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Sp: Methods 1 > 7. ACLS Concepts - Edited > Flashcards

7. ACLS Concepts - Edited Flashcards

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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

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2
Q

what is rtPA used for?

A

fibrinolytic used to treat pts with STEMI

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3
Q

agonal breathing

A

more than half cardiac arrest pts experience “gasps”, gurgling, moaning, snorting, or labored breathing

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4
Q

agonal rhythm

A

slow complex rhythms that immediately precede asystole

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5
Q

are agona breaths considered breathing?

A

No - they do not provide oxygenation

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6
Q

what do agonal gasps indicate

A

pt is in cardiac arrest
brain is still alive

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7
Q

what should be initiated when agonal rhythms are incountered?

A

chest compressions bc agonal rhythms do not produce life sustaining cardiac output

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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%

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9
Q

ways to incr CCF

A
  1. hover hands over chest during pauses in compressions
  2. use CPR feedback device
  3. pre-charge defibrillator 15 secs
  4. continue CPR during charging
  5. clear and shock in 5-10 secs
  6. intubate w/o pausing compressions
  7. have next compressor ready to relieve
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10
Q

neonate

A

0-28 days

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11
Q

infant

A

1 month-1 year

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12
Q

child

A

1 year to puberty (breast development or axillary hair in males)

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13
Q

adult

A

puberty or older

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14
Q

lay person or lay provider definition

A

no specialized/professional knowledge of a subject

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15
Q

penumbra

A

ischemic but salvageable brain tissue

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16
Q

PCI

A

stent to open blocked coronary artery

(AKA angioplasty w/stent)

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17
Q

Reperfusion therapy

A

opening obstructed coronary artery with stent (PCI) or drugs (fibrinolytics)

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18
Q

ROSC

A

pt coming out of cardiac arrest
- reestablish organize rhythm
- adequate BP
- > 40mmHg EtCO2

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19
Q

when do most pts die after ROSC post-cardiac arrest?

A

within 24 hrs

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20
Q

mild respiratory distress

A

change in airway sounds

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21
Q

severe respiratory distress

A

deterioration in color

changes in mental status

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22
Q

hypoventilation RR

A

<6

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23
Q

bradypnea RR

A

<12

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24
Q

normal RR

A

12-16

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25
Q

tachypnea RR

A

> 20

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26
Q

stable

A

normal BP and signs of good perfusion

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27
Q

what are the signs of good perfusion

A 
good color
good pulse
good capillary refill
warm
awake and alert
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28
Q

unstable

A

hypotension and signs of poor perfusion

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29
Q

what are the signs of poor perfusion

A 
blue or pale
weak pulse
delayed capillary refill
cold
altered or depressed consciousness
sick
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30
Q

triage

A

process of deciding which pt should be treated first and where they should go based on how sick they are

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31
Q

name the 6 person high performance teams (in order)

A 
1- team leader
2- compressor
3- AED/monitor/defibrillator
4- airway
5- IV/IO/Medication
6- timer/recorder
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32
Q

what does the team leader do

A

assigns roles to team members, makes decisions, provides feedback and responsible for unassigned roles

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33
Q

how often does the compressor alternate? and with who do they alternate with?

A

alternates with AED person every 5 cycles (2min) or when fatigue sets in

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34
Q

what does the AED/monitor/defibrillator person do?

A

obtains and operates defib and places monitor so team leader can see
rotates with compressor

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35
Q

what does the airway person do?

A

ventilates and intubates if necessary

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36
Q

what team member establishes access and pushes drugs?

A

IV/IO/medications member

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37
Q

what does the timer/recorder do?

A

records times of interventions/medications
announces when next drug is due
records frequency and duration of interruptions in compressions

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38
Q

what if you have less than 6 people?

A

multiple providers can take higher priority tasks

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39
Q

at what number of providers should there be a team leader?

A

2 or more

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40
Q

cardiac arrest teams

A

code blue teams

do NOT prevent, only respond after arrest has occured

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41
Q

RRT or METS purpose

A

identify and treat early clinical deterioration BEFORE arrest

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42
Q

what percent of IHCA pts have abnormal vitals documented for up to 8 hours?

A

80%

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43
Q

what are the three components of a rapid response team?

