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ACLS (Notes) (Printable)

This document provides guidelines for treating tachycardia and bradycardia in ACLS. For unstable tachycardia, it recommends synchronized cardioversion. For stable narrow complex tachycardia it recommends vagal maneuvers, adenosine, diltiazem or metoprolol. For stable wide complex tachycardia it recommends amiodarone or procainamide. For unstable bradycardia it recommends atropine, transcutaneous pacing, dopamine or epinephrine. For stable bradycardia it recommends monitoring and preparing for pacing or inotropes if needed.

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259 views2 pages

ACLS (Notes) (Printable)

This document provides guidelines for treating tachycardia and bradycardia in ACLS. For unstable tachycardia, it recommends synchronized cardioversion. For stable narrow complex tachycardia it recommends vagal maneuvers, adenosine, diltiazem or metoprolol. For stable wide complex tachycardia it recommends amiodarone or procainamide. For unstable bradycardia it recommends atropine, transcutaneous pacing, dopamine or epinephrine. For stable bradycardia it recommends monitoring and preparing for pacing or inotropes if needed.

Uploaded by

mike_germain1172
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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ACLS

TACHYCARDIA: HR>150 UNSTABLE: Hypotension, AMS, shock, ischemic chest pain, acute HF
Synchronized cardioversion a. O2 saturation monitor b. IV Access c. Intubation kit, Suction d. Midazolam (Versed) 2mg IVP e. Fentanyl 100-300ug IVP, titrate to effect NARROW COMPLEX Irregular: 120-200J biphasic, or 200J monophasic Regular: 50-100J WIDE COMPLEX Regular: 100J Irregular: Defibrillate (NOT synchronized)

STABLE

1. Oxygen 2. IV access 3. Pulse Ox 4. BP 5. 12-Lead EKG, Cardiac monitor NARROW COMPLEX Irregular Rhythm: Atrial fibrilliation, Atrial flutter, Multifocal Atrial Tach -Diltiazem 15-20mg IV over 2min, 20-25mg over 2min 15min later if needed. Infusion: 5-15mg/hr in NS or D5W titrated to effect. -Metoprolol Tartrate 5mg slow IV q 5min, up to x3. Begin oral regimen to follow IV dose with 50mg PO; titrate to effect. Regular Rhythm: 1. Vagal Maneuvers: bearing down, coughing, blowing in syringe 2. Adenosine 6mg rapid IVP then 20cc NS bolus, 12mg IVP q2min x2 if needed. If responds likely AVNRT or AVRT. 3. -Diltiazem 15-20mg IV over 2min, 20-25mg over 2min 15min later if needed. Infusion: 5-15mg/hr in NS or D5W titrated to effect. -Metoprolol Tartrate 5mg slow IV q 5min, up to x3. Begin oral regimen to follow IV dose with 50mg PO; titrate to effect. WIDE COMPLEX Irregular Rhythm DO NOT GIVE ADENOSINE 1. -Amiodarone 150mg IV over 10min. Repeat as needed. Infusion at 1mg/min for first 6hrs. -Procainamide 50 mg/min until suppression or max dose of 17mg/kg at (avoid if decreased EF) 2. If torsades, Mg 2g IV over 5min, consider overdrive pacing 3. Prepare for defibrillation, have next to bedside. Regular Rhythm 1. -Amiodarone 150mg IV over 10min. Repeat as needed. Infusion at 1mg/min for first 6hrs. -Procainamide 50 mg/min until suppression or max dose of 17mg/kg at (avoid if decreased EF) 2. Prepare for synch cardioversion, have next to bedside.

ACLS.

BRADYCARDIA: HR<50
1. Oxygen 2. IV access 3. Pulse Ox 4. BP 5. 12-Lead EKG, Cardiac monitor

UNSTABLE: Hypotension, shock, AMS, chest pain

1. Prepare for transcutaneous pacing, use without delay for Second degree Type II or Third degree AV Block. 2. Atropine 0.5mg IV q3-5min, max 6 doses (3mg) 3.-Transcutaneous pacing set at 80/min, increase current until capture is achieved (wide QRS and broad T wave after each pacing spike). -Dopamine 2-10ug/kg/min -Epinephrine 2-10ug/min 4. Call cardiology, ask about transvenous pacing.

STABLE

1. Oxygen, Assist breathing as necessary 2. IV Fluids if indicated 3. Monitor and observe 4. Prepare for transcutaneous pacing, Dopamine 2-10ug/kg/min, OR Epinephrine 2-10ug/min, if worried.

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