Term
| ACLS 2006 Indications for Oxygen. |
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Definition
-Any suspected cardiopulmonary emergency
-Complaints of shortness of breath and suspected ischemic chest pain
-ACS: administer to all patients for first 6 hours. Continue if pulmonary congestion, ongoing ischemia, or oxygen saturation is <90%
-For patients with suspected stroke and hypoxemia or unknown oxyhemogloblin saturation. May consider administration to patients who are not hypoxemic. |
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Term
| ACLS 2006 Indications for Epinephrine. |
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Definition
-Cardiac arrest: VF, pulseless VT, asystole, pulseless electrical activity.
-Symptomatic bradycardia: Can be considered after atropine as an alternative infusion to dopamine.
-Severe hypotension: Can be used when pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesterase enzyme inhibitor.
-Anaphylaxis, severe allergic reactions: Combine with large fluid volumes, corticosteroids, antihistamines. |
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Term
| ACLS 2006 Indications for Atropine. |
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Definition
-First drug for symptomatic sinus bradycardia
-May be beneficial in presence of AV nodal block or ventricular asystole. (Will NOT be effective for infranodal {Mobitz type II} block)
-Second drug (after epinephrine or vasopressin) for asystole or bradycardic pulseless electrical activity.
-Organophosphate (eg, nerve agent) poisoning: extremely large doses may be needed. |
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Term
| ACLS 2006 Indications for Lidocaine. |
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Definition
-Alternative to amiodarone in cardiac arrest from VF/VT.
-Stable monomorphic VI with preserved ventricular function
-Stable polymorphic VT with normal baseline QT interval and preserved LV function when ischemia is treated and electrolyte balance is corrected.
-Can be used for stable polymorphic VT with baseline QT interval prolongation if torsades suspected. |
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Term
| ACLS 2006 Indications for Procainamide. |
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Definition
-Useful for treatment of a wide variety of arrhythmias, including stable monomorphic VT with normal QT interval and preserved LV function.
-May use for treatment of PSVT uncontrolled by adenosine and vagal maneuvers if blood pressure stable.
-Stable wide-complex tachycardia of unknown origin.
-Atrial Fibrillation with rapid rate in WPW syndrome |
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Term
| ACLS 2006 Indications for Vasopressin. |
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Definition
-May be used as an alternative pressor to epinephrine in the treatment of adult shock-refractory VF.
-May be useful alternative to epinephrine in asystole, PEA.
-May be useful for hemodynamic support in vasodilatory shock (e.g, septic shock) |
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Term
| ACLS 2006 Indications for Adenosine. |
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Definition
-First drug for most forms of stable narrow-complex PSVT. Effective in terminating those due to reentry involving AV node or sinus node.
-May consider for unstable for narrow-complex reentry tachycardia while preparations made for cardioversion.
-Wide-complex regular tachycardia, thought to be or previously defined to be, reentry SVT.
-Does not convert atrial fibrillation, atrial flutter, or VT.
-Undefined, stable narrow-complex SVT as a diagnostic maneuver. |
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Term
| ACLS 2006 Indications for Magnesium. |
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Definition
-Recommended for use in cardiac arrest only if torsades de pointes or suspected hypomagnesemia is present
-Life-threatening ventricular arrhythmias due to digitalis toxicity
-Routine administration in hospitalized patients with AMI is NOT recommended. |
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Term
| ACLS 2006 Indications for Sodium Bicarbonate. |
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Definition
-Known preexisting hyperkalemia
-Known preexisting bicarbonate responsive acidosis, tricyclic antidepressant or aspirin overdose, cocaine, or diphenhydramine.
-Prolonged resuscitation with effective ventilation upon return of spontaneous circulation after long arrest interval.
-Not useful or effective in hypercarbic acidosis (eg cardiac arrest and CPR without intubation) |
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Term
| ACLS 2006 Indications for Morphine. |
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Definition
-Chest pain with ACS unresponsive to nitrates
-Acute cardiogenic pulmonary edema (if blood pressure is adequate) |
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Term
| ACLS 2006 Indications for Norepinephrine. |
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Definition
-Severe cardiogenic shock and hemodynamically significant hypotension (systolic blood pressure <70 mmHg) with low total peripheral resistance.
-Agent of last resort for management of ischemic heart disease and shock |
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Term
| ACLS 2006 Indications for Dopamine. |
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Definition
-2nd line drug for symptomatic bradycardia (after atropine).
-Use for hypotension (systolic blood pressure < 70 to 100 mmHg) with signs and symptoms of shock. |
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Term
| ACLS 2006 Indications for Dobutamine. |
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Definition
| Consider for pump problems (congestive heart failure, pulmonary congestion) with systolic blood pressure of 70 to 100 mmHg and no signs of shock. |
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Term
| ACLS 2006 Indications for Isoproterenol. |
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Definition
-Use cautiously as temporizing measure if external pacer is not available for treatment of symptomatic bradycardia
-Refractory torsades de pointes unresponsive to magnesium sulfate
-Temporary control of bradycardia in heart transplant patients (denervated heart unresponsive to atropine)
-Poisoning from B-Blockers |
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Term
| ACLS 2006 Indications for Nitroglycerin. |
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Definition
-Initial antianginal for suspected ischemic pain.
-For intial 24 to 48 hours in patients with AMI and CHF, large anterior wall infarction, persistent or recurrent ischemia, or hypertension.
-Continued use (beyond 48 hours)for patients with recurrent angina or persistent pulmonary congestion. -Hypertensive urgency with ACS. |
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Term
| ACLS 2006 Indications for Furosemide. |
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Definition
-For adjuvant therapy of acute pulmonary edema in patients with systolic blood pressure >90 to 100 mmHg (without signs and symptoms of shock)
-Hypertensive emergencies
-Increased intracranial pressure. |
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Term
| ACLS 2006 Indications for Tissue Plaminogen Activator. |
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Definition
-For AMI in adults
o ST Elevation (>1 mm in >2 contiguous leads) or new or presumably new LBBB.
o In context of signs and symptoms of AMI
o Time from onset of symptoms < 12 hrs
-For Acute Ischemic Stroke
o Sudden onset of focal neurologic deficits or alterations in consciousness (eg facial droop, arm drift, abnormal speech).
o Absence of intracerebral or subarachnoid hemorrhage or mass effect on CT scan.
o Absence of variable or rapidly improving neurologic deficits.
o Alteplase can be started in < 3 from symptom onset. |
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Term
| ACLS 2006 Indications for Nitroprusside. |
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Definition
-Hypertensive crisis
-To reduce afterload in heart failure and acute pulmonary edema.
-To reduce afterload in acute mitral or aortic valve regurgitation |
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