7. ACLS Concepts - Edited Flashcards
:(
1
Q
pts that display one of what have ROSC? 3
A
1 pulse and adequate BP
2 abrupt increase in etCO2 >40mmHg
3 spontaneous arteral BP waves via aline
2
Q
what is rtPA used for?
A
fibrinolytic used to treat pts with STEMI
3
Q
agonal breathing
A
more than half cardiac arrest pts experience “gasps”, gurgling, moaning, snorting, or labored breathing
4
Q
agonal rhythm
A
slow complex rhythms that immediately precede asystole
5
Q
are agona breaths considered breathing?
A
No - they do not provide oxygenation
6
Q
what do agonal gasps indicate
A
pt is in cardiac arrest
brain is still alive
7
Q
what should be initiated when agonal rhythms are incountered?
A
chest compressions bc agonal rhythms do not produce life sustaining cardiac output
8
Q
what is the definition of CCF and what is the correct fraction
A
proportion of time spent performing chest compressions
at least 60% but ideally >80%
9
Q
ways to incr CCF
A
- hover hands over chest during pauses in compressions
- use CPR feedback device
- pre-charge defibrillator 15 secs
- continue CPR during charging
- clear and shock in 5-10 secs
- intubate w/o pausing compressions
- have next compressor ready to relieve
10
Q
neonate
A
0-28 days
11
Q
infant
A
1 month-1 year
12
Q
child
A
1 year to puberty (breast development or axillary hair in males)
13
Q
adult
A
puberty or older
14
Q
lay person or lay provider definition
A
no specialized/professional knowledge of a subject
15
Q
penumbra
A
ischemic but salvageable brain tissue
16
Q
PCI
A
stent to open blocked coronary artery
(AKA angioplasty w/stent)
17
Q
Reperfusion therapy
A
opening obstructed coronary artery with stent (PCI) or drugs (fibrinolytics)
18
Q
ROSC
A
pt coming out of cardiac arrest
- reestablish organize rhythm
- adequate BP
- > 40mmHg EtCO2
19
Q
when do most pts die after ROSC post-cardiac arrest?
A
within 24 hrs
20
Q
mild respiratory distress
A
change in airway sounds
21
Q
severe respiratory distress
A
deterioration in color
changes in mental status
22
Q
hypoventilation RR
A
<6
23
Q
bradypnea RR
A
<12
24
Q
normal RR
A
12-16
25
tachypnea RR
>20
26
stable
normal BP and signs of good perfusion
27
what are the signs of good perfusion
```
good color
good pulse
good capillary refill
warm
awake and alert
```
28
unstable
hypotension and signs of poor perfusion
29
what are the signs of poor perfusion
```
blue or pale
weak pulse
delayed capillary refill
cold
altered or depressed consciousness
sick
```
30
triage
process of deciding which pt should be treated first and where they should go based on how sick they are
31
name the 6 person high performance teams (in order)
```
1- team leader
2- compressor
3- AED/monitor/defibrillator
4- airway
5- IV/IO/Medication
6- timer/recorder
```
32
what does the team leader do
assigns roles to team members, makes decisions, provides feedback and responsible for unassigned roles
33
how often does the compressor alternate? and with who do they alternate with?
alternates with AED person every 5 cycles (2min) or when fatigue sets in
34
what does the AED/monitor/defibrillator person do?
obtains and operates defib and places monitor so team leader can see
rotates with compressor
35
what does the airway person do?
ventilates and intubates if necessary
36
what team member establishes access and pushes drugs?
IV/IO/medications member
37
what does the timer/recorder do?
records times of interventions/medications
announces when next drug is due
records frequency and duration of interruptions in compressions
38
what if you have less than 6 people?
multiple providers can take higher priority tasks
39
at what number of providers should there be a team leader?
2 or more
40
cardiac arrest teams
code blue teams
| do NOT prevent, only respond after arrest has occured
41
RRT or METS purpose
identify and treat early clinical deterioration BEFORE arrest
42
what percent of IHCA pts have abnormal vitals documented for up to 8 hours?
