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PCIV > 2020 AHA ACLS P1 > Flashcards

2020 AHA ACLS P1 Flashcards

1
Q

DID NOT MAKE FLASH CARDS OVER MATERIAL IN QUICK BOOK PAMPHLETS

A

DID NOT MAKE FLASH CARDS OVER MATERIAL IN QUICK BOOK PAMPHLETS

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2
Q

The book heavily covers that by keeping interruptions from compressions to shock (“pre-shock pause”)down to a max of _____ that the chances of a successful shock are much higher.

A

10 second or less

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3
Q

It is important for every resuscitation team to debrief themselves on their performance after how many resuscitations?

A

After EVERY resuscitation either immediately or later

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4
Q

What is a “System” and what does the System of Care do?

A

A SYSTEM is a group of interdependent components that regularly interact to form a whole.

The system of Care:

  • provides the links for the Chain of Survival
  • Determines the strength of each link
  • Determines the ultimate outcome
  • Provides collective support and organization
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5
Q

What are the components of the System of Care? (x4)

What are the components of the Continuous Quality Improvement (CQI) that keeps the system sharp? (x5)

A

The System of Care consists of:

  • Structure (people, education, equipment)
  • Process (protocols, policy, procedures)
  • System (programs, organizations, culture)
  • Patient Outcome (consider satisfactions, quality, and safety)

CQI consists of:

  • Integrations
  • Collaboration
  • Measurement (actual measurable things during resuscitation like depth, rate, recoil, etc.
  • Benchmarking (collection and documentation of feedback data)
  • Feedback
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6
Q

______ and _____ in Systems of Care must continually asses the performance of each system component.

A

Participants AND Leaders

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7
Q

Apart from the components of CQI, what does CQI provide?

A

An iterative cycle of:

  • Systematically evaluating resuscitation care and outcome
  • Creating benchmarks with stakeholder feedback
  • Strategically addressing identified deficiencies
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8
Q

What is the Chain of Survival and what are the components for the In Hospital Care (IHCA) and Out of Hospital Care (OHCA) chains? (x6 for both)

A

The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive coordinated actions necessary to maximize survival.

(Below are on Pg. 9)

OHCA:

  • Activation of Emergency Response
  • High-Quality CPR
  • Defibrillation
  • Advanced Resuscitation ***
  • Post-Cardiac Arrest Care
  • Recovery

IHCA:

  • Early Recognition ***
  • Activation of Emergency Response
  • High-Quality CPR
  • Defibrillation
  • Post-Cardiac Arrest Care
  • Recovery
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9
Q

Patients who achieve ROSC after a cardiac arrest event have complex pathophysiologic process called ______ which include _____(x4)

A

Post Cardiac Arrest Syndrome:

  • Post arrest brain injury
  • Post arrest myocardial dysfunction
  • Systematic ischemia and reperfusion response
  • Persistent acute and chronic pathology that may have precipitated the cardiac arrest
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10
Q

Treatment for post cardiac arrest should address _____ (x5)

A
  • Ventilation and Hemodynamic optimization
  • Targeted Temp Management (TTM)
  • Immediate Coronary reperfusion with percutaneous coronary intervention (PCI) for eligible pts
  • Neurologic care and prognostication
  • Other structured interventions
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11
Q

The Post Cardiac Arrest Care chain is where both chains converge right before Recovery. What is the chain sign depicting and what does it stand for?

A

It is depicted by a bed, monitor, and thermometer.

Which stands for critical care interventions, advanced monitoring, and targeted temperatures.

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12
Q

What are the Utstein-Style guidelines and templates used for?

A

It is a set of guidelines and templates used for reporting resuscitation outcomes after Trauma and Drowning. It provides guidance for core performance and MEASURES

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13
Q

What are two devices that can be used during CPR resuscitation to help the effectiveness of CPR?

A

ETCO2 can be used as an indicator of cardiac output and signal ROSC

CPR performance monitors provide real time feedback on quality of CPR being delivered

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14
Q

Examples of immediately available feedback vs feedback for review?

