ACLS review

231.  What are the therapeutic effects of epinephrine and vasopressin during a pulseless arrest?

Epinephrine is use during resuscitation primarily for its alpha-adrenergic effects which lead to peripheral vascular vasoconstriction.  This increases both cerebral and coronary blood flow during CPR.  Vasopressin is a noradrenergic agent which also causes peripheral vasoconstriction.  Overall, the effects of vasopressin have not been shown to be different from that epinephrine.

232.   After a third shock, epinephrine 1mg IV is administered to a patient in pulseless VF/VT.  What would be the next appropriate intervention for this patient?

Continue CPR to circulate the epinephrine and complete the 5 cycles of CPR and perform a rhythm analysis and pulse check.  If the rhythm analysis reveals refractory VF/VT, then prepare for a fourth shock and prepare either a second dose of epinephrine 1mg IV or an initial dose of vasopressin 40 U.

233.  What three antiarrhythmic agents can be used in the treatment of pulseless VF/VT?

Amiodarone 300mg IV/IO once, then consider and additional dose of 150mg IV/IO

Lidocaine 1-1.5mg/kg IV/IO, then 0.5-.75mg/kg IV/IO at 5-10 minute intervals to a maximum dose of 3mg/kg

Magnesium for torsades de pointes, loading dose 1-2 g IV/IO diluted in 10ml of D5W given IV/IO push, typically over 5-20 minutes.

234.  As CPR continues, Amiodarone 300mg IV is administered to a patient in refractory VF/VT.  What would be the next appropriate intervention for this patient?

Continue CPR to circulate the Amiodarone and complete the 5 cycles of CPR and perform a rhythm analysis and pulse check.  If the rhythm analysis reveals refractory VF/VT, then prepare for a fourth shock and prepare a second dose of Amiodarone at 150mg IV/IO.

235.  During cardiac arrest, what drug has been shown to improve survival to hospital discharge or improved neurologic function after a cardiac arrest?

No single drug has been shown to improve survival to hospital discharge or improved neurologic function after a cardiac arrest.  Therefore, priority is given to high quality CPR and early defibrillation.  

Reviewed 2/28/16