80%
43
what are the three components of a rapid response team?
1 -event detection and activating response (by nurse, family, doc)
2- planned response arm (RRT) (hosp sets criteria as trigger)
3- quality monitoring and administrative support
44
8 steps to successful team dynamics
```
1- have clear roles
2- know your limits
3- have constructive intervention
4- share knowledge
5- summarize and re-evaluate
6 have a closed loop communication
7- give clear messages
8- have mutual respect
```
45
what is the most important role of a team member?
being proficient in skills according to your scope of practice
46
what should you do if you are assigned a task you do not feel proficient in?
ask for a new task
47
what are the 3 steps to knowing your limits
1- call for assistance EARLY
2- don't initiate unfamiliar therapy without advice
3- don't take on too many tasks
48
should you suggest an alternative drug, dose or question someone if they are about to make a mistake?
YES but do so tactfully so it is a CONSTRUCTIVE INTERVENTION
49
how do you share knowledge 3
1 avoid fixation error (fixating on one thing when there are more important ones)
2 encourage environment of sharing
3 ask if anything has been overlooked
50
how do you summarize and re-evaluate during a code? 3
- keep records of drugs/therapy
- monitor and reassess after treatments
- inform arriving personnel of status/plans
51
can you give a drug without confirming verbally with your team leader?
NO
52
explain closed loop communication
team leader gives order
confirms it was heard
listens to confirmation from team member before assigning another task
53
3 steps to giving clear messages during a code
speak clearly no shout/mumble
repeat if necessary
question if there is any doubt
54
what two things should you do before approaching the pt?
use universal precautions (gloves)
| make sure scene is safe (if in field)
55
what assessment do you do if the pt is unconscious?
BLS RACD
56
RACD
- Responsiveness
- Activate EMS and get AED
- Circulation check (pulse and breathing simutaneously)(CPR)
- Defibrillation
57
during RACD you check the circulation and there is no pulse what do you do?
begin chest compressions
58
during RACD you check the circulation and there is a pulse but no breathing what do you do?
10 breaths per min for adults
20 breaths per min for kids
59
unconscious pt treatment
initial assessment
check responsiveness
RACD
ABCDE (primary)
60
consious pt treatment
initial assessment
check responsiveness
ABCDEs (primary)
61
what assessment should you do if the patient is conscious?
primary assessment (ABCDEs)
62
what if you are unsure if the patient is conscious?
start RACD (check responsiveness)
63
what is ABCDEs?
```
PRIMARY ASSESSMENT
airway
breathing
circulation
disability
exposure
```
64
A of primary assessment
airway
| check patency and consider advanced airway placement
65
B of primary assessment
breathing
| consider supplementary oxygen and advanced airway placement, monitor oxygenation and ventilation
66
C of primary assessment
circulation
assessing pulse, EKG, BP (stable vs unstable), CPR effectiveness, temp and glucose, need for fluid or drugs, need for cardioversion/defib
67
D of primary assessment
disability
check neurologic function (responsive, conscious level, pupil dilation)
AVPU
68
AVPU
alert, voice, painful, unresponsive
69
E of primary assessment
exposure
remove clothing to perform quick physical exam
look for signs of trauma, bleeding, burns, medical alert bracelet
70
initial steps on conscious pt what things do you want to verbilize?
1. Monitors
2. IV access
3. Oxygen
71
what makes up the secondary assessment?
SAMPLE and H's & T's
| searches for cause of problem
72
SAMPLE
```
signs and symptoms
allergies
medications
past medical history
last meal
events
```
73
when should you verbalize SAMPLE?
ALL patients
74
when should you verbalize Hs and Ts
pts in cardiac arrest
75
how many hypos, hypers and H+ are in the H's?
5 hypos
1 hyper
1 H+
76
what are the 7 H's of pulseless arrest?
```
hypovolemia
hypoxemia
hypothermia
hypoglycemia
hypokalemia
hyperkalemia
acidosis (H+)
```
77
what are the 5 T's of pulseless arrest?
