microsoft word - aclsletter2012-ph main jan-june

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ACLS Cardiac Arrest Algorithm

Neumar, R. W. et al. Circulation 2010;122:S729-S767


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ACLS Cardiac Arrest Circular Algorithm



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Bradycardia Algorithm



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Tachycardia Algorithm


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Post-cardiac arrest care algorithm

Peberdy, M. A. et al. Circulation 2010;122:S768-S786


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O'Connor, R. E. et al. Circulation 2010;122:S787-S817

Acute Coronary Syndromes Algorithm


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Goals for management of patients with suspected stroke

auch, E. C. et al. Circulation 2010;122:S818-S828J


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ACLS Code DrugsDrug Indications Dosage Administration

Adenosine/

Adenocard

Narrow PSVT/SVTWide QRS Tachy of

uncertain cardiac origin

6 mg followed by 12mg in 1-2min.

Rapid IV push close to thehub followed by a saline

bolus.

Amiodarone Vfib/pulseless VT,VT with a pulse. May be

used for rate control of

WPW or atrial tachycardias.

300mg IVP for cardiac arrest.

Consider repeating with 150mg

in 3-5 min.

150mg over 10 min for stableVT, may repeat 150mg every 10

min as needed. Cumulative dose

of 2.2 IV in 24 hrs.

Slow infusion 360mg IV over 6hrs, maintenance 540mg over 18

hrs. (0.5mg/min)

Draw up with filtered

needle. Administer drip with

filtered tubing.

Gtt infusion mixed

900mg/500 D5W.

1mg/min = 33.3cc/hr

.5mg/min = 16.6cc/hr

Half life is up to 40 days.

Atropine Symptomatic sinusbradycardia.

.5 mg IV every 3-5 min for

bradycardia, not to exceed 3 mg

Tracheal 2-3mg diluted in 10ccNS.

Do not give less than 0.5mg

IV.

May be given IV, IO, or ET

Does not work with heart

transplant patients due todenervation.

Calcium Chloride Known or suspectedhyperkalemia (renal fx).Hypocalcemia after multiple

blood tx. Antidote forcalcium channel blockers or

beta blocker overdose

8-16mg/kg IV for hyperkalemia

and calcium channel blockeroverdose.

Do not mix with sodium

bicarbonate.

Dopamine Used for hypotension withsigns and symptoms of

shock or bradycardia

Mixed 400mg/250D5W

2-10mcg/kg/min.

IV line must be a good one.Will cause extravasation

with infiltration

Do not mix with sodium

bicarbonate.

Epinephrine Cardiac arrest, VF, pulselessVT, asystole, PEA

Symptomatic bradycardia,

severe hypotension,anaphylaxis

Cardiac arrest: 1mg of the1:10,000 administered q 3-5 min

follow each dose with IV flush.

Bradycardia or hypotension usea gtt.

1mg/250cc: 1mcg/min = 15cc/hr.

May be given IV, IO or ET


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Drug Indications Dosage AdministrationMagnesium Sulfate Torsades de pointes or

suspected hypomagnesemia.

Life threatening arrhythmiasdue to dig toxicity.

1-2 gm diluted in 10 cc D5W

IVP if in cardiac arrest.

If not in cardiac arrest mix 1-2

gm in; 50 to 100 cc D5W to

infuse over 5 to 60 min.

May cause fall in BP with

rapid administration.

Use with caution if renal

failure is present.

Morphine Sulfate Used for treatment ofischemic chest pain, acutecardiogenic pulmonary

edema, anxiety

Decreases the myocardial

preload and causes

peripheral venous pooling.

Dosage should be in 1 to 2 mg

increments up to 10 mg max

Given slow IV over 1-2 min

Precautions: respiratory

depression and hypotension

Narcan/Naloxone Used to reverse respiratorydepression that results from

narcotics

Also used for coma of

unknown etiology

Dosage 0.4 mg to 2 mg IV or

IO and may be given ET

IV or IO meds should be

given over 1 min.

Precautions: If given rapidly

IV/IO can cause projectile

vomiting

Patient may become

agitated or violent

Procainamide Anti-arrhythmic for stablewide QRS Tachycardia

20-50 mg/min End Points: Arrhythmia

suppressed, hypotension

ensues, QRS duration

increase >50%, max dose17 mg/kg

Sotalol Hemodynamically StableMonomorphic Ventricular

Tachycardia

3rdLine Anti-Arrhythmic

100 mg over 5 min or1.5 mg/kg over 5 min

Avoid if prolonged QT

Sodium Bicarbonate Preexisting hyperkalemia,metabolic acidosis,

prolonged resuscitation.

1 meq/kg IV bolus.Repeat half dose q 10 min

Not recommended forroutine use in cardiac arrest

patients.

Vasopressin May be used as analternative pressor to epi in

the treatment of CardiacArrest instead of 1stor 2nd

dose of epi

IV, IO 40 U IV push X 1 dose

only.

ET 80U X 1 dose only

Do not give any epi for

10 min after vosopressin is

given.

Compiled by:Rebecca Cass NREMT-P

innovative solutionsin healthcare education, llc

5923 cherrycrest lane

charlotte, nc 28217

704-527-5119 www.innosols.com

microsoft word - aclsletter2012-ph main jan-june

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