ACLS RENEWAL TEST
2022.
Therapeutic Hypothermia cooling goals post ROSC VF Cardiac Arrest ans: 32C-34C or 89.6F -
93.2F for 12-24 hours in order to protect brain and other organs. May be >24 hrs. Pt core temp
taken via esophageal thermometer or bladder catheter in non anuric pts or pulm artery catheter.
Ventilation Optimization goals ans: PETCO2 35-40 PACO2 40-45
If PETCO2 <10 mm Hg attempt to improve CPR quality
Post cardiac arrest MAP goal ans: >65 mmHG
Glycemic Control post ROSC w/ cardiac arrest ans: 144-180 mg/dL no titrating to 80-110 d/t
risk of hypoglycemia
RRT criteria ans: -threatened airway
-RR <6 or >30 bpm
-HR <40 or >140
-SBP <90
-symptomatic HTN
-dec. LOC
-unexplained agitation
-seizure
-low UO
-subjective concern for pt
Ventilation Rates ans: -Bag Mask: 2 ventilations every 30 compressions
-Advanced Airway: 1 ventilation every 6-8 seconds (8-10 breaths per min)
-Resp. Arrest w/ pulse present: 1 ventilation every 5-6 seconds (10-12 breaths/min)
Monitoring to improve CPR quality ans: Quantitative waveform capnography
-PETCO2 <10mmHg (improve CPR QUALITY)
Intra-arterial pressure <20mmHg diastolic pressure (improve CPR quality and implement
vasopressor therapy)
PaCO2 40-45 mmHg
ScvO2 norm 60-80%... <30% improve chest compression and vasopressor therapy
PETCO2 determinant ans: End tidal CO2 is the conc. of carbon dioxide in exhaled air at end of
expiration. PETCO2 determines blood delivery to the lungs during CPR.
partial pressure of end-tidal CO2, a measure of the amount of carbon dioxide present in the
exhaled air
35-40mmHg = ROSC
, Most reliable method of confirming and monitoring correct placement of ET tube ans: waveform
capnography
Nasopharyngeal Airway sizing guide ans: distance from the tip of the nose to the earlobe
Quality CPR ans: compress center of chest (lower half of sternum) 100 compressions/min depth
of 2 inches
Allow complete chest recoil after each compression
avoid excessive ventilation
PEA ans: Pulseless electrical activity
Biphasic Shock energy ans: 120-200 J - if unknown use max available
Monophasic Shock energy ans: 360 J
Cardiac Arrest ACLS Drug Therapy ans: -Epinephrine IV/IO Dose 1mg Q3mins
-Vasopressin IV/IO dose (40U can replace 1st or 2nd dose of epinephrine)
-Amiodarone IV/IO Dose- 1st dose: 300mg bolus
2nd dose 150mg bolus... if amio is not available providers may admin lidocaine
Epinephrine hydrochloride ans: used during resuscitation for its alpha-adrenergic effects, ie,
vasoconstriction. Vasoconstriction increases cerebral and coronary blood flow during CPR by
increasing MAP and aortic diastolic pressure
Vasopressin ans: nonadrenergic peripheral vasoconstrictor that increases arterial blood pressure.
amiodarone ans: first line anti-arrythmic agent given in cardiac arrest
for refractory VF/VT... Used in tx of VF or pulseless VT unresponsive to shock delivery, CPR
and vasopressors
-Amio is a complex drug that affects na, k, and ca channels. also has alpha-adrenergic and beta-
adrenergic blocking properties
Lidocaine ans: used if amio is not available
1-1.5mg/kg IV/IO first dose
0.5-7.5mg/kg at 5-10 min intervals
max dose of 3 mg/kg
if no iv/io available ET dose 2-4mg/kg
Mag Sulfate ans: is an adjunctive agent used to prevent recurrent or treat persistent VT assoc. w/
torsades de pointes
indicated for pts with known/suspected low serum mag. -alcoholism or other conditions assoc.
w/ malnutrition/hypomag states
loading dose 1-2g IV/IO diluted in 10mL
typically over 5-20mins
2022.