```
tamponade
thrombosis (coronary/pulm)
tension pneumothorax
trauma
toxins
```
78
how is cardiac tamponade diagnosed and treated
diagnosed with ultrasound
treated with pericardiocentesis
| treated with pericardiocentesis
79
in pts with cardiac arrest due to presumed or known PE what is it reasonable to do?
administer fibrinolytics
80
what is the diagnosis for a tension pneumothorax
```
unilateral absent breath sounds
deviated trachea
hypotension
CXR
bedside ultrasound
```
81
treatment for tension pneumo
needle decompression
chest tube
| then chest tube
82
needle decompression
2nd intercostal space
mid clavicular line
| mid clavicular line
83
chest tube
6th intercostal space
mid axillary line
| mid axillary line
84
what can toxins or drug overdose lead to? ECG
prolonged QT on ECG
85
how do you treat toxins or drug OD?
```
monitor blood sugar (beta blocker or alcohol can lead to hypoglycemia)
gastric lavage (wash out stomach)
charcoal tablets
ECMO/Dialysis
```
86
what should be considered to id potentially reversible causes of cardiac arrest
ultrasound
87
unconscious pt ABC or CAB
C
A
B
88
conscious pt ABC or CAB
A
B
C
(prioritize greatest need)
89
what should wall suction be capable of ?
-80 to -120 mmHg
| usually >-300
90
effective suction technique
<10 sec, <10 attempts
| follow with short period of O2
91
what should you do if suctioning thick material?
squirt 1-2cc N/S before suctioning
92
what type of suction goes down ETT and is better for thin secretions
soft suction catheter
93
in trauma pts how should the airway be opened? what should be avoided and why
jaw thrust
avoid chin lift bc of potential cervical instability
94
for trauma pts should manual spinal motion restriction or immobilization devices be used?
manual spinal motion restriction bc the collars can complicate airway management
95
low flow O2 devices
simple mask
nasal cannula
96
simple mask FioO2
35-60%
97
nasal cannula FiO2
22-60%
98
high flow devices
high flow nasal cannula
nonrebreather
99
high flow nasal cannula flow rate infants
4L/min
100
high flow nasal cannula flow rate adolescent
40L/min
101
high flow nasal cannula FiO2
95%
102
nonrebreather FiO2
95%
103
stroke/general care SpO2 titration
95-98%
104
post cardiac arrest adults SpO2 titration
92-98%
105
post cardiac arrest kids SpO2 titration
94-99%
106
acute coronary syndrom (heart attack) SpO2 titration
>=90%
107
respiratory or cardiac arrest and CPR
100% high flow O2
108
chokcing in unresponsive patient
start CPR immediately
look for object in mouth when you deliver breath
109
chocking in responsive adult
heimlich (above navel below breastbone)
| examined post heimlich to rule out damage
110
choking in responsive child
heimlich maneuver or abdominal thrusts below xyphoid
111
severe choking in responsive infant protocol
prone in one arm and 5 back blows
5 chest thrusts w/2 fingers
| flip supine in other arm and 5 downward chest thrust two fingers (exactly where compressions would be)
112
choking pt after the obstruction is relieved protocol
place in recovery position (on side)
113
drowning protocol
immediate CPR
| if in icy water then rewarming core temp to at least 30C is recommended before abandoning CPR
114
what is the most rapid and effective technique for rewarming hypothermic cardiac arrest
extracorporeal circulation
115
Airway management for foreign body airway obstruction
1. keep pt calm
2. pt spontaneously ventilates
3. mask induction or IV induction w/spontaneous ventilation
4. mask adapter for O2 and VA delivery
116
mx anesthetic for foreign body airway removal
propofol-remi TIVA
VA (not preferred)
117
what treats inflammation or airway edema caused by bronchoscopy?
steroids (dexamethasone)
118
what could you use to blunt the gag reflex during bronchoscopy?