A

Immediately:

  • chest compression rate
  • depth
  • recoil

Later Review:

  • chest compression fraction (time during call that is spent on actual compressions. figured by (time on compressions) / (total call time))
  • preshock, perishock, and post shock pauses
  • airway pressure
  • tidal volume
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15
Q

Do current CPR monitoring devices always provide optimal feedback?

A

NO

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16
Q

What are two resources available for benchmarking feedback data?

A
  • Cardiac Arrest Registry to Enhance Survival (CARES) for OHCA
  • Get With The Guidelines-Resuscitation Program for IHCA
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17
Q

By _____ and _____ systems can positively influence pt outcome.

A

Measuring and Benchmarking

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18
Q

What is the goal of STEMI care?
What are the 4 links in STEMI Chain of Survival?
What are the 4 main components of the EMS link?

A

The goal of STEMI care is to minimize heart damage and maximize the pts recovery

STEMI Chain of Survival:

  • Recognition and reaction to STEMI warning signs
  • EMS dispatch and rapid EMS transport with prearrival notification to the receiving hospital
  • Assessment and diagnosis in the ED or Cath lab
  • Treatment

To elaborate on the EMS component:

  • Obtain prehospital ECGs
  • Notify receiving facility of possible STEMI
  • Activate cardiac catheterization team
  • Continuously review and improve quality
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19
Q

For a pt with a possible STEMI or STEMI like symptoms, dispatch is authorized to tell the pt to _____ before EMS arrival?

A

Chew 162-325mg of Aspirin; so long as the pt does not have an allergy or any recent GI bleeds

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20
Q

What is the goal of Stroke care?

Stroke Chain of Survival Includes what 4 links?

A

The goal of Stroke care is to minimize brain injury and maximize the pts recovery

Stroke Chain of Survival:

  • Recognition and reaction to Stroke warning signs
  • Rapid use of 911 and EMS dispatch
  • Rapid EMS recognition of Stroke, triage, transport, and prehospital notification to the receiving hospital
  • Rapid diagnosis and treatment in the hospital
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21
Q

What is the Systematic approach used for optimal care to approach, assess, and treat arrest and acutely ill pts?

A

Aim to support and restore effective oxygenation, ventilation, and circulation with return of intact neurologic function. An intermediate goal of resuscitation is ROSC.

Systematic Approach on pg. 15:

  • Scene safety and Initial Impression (is pt conscious or unconscious)
  • If pt is UNCONSCIOUS go to BLS Assessment (check responsiveness, activate ERS/get defibrillator, check breathing and pulse) ; then to Primary and then Secondary assessment
  • Of pt is CONSCIOUS go to Primary Assessment (ABCDE) and then secondary assessment (SAMPLE, Hs&Ts)
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22
Q

LOOK OVER EXPANDED SYSTEMATIC APPROACH ON PG. 16

A

LOOK OVER EXPANDED SYSTEMATIC APPROACH ON PG. 16

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23
Q

5 staples to quality CPR

A
  • Compressions of at least 2 inches (but not more than 2.4inch) at 100-120/min ; 30 to 2 compression to vent rate
  • Allow complete chest recoil
  • Switch compressors about every 2 minutes or 5 rounds; should only take 5 seconds
  • Minimize interruptions in compressions to 10 sec or less
  • Avoid Excess Ventilation
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24
Q

BLS assessment run down

A
  • Check Responsiveness
  • Shout for help, activating the ERS and get an AED
  • Check for breathing and pulse (at least 5 but not more than 10 seconds) (if no pulse start CPR; if pulse start rescue breaths but check pulse every 2 minutes)
  • Defibrillate
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25
Q

ABCDE?

A
  • Airway
  • Breathing
  • Circulation
  • Disability (AVPU and LOC)
  • Exposure (remove cloths to examine, “expose” the pt)
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26
Q

Coronary Perfusion Pressure and ETCO2 in Arrest Pts

A

Coronary Perfusion Pressure (CPP) is aortic relaxation pressure minus right atrial relaxation pressure. CPP should be aimed for a minimum of 20mmHg during CPR for ROSC to be achievable

ETCO2 during CPR shows how much blood is passing the lungs during CPR, this should be aimed at a minimum 10 mmHg during CPR for a chance of ROSC

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27
Q

What are the 5 H’s and 5 T’s?

