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XmasShopperRN 3,287 Views

Joined: Nov 28, '12; Posts: 80 (41% Liked) ; Likes: 72

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  • Jul 14 '17

    Quote from Orion81
    Wow, thank you so much. That cleared it up for me completely. The way I was interpreting the algorithm for VF/VT was alternating epi and amiodarone after each shock because of the way the arrows go full circle starting over the whole cycle again (assuming shockable rhythm). But thank you for clearing that up for me because I just wasn't getting it.
    No worries, glad to help. The algorithms can be really confusing until you actually see ACLS in practice. The reason the algorithms go in a circle is because your next intervention depends on what's going on now. And it's not uncommon for a code to require several rounds of meds/defib before return of spontaneous circulation or code team is willing to call the code. I really enjoy ACLS and PALS (if you couldn't tell . Feel free to ask if you have anymore questions!

  • Jul 14 '17

    Quote from Orion81
    Hello, I was hoping someone could clarify something for me. I'm taking ACLS in a few weeks and am studying the algorithms. For cardiac arrest it says to give epinenephrine q 3-5 min. Let's say you give it, the rhythm is shock able and you continue CPR for 2 minutes. It then says give amiodarone. Here's my question: Since it is then almost time to readminister the epinephrine, do you give the 2 drugs back to back? Give amiodarone and then almost immediately epinephrine. Obviously I'm a newbie, as this is a very basic question. 1 more question. My experience thus far has only been in LTC. I haven't yet had to start an IV. I've only done it twice, almost a year and a half ago in the ED during clinical with the guidance of a nurse. Do you learn IV access in the class? I'll YouTube it, and go over the steps, but that's all I can do for now. Any advice is greatly appreciated. Thanks
    I would just add that the intervention of choice during for ACLS for shockable rhythms (vfib, pulselss vtach) is defibrillation. When a code's beginning, BLS (compressions and ventilation) applies. Once a rhythm is identified, ACLS interventions begin. If the initial rhythm is vfib or pulseless vtach, defibrillation takes precedence over med. So you're clearing, shocking, immediately resuming compressions; all the while whomever you've designated for meds should be drawing up med. Once IV access is established (or already is) epi or vasopressin IVP during compressions because compressions help circulate med. CPR continues for 2 min at which time a pulse/rhythm check occurs (stop compressions). If asystole or PEA, resume CPR, and epi can be administered IVP if it's been 3 min since last dose. If rhythm is shockable (vfib or pulseless vtach), defibrillate. The team leader (usually physician) can choose vasopressin in place of 1st or 2nd epi. Amiodarone can be substituted for refractory vfib/pulseless vtach after at least first round of defib/pressor. You wouldn't administer amiodarone and a vasopressor together.
    So basically during your mock code, you're going to be the team leader; you're assigning a specific responsibility to each member. 1: meds/IV 2: document 3: defib 4: airway 5: compressions. All you're doing is telling each person what you'd like for them to do based on the present situation. It's unnerving at first, but just review your algorithms and take your time. You'll be golden Good luck!