Therapeutic Hypothermia cooling goals post ROSC VF Cardiac Arrest ans: 32C-34C or 89.6F -
93.2F for 12-24 hours in order to protect brain and other organs. May be >24 hrs. Pt core temp
taken via esophageal thermometer or bladder catheter in non anuric pts or pulm artery catheter.
Ventilation Optimization goals ans: PETCO2 35-40 PACO2 40-45
If PETCO2 <10 mm Hg attempt to improve CPR quality
Post cardiac arrest MAP goal ans: >65 mmHG
Glycemic Control post ROSC w/ cardiac arrest ans: 144-180 mg/dL no titrating to 80-110 d/t
risk of hypoglycemia
RRT criteria ans: -threatened airway
-RR <6 or >30 bpm
-HR <40 or >140
-SBP <90
-symptomatic HTN
-dec. LOC
-unexplained agitation
-seizure
-low UO
-subjective concern for pt
Ventilation Rates ans: -Bag Mask: 2 ventilations every 30 compressions
-Advanced Airway: 1 ventilation every 6-8 seconds (8-10 breaths per min)
-Resp. Arrest w/ pulse present: 1 ventilation every 5-6 seconds (10-12 breaths/min)
Monitoring to improve CPR quality ans: Quantitative waveform capnography
-PETCO2 <10mmHg (improve CPR QUALITY)
Intra-arterial pressure <20mmHg diastolic pressure (improve CPR quality and implement
vasopressor therapy)
PaCO2 40-45 mmHg
ScvO2 norm 60-80%... <30% improve chest compression and vasopressor therapy
PETCO2 determinant ans: End tidal CO2 is the conc. of carbon dioxide in exhaled air at end of
expiration. PETCO2 determines blood delivery to the lungs during CPR.
partial pressure of end-tidal CO2, a measure of the amount of carbon dioxide present in the
exhaled air
35-40mmHg = ROSC
, Most reliable method of confirming and monitoring correct placement of ET tube ans: waveform
capnography
Nasopharyngeal Airway sizing guide ans: distance from the tip of the nose to the earlobe
Quality CPR ans: compress center of chest (lower half of sternum) 100 compressions/min depth
of 2 inches
Allow complete chest recoil after each compression
avoid excessive ventilation
PEA ans: Pulseless electrical activity
Biphasic Shock energy ans: 120-200 J - if unknown use max available
Monophasic Shock energy ans: 360 J
Cardiac Arrest ACLS Drug Therapy ans: -Epinephrine IV/IO Dose 1mg Q3mins
-Vasopressin IV/IO dose (40U can replace 1st or 2nd dose of epinephrine)
-Amiodarone IV/IO Dose- 1st dose: 300mg bolus
2nd dose 150mg bolus... if amio is not available providers may admin lidocaine
Epinephrine hydrochloride ans: used during resuscitation for its alpha-adrenergic effects, ie,
vasoconstriction. Vasoconstriction increases cerebral and coronary blood flow during CPR by
increasing MAP and aortic diastolic pressure
Vasopressin ans: nonadrenergic peripheral vasoconstrictor that increases arterial blood pressure.
amiodarone ans: first line anti-arrythmic agent given in cardiac arrest
for refractory VF/VT... Used in tx of VF or pulseless VT unresponsive to shock delivery, CPR
and vasopressors
-Amio is a complex drug that affects na, k, and ca channels. also has alpha-adrenergic and beta-
adrenergic blocking properties
Lidocaine ans: used if amio is not available
1-1.5mg/kg IV/IO first dose
0.5-7.5mg/kg at 5-10 min intervals
max dose of 3 mg/kg
if no iv/io available ET dose 2-4mg/kg
Mag Sulfate ans: is an adjunctive agent used to prevent recurrent or treat persistent VT assoc. w/
torsades de pointes
indicated for pts with known/suspected low serum mag. -alcoholism or other conditions assoc.
w/ malnutrition/hypomag states
loading dose 1-2g IV/IO diluted in 10mL
typically over 5-20mins