A

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

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44
Q

8 steps to successful team dynamics

A 
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
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45
Q

what is the most important role of a team member?

A

being proficient in skills according to your scope of practice

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46
Q

what should you do if you are assigned a task you do not feel proficient in?

A

ask for a new task

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47
Q

what are the 3 steps to knowing your limits

A

1- call for assistance EARLY
2- don’t initiate unfamiliar therapy without advice
3- don’t take on too many tasks

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48
Q

should you suggest an alternative drug, dose or question someone if they are about to make a mistake?

A

YES but do so tactfully so it is a CONSTRUCTIVE INTERVENTION

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49
Q

how do you share knowledge 3

A

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

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50
Q

how do you summarize and re-evaluate during a code? 3

A
  • keep records of drugs/therapy
  • monitor and reassess after treatments
  • inform arriving personnel of status/plans
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51
Q

can you give a drug without confirming verbally with your team leader?

A

NO

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52
Q

explain closed loop communication

A

team leader gives order
confirms it was heard
listens to confirmation from team member before assigning another task

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53
Q

3 steps to giving clear messages during a code

A

speak clearly no shout/mumble
repeat if necessary
question if there is any doubt

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54
Q

what two things should you do before approaching the pt?

A

use universal precautions (gloves)

make sure scene is safe (if in field)

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55
Q

what assessment do you do if the pt is unconscious?

A

BLS RACD

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56
Q

RACD

A
  • Responsiveness
  • Activate EMS and get AED
  • Circulation check (pulse and breathing simutaneously)(CPR)
  • Defibrillation
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57
Q

during RACD you check the circulation and there is no pulse what do you do?

A

begin chest compressions

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58
Q

during RACD you check the circulation and there is a pulse but no breathing what do you do?

A

10 breaths per min for adults
20 breaths per min for kids

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59
Q

unconscious pt treatment

A

initial assessment
check responsiveness
RACD
ABCDE (primary)

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60
Q

consious pt treatment

A

initial assessment
check responsiveness
ABCDEs (primary)

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61
Q

what assessment should you do if the patient is conscious?

A

primary assessment (ABCDEs)

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62
Q

what if you are unsure if the patient is conscious?

A

start RACD (check responsiveness)

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63
Q

what is ABCDEs?

A 
PRIMARY ASSESSMENT
airway
breathing
circulation
disability
exposure
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64
Q

A of primary assessment

A

airway

check patency and consider advanced airway placement

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65
Q

B of primary assessment

A

breathing

consider supplementary oxygen and advanced airway placement, monitor oxygenation and ventilation

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66
Q

C of primary assessment

A

circulation
assessing pulse, EKG, BP (stable vs unstable), CPR effectiveness, temp and glucose, need for fluid or drugs, need for cardioversion/defib

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67
Q

D of primary assessment

A

disability
check neurologic function (responsive, conscious level, pupil dilation)
AVPU

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68
Q

AVPU

A

alert, voice, painful, unresponsive

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69
Q

E of primary assessment

A

exposure
remove clothing to perform quick physical exam
look for signs of trauma, bleeding, burns, medical alert bracelet

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70
Q

initial steps on conscious pt what things do you want to verbilize?

A
  1. Monitors
  2. IV access
  3. Oxygen
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71
Q

what makes up the secondary assessment?

A

SAMPLE and H’s & T’s

searches for cause of problem

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72
Q

SAMPLE

A 
signs and symptoms
allergies
medications
past medical history
last meal
events
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73
Q

when should you verbalize SAMPLE?

A

ALL patients

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74
Q

when should you verbalize Hs and Ts

A

pts in cardiac arrest

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75
Q

how many hypos, hypers and H+ are in the H’s?

A

5 hypos
1 hyper
1 H+

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76
Q

what are the 7 H’s of pulseless arrest?

A 
hypovolemia
hypoxemia
hypothermia
hypoglycemia
hypokalemia
hyperkalemia
acidosis (H+)
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77
Q

what are the 5 T’s of pulseless arrest?

A 
tamponade
thrombosis (coronary/pulm)
tension pneumothorax
trauma
toxins
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78
Q

how is cardiac tamponade diagnosed and treated

A

diagnosed with ultrasound

treated with pericardiocentesis

treated with pericardiocentesis

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79
Q

in pts with cardiac arrest due to presumed or known PE what is it reasonable to do?

