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ACLS Lists > 10 Scenario's > Flashcards

10 Scenario's Flashcards

1
Q

Respiratory Arrest

Not breathing, has pulse

A
  1. Responsiveness
  2. Acvitvate EMS / Get AED
  3. Check Circulaiton and Breathing
  4. Give 10 breaths/min
  5. Consider Naloxone if OD suspected

Naloxone: 0.4mg IM or 2/4mg intranasal

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2
Q

Bradycardia
* Stable BP

3

A
  1. Consider atropine
  2. Monitor and observe
  3. SAMPLE
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3
Q

Bradycardia
* Unstable BP

4

A
  1. Atropine
  2. If atropine ineffective consider Epi or Dopamine infusion / Transcutaneous Pacing
  3. SAMPLE
  4. Consider expert consult or transvenous pacing

Atropine: 1mg every 3-5 min (Max 3mg)
Epi: 2-10 mcg/min
Dopamine: 5-20mcg/kg/min
Pacing: 40-80mA

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4
Q

SVT
* Stable BP

5

A
  1. Vagal Maneuvers
  2. Adenosine
  3. BB or CCB
  4. SAMPLE
  5. Consider expert consult

Adenosin: 6mg then 12mg

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5
Q

SVT
* Unstable BP

2

A
  1. Prompt synchronized cardioversion
  2. Consider adenosine, BB, CCB

Adenosin: 6mg then 12mg(x2)
Sotalol: 100mg or 1.5mg/kg

Cardioversion:
Adult = 50-100 J
Pedi:
1st shock = 0.5-1 J/kg
2nd shock = 2 J/kg

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6
Q

Afib / A flutter
* Stable BP

3

A
  1. Consider expert consult
  2. SAMPLE
  3. Can give adenosin to diagnose between SVT

Adenosin: 6mg then 12mg(x2)

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7
Q

Afib / A flutter
* Unstable BP

3

A
  1. Prompt synchronozed cardio version
  2. SAMPLE
  3. Can give adenosin to diagnose between SVT

Cardioversion:
Adult = 120-200 J
Pedi:
1st shock = 0.5-1 J/kg
2nd shock = 2 J/kg

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8
Q

Monomorphic Vtach with Pulse
* Stable BP

4

A
  1. Antiarrhythmics
    * Amiodarone
    * Lidocaine
    * Sotalol (only if there is a pulse!)
    * Procainamide
  2. Expert consult before cardioversion
  3. Consider cardioversion
  4. SAMPLE

Amiodarone: 150mg/10 min
Lido: 1.5mg/kg
Sotalol: 100mg
Procainamide: 20-50mg/min

Cardioversion:
Adult = 100 J
Pedi:
1st shock = 0.5-1 J/kg
2nd shock = 2 J/kg

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9
Q

Monomorphic Vtach with a Pulse
* Unstable BP

A
  1. Synchronized cardioversion
  2. SAMPLE

Cardioversion:
Adult = 100 J
Pedi:
1st shock = 0.5-1 J/kg
2nd shock = 2 J/kg

Consider sedation and antiarrythmics:

Amiodarone: 150mg/10 min
Lido: 1/5mg/kg
Sotalol: 100mg
Procainamide: 20-50mg/min

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10
Q

Vfib / Monomorphic Vtach
* Pulseless

CPR / Shock Routine (8 steps)

A
  1. Start CPR
  2. Defib ASAP
  3. Resume CPR
  4. Analyze rhythm / check pulse
  5. Defib
  6. Resume CPR
  7. Analyze rhythm / check pulse
  8. Repeat cycle: Defib-CPR-Analyze

Adult = 120-200 J

Pedi:
1st shock = 2J/kg
2nd shock = 4 J/kg
Subsequent = up to 10J/kg

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11
Q

Vfib / Monomorphic Vtach
* Pulseless

During CPR

A
  1. Epi (after 2nd shock)
  2. Consider H’s & T’s
  3. Consider intubation, capnography, and steroids
  4. Give amiodarone or Lido if Epi and defib are ineffective (after 3rd shock)
  5. Consider hypothermia if patient achieves ROSC

Epi: 1mg every 3-5 mins
Amiodarone: 300mg
Lido: 1-1.5mg/kg

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12
Q

H’s

7

A
  1. Hypovolemia
  2. Hypoxia
  3. Hypothermia
  4. Hypoglycemia
  5. Hypokalemia
  6. Hyperkalemia
  7. H+ (acidosis)
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13
Q

