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    Advanced Cardiac Life Support

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    Irving H Torres Lopez
    The document outlines the key drugs and procedures used in Advanced Cardiac Life Support (ACLS) for conditions such as ventricular fibrillation, ventricular tachycardia, asystole, and pulseless electrical activity. It details the administration routes, doses, and side effects of drugs that control heart rate and rhythm, improve cardiac output and blood pressure, and treat underlying conditions like acidosis. The goal of ACLS is to defibrillate, cardiovert, and administer medications to stabilize the patient's cardiovascular system and restore spontaneous circulation.

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    © All Rights Reserved
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    Advanced Cardiac Life Support

    Uploaded by

    Irving H Torres Lopez
    23 views40 pages
    The document outlines the key drugs and procedures used in Advanced Cardiac Life Support (ACLS) for conditions such as ventricular fibrillation, ventricular tachycardia, asystole, and pulseless electrical activity. It details the administration routes, doses, and side effects of drugs that control heart rate and rhythm, improve cardiac output and blood pressure, and treat underlying conditions like acidosis. The goal of ACLS is to defibrillate, cardiovert, and administer medications to stabilize the patient's cardiovascular system and restore spontaneous circulation.

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    ACLS

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    Acls

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    The document outlines the key drugs and procedures used in Advanced Cardiac Life Support (ACLS) for conditions such as ventricular fibrillation, ventricular tachycardia, asystole, and pulseless electrical activity. It details the administration routes, doses, and side effects of drugs that control heart rate and rhythm, improve cardiac output and blood pressure, and treat underlying conditions like acidosis. The goal of ACLS is to defibrillate, cardiovert, and administer medications to stabilize the patient's cardiovascular system and restore spontaneous circulation.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    23 views40 pages

    Advanced Cardiac Life Support

    Uploaded by

    Irving H Torres Lopez
    The document outlines the key drugs and procedures used in Advanced Cardiac Life Support (ACLS) for conditions such as ventricular fibrillation, ventricular tachycardia, asystole, and pulseless electrical activity. It details the administration routes, doses, and side effects of drugs that control heart rate and rhythm, improve cardiac output and blood pressure, and treat underlying conditions like acidosis. The goal of ACLS is to defibrillate, cardiovert, and administer medications to stabilize the patient's cardiovascular system and restore spontaneous circulation.

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    ACLS

    Advanced Cardiac Life Support

    RC 275
    Defibrillation

    External depolarization of the heart to


    stop Vfib or Vtach (that has not
    responded to other maneuvers)
    Automated External Defibrillator
    Defibrillation Procedure
     Position paddles
     “Clear” the patient
     Shock and then
    resume CPR for 5
    cycles then re-analyze
    after each shock
     Prepare drug therapy
    ACLS Drug Therapy
    Routes of Administration
     Peripheral IV – easiest to insert during CPR
     Central IV – fast onset of action
     Intratracheally (down an ET tube)
     Intraosseous – alternative IV route in peds
    Oxygen
     FIO2 100%
     Assist Ventilation
     O2 Toxicity should not be a concern during
    ACLS
    IV Fluids
     Volume Expanders – crystalloids , eg
    Ringer’s lactate, N/S, or colloids, eg
    Albumin or Hetastarch
     TKO – D5W, N/S
    Morphine Sulfate
     Drug of choice for pain
     Also decreases pre-load
     IV dose – 2-4 mg as often as every 5
    minutes
     Precautions
     May cause respiratory depression
    The Following Drugs Help to
    Control Heart Rate & Rhythm
    Lidocaine
     Indications:
     PVCs, Vtach, Vfib

     Can be toxic so no longer given


    prophylactically
     IV dose :
     1-1.5 mg/kg bolus then continuous infusion of
    2-4 mg/min
     Can be given down ET tube

     Signs of toxicity:
     slurred speech, seizures, altered consciousness
    Amiodarone (Cordarone)
     Indications:
     Like Lidocaine – Vtach, Vfib

     IV Dose:
     300 mg in 20-30 ml of N/S or D5W

     Supplemental dose of 150 mg in 20-30 ml of


    N/S or D5W
     Followed with continuous infusion of 1
    mg/min for 6 hours than .5mg/min to a
    maximum daily dose of 2 grams
     Contraindications:
     Cardiogenic shock, profound Sinus
    Bradycardia, and 2nd and 3rd degree blocks that
    do not have a pacemaker
    Procainamide (Pronestyl)
     Indications:
     Like lidocaine (is usually a second choice)
     Uncontrolled Afib or Atrial flutter if no signs of
    heart failure
     Dose :
     continuous IV infusion. Initially 20mg/min
    then titrated down to 1-4 mg/min
     Side effects
     Hypotension
     Widening of the QRS
    Atropine
     Indications:
     Symptomatic sinus bradycardia

     Second Degree Heart Block Mobitz I

     May be tried in asystole

     Organophosphate poisoning

     IV Dose:
     .5 – 1 mg every 3-5 minutes

     Max dose is .04mg/kg

     Can be given down ET tube

     Side Effects:
     May worsen ischemia
    Isoproterenol (Isuprel)
     Indications:
     Temporary stimulant prior to pacemaker

     Bradycardia refractory to atropine

     Torsades de Pointes refractory to


    magnesium sulfate
     IV dose:
     Continuous infusion of 2-10
    micrograms/ml of infusion fluid
    Adenosine
     Indication:
     PSVT

     IV Dose:
     6 mg bolus followed by 12 mg in 1-2 minutes if
    needed
     Side Effects:
     Flushing