A

administer fibrinolytics

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80
Q

what is the diagnosis for a tension pneumothorax

A 
unilateral absent breath sounds
deviated trachea
hypotension
CXR
bedside ultrasound
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81
Q

treatment for tension pneumo

A

needle decompression
chest tube

then chest tube

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82
Q

needle decompression

A

2nd intercostal space
mid clavicular line

mid clavicular line

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83
Q

chest tube

A

6th intercostal space
mid axillary line

mid axillary line

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84
Q

what can toxins or drug overdose lead to? ECG

A

prolonged QT on ECG

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85
Q

how do you treat toxins or drug OD?

A 
monitor blood sugar (beta blocker or alcohol can lead to hypoglycemia)
gastric lavage (wash out stomach)
charcoal tablets
ECMO/Dialysis
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86
Q

what should be considered to id potentially reversible causes of cardiac arrest

A

ultrasound

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87
Q

unconscious pt ABC or CAB

A

C
A
B

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88
Q

conscious pt ABC or CAB

A

A
B
C

(prioritize greatest need)

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89
Q

what should wall suction be capable of ?

A

-80 to -120 mmHg

usually >-300

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90
Q

effective suction technique

A

<10 sec, <10 attempts

follow with short period of O2

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91
Q

what should you do if suctioning thick material?

A

squirt 1-2cc N/S before suctioning

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92
Q

what type of suction goes down ETT and is better for thin secretions

A

soft suction catheter

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93
Q

in trauma pts how should the airway be opened? what should be avoided and why

A

jaw thrust

avoid chin lift bc of potential cervical instability

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94
Q

for trauma pts should manual spinal motion restriction or immobilization devices be used?

A

manual spinal motion restriction bc the collars can complicate airway management

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95
Q

low flow O2 devices

A

simple mask
nasal cannula

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96
Q

simple mask FioO2

A

35-60%

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97
Q

nasal cannula FiO2

A

22-60%

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98
Q

high flow devices

A

high flow nasal cannula
nonrebreather

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99
Q

high flow nasal cannula flow rate infants

A

4L/min

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100
Q

high flow nasal cannula flow rate adolescent

A

40L/min

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101
Q

high flow nasal cannula FiO2

A

95%

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102
Q

nonrebreather FiO2

A

95%

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103
Q

stroke/general care SpO2 titration

A

95-98%

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104
Q

post cardiac arrest adults SpO2 titration

A

92-98%

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105
Q

post cardiac arrest kids SpO2 titration

A

94-99%

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106
Q

acute coronary syndrom (heart attack) SpO2 titration

A

> =90%

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107
Q

respiratory or cardiac arrest and CPR

A

100% high flow O2

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108
Q

chokcing in unresponsive patient

A

start CPR immediately

look for object in mouth when you deliver breath

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109
Q

chocking in responsive adult

A

heimlich (above navel below breastbone)

examined post heimlich to rule out damage

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110
Q

choking in responsive child

A

heimlich maneuver or abdominal thrusts below xyphoid

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111
Q

severe choking in responsive infant protocol

A

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)

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112
Q

choking pt after the obstruction is relieved protocol

A

place in recovery position (on side)

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113
Q

drowning protocol

A

immediate CPR

if in icy water then rewarming core temp to at least 30C is recommended before abandoning CPR

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114
Q

what is the most rapid and effective technique for rewarming hypothermic cardiac arrest

A

extracorporeal circulation

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115
Q

Airway management for foreign body airway obstruction

A
  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
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116
Q

mx anesthetic for foreign body airway removal

A

propofol-remi TIVA

VA (not preferred)

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117
Q

what treats inflammation or airway edema caused by bronchoscopy?

A

steroids (dexamethasone)

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5
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118
Q

what could you use to blunt the gag reflex during bronchoscopy?

A

Local

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119
Q

induction anesthetic for foreign body airway obstruction

A

mask induction
cautious IV induction

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120
Q

what should your caution be when securing the ETT?

