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VF/pulseless VT Asystole/PEA Bradycardia Tachycardia ACLS Shock/pulmonary edema Acute coronary syndrome

Case 1 療理錄 50 亮立來?

Triad : (ABC,s)

VF 150J

VT/VF Epinephrine 1mg/1cc, every 3-5 min Vasopressin 20U/1amp Amiodarone (Cordarone 150mg/amp) MgSO4 Lidocaine (Xylocaine 100mg/5cc)

Epinephrine (Bosmin) 刺狀流 VF 率 : 1mg IVP Q 3-5 min

Vasopressin 療 EV bleeding 狀流 40 U IV st Half-life: 10-20 min

Amiodarone : 1. Pulseless VT/VF 2. Polymorphic VT 3. Wide-QRS tachycardia 4. Stable VT 5. SVT/PSVT, atrial tachycardia 6. Rhythm control of AF 7. Rate control of AF ( 療 )

Amiodarone 量 : 療 VT VF, 300mg IV push 150mg 律復 900mg in D5w 500cc iv drip 34cc/hr (1mg/min) for 6 hr, then 17cc/hr(0.5mg/min) for 18hr 量 : 2.2gm/24hr 2gm/24hr QT 不 Torsades de points

MgSO4 magnesium sulfate) 硫 --Torsades de points (Tdp) -- VF/VT --Rhythm control for PAF < 48 hrs duration -- 量 - dp 1-2 gm in 10ml NS (or D5W) IVP slowly - Tdp PAF: PAF 1-2 gm in 50ml D5W IV drip 5-60min ( 不 AV block 神 DTR 降 calcium

Lidocaine 1%, 2%, 10% Na 離 epinephrine VT/VF 1 to1.5mg/kg IV bolus, 5-10 量量不 3mg/kg g IV bolus 若律復 maintenance infusion 1-4mg/min. (2gm in D5W 500cc, IVD 15-60cc/hr) 60 kg, 2% xylocaine c c? Ans: 4.5 cc ( 20mg/cc)

Asystole

PEA

Asystole/PEA Epinephrine IV Q 3-5min Atropine 1mg IVP 3-5min, Max. 0.04mg 04mg /kg 神

Case 2 64 來 12? VT PSVT AF/Af

Triad : 路 O2, IV, Monitor

EKG VT, 臨 VT VT? 不!

VT? Widen-QRS tachycardia???? Triad : id 若 BP 120/80 mmhg, stable? Or Unstable?

Tachycardia 2A-B-2C-D-L 2C denosine 6mg/vial miodarone 150mg/amp Inderal 1mg/amp p( ( -blocker) Verapamil 5mg/2cc/amp( -channel blocker) Diltizem 50mg/amp ( ) igoxin 0.25mg/amp idocaine

Adenosine (adenocor) 6mg/amp 療 PSVT SA AV node Half-life lif 9 sec 6 mg IVP 1-2 sec, 1-2 min 12mg IVP g, g 1-2 sec 1-2 min push 12mg

Amiodarone in stable tachycardia VT rhythm control for PAF W-P-W with Af PSVT loading 150 mg IV push 10min, 10 900mg in D5W 500cc, 1mg/min X 6hrs 0.5mg/min X 18hrs 降, AF, PSVT, VT, VF 律不 QT 不 Torsades de points

Varapamil (Isoptin 5mg/2cc/amp) PSVT, AF AV node 2-5mg IV push slowly l over 2 min Onset of action: 2-5 min Duration: 2 hours 降

50mg/1 amp Diltiazem (Hebessor) For PSVT: 0.25mg/kg IVbolus over 2 min 15 量 Onset of action: 0.5-1 hr Duration: 1 to 3 hr 降 verapamil p

Digoxin 0.25mg/amp SA AV nodes 神 ATPase 離流力 Indications: 狀 --Rate control for Af/AF --PSVT -- 不良易若異 SA block or complete AV block 量 : loading 0.013mg/kg 0.25mg 013 025 IVD30min q 48h 4-8 h.

