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ACUTE CARDIAC LIFE SUPPORT between compressions and rescue breaths.
PHARMACOLOGICAL TOOLS
AIRWAY MANAGEMENT
BASIC AIRWAY ADJUNCTS DRUGS MAIN USE DOSE/ROUTE
● OROPHARYNGEAL AIRWAY (OPA): J-shaped device
Adenosine Tachycardia, aside 6 mg IV bolus, repeat
that fits over the tongue to hold the soft hypopharyngeal from irregular wide with 12 mg in 1 to 2
structures and the tongue away from the posterior wall of QRS min.
the pharynx; for unconscious patients without gag reflex.
○ Too large or too small may obstruct the airway. Causes flushing and
● NASOPHARYNGEAL AIRWAY (NPA): Soft rubber or chest heaviness
plastic uncuffed tube that provides a conduit for airflow
Amiodarone VF/pVT VF/VT: 300 mg in 20
between nares and pharynx; used in conscious individuals VT with pulse to 30 mL dilution,
with intact cough and gag reflex; use with caution in Tachycardia repeat 150 mg in 3-5
patients with facial trauma. minutes
○ NPAs sized incorrectly may enter the esophagus.
● SUCTIONING: Suction immediately if there are copious Anticipate HTON,
secretions, blood, or vomit; should not exceed 10 bradycardia, and GI
toxicity.
seconds.
Do not use in 2nd or
○ When suctioning OPA, do not insert the catheter too 3rd-degree AV block
deeply.
○ When suctioning an ET, use sterile technique Atropine Symptomatic 0.5 mg IV/IO q3-5min
because you are suctioning near the bronchi or lung. bradycardia Max dose: 3mg
○ Monitor VS during suctioning and stop immediately if Toxins/overdose
Do not use in
a person experiences hypoxemia.
glaucoma or
tachyarrhythmias
ADVANCED AIRWAY ADJUNCTS Minimum dose is
● ENDOTRACHEAL TUBE: inserted through the mouth or 0.5mg
nose; most secure airway available; uses laryngoscope
● LARYNGEAL MASK AIRWAY: alternative to ET tube Dopamine Symptomatic 2-20 mcg/kf/min
bradycardia
● LARYNGEAL TUBE: more compact, less complicated to
(2nd-line Fluid resuscitation
insert management) first
● ESOPHAGEAL-TRACHEAL TUBE: combitube; two
separate balloons that must be inflated and two separate Shock/CHF
ports.
Epinephrine Cardiac arrest Cardiac arrest: 1.0
Anaphylaxis mg (1:10000) IV or 2
ROUTES OF ACCESS
Symptomatic to 2.5 mg (1:1000)
● INTRAVENOUS ROUTE: preferred unless central line is bradycardia/shock
already available; does not require CPR interruption Bradycardia: 2-10
○ Push bolus, flush with 20 mL of fluid or saline, raise mcg/min infusion
extremity for 10 to 20 seconds to enhance delivery
Give via central line
when possible
● Once the rhythm is analyzed, the device will direct you to
Lidocaine VF/VT VF/VT: 1 to 1.5 mg/kg
Wide complex IV, half of first dose in shock the individual if a shock is indicated.
tachycardia with 5 to 10 min ● The shock is intended to reset the heart’s abnormal
pulse Tachycardia: 0.5 to electrical activity into a normal rhythm.
1.5 mg/jg IV ● KEY POINTS:
○ Assure oxygen is not flowing across the patient’s
Rapid bolus can chest when delivering shock
cause HTON and
bradycardia ○ Do NOT stop chest compressions for more than 10
Use with caution in seconds when assessing the rhythm.
RF ○ Stay clear of patients when delivering shock.
○ Assess pulse after the first two minutes of CPR.
Magnesium Cardiac Cardiac arrest: 1 to 2 ○ If the end-tidal CO2 is less than 10 mmHg during
Sulfate arrest/pulseless gm diluted in 10 mL
CPR, consider adding a vasopressor and improve
torsades
If not cardiac arrest: 1 chest compressions. However, after 20 minutes of
Torsades de to 2 gm IV over 5 to CPR for an intubated individual, you may consider
Pointes with pulse 60 min stopping resuscitation attempts.
● BASIC AED OPERATION:
Calcium chloride can ○ Attach the pads to bare chest (not over medication
reverse patches) and make sure cables are connected. (Dry
hypermagnesemia
the chest if necessary.)
Procainamide Wide QRS 20 to 50 mg/min IV ○ Place one pad on upper right side and the other on
tachycardia until rhythm improves the chest a few inches below the left arm.
Max: 17 mg/kg ○ Clear the area to allow AED to read rhythm, which
Preferred for VT may take up to 15 seconds.
with pulse (stable) Caution with acute MI ○ If the AED states “no shock advised”, restart CPR.
Do not give with
○ Press the “Shock” button.
amiodarone
○ Immediately resume CPR starting with chest
Sotalol Tachyarrhythmia 100 mg (1.5mg/kg) IV compressions.
Monomorphic VT over 5 minutes ● If the AED is not working properly, continue CPR. Do not
3rd line waste excessive time troubleshooting the AED. CPR
antiarrhythmic Do not used in always comes first, and AEDs are supplemental.
prolonged QT
● Do not use the AED in water.
● AED is not contraindicated in individuals with implanted
PRINCIPLES OF EARLY DEFIBRILLATION defibrillator/pacemaker; however, do not place pad directly
● The earlier the defibrillation occurs, the higher the survival over the device.
rate.
● The purpose of defibrillation is to disrupt a chaotic rhythm ACLS CASES
and allow the heart’s normal pacemakers to resume RESPIRATORY ARREST
effective electrical activity. ● Individuals with ineffective breathing patterns are
● Monophasic: 360 J single shock; biphasic: depending on considered to be in respiratory arrest.
manufacturer (for VT/VT → 120J-200J) ● If with a pulse, start rescue breathing. Without a pulse,
● Continue CPR while the defibrillator is charging. start CPR.
● Clear the individual by ensuring that oxygen is removed,
and no one is touching the individual prior to delivering the VENTRICULAR FIBRILLATION AND PULSELESS
shock. VENTRICULAR TACHYCARDIA