T’s

5

A
  1. Cardiab Tamponade
  2. Thrombosis (coronary or pulmonary)
  3. Tension pneumothorax
  4. Toxins
  5. Trauma
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14
Q

Asystole / PEA

2

CPR steps / DO NOT SHOCK

A
  1. CPR
  2. Epi ASAP

1mg every 3-5 min

DO NOT SHOCK

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15
Q

Asystole / PEA

3

During CPR / DO NOT SHOCK

A
  1. Consider H’s and T’s
  2. Consider intubation, capnography, and steroids
  3. Consider hypothermia if patient achieves ROSC

DO NOT SHOCK

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16
Q

Polymorphic Vtach
“Torsades de Pointes”

Same as pulseless Monomorphic Vtach / Vfib

CPR / Shock Routine (8 steps)

A
  1. Start CPR
  2. Defib ASAP
  3. Resume CPR
  4. Analyze rhythm / check pulse
  5. Defib
  6. Resume CPR
  7. Analyze rhythm / check pulse
  8. Repeat cycle: Defib-CPR-Analyze

Adult = 120-200 J

Pedi:
1st shock = 2J/kg
2nd shock = 4 J/kg
Subsequent = up to 10J/kg

17
Q

Polymorphic Vtach
“Torsades de Pointes”

During CPR

A
  1. Epi (after 2nd shock)
  2. Give magnesium and/or Lido
  3. Consider H’s & T’s
  4. Consider intubation, capnography, and steroids
  5. Consider hypothermia if patient achieves ROSC

Mono / Vfib is amiodarone, this is magnesium!

Epi: 1mg every 3-5 mins
Magnesium: 1-2g
Lido: 1-1.5mg/kg

18
Q

ROSC Protocol
* Airway / Breathing

A
  • SpO2: 92-98%
  • Consider intubation
  • Target PaCO2: 35-45 mmHg
19
Q

ROSC Protocol
* Circulation

A
  • 12 lead ECG ASAP
  • Coronary reperfusion if STEMI or AMI susptected
  • MAP ≥ 65mmHg
  • Systolic ≥ 90mmHg
  • Consider prophylatic antiarrythmics
  • Consider H’s and T’s

Norepi: 0.1-0.5mcg/kg/min
Epi: 2-10mcg/kg/min
Dopamine: 5-20mcg/kg/min

20
Q

ROSC Protocol
* Disability / Exposure

A
  • If comatose consider TTM, brain CT, start EEG monitoring
  • If awake start critical care management
  • Draw labs (Blood sugar, ABG’s, BMP). Treat hypoglycemia if applicable
  • Neurological care and prognostication
21
Q

Acute Coronary Syndrome

EMS

A
  1. 12 lead EKG, IV, O2
  2. OAN-M
  3. STEMI, notify hospital in route
  4. Consider fibrinolytic. Use checklist
22
Q

Acute Coronary Syndrome

In Hospital

A
  1. 12 lead EKG, IV, O2
  2. Activate STEMI team (if STEMI present)
  3. Immediate OAN-M
  4. Fibrinolytic checklist and past medical history
  5. Obtain labs and chest x-ray (in 30 mins)
  6. Decide on PCI or fibrinolytics
23
Q

Acute stroke

EMS

A
  1. 12 lead EKG, IV, O2
  2. FAST / CPSS / NIHSS
  3. Time of symptom onset
  4. Notify hospital and transfer to stroke center (skip ED, go to brain scan)
  5. Check glucose and treat if needed
24
Q

Acute Stroke

In Hospital

A
  1. Skip ED, go to brain scan
  2. 12 lead EKG, IV, O2 (assess withing 10 mins)
    * CPSS / NIHSS
    * Quick history
  3. Neurlogical assesment and CT scan (within 20 mins)
  4. Labs (within 30 mins)
  5. Interpret CT (within 45 mins)
25
Q

If Hemorrhagic stroke

A
  • get consult
  • admit to stroke unit or ICU

patient should be admitted to a monitored bed within 3 hours

26
Q

If Ischemic Stroke

A
  • Administer fibrinolytics (alteplase) (within 60 mins of arrival or 3-4.5 hours of symptom onset)
  • Administer aspirin if alteplase contraindicated
  • Consider endovascular therapy
    1. Door to device: 90 mins
    2. Ideally within 6 hours (up to 24 hours if penumbral imaging has been done)
    3. Interfacility transfer: 60 mins

patient should be admitted to a monitored bed within 3 hours

ACLS Lists (3 decks)

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