Lidocaine 1%, 2%, 10% VT, Widen-QRS tachycardia 1 to1.5mg/kg IV bolus, 5-10 量量不 3mg/kg 1-1.5mg/kg IVP, Max. 3mg/kg 量 1-4mg/min. (2gm in D5W 500cc, IVD 15-60cc/hr) 列量 1-2mg/min) --After 24hr infusion --CHF AMI with shock, Age>70 不良 SSS AB block W-P-W syndrome 律暈不亂 Onset of action: 45-90 sec Duration: 10-20 min

Case 3 60 來力? (SSS) AV block)

Triad : 路 O2, IV, Monitor

Complete AV block Triad : BP 80/50 mmhg, Unstable?

Bradycardia Atropine TCP Transcutanous Cardiac Pacing) Dopamine Epinephrine

Atropine 1mg/amp 神療狀 narrow-qrs PEA/asystoley epinephrine 0.5mg-1mg q3-5min 0.5mg bradycardia VT/VF AMI 不 Mobitz II 2nd AVB, 3rd AVB with widen QRS

Dopamine 200mg/amp 尿量量量 : 1-2 ug/kg/min, 刺 dopamine 量 : 2-10ug/kg/min 刺量 : >10ug/kg/min 刺不 NaHCO3 漏 Standard dose, double dose, half dose 800mg in D5W 500ccdouble dose), 60KG, 12cc/hr 量?

度 800mg/500cc= 1.6mg/cc= 1600ug/cc 量 12cc/hr = 12 microdrops/min = 12/60 cc /min : 1600ug/cc X 1/5 cc/min= 1600/5 ug/min :60kg 量 = 1600/5X60 = 5.33 ug/kg/min

400 mg in D5W 500cc, 80KG, 量 5mg/kg/min? 800/ 80 X a = 5, a= 2 ½ cc/min = 30cc/hr = 30 /min

Epinephrine 療不 1mg IV push 2mg in D5W or NS 500cc = 4 ug/cc 2-10 ug/min (30cc-150cc/hr)

Pulmonary edema Lasix 20mg/amp, 0.5-1mg/kg IV push Morphine 10mg/amp, 1-2 mg IV push q5 min NTG (0.6mg/tab; 25mg/vial) 5-20 ug/min Isoket 10mg/1amp, 2amp in D5W 80 cc 20mg/100cc, 200ug/cc; 3cc/hr = 10ug/min

Lasix 力尿 0.5-1mg/kg IV push slowly over 2min -- 類利尿 -- anuria --Hypotension -- 不 Onset of action: venodilation < 5min, diuresis:5min, peak effect < 30min Duration: venodilation < 2hr, diuresis: 2hr

Morphine 10mg/amp 降神量 2-4 mg IV slowly 5-15 量 -- CO2 retention) -- 識不 --IICP --Asthma undiagnosed abdominal pain -- 例 ABG: PH 7.30, PO2 52mmHg, PCO2 48mmHg CO2 retention) endo orphine Apnea Onset of action: immediate (peak 20min) Duration: 2-4 hrs Naloxone 0.4-2mg IV

Nitroglycerin 滑狀狀流 Indications: -- 行 -- -- : 量 5ug/min 3-5 5ug/min, 若 10-20ug/min 量 (30-40ug/min) 量 (>150ug/min) : --viagra use with 48hrs --RV infarct --Hypotension (SBP < 90mmHg) --IICP and inadequate cerebral circulation --Tachycardia and marked bradycardia (< 50bpm) --Uncorrected hypovolumia Onset of action: immediate (<1.5 min) Duration: 1-10 min after DC IV NTG

Shock Dopamine Dobutamine (250mg/20cc/amp) SBP >100mg, CHF, 療量 5-20ug/kg/min 500 mg in D5W 460cc Norepinephine (Levophed 4mg/4mg/amp) SBP < 70 mmhg or dopamine > 15ug/kg/min / 療量 0.5-30ug/min. 4 mg in NS 96cc; 40ug/cc if 1cc/hr = 40ug/60min= 0.7ug/min

Heparin (5000u/cc), 60U/kg loading 4cc in D5w 500cc, 40u/cc, 15-20cc/hr, APTT 50-75 sec Glycoprotein IIb/IIIa (Aggrastat), 50cc/vial t-pa: 50mg/vial, 15mg iv bolus, 50mg IVD 30min, 35mg IVD 60min

Atropine 0.02mg/kg IV Lidocaine 1.5mg/kg IV over 60 sec Midazolam 0.05-0.3mg/kg 05 0 IV slowly Valium 5-10mg iv push slowly Propofol 2-2.5mg/kg IV