Local
119
induction anesthetic for foreign body airway obstruction
mask induction
cautious IV induction
120
what should your caution be when securing the ETT?
potential danger of obstructing venous return from brain with tube tie
121
uncuffed tubes are recommended for
kids <8
122
uncuffed size
age/4 + 4
123
cuffed tube size
age/4+3
124
correct ETT insertion depth for kids <=2 years
internal diameter x 3
(cm)
125
correct ETT insertion depth for kids >2 years
age/2 + 12
126
is cricoid recommended in ACLS?
not recommended
127
what is the preferred method of confirming ETT placement
etCo2 continuous waveform
| as in exact co2
128
what is used if continuous etco2 waveform is not available?
colorimetric capnography
129
what type of capnography is colorimetric
semi-qualitiative
confirms there is etco2 but not exactly what it is
may fail to detect co2 when ETT is correctly placed
130
purple colorimetric capnography
<2.28mmHg
131
beige colorimetric capnography
3.8-7.6mmHg
132
yellow colorimetric capnography
>15.2mmHg
| **GOLD=GOOD**
133
EtCo2 is a reliable indicator of
- confirming correct ETT placement
- chest compression effectiveness
- ROSC
134
oxygen therapy during arrest and initial resuscitation
high flow oxygen 100%
135
oxygen therapy after ROSC
titrated to spo2 of 94=99 for non ACS
| >90% fot ACS
136
mouth to mouth breathing adults protocol
pinch nose chin lift
137
what is the FiO2 of mouth to mouth? CO2?
17% fiO2
| 4% CO2
138
mouth to mouth breathing kids protocol
place mouth over victims mouth and nose
139
which should be performed with one rescuer? two rescuer?
mouth to mouth
bag mask
```
one= mouth to mouth
two= bag mask
```
140
PP breathing rate adults
10 breaths per minute
(1 breath every 6 sec)
141
PP breathing rate peds
20-30 breaths per min
(1 breath every 2-3 sec)
142
what are the 6 disadvantages to excessive ventilation
1. incr intrathoracic P
2. decr venous return
3. decr CO
4. Decr perfusion
5. air trapping (barotrauma)
6. incr regurge/aspiration
143
what is the best way to avoid excessive ventilation?
give breath until chest rise is observed
ventilate slowly
each breath over 1 sec
144
what is the goal tidal volume for adults during arrest
500-600mL
145
what is the breathing rate if compressions are required? (cardiac arrest)
LOWER 10 breaths/min
| venous return more important
146
what is the breathing rate if compressions are not required?(resp arrest)
HIGHER 10-12 breaths/min
| venous return less important
147
what is the breathing rate for mask ventilated pts (resp arrest)?
10-12 breaths/min (every 5-6 sec)
| bc breath not as effective
148
what is the breathing rate for intubated pt? (resp or cardiac arrest)
10breath/min
| bc breaths are more effective
149
what should agonal breaths be treated the same as?
apnea
150
ratio of compressions to breath mask ventilation cardiac arrest
30:2
151
when you check pulse and breathing for RACD how long should you do it?
5-10 sec and recheck every 2 min
152
153
what is the priority for establishing vascular access?
1st: IV
2nd: IO
3rd: meds down ETT
154
what should you do when injecting medication IV during code?
dose followed by N/S bolus 5 mL for peds 20mL for adults
| extremity elevated for 10-20 sec
155
when should IV drugs be given?
during compressions
156
is dosing in the IO the same as IV?
yes
157
where is the best IO access? confirmation?
anterior tibia
| fluids can flow freely without local soft tissue swelling
158
IO access contrainducations
1. infection at site
2. ipsilateral fracture or crush injury
3. previous attempt on same bone
159
ETT access for meds protocol
inject drug in ETT
5-10mL N/S flush
5 rapid PP ventilations
compressions temporarily interrupted to avoid regurg of drug
160
what can low dose epi via ETT cause?
beta 2 effects
- vasodilation
- hypotension
- decr CPP
- decr chance of ROSC
161
ETT access dose ALL MEDS adults
2-3 times IV/IO
162
ETT access dose ALL MEDS PEDS (not epi)
2-3 time IV/IO
163
what is the acronym for possible ETT drugs adults
```
NAVEL
narcan
atropine
vasopressin
epi
lidocaine
*** lipid soluble***
```
164
what is the acronym for possible ETT drugs peds
```
LEAN
lidocain
epi
atropine
narcan
```
165
what is the indication for compressions adults
no pulse
166
what is the indication for compressions children up to puberty
HR<60
167
what is the indication for compression "larger children"
HR<40
168
what is the rate for compressions
100-120 per min
169
how many compressions does it take before good blood flow?