A

potential danger of obstructing venous return from brain with tube tie

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121
Q

uncuffed tubes are recommended for

A

kids <8

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122
Q

uncuffed size

A

age/4 + 4

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123
Q

cuffed tube size

A

age/4+3

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124
Q

correct ETT insertion depth for kids <=2 years

A

internal diameter x 3

(cm)

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125
Q

correct ETT insertion depth for kids >2 years

A

age/2 + 12

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126
Q

is cricoid recommended in ACLS?

A

not recommended

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127
Q

what is the preferred method of confirming ETT placement

A

etCo2 continuous waveform

as in exact co2

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128
Q

what is used if continuous etco2 waveform is not available?

A

colorimetric capnography

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129
Q

what type of capnography is colorimetric

A

semi-qualitiative
confirms there is etco2 but not exactly what it is
may fail to detect co2 when ETT is correctly placed

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130
Q

purple colorimetric capnography

A

<2.28mmHg

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131
Q

beige colorimetric capnography

A

3.8-7.6mmHg

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132
Q

yellow colorimetric capnography

A

> 15.2mmHg

GOLD=GOOD

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133
Q

EtCo2 is a reliable indicator of

A
  • confirming correct ETT placement
  • chest compression effectiveness
  • ROSC
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134
Q

oxygen therapy during arrest and initial resuscitation

A

high flow oxygen 100%

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135
Q

oxygen therapy after ROSC

A

titrated to spo2 of 94=99 for non ACS

>90% fot ACS

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136
Q

mouth to mouth breathing adults protocol

A

pinch nose chin lift

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137
Q

what is the FiO2 of mouth to mouth? CO2?

A

17% fiO2

4% CO2

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138
Q

mouth to mouth breathing kids protocol

A

place mouth over victims mouth and nose

139
Q

which should be performed with one rescuer? two rescuer?

mouth to mouth
bag mask

A 
one= mouth to mouth
two= bag mask
140
Q

PP breathing rate adults

A

10 breaths per minute
(1 breath every 6 sec)

141
Q

PP breathing rate peds

A

20-30 breaths per min
(1 breath every 2-3 sec)

142
Q

what are the 6 disadvantages to excessive ventilation

A
  1. incr intrathoracic P
  2. decr venous return
  3. decr CO
  4. Decr perfusion
  5. air trapping (barotrauma)
  6. incr regurge/aspiration
143
Q

what is the best way to avoid excessive ventilation?

A

give breath until chest rise is observed
ventilate slowly
each breath over 1 sec

144
Q

what is the goal tidal volume for adults during arrest

145
Q

what is the breathing rate if compressions are required? (cardiac arrest)

A

LOWER 10 breaths/min

venous return more important

146
Q

what is the breathing rate if compressions are not required?(resp arrest)

A

HIGHER 10-12 breaths/min

venous return less important

147
Q

what is the breathing rate for mask ventilated pts (resp arrest)?

A

10-12 breaths/min (every 5-6 sec)

bc breath not as effective

148
Q

what is the breathing rate for intubated pt? (resp or cardiac arrest)

A

10breath/min

bc breaths are more effective

149
Q

what should agonal breaths be treated the same as?

150
Q

ratio of compressions to breath mask ventilation cardiac arrest

151
Q

when you check pulse and breathing for RACD how long should you do it?

A

5-10 sec and recheck every 2 min

153
Q

what is the priority for establishing vascular access?

A

1st: IV
2nd: IO
3rd: meds down ETT

154
Q

what should you do when injecting medication IV during code?

A

dose followed by N/S bolus 5 mL for peds 20mL for adults

extremity elevated for 10-20 sec

155
Q

when should IV drugs be given?

A

during compressions

156
Q

is dosing in the IO the same as IV?

157
Q

where is the best IO access? confirmation?

A

anterior tibia

fluids can flow freely without local soft tissue swelling

158
Q

IO access contrainducations

A
  1. infection at site
  2. ipsilateral fracture or crush injury
  3. previous attempt on same bone
159
Q

ETT access for meds protocol

A

inject drug in ETT
5-10mL N/S flush
5 rapid PP ventilations
compressions temporarily interrupted to avoid regurg of drug

160
Q

what can low dose epi via ETT cause?