A

H’s:

  • Hypovolemia
  • Hypoxia
  • Hydrogen Ion (Acidosis)
  • Hypo/Hyperkalemia
  • Hypothermia

T’s:

  • Tension Pneumothorax
  • Tamponade (Cardiac)
  • Toxins
  • Thrombosis (Pulmonary)
  • Thrombosis (Coronary)
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28
Q

What are the 2 most common causes of PEA?

A

Hypovolemia and Hypoxia

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29
Q

What are the 4 cardiac arrest rhythms?

A
  • V-Fib
  • Pulseless V-Tach
  • PEA
  • Asystole
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30
Q

To search for the underlying cause of an arrest what 4 things can you do?

A
  • Consider H’s & T’s
  • Analyze an ECG
  • Recognize hypovolemia
  • Recognize drug OD/poisonings
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31
Q

What will hypovolemia cause on an ECG?

A
  • Narrow complex Sinus Tachy
  • Decreased systolic and increased diastolic
  • In advanced cases (decomp), blood pressure will tank all together but narrow QRS complexes and rapid rate will continue (PEA)
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32
Q

Does giving routine fibrinolytics during CPR help?

A

NO

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33
Q

Examples of criteria used to determine if the pt is deteriorating?

A
  • airway compromise
  • Resp rate less than 6 or greater than 30
  • Heart rate less than 40 or greater than 140
  • Systolic less than 90
  • Symptomatic hypertension
  • Unexpected decrease in LOC
  • Unexplained agitation
  • Seizure
  • Significant urine output decrease
  • Subjective concern about pt
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34
Q

What are the 4 components of the In Hospital Care Rapid Response System?

A
  • Event Detection and response-triggering
  • Planned response arm, such as an RRT or MET
  • Quality monitoring
  • Administrative support

(RRTs and METs are providers who specialize in rapid assessment of a possibly deteriorating pt and can give immediate treatment or drug therapy)

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35
Q

When obtaining an ECG on a pt who shows signs of ACS, the ECG will put the pt into one of what 2 categories?

What will you do for a pt with the first one?

A

Either a STEMI (elevated ST seg) or Non-STEMI (ST-seg depression, Inverted T wave, transient ST-seg elevation, Normal ECG)

For a pt with signs of a STEMI:

  • Identify, assess, and triage acute ischemic chest discomfort
  • Provide initial treatment of possible ACS
  • Emphasize early reperfusion of the pt with ACS/STEMI
36
Q

What are the 4 goals for a pt with ACS?

A
  • Prevention of major adverse cardiovascular events
  • Identification of pts with STEMI
  • Relief of ischemic chest pain
  • Treatment of acute, life threatening complication of ACS (VF/pVT, unstable brady/tachy, Ventricular wall rupture, papillary muscle rupture, or decomp shock)
37
Q

What rhythms might occur with a ACS pt?

A

Sudden cardiac death, V-Tach, and hypotensive Brady may occur with acute ischemia

38
Q

What drugs may be used for ACS pt?

A
  • O2
  • Aspirin
  • Nitro
  • Morphine
  • Fibrinolytics
  • Heparin
39
Q

What are the 4 links in the STEMI and/or Stroke Chain of Survival?

A
  • Recognition and reaction to STEMI/Stroke warning signs
  • EMS dispatch and rapid EMS transport with prearrival notification to receiving hospital
  • Assessment and diagnosis in the ED or cath lab/CT scan
  • Treatment
40
Q

How many pts die before they arrive to the hospital when they have signs of ACS?

What are the 2 most common precipitating rhythms in these cases?

A

1/2 die before hospital

VF or pVT are most common pre-death rhythms

VF usually occurs within 4 hours of symptom onset

41
Q

What are the 5 steps of the pathophysiology of an ACS pt?

A
  • Unstable Plague
  • Plaque Rupture
  • Unstable Angina
  • Microemboli
  • Occlusive Thrombus

This is usually a precipitated by a pt with atherosclerosis

42
Q

What is the goal of ACS management?