20-25
170
how will you know if you are pushing too fast for compressions?
special monitors are available to alert you
171
Effective CPR
```
1 Hard/flat surface
2 push fast
3 push hard
4 <10 sec to check f/pulse
5 allow complete recoil
6 avoid excessive ventilation
7 rotate compressors
8 EtCO2 > 10-20mmHg
9 DBP > 20mmHg
10 CPR coach/feedback device
```
172
goal EtCO2 during chest compressions
>10-20 mmHg
173
goal DBP during chest compressions
>20mmHg
174
adequate compression depth adults? children?
adult 2-2.4 inches
kids 2"
infants/neonates 1.5"
175
compression depth kids
2 inches
176
compression depth infants
1.5 inches
177
high quality CPR pneumonic
CPR
Chest recoil
Push hard/fast
Rotate rescuer
178
adults/kids>8 CPR technique
2 handed
179
kids 1-8 years old CPR technique
2 handed
or
1 handed
180
infants w/2 responders CPR technique
| ?
thumb encircling
181
infants w/1 responder CPR technique
2 finger
or
thumb-encircling
182
CPR in mask ventilated pts
- compressions are interrupted when performing breaths
- CPR cycles: 5 cycles over 2 min period
| CPR in 5 cycles over 2 min
183
cycle ratio of CPR mask vent adults
30:2
184
cycle ratio of CPR mask vent infant/children
1 provider
30:2
2 provider
15:2
185
cycle ratio of CPR mask vent neonate
respiratory arrest
3:1
cardiac arrest
15:2
186
CPR in intubated pts
-chest compressions are not interrupted during breaths
- CPR in 2 min increments
| CPR performed in two min increments NOT cycles
187
CPR intubated adults
100-120 compressions/min
| 10 breaths/min
188
CPR intubated kids
100-120 compressions/min
| breathing rate is faster depending on age
189
starting compressions takes priority over everything except
calling for help
defibrillating Vfib/Vtach
| defibrillating vfib/vtach when pads are on and ready
190
can chest compreswsions continue when defib is charging
yes
191
192
193
194
CPR protocol when defibrillating 6
1 check the pulse (no longer than 10 sec)
2 perform CPR until AED arrives
3 defib ASAP
4 resume 2 min of CPR
5 reanalyze rhythm (and check pulse if organized rhythm present) within 10sec
6 repeat cycle as needed
195
where do you check the pulse adults? infants?
adult carotid
| infant brachial
196
why do we continue CPR for 2 min before reanalyzing
be rhythms dont usually create perfusion in the first few min
197
when should IV/IO meds be given during CPR protocol/defib
immediately before or after shock delivery, so there is time to circulate before next check
198
ECMO for arrest?
may be considered in select cardiac arrest pts who havent responded to conventional CPR
199
abilities of the AED/AED pads
```
sense and analyze vfib/vtach
can defibrillate (auto energy dose)
```
200
limitations of AED/AED pads
does not produce ECG strip (cannot sense anything except vfib/vtach
cannot pace
cannot perform synchronized cardioversion
201
automated external defibrillator (AED)
automated means semi or fully
semi= advises if shock is indicated and provider pushes button
fully= shocks for you if indicated
202
AED protocol
```
power on AED
attach electrode pads
clear the victim
analyze rhythm
charge and shock if advised
```
203
manual defibrillator extra abilities on top of AED
show ECG strip
can perform synchronized cardioversion
can perform transcutaneous pacing
204
manual defib vs AED
manual defib is preferred if the providers skills are adequate
205
when is the analyze button used on a defibrillator
when BLS provider cannot analyze rhythm
206
energy select button on defib
adjusts the energy you shock with
207
how long should the clear and shock process take
<5 sec
208
knob set to monitor
3 tracing screens
209
knob set to defib
allows defib and synchronized cardioversion
210
knob set to pacer
allows the defib to pace
211
when do you use transcutaneous pacing
pt is bradycardic and does not respond to atropine
212
transcutaneous pacing defibrillator setup
place pads
turn knob to pacer
set HR
turn current until capture (heart starts pacing ~40-80 mA)
213
transvenous pacing
requires expert placment with fluroscopy
more effective
only useful in stable brady
214
are most defib today mono or bi phasic?