A

beta 2 effects
- vasodilation
- hypotension
- decr CPP
- decr chance of ROSC

161
Q

ETT access dose ALL MEDS adults

A

2-3 times IV/IO

162
Q

ETT access dose ALL MEDS PEDS (not epi)

A

2-3 time IV/IO

163
Q

what is the acronym for possible ETT drugs adults

A 
NAVEL
narcan
atropine
vasopressin
epi
lidocaine

*** lipid soluble***
164
Q

what is the acronym for possible ETT drugs peds

A 
LEAN
lidocain
epi
atropine
narcan
165
Q

what is the indication for compressions adults

166
Q

what is the indication for compressions children up to puberty

167
Q

what is the indication for compression “larger children”

168
Q

what is the rate for compressions

A

100-120 per min

169
Q

how many compressions does it take before good blood flow?

170
Q

how will you know if you are pushing too fast for compressions?

A

special monitors are available to alert you

171
Q

Effective CPR

A 
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
Q

goal EtCO2 during chest compressions

A

> 10-20 mmHg

173
Q

goal DBP during chest compressions

174
Q

adequate compression depth adults? children?

A

adult 2-2.4 inches
kids 2”
infants/neonates 1.5”

175
Q

compression depth kids

176
Q

compression depth infants

A

1.5 inches

177
Q

high quality CPR pneumonic

A

CPR
Chest recoil
Push hard/fast
Rotate rescuer

178
Q

adults/kids>8 CPR technique

179
Q

kids 1-8 years old CPR technique

A

2 handed
or
1 handed

180
Q

infants w/2 responders CPR technique

?

A

thumb encircling

181
Q

infants w/1 responder CPR technique

A

2 finger
or
thumb-encircling

182
Q

CPR in mask ventilated pts

A
  • compressions are interrupted when performing breaths
  • CPR cycles: 5 cycles over 2 min period

CPR in 5 cycles over 2 min

183
Q

cycle ratio of CPR mask vent adults

184
Q

cycle ratio of CPR mask vent infant/children

A

1 provider
30:2
2 provider
15:2

185
Q

cycle ratio of CPR mask vent neonate

A

respiratory arrest
3:1
cardiac arrest
15:2

186
Q

CPR in intubated pts

A

-chest compressions are not interrupted during breaths
- CPR in 2 min increments

CPR performed in two min increments NOT cycles

187
Q

CPR intubated adults

A

100-120 compressions/min

10 breaths/min

188
Q

CPR intubated kids

A

100-120 compressions/min

breathing rate is faster depending on age

189
Q

starting compressions takes priority over everything except

A

calling for help
defibrillating Vfib/Vtach

defibrillating vfib/vtach when pads are on and ready

190
Q

can chest compreswsions continue when defib is charging

194
Q

CPR protocol when defibrillating 6

A

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
Q

where do you check the pulse adults? infants?

A

adult carotid

infant brachial

196
Q

why do we continue CPR for 2 min before reanalyzing

A

be rhythms dont usually create perfusion in the first few min

197
Q

when should IV/IO meds be given during CPR protocol/defib

A

immediately before or after shock delivery, so there is time to circulate before next check

198
Q

ECMO for arrest?

A

may be considered in select cardiac arrest pts who havent responded to conventional CPR

199
Q

abilities of the AED/AED pads

A 
sense and analyze vfib/vtach
can defibrillate (auto energy dose)
200
Q

limitations of AED/AED pads

A

does not produce ECG strip (cannot sense anything except vfib/vtach
cannot pace
cannot perform synchronized cardioversion

201
Q

automated external defibrillator (AED)

A

automated means semi or fully
semi= advises if shock is indicated and provider pushes button
fully= shocks for you if indicated

202
Q

AED protocol

A 
power on AED
attach electrode pads
clear the victim
analyze rhythm
charge and shock if advised
203
Q

manual defibrillator extra abilities on top of AED

A

show ECG strip
can perform synchronized cardioversion
can perform transcutaneous pacing

204
Q

manual defib vs AED

A

manual defib is preferred if the providers skills are adequate

205
Q

when is the analyze button used on a defibrillator

A

when BLS provider cannot analyze rhythm

206
Q

energy select button on defib

A

adjusts the energy you shock with

207
Q

how long should the clear and shock process take

208
Q

knob set to monitor

A

3 tracing screens

209
Q

knob set to defib

A

allows defib and synchronized cardioversion

210
Q

knob set to pacer

A

allows the defib to pace

211
Q

when do you use transcutaneous pacing

A

pt is bradycardic and does not respond to atropine

212
Q

transcutaneous pacing defibrillator setup

A

place pads
turn knob to pacer
set HR
turn current until capture (heart starts pacing ~40-80 mA)

213
Q

transvenous pacing

A

requires expert placment with fluroscopy

more effective
only useful in stable brady

214
Q

are most defib today mono or bi phasic?