KNOW THE ACS ALGORITHM ON PG.32 AND IN QUICK STUDY PAMPHLET

A

Early reperfusion of the STEMI pt, emphasizing initial care and rapid triage for reperfusion therapy

KNOW THE ACS ALGORITHM ON PG.32 AND IN QUICK STUDY PAMPHLET

43
Q

If a pt has positive STEMI on an ECG, do you have to also have biomarkers (troponin) in order to start fibrinolytic therapy or perform diagnostic coronary angiopathy with coronary intervention (angioplasty/stenting)?

A

NO

44
Q

What is the most common symptom felt by a STEMI pt?

Who are the populations that might have different symptoms?

A

Retrosternal chest discomfort (could be pain, tightness, pressure, or all)

Elderly, diabetic, female, or hypertensive pts may present with atypical symptoms

Other possible symptoms include:

  • pain in shoulders, neck, jaw, arms, or b/w shoulder blades
  • light headed/dizzy/fainting/syncope
  • nausea/vomiting
  • unexplained shortness of breath
  • indigestion like symptoms
45
Q

O2 should be delivered to a pt who is _____x3?

A
  • Dyspneic or hypoxic
  • Obvious signs of heart failure
  • O2 sat less than 90
46
Q

How much Aspirin should be given to a ACS pt?
What does it do?
What should you do if the pt has nausea/vomiting, active peptic ulcers, or upper GI disorder?
What are the major contraindications?

A

For a ACS pt give 162-325mg of Non-Enteric coated or chewed aspirin. (chewed aspirin is absorbed much quicker)

It causes an immediate near total inhibition of Thromboxane A2 production by inhibiting platelet cyclooxygenase

If pt has nausea/vomiting, active peptic ulcers, or upper GI disorder give 300mg rectal aspirin suppositories

Contraindications are allergy or active/recent GI bleeds

47
Q

What does Nitro do?

How much can you give?

What are the major contraindications?

What is a key thing to remember about nitro, especially when it works?

A

Nitro is given ONLY for ischemic chest discomfort; it also causes a reduced Left Vent and Right Vent preload through peripheral arterial and venous dilation.

You can give 1 sublingual nitro tablet every 3-5 minutes up to 3 total doses so long as the pt’s BP is greater than 90mmHg or no lower than 30mmHg below baseline if known and the HR is 50-100BPM

Major contraindications include:

  • Inferior wall MI and RV infarction
  • Hypotension, Brady or Tachycardia
  • Recent phosphodiesterase inhibitor use (ED pills) within 24-48 hours

**KEY TO REMEMBER: Nitro when successful DOES NOT diagnose ACS, this is b/c other things that cause chest pain other than ACS may be improved with nitro.

48
Q

When is morphine given in a ACS pt?

Why is morphine useful?

A

Morphine is only given when the pts pain persists POST Nitro admin.
However, no data links morphine admin to more successful survival to ACS, and it can actually SLOW the absorption of orally ingested aspirin and also CANNOT be given in a hypotensive pt

It is useful to manage ACS because it:

  • produces CNS analgesia which reduces neurohumoral activation, catecholamine release, and therefore lowers O2 demand
  • Alleviates dyspnea
  • Produces vasodilation, which reduces LV preload and O2 requirement
  • Decreases systemic vascular resistance, which reduces LV afterload
  • Helps redistribute blood volume in pts with acute pulmonary edema
49
Q

What pharmacology should NOT be used in ACS patients?

A

NSAIDS (other than aspirin)

50
Q

What is the only way to determine a STEMI?

A

ONLY a 12 lead may identify a STEMI

51
Q

What criteria place the pt in either the STEMI or NSTE-ACS categories?

A

STEMI:
- ST seg elevation in 2 or more contiguous leads or new onset of LBBB. Elevation should be 2mm unless under 40yo male - 2.5mm ; female ; 1.5mm ; or can have 1mm in all leads

NSTE-ACS:

  • ST seg depression of 0.5mm or greater
  • T-wave inversion w/ pain
  • 0.5mm elevation for less than 20 minutes (transient)
52
Q

What are the 4 D’s of in-hospital therapy?

A

Door to Data
Data to Decision
Decision to Drug

53
Q

What is the most common form of PCI for ACS pts? (Primary Care Intervention?)