biphasic
they are more effective at defibrillating
waveform is up and down
215
sync button for synchronized cardioversion does what
ensures shock wave occurs during R wave not during T wave
216
indications for synchronized cardioversion
unstable supraventricular rhythms (SVT, afib, aflutter
Have a pulse
Identifiable R wave
Unstable:
- SVT
- Afib
- Aflutter
- monomorphic VTACH w/pulse
| unstable monomorphic vtach with pulse
217
how to perform synchronized cardioversion 6
1 place pads in posterior, left anterior (ventricular) right anterior (atrial)
2 knob to defib
3 sync button prior to each shock attempt
4 select 75-120 J energy
5 hit charge
6 hit shock
218
when is defibrillation indicated?
all ventricular rhythms that are pulseless and/or irregular (vfib, vtach, torsades)
219
when is defibrillation NOT indicated
supraventricular rhythms
asystole
pulseless electrical activity (PEA)
220
is sedation necessary with defibrillation
no
221
should you sedate with synchronized cardioversion
yes
222
how to perform defibrillation 5
```
1 place pads posterior-anterior or anterior-anterior
2 knob to defib
3 select 200J energy
4 charge
5 shock
```
223
adult defib biphasic energy dose
120-200 J
224
pediatric defib biphasic 1st,2nd,up-to doses
2J/kg
4J/kg
up to 10J/kg
225
synchonized cardioversion biphasic afib energy dose?
120-200J
| mono= 200J
226
synchronized cardioversion biphasic regular SVT energy dose
50-100J
227
synchronized cardioversion biphasic monomorphic vtach energy dose
100J
228
transcutaneous pacing biphasic energy dose
40-80mA
229
peds synchronized cardioversion biphasic 1st/2nd shock
1st: 0.5-1 J/kg
2nd: 2 J/kg
230
if the pt has a ICD how far away should you place the pad?
1 inch to the side
231
if the pt is laying in water can you shock them
move to dry area then shock
232
electrical arcing
flow of current through air between electrodes can induce fire, explosion, and thermal injury
233
how many shocks are given at once?
1 shock at a time
234
how long should the time from arrival to first shock be?
<90sec
235
236
post cardiac arrest syndrome includes
237
238
what is the first priority for someone who achieves ROSC?
oxygenation and ventilation
239
ROSC SpO2
adults: 92-98%
kids: 94-99%
240
ventilation goals post ROSC
1. SpO2
2. EtCO2 35-455 mmHg
3. avoid hyperventilation
241
circulation goals post ROSC
1. 12 lead ECG
2. MAP >65
3. SBP > 90
(5th percentile for peds)
4. antiarrhtymics
5. H and Ts
242
goals for post ROSC disability/exposure
EEG monitoring
TTM
draw labs
treat hypglycemia
CT or MRI
treat seizures
avoid ICP increases
243
airway management for unconscious pt with ROSC
advanced airway usually
| potentially head at 30 degrees to decrease cerebral edema, aspiration, and vent pneumonia
244
what is the only post ROSC intervention demonstrated to improve neurologic recoveru?