     Dyspnea

     Chest Pain

     Sinus Brady

     PVCs
    Verapamil
     Indications:
     Is a calcium channel blocker that may terminate
    PSVT (is a backup to Adenosine) as well as
    atrial flutter and uncontrolled atrial fib
     IV Dose:
     2.5-5 mg over 2 minutes up to 20 mg

     Side Effects:
     Hypotension

    N &V
    Magnesium
     Used for refractory Vfib or Vtach caused by
    hypomagnesemia and Torsades de Pointes
     Dose:
     1-2 grams over 2 minutes

     Side Effects
     Hypotension

     Asystole!
    Propranolol
     Beta blocker that may be useful for Vfib
    and Vtach that has not responded to other
    therapies
     Very useful for patients whose cardiac
    emergency was precipitated by
    hypertension
     Also used for Afib, Aflutter, & PSVT
    The Following Drugs Improve
    Cardiac Output &Blood Pressure
    Epinephrine
     Because of alpha, beta-1, and beta-2 stimulation, it
    increases heart rate,stroke volume and blood
    pressure
     Helps convert fine vfib to coarse Vfib

     May help in asystole

     Also PEA and symptomatic bradycardia

     IV Dose:
     1 mg every 3-5 minutes

     Can be given down the ET tube

     Can also be given intracardiac

     May increase ischemia because of increased O2


    demand by the heart
    Vasopressin (ADH)
     Similar effects to Epinephrine without as
    much cardiovascular side effects!
     IV dose = 40 IU
     Can be given down ET tube
     May be better for asystole
    Norepinephrine (Levarterenol)
     Similar in effect to epinephrine
     Used for severe hypotension that is NOT due to
    hypovolemia
     Cardiogenic shock
     Administered as a continuous infusion
     Adult rate is usually 2-12 micrograms/min

     Range is .5-1 microgram up to 30!

     Side effects:
     Like epinephrine, it may worsen ischemia

     Extravasation causes tissue necrosis


    Dopamine
     Used for hypotension (not due to hypovolemia)
     Usually tried before norepinephrine

     Has alpha, beta, and dopaminergic properties

     Dopaminergic dilates renal and mesenteric


    arteries
     Second choice for bradycardia (after Atropine)
     IV Dose:
     1-20 micrograms/kg

     Side effects:
     Ectopic beats
    Dobutamine
     Actions similar to Dopamine
     Used for CHF with hypotension
     IV Dose:
     2-20 micrograms/minute

     Side effects:
     Tachycardia

    N &V

     Headache

     Tremors
    Digitalis (Digoxin)
     Slows conduction through A-V node and increases
    force of contraction
     Used in CHF and chronic atrial fib/flutter
     Can be given orally or IV
     Side effects:
     Arrhythmias

     N & V, diarrhea

     Agitation
    Nitroglycerin
     Vasodilator that helps relieve pain from angina
    pectoris
     Can be given IV, sublingually, as an ointment or a
    slow release patch
     Side effects:
     Headache

     Hypotension

     Syncope

     V/Q mismatch
    Sodium Nitroprusside (Nipride)
     Vasodilator used for hypertensive crisis
     IV dose:
     Loading dose of 50 –100 mg followed by
    infusion of .5-8 micrograms/kg/min
     Is light sensitive so IV bag must be wrapped in
    tin foil
     Side effects:
     Hypotension so patient must have continuous
    hemodynamic monitoring
    Sodium Bicarbonate
     Used for METABOLIC acidosis hyperkalemia
     H + HCO3 >H2CO3>H2O and CO2

     Airway and ventilation have to be functional!

     IV Dose:
     1 mEq/kg

     If ABGs, [BE] x wt in kg/6

     Side effects:
     Metabolic alkalosis

     Increased CO2 production


    Thrombolytics
     Used to improve coronary blood flow by
    lysing clots, ie coronary thrombosis
     Best if given within six hours of onset of
    chest pain
     Examples: TPA/Alteplase(Activase),
    Streptokinase
     Side effects:
     Bleeding
    ACLS Scenario

    You Run the Code!


    A 62 year old female is admitted
    to the ER with chest pain,
    dyspnea, and moist, gurgling
    crackles. She appears in acute
    distress and is cyanotic. Vital
    signs are: P =110, R = 20, BP =
    80/40.
    Cardiac monitoring is initiated
    and the following EKG is
    observed:

     What is the patients arrhythmia and probable


    medical problem?
     What therapies should be done? Explain each one.
    The EKG began to show:

     What is occurring in the heart to cause this


    arrhythmia?
     How is this treated?
     What other arrhythmias may occur now?
    The patient suddenly becomes
    lifeless and the EKG shows:

     Uh oh! What now?


    The treatment(s) are unsuccessful
    and the following EKG appears:

     What should be done now and why?


    Finally, the following EKG is
    obtained. However, BP is 40/0

     What needs to be done now?


    You saved her! The course is complete!
    Bretylium Tosylate (Bretylol)
     Indications:
     Same as lidocaine and procainamide (usually
    when condition doesn’t respond to these two)
     IV dose:
     5-10mg/kg bolus followed by continuous
    infusion of 1-2 kg/min
     Side Effects:
    N &V

     Hypotension
    Amrinone
     Similar to dobutamine
     Used for refractory CHF
     IV Dose:
     2-15 micrograms/kg/min

     Side effects:
     May worsen ischemia

    N &V

     Thrombocytopenia

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