cardioversion fails and patient is in pulseless VT:
- Administer one unsynchronized shock between 120-200 J.
- Rapid defibrillation is critical for converting pulseless VT.
CPR and Epinephrine Use
- After defibrillation with 120 J, the next intervention is 5 cycles of CPR.
- Upon rhythm check revealing no change, deliver a second shock at 200 J and continue CPR.
- Administer epinephrine 1 mg IV push every 3-5 minutes during CPR.
Further Defibrillation and Drug Administration
- After the second defibrillation attempt, set the next defibrillator shock to 300 J, increasing incrementally from previous doses.
- After the third shock, during CPR, administer amiodarone.
Amiodarone and Lidocaine Dosing
- Correct amiodarone dosing in cardiac arrest:
- 300 mg IV once, followed by consideration of an additional 150 mg IV.
- Lidocaine alternative dosing options:
- Initial: 1 to 1.5 mg/kg IV
- Subsequent doses: 0.5 to 0.75 mg/kg IV.
Post-Resuscitation Care
- After successful restoration of a normal sinus rhythm and pulse (ROSC), monitor for arrhythmias.
- Maximum cumulative dose for amiodarone in 24 hours: 2.2 grams to prevent toxicity, notably pulmonary toxicity.
- For unresponsive patients post-ROSC, initiate targeted temperature management (TTM) to improve neurologic outcomes. TTM also known as therapeutic hypothermia.
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Description
Test your knowledge and skills in Advanced Cardiovascular Life Support (ACLS) with these flashcards. This quiz focuses on real-life scenarios encountered in the ER and essential interventions for critical care patients. Perfect for healthcare professionals and students preparing for ACLS certification.