TTM
245
are TTM and PCI at the same time safe?
yes feasible and safe
246
when should TTM be administered
comatose and unresponsive after ROSC
247
what is the goal temp for TTM: adults
32-36 C for 24 hr
248
goal temp for TTM: peds
32-34C for 48 hrs
249
what sites should be used for core temp measurement
esophageal
| bladder
250
earliest neurologic status check not treated with TTM
72 hr
251
earliest neurologic status check with TTM
72 hr after return of normothermia
252
methods of initiating TTM
rapid infusion of ice cold isotonic non glucose fluid (30mL/kg) =best for fast not for targeted temp
surface cooling devices
ice bags
253
254
| etCO2 35-40mmHg
255
cardiovascular care after ROSC
12 lead ECG ASAP
| consider coronary reperfusion therapy if stemi or AMI
256
goal BP after ROSC
MAP > 65
Sys P>90
hypotension treated with fluids or pressor
257
is TTM considered in conscious pts?
no
258
post ROSC lab and diagnositic tests
`look for electrolyte abnormalities
| look for pulm,cariac, or neurologic precipitants of arrest
259
prophylactic antiarrhythmic therapy after ROSC
following vtach/vfib
consider beta blockers
consider lidocaine
260
when can you consider terminating resuscitative efforts?
unable to get etCO2 >10mmHg after 20 min of CPR in intubated pts
DNAR order presented
dangerous environment
261
when should you consider prolonging resuscitative efforts? >20min
cause of cardiac arrest is reversible (hypotherm, drugs)
| ROSC at any time throughout attempt
262
why is resuscitation in hypothermic pts different?
may be unresponsive to drugs, defib and pacing (drugs could accumulate)
should concentrate on rewarming (extracorporeal circulation)
263
protocol for severe <30C hypothermic vfib/vtach
single defib then hold until >30C
264
protocol for moderate <34C hypothermic vfib/vtach
defib but wait longer intervals
265
when should termination of resuscutative efforts happen for hypothermic pts?
core temp is at least 30C before terminate
266
7 things you must say to do after ROSC
1- 12 lead EKG
2- consider hypothermia
3- maintain normal BP (1-2L crystalloid bolus)
4- frequent lab work
5- maintain spO2 94-99%
6- consider intubation and maintain etCo2
7- consider lidocaine or BB
267
what is the most common cause of cardiac arrest?
ischemia from CAD
268
how do you assess neurologic function
check blood sugar
check pupil response
AVPU peds scale
Glascow coma scale
269
hypoglycemia can cause
somnolence
270
normal glucose range
80-110 mg/dL
271
pupil exam
PERRL
272
PERRL
pupils
equal
round
reactive to
light
273
what can be indicated by unequal pupil size
incr ICP
brain stem injury
274
AVPU scale
Alert
Voice
Pain
Unresponsive
275
who can use an AVPU scale
anyone
276
Glascow coma scale assesses
1. eye opening
2. verbal response
3. motor function
277
GCS low score
3
278
GCS high score
15
279
GSC intubation indication
<= 8
280
GCS mild head injury
13-15
281
GCS mod head injury
9-12
282
GCS sev head injury
3-8
283
respiratory arrest treatment
rescue breathing
consider narcan
284
bradycardia rhythms
sinus brady
type 1 and type 2 block
3rd deg heart block
afib w/slow ventricular
escape rhthyms
285
bradycardia treatment
atropine
epi
dopamine
transcutaneous pacing
286
SVT
HR>150bpm
normal QRS
may look like junctional tachycardia
287
ACLS/PALS assumes all SVT is
AVNRT
288
SVT treatment: Stable
slow conduction in AV
- vagal maneuvers
- adenosine
289
SVT treatment: unstable
synchronized cardioversion
290
afib ectopy
atrial myocardium
291
SVT ectopy
AV node
292
Afib/Aflutter treatment: stable
monitor/observe
seek consult
293
AFib/Aflutter treatment: unstable
synchronized cardioversion
294
monomorphic VTACH w/pulse treatment: stable
amiodarone
procainamide
sotalol
lidocaine
295
monomorphic VTACH w/pulse: unstable
synchronized cardioversion
296
Vfib/pulseless VTACH
CPR
Epi
defibrillation
lidocaine