PCI info and Fibrinolytic criteria on pg.41

A

Coronary Angioplasty with stent placement

PCI info and Fibrinolytic criteria on pg.41

54
Q

What drugs are used for Stroke ACLS?

A
  • Approved fibrinolytic agent (alteplase)
  • Glucose (D10/D50)
  • Labetalol
  • Nicardipine
  • Clevidipine
  • Aspirin
55
Q

Ischemic Vs Hemorrhagic Strokes?

A

Ischemic - Account for 87% of strokes, is caused by an occlusion of an artery to a region of the brain

Hemorrhagic - Account of 13% of strokes, caused by a blood vessel in the brain suddenly rupturing into the surrounding tissue

1/3 of stroke patients are under 65
1/2 of stroke pts actually call EMS for transport
Blacks are 2x as likely to get a stroke

56
Q

What is the goal of stroke care?

A

To minimize brain injury and maximize patient recovery

57
Q

What are the 8 D’s of stroke care?

A

They are the major steps in diagnosis and treatment of stroke and key points at which delays occur:

  • Detection
  • Dispatch
  • Delivery
  • Door (to hospital/imaging suite)
  • Data (brain imaging, lab testing, clinical eval)
  • Decision
  • Drug/Device
  • Disposition (transfer to stroke unit or critical care unit)
58
Q

What are some important time frames for stroke care?

A
  • immediate general assessment within 10 min
  • immediate neurologic assessment within 20 min
  • Acquisition of CT/MRI within 20 min
  • Interpretation of CT/MRI within 45 min
  • Admin of Fibrinolytics from time arrived at imaging suite within 60 min
  • Admin of fibrinolytic therapy from symptom onset within 3 hours or 4.5 hours for select pts
  • Admin to monitored bed within 3 hours
59
Q

Possible signs or symptoms of a stroke x7

A
  • Sudden weakness in face, arm, or legs, especially if one sided
  • Trouble speaking or understanding
  • sudden trouble seeing in one or both eyes
  • sudden trouble walking
  • dizziness or loss of balance/coordination
  • sudden severe headache with no known cause
  • sudden confusion
60
Q

What is EMSs most important role in strokes?

A

To minimize the time between symptom onset and pt arrival to imaging suite or CT/MRI. DO NOT DELAY TRANSPORT for care and extensive assessments that can be done on route

61
Q

The Cincinnati Stroke Scale should take less than _____ minute(s) and if even one finding is confirmed that increases the probability of stroke to _____%

A

It should take less than 1 minute, if one test is positive for abnormalities then it raises stroke probability to 72%

62
Q

Strokes have the best probable outcomes when taken to a stroke certified hospital/stroke centers. What are the 4 different stroke center certification levels given based off specific capabilites?

A
  • Acute Stroke Ready Facility: Typically serve rural and under-resources areas. Typically uses telemedicine for emergency alteplase admin when appropriate, after emergent identification of stroke. Typically pts are later transferred to a stroke unit or for a higher level of care
  • Primary Stroke Center: Are the “cornerstone”; they are a wide range of hospitals able to quickly identify a stroke, provide alteplase, and admit pts to a dedicated stroke center. Roughly 1/2 of all stroke pts receive care here.
  • Thrombectomy-Capable Stroke Center: Have the same qualifications as a Primary Stroke Center but with the added qualification to provide EVT for pts with LVO.
  • Comprehensive Stroke Center: Capable of managing all forms and severities of strokes, both ischemic and hemorrhagic, and can provide 24/7 care and neurosurgery, EVT, and neurocritical care. Serves as the hub of a regional stroke system of care providing receiving capabilities for transferred pts and providing feedback and educational programs
63
Q

Who is qualified to give fibrinolytics?

A
  • physicians using a clearly defined protocol
  • a knowledgeable interdisciplinary team familiar with stroke care
  • an institution with commitment to quality stroke care
64
Q

What scale is used to determine the probability of a Large Vessel Occlusion (LVO)? Why is it important to weigh when symptoms started or a Last known normal time is determined and the likely hood of an LVO?

