ACLS Cram
ACLS Class
Cram Notes
-Minimize interruptions in compressions to 10 seconds or less.
-5 cycles of 30:2 compressions before switching (2 minutes)
[switch should take 5 seconds or less]
-atleast 2 inches compression (5cm)
[2 to 2.4 inches: 5 to 6 cm]
-rate 100 to 120/min
-TV 500 to 600 ml (1/2 bag squeeze) (6 to 7 ml/kg)
[protective vent strategy is 6 ml/kg]
-1 breath every (5 to 6 seconds) p.46—recheck pulse about every 2 minutes: take 5 seconds but no more than 10 seconds
-p.57 with advanced airway:
one breath every 6 seconds during cardiac arrest and
once every 5 to 6 seconds during respiratory arrest
-1 breath every 3 to 5 seconds for infant or child [12 to 20 breaths per minute]
[infants and children with 2 rescuers 15:2--30:2 otherwise]
-infant is 1 year or less
[start chest compressions on infant with HR < 60]
-child is no signs of puberty
-in lecture want CCF chest compression fraction > 60% and ideally > 80%: time during code actually spent doing CPR
Suction p.55
-Portable force of -80 to -120 mmHG
-wall mounted: airflow > 40 L/min: when clamped > -300 mmHg
Oxygen to keep sat 94% or greater in CVA, ROSC, p.81,
For > 90% for acute coronary syndrome p.63
6 person team roles
-leader
-compressor
-Airway
-AED/Defib/Monitor
-Meds [IV access]
-recorder
CPR 2,10,15,20,100,120
-change compressor every 2 minutes
-want PETCO2 10 mm Hg or greater or don’t pause more than 10 seconds
[need CPP = coronary perfusion pressure >15 mm Hg p. 37]
-Diastolic BP > 20 mmHG by a line
-compresssion rate 100 to 120
ROSC 65,90,94
2016 ALCS p.19
-ideal bp unknown: MAP 65 mmHg or greater is reasonable goal.
-sys BP 90 or greater
-titrate FiO2 to keep sat 94% or greater
[100% FiO2 during cardiac arrest]
--in general PETCO2 30 to 40: PaCO2 35 to 45 mm Hg.
-in lecture <35 was hyperventilation and > 45 was hypoventilation
Unconscious patients usually required “advanced airway”
Ventilate to PETCO2 35 to 40 or PaCO2 40 to 45 mmgHg
(2016 ACLS p.146)
-lab value for PaCO2 may be reported lower than actual for cold patients: accept lower number in cold patients
Consider emergent c section if no ROSC in 4 minutes
Electricity synchronized cardioversion in unstable tachycardia with pulse
50-100, 100, 120-200, 200
50-100 Narrow regular (SVT)
100 Wide regular (VT)
120-200 Narrow irregular (Afib)
200 wide irregular defib—not cardiovert
rtPA for CVA
bp < 185/110
-tx sys 180 to 230 or dias 105 to 120 after rtPA
Labetalol 10 mg iv then 2 to 8 mg/min or
Nicardipine 5 mg/hr IV titirate up 2.5 mg/hr q 5 to 15 min up to 15 mg/hr max. same drip rate as diltiazem for narrow tachy
3rd line of dias > 140 or BP no controlled: nipride
Management of BP if not giving rTPA
.”if bp not maintained below 185/110 do not give rTPA”
Card states to
Consider tx Sys BP > 220 or Dias > 120
“reasonable target is lower BP by 15% within first 24hours”
For STEMI fibrinolytic check list
180-200/100-110—handbook page 27
Naloxone (2016 ACLS p.108) q 4 minutes
0.4 mg IM/IV: 2 mg intranasal
Can give IV, IM, IN, subQ, nebulized, ETT
ACS = acute coronary syndrome
-120 minutes if transferring hospitals for first medical contact to PCI
-door to balloon inflation: 90 minutes
-door to needle: 30 minutes
Symptomatic bradycardia HR < 50
Procainamide
-20 to 50 mg/ min up to 17 mg/kg or effective or QRS increases 50%
-drip at 1 to 4 mg/min: same drip rate as lidocaine
-still in 2016 ACLS for stable wide QRS tachy
(could also give amiodarone 150 mg over 10 minutes repeat as needed and drip at 1 mg/min: Also sotalol 100 mg (1.5 mg/kg) over 5 minutes is listed but avoid sotalol with long QT
Verapamil
2.5 to 5 mg iv over 2 minutes
May repeat 5 mg q 15 to 30 minutes to max 20 mg
Diltiazem
15 to 20 mg (0.25 mg/kg) IV over 2 minutes
May repeat 20 to 25 mg (0.35 mg/kg) in 15 minutes over 2 minutes
5 to 15 mg/hour titrated to heart rate
-consider expert consult
Metoprolol = Lopressor
B1 selective
5 mg IV q 5 min x 3
(2.5 to 5 mg IV q 2 to 5 minutes upto 15 mg—titrate to BP and HR)
I usually give 1 mg and repeat q 1minute
Atenolol = Tenormin
B1 selective
5 mg slow IV over 5 min if tolerated in AMI-repeat dose in 10 minutes (ACLS handbook 2010 p.42)
CVA
Key times: 10,25,45,1,3, 4.5, 6
From Hospital arrival
10 min: general assessment
25 min: Neuro assessment
25 min: CT head
45 min: CT interpretation
60 min: Fibrinolytic administered
3 (or 4.5 hours): fibrinolytic admin from time of onset of symptoms
Up to 6 hours: possible endovascular treatment
