2020 AHA ACLS P2 Flashcards
To function effectively a high performance team needs to focus on ____x4?
- Timing
- Quality
- Coordination
- Administration
What are some ways to increase Chest Compression Fraction (CCF)?
- Precharge the defibrillator
- Perform a pulse check during the precharge phase
- Have compressor hover over the chest during shock in order to immediately get back to compression
- Have the next compressor ready to take over immediately
- Intubate and deliver meds during compressions
- use cpr and vents continuously together
Describe the role of the Team Leader
The Team Leader should focus on comprehensive pt care, not just one role. They must ensure everything is being done at the right time and the right way.
The Team Leader:
- organizes the group
- monitors individual performance
- backs up team members
- models excellent team behavior
- trains and coaches (even future team leaders)
- Facilitates understanding
- Focuses on comprehensive pt care
- Temporarily designates another team member to take over at Team Leader if an advanced procedure is required.
Describe the Role of a Team Member
A Team Member:
- Proficient in performing the skills in their scope
- Clear about role assignments
- Prepare to fulfill their role
- Well practiced in resuscitation skills
- Knowledgeable about the algorithms
- committed to success
Describe the Role of the CPR Coach
The CPR Coach’s main responsibility is to help members provide high quality CPR and minimize pauses in compressions. They can deliver feedback about:
- Compressors rate, depth, recoil
- Rate and Volume of Ventilations
- Compression Pauses
They should have clear line of site to the compressor and should therefore stand by the defibrillator. It is because of this that often the CPR Coach is also in charge of the Monitor/Defibrillator; they don’t have to only be the CPR Coach.
An overview of their job is:
- Coordinate the start of CPR
- Coach to improve the quality of chest comps
- State midrange targets (say 110 comp/min instead of 100-120)
- Coach to the midrange targets
- Help minimize the length of pauses in compressions
What are the elements of Effective Team Dynamics as part of a High-Performance Team (8x)
- Clear Roles and Responsibilities
- Knowing your Limitations
- Constructive Interventions
- Knowledge Sharing
- Summarizing and Reevaluating
- Closed Loop Communications
(1. give order 2. get eye contact and response that they understand 3. confirm that order is completed before giving that member another) - Clear Messages (don’t yell, speak calm and clear)
- Mutual Respect
What are the 6 possible roles when enough people are present?
- Team Leader
- Monitor/Defibrillator/CPR Coach
- Compressor
- Airway
- IV/IO/Medications
- Timer/Recorder
Tidal Volume and Hypoventilation according to AHA
Tidal volume is 6-8mL/kg for normal oxygenation (usually just go by 500mL outside of AHA)
Hypoventilation is anything below 6 breaths/min and requires a bag-mask device or advanced airway with O2
Tachypnea and bradypnea are still considered anything above or below 12-20
Respiratory Distress (mild to severe) VS Respiratory Failure VS Respiratory Arrest
Resp DISTRESS is when there is an abnormal rate or effort present at rest. Usually if it is only increased rate or effort alone it is mild but when you have signs of tachycardia, skin changes, significant rate or effort increase, changes in mental status ect, it is considered severe respiratory distress.
Resp FAILURE is when the pt is in a state of inadequate oxygenation, ventilation, or both. Usually this is once the pt is so exhausted they are no longer trying to vent as much
Resp ARREST is the absence of breathing
This is when you should deliver 500-600mL of ventilation via bag valve mask. Sometimes a higher volume is needed so be sure you can bypass or block off the pressure relieve valve on a BVM. Remember that an adult BVM has way more than 500mL so you do not want to squeeze the whole bag!
What are the dangers of Hyperventilation, either too much volume or too many breaths/min?
- It can cause gastric inflation and lead to regurgitation and aspiration
- It increases intrathoracic pressure
- decreases venous return to the heart
- diminishes cardiac output and survival
- may cause cerebral vasoconstriction, reducing blood flow to the brain
How does AHA want you to deliver breaths in a respiratory arrest WITH a pulse?
1 breath every 6 seconds, OR 10 breaths/min with a bag-valve mask or any advanced airway.
Deliver breath over 1 second and watch for chest rise and fall
Check pulse every 2 minutes only taking about 5-10 seconds to asses. If no pulse then start CPR
What are your O2 sat goals for ACS, Respiratory Arrest/Acute Cardiac Symptoms, stroke, and Post-Cardiac Arrest care?
ACS = at least 90%
Acute Cardiac Symptoms/Resp Arrest = at least 95%
Stroke = 95-98%
Post Cardiac Arrest Care = 92-98%
(AHA says normal is 95-98%)
When someone is choking and you can’t remove the object via the Heimlich maneuver and you cant see it to remove with your fingers, what should you do as they begin to go into respiratory arrest and unconsciousness?
START CPR, check for obstruction visibility in the mouth every time you give ventilations
Measuring and sizing OPAs and NPAs
OPA:
- After clearing mouth of secretions, pick an OPA that is from corner of the mouth to the angle of the mandible. They do not care if you go 180 or 90 degree turn
NPA:
- Use width of pinky finger as guide to size, but you should not see blanching of the nostril upon insertion.
Length is judged by tip of pts nose to the earlobe. If you experience resistance upon insertion try either twisting is or using other nostril. Always lubricate before insertion to ease the passage.
(Picture shows bevel facing lateral aka NOT medial)
Wall mounted suction units should be able to provide airflow of more than _____ and suction of more than _____ when clamped at full suction?
Wall mounted suction units should be able to provide airflow of more than 40 L/min and suction of more than -300mmHg when clamped at full suction?
When to use Rigid VS Flexible Catheters
FLEXIBLE:
- in mouth or nose
- for ET suctioning
- For aspiration of thin secretions from the oro or nasopharynx
- to perform intratracheal suctioning
- to suction through an in place airway to access the back of the pharynx in a pt with clenched teeth
RIGID:
- for more effective suctioning of the oropharynx
- for thick secretions or particulate matter
Suctioning procedure list
- measure catheter before suctioning
- place catheter into oropharynx past tongue, DO NOT inset beyond the distance from the tip of nose to earlobe
- Apply suction with a rotating or twisting motion
- Limit each suction attempt to 10 seconds or less
What is the ideal minimum of CCF percentage?
Ideally Chest Compression Fraction should be at Least 80%
Is agonal gasping a sign of breathing?
NO, pts in cardiac arrest may have Agonal Gasps for the first few minutes but this is NOT BREATHING it is a sign of cardiac arrest
What is another way to calculate CCF when an automated feedback device is not available?
Use 2 timers, one that starts and stops when the code begins and ends (total code time) and another that starts and stops when chest compressions are being done. Then use the formula:
CCF = Actual Chest Comp Time + Total Code Time