A

NIH Stroke Scale

If LKN was within 24 hours, the pt may be a candidate for Endovascular Therapy (EVT) and may need to go to a facility capable of it

65
Q

What are the rhythms of Bradycardia? (x4)

Which of the 2 second degree blocks occurs at or below the AV node

A
  • Sinus Brady
  • All 3 types of blocks

Type 1 “Wenckebach” occurs AT the AV node typically

Type 2 occurs below the AV node typically

66
Q

What are the drugs for Bradycardia?

A
  • Atropine
  • Dopamine
  • Epinephrine
67
Q

Typically Bradycardia is considered anything below 60 bpm but for symptomatic bradycardia it is considered _____bpm?

What is functional or relative bradycardia?

What is one of the biggest things to consider when dealing with a pt who has symptomatic bradycardia?

A

50bpm

Functional or relative bradycardia is when a heart rate may be in normal ranges for a normal healthy heart but for a heart that is in sepsis or cardiogenic shock, that normal range might be “relatively” too slow

One of the key things to think about in symptomatic bradycardia is if the bradycardia itself is causing the symptoms or could it be something else

68
Q

What are the 3 criteria of unstable bradycardia?

What are serious signs and symptoms of Unstable Bradycardia?

A

Bradycardia is unstable if:

  • the heart rate is slow
  • patient has symptoms
  • symptoms are due to the slow heart rate

S&Ss may include:

  • Hypotension
  • Acutely altered mental status
  • signs of shock
  • ischemic chest discomfort
  • acute heart failure
69
Q

When should Atropine not be relied upon in a bradycardia scenario?

When could it actually do more harm?

A

When there is a 2nd degree type 2 heart block or 3rd degree heart block with a new wide QRS complex because it may be an indication that the block is in intranodal tissue. B/c of this atropine is not likely to be effective so you should quickly move on to TCP/dopamine or epinephrine

Atropine effectively speeds up heart rate and conduction so if there is an active heart attack it is going to increase the O2 demand on the heart which could increase ischemic damage

70
Q

How does Atropine Sulfate work?

A

It acts by reversing cholinergic-mediated decreases in the heart rate and AV nodal conduction

71
Q

At what rate should you set the pacer in TCP for Brady either as a second line of defense to refractory Atropine or b/c there is no venous access?

A

Set the pace to the slowest possible pace/rate based on clinical assessment and symptom resolution. This is because heart rate is a major determinant of myocardial oxygen consumption

72
Q

Should a pt be sedated before TCP?

A

If conscious then yes! So long as the pt is not rapidly deteriorating and is conscious, give the pt a narcotic for analgesia and a benzo for anxiety and muscle contractions. DO NOT wait to give a pt TCP before sedation if they are rapidly deteriorating and need it immediately

73
Q

What is the goal of TCP?
Transcutaneous Pacing (TCP) indications and contraindications.(2x)
Steps to achieve TCP. (4x)

A

The goal of TCP is to improve signs and symptoms rather than target a precise heart rate.

TCP INDICATIONS:

  • Hemodynamically unstable bradycardia
  • Bradycardia with stable ventricular escape rhythms

TCP CONTRAINDICATIONS:

  • Severe hypothermia
  • Conscious pt requiring analgesia for discomfort unless delay for sedation will cause or contribute to deterioration
  • Do not assess the carotid pulse to confirm mechanical capture; electrical stimulation causes muscular jerking that may mimic a carotid pulse

STEPS of TCP:

  • Place electrodes on according to package
  • turn on pacer
  • Set demand rate to 60-80/min
  • Set current milliamperes output 2mA above the dose at which consistent capture is observed
74
Q

Can TCP help pts with ventricular escape rhythms caused by bradycardia?

A

Yes! A pt may develop ventricular escape rhythms caused by bradycardia shown by developing wide QRS complexes.

Because of this you should place TCP electrodes on any pt with acute myocardial ischemia or infarction associated with:

  • SA node dysfunction with symptomatic brady
  • Asymptomatic 2nd degree type 2 and 3rd degree
  • New L or R BBB or bifascicular blocks in the setting of AMI
75
Q

At what heart rate is a rhythm tachycardic?

What are the rhythms of tachycardia?

A

A pt is tachycardic when they have a heart rate of 100+bpm but does not become clinically significant until it reaches equal to or greater than 150bpm at which point arrhythmias are likely.