amiodarone
297
epi dosing
1mg ever 3-5 mins
298
polymorphic Vtach (Torsades) (pulseless)
CPR
epi
defibrillation
lidocaine
magnesium
299
is amiodarone better than lidocaine
both are equal
300
what does epi do
incr myocardial blood flow
stimulated myocardial contraction
for pulseless rhythm
301
when is epi recommended in ACLS algorithm
after 2 defib attempts
(although typically given immediately)
302
Course Vfib
higher waves
higher chance of conversion
303
Fine Vfib
smaller waves
lower chance of conversion
AFTER course vfib
304
does Vfib have a pulse
no
305
torsades
R wave alternate polarity/amplitude
prolonged QT
306
PEA
no pulse
organized rhythm
307
PEA causes
hypovolemia
hypoxia
(most common w/slowish rhythms)
308
asystole/PEA tratment
CPR
epi
treat any reversible causes
309
do you defibrilalte pts in asystole or PEA
no
310
lone rescuer: respiratory arrest
CPR for 2 mins FIRST
then call for help/activate EMS/get AED
311
lone rescuer: did not witness arrest
CPR for 2 mins FIRST
then call for help/activate EMS/get AED
312
lone rescuer: witnessed cardiac arrest/collapse
call for help/activate EMS/get AED FIRST
then start CPR
313
what change should you make for hypothermic patients during resuscitation?
give medications at longer spaced intervals
314
when should you terminate CPR efforts on hypothermic patients
rewarm to 30C prior to terminating efforts
315
severe hypothermic pt (<30c)
single defibrillation attempt
delay additional attempts until temp > 30C
316
moderately hypothermic pt (<34c)
defibrillate as normal
longer intervals between drug doses
317
defibrillator pads for children >8 years old
AED w/adult pads
318
defibrillator pads for 1-8 year old
1. AED w/peds pads and ped dose attenuator
2. manual defib w/peds pads
3. adult AED pads
319
<1 year old defibrillator pads
1. manual defib w/peds pads
2. AED w/peds pads and dose attenuator
3. adult AED pads
320
narrow complex tachycardia
SVT
321
wide complex tachycardia
>0.12 s
ventricular tachycardia
322
what can help differentiate between SVT or afib/aflutter
adenosine
323
if rhythm is SVT, adenosine will
convert to sinue
324
if rhythm is afib/aflutter, adenosine will
not convert rhythm
will slow ventricular rate
325
SVT
regular rhythm
narrow complex tachycardia
326
Afib
irregular rhythm
narrow complex tachycardia
327
what can help differentiate between SVT and VTACH
adenosine
328
if rhythm is VTACH, adenosine will
wont convert rhythm
wont slow down rhythm
(no change)
329
ECMO
heart lung machine used for both cardiac arrest and resipratory arrest
330
what patients should you consider ECMO?
reversible causes of cardiac arrest that have not responded to initial CPR
331
most common cause of OHCAs in adults
ischemia from CAD
332
more than 1/2 of IHCAs are due to
respiratory failure
or
hypovolemic shock
333
what double the delivery of victims chance of survival from cardiac arrest
prompt CPR delivery
334
what is the leading cause of death in infants
SIDS
335
survival rate for shockable rhythm
25-34%
336
survival rate for asystole
7-24%
337
survival rate for bradycardia
64%
338
what might be the first indicator of cardiac arrest in adults
brief generalized seizures
339
when is VFIb most likely to develop
within 4 hours of ACS symptoms
340
what are major factors that determine survival after cardiac arrest
brain injury
cardiovascular instability
341
when to withhold or terminate resuscitation
1. unable to get EtCO2 > 10mmHg after 20 mins of CPR in intubated pts
2. valid DNAR order
3. dangerous environmental hazards to resuscitation
4. rigor mortis or lividity
342
rigor mortis
stiffening of limbs after death
343
lividity
black and blue discoloration of skin resulting from an accumulation of deoxy blood in subQ vessels
344
when to consider prolonging resuscitation
1. cause if cardiac arrest is reversible
2. if you achieve ROSC