Tachycardic rhythms include:

  • Sinus Tach
  • Atrial flutter/fibrillation
  • SVT
  • Mono or Polymorphic VT
  • Wide Complex Tachycardia of uncertain type
76
Q

What are the S&Ss of unstable tachy?

A

S&Ss may include:

  • Hypotension
  • Acutely altered mental status
  • signs of shock
  • ischemic chest discomfort
  • acute heart failure
77
Q

What is one important thing to quickly determine in a tachy pt?

A

Is the tachy producing hemo instability and the S&Ss or are the S&Ss (pain and distress) causing the tachy

78
Q

What is the first key thing to determine when having a tachy pt before you continue assessing the specifics of the tachy?

Once that is determined and you confirm it is the right kind of tachy, what immediate things are you going to look for that will change your treatment plan? (4x)

A

Is there pulses present or not! If not then follow the PEA chain of treatment under cardiac arrest.

If pulses ARE present then you should examine the following;

  • Is the pt symptomatic (stable or unstable)
  • is the QRS wide?
  • Is the rhythm regular?
  • Is the QRS polymorphic or monomorphic?
79
Q

Can you sedate a conscious pt before cardioverting?

A

YES, if the pt is conscious you can sedate them before cardioverting unless they are extremely unstable in which case do not delay!

80
Q

When does a synchronized cardioversion deliver the shock?

When is synchronized cardioversion indicated?
When is UNsynchronized cardioversion indicated?

A

It will deliver the shock at the peak of the R wave in a QRS complex

Indication for synchronized cardioversion:

  • Unstable SVT
  • Unstable A-fib
  • Unstable A-flutter
  • Unstable regular monomorphic tachy w/ pulses

Indications for UNsynchronized cardioversion:

  • Pt with no pulse (VF/pVT)
  • When a pt is in pre-arrest/quickly deteriorating or in polymorphic VT when you believe delaying shock will risk pt going into full arrest
  • When synchronization is not possible but the pt is unstable and deteriorating quickly
  • When you cannot decide between mono or poly in an unstable pt
81
Q

When cardioverting what should you have readily available? (4x)

A
  • O2 sat monitor
  • Suction device
  • IV line
  • Intubation equipment
82
Q

When giving Adenosine for a stable tachy with a wide QRS, what other qualifications for the rhythm must be present?

A

It must be regular and monomorphic

83
Q

Why is Sinus Tachy different and not considered to be a part of the Tachy w/ a Pulse Algorithm?

A

Sinus Tachy is considered to be caused by external influences on the heart such as fever, anemia, hypotension, blood loss, or exercise — it is systemic, not cardiac

It typically does not get above 120-130bpm and has a gradual onset and dissipation

In Sinus Tachy pts the GOAL is to identify and correct the underlying causes, and cardioversion is CONTRAINDICATED

84
Q

When might B-Blockers be dangerous for a pt with tachy?

A

If the tachy is arising from a compensatory mechanism to a low cardiac output for whatever reason, then giving a beta blocker will take away that compensatory mechanism and tank the cardiac output

(CO = SV + HR)

85
Q

Remember that you tachy rhythms that are wide are an indication that the impulse is coming from the ventricles b/c that is the hallmark sign of a ventricular rhythm, so your narrow complexes are probably coming from the atria or junction

A

Remember that you tachy rhythms that are wide are an indication that the impulse is coming from the ventricles b/c that is the hallmark sign of a ventricular rhythm, so your narrow complexes are probably coming from the atria or junction

86
Q

Apart from adenosine, what are another 3 antiarrhythmic drugs you can give if refractory to adenosine?

A

Procainamide
Amiodarone
Sotalol

87
Q

Will adenosine terminate Afib or Aflutter?
What pts should not receive adenosine?
What will adenosine terminate indicating that it is that rhythm, and vice versa if it does not terminate then it is probably A flutter?

A

No, but it will slow down AV node conduction enough to identify flutter or fib waves.

Adenosine can cause bronchospasms so asthma and COPD pts should not receive adenosine

Adenosine will terminate reentry SVT, so if it does convert it is probably SVT but if it doesn’t then it is probably Aflutter

PCIV (5 decks)

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