A

biphasic
they are more effective at defibrillating
waveform is up and down

215
Q

sync button for synchronized cardioversion does what

A

ensures shock wave occurs during R wave not during T wave

216
Q

indications for synchronized cardioversion

A

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
Q

how to perform synchronized cardioversion 6

A

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
Q

when is defibrillation indicated?

A

all ventricular rhythms that are pulseless and/or irregular (vfib, vtach, torsades)

219
Q

when is defibrillation NOT indicated

A

supraventricular rhythms
asystole
pulseless electrical activity (PEA)

220
Q

is sedation necessary with defibrillation

221
Q

should you sedate with synchronized cardioversion

222
Q

how to perform defibrillation 5

A 
1 place pads posterior-anterior or anterior-anterior
2 knob to defib
3 select 200J energy
4 charge
5 shock
223
Q

adult defib biphasic energy dose

224
Q

pediatric defib biphasic 1st,2nd,up-to doses

A

2J/kg
4J/kg
up to 10J/kg

225
Q

synchonized cardioversion biphasic afib energy dose?

A

120-200J

mono= 200J

226
Q

synchronized cardioversion biphasic regular SVT energy dose

227
Q

synchronized cardioversion biphasic monomorphic vtach energy dose

228
Q

transcutaneous pacing biphasic energy dose

229
Q

peds synchronized cardioversion biphasic 1st/2nd shock

A

1st: 0.5-1 J/kg
2nd: 2 J/kg

230
Q

if the pt has a ICD how far away should you place the pad?

A

1 inch to the side

231
Q

if the pt is laying in water can you shock them

A

move to dry area then shock

232
Q

electrical arcing

A

flow of current through air between electrodes can induce fire, explosion, and thermal injury

233
Q

how many shocks are given at once?

A

1 shock at a time

234
Q

how long should the time from arrival to first shock be?

236
Q

post cardiac arrest syndrome includes

238
Q

what is the first priority for someone who achieves ROSC?

A

oxygenation and ventilation

239
Q

ROSC SpO2

A

adults: 92-98%
kids: 94-99%

240
Q

ventilation goals post ROSC

A
  1. SpO2
  2. EtCO2 35-455 mmHg
  3. avoid hyperventilation
241
Q

circulation goals post ROSC

A
  1. 12 lead ECG
  2. MAP >65
  3. SBP > 90
    (5th percentile for peds)
  4. antiarrhtymics
  5. H and Ts
242
Q

goals for post ROSC disability/exposure

A

EEG monitoring
TTM
draw labs
treat hypglycemia
CT or MRI
treat seizures
avoid ICP increases

243
Q

airway management for unconscious pt with ROSC

A

advanced airway usually

potentially head at 30 degrees to decrease cerebral edema, aspiration, and vent pneumonia

244
Q

what is the only post ROSC intervention demonstrated to improve neurologic recoveru?

245
Q

are TTM and PCI at the same time safe?

A

yes feasible and safe

246
Q

when should TTM be administered

A

comatose and unresponsive after ROSC

247
Q

what is the goal temp for TTM: adults

A

32-36 C for 24 hr

248
Q

goal temp for TTM: peds

A

32-34C for 48 hrs

249
Q

what sites should be used for core temp measurement

A

esophageal

bladder

250
Q

earliest neurologic status check not treated with TTM

251
Q

earliest neurologic status check with TTM

A

72 hr after return of normothermia

252
Q

methods of initiating TTM

A

rapid infusion of ice cold isotonic non glucose fluid (30mL/kg) =best for fast not for targeted temp
surface cooling devices
ice bags

254
Q
A

etCO2 35-40mmHg

255
Q

cardiovascular care after ROSC

A

12 lead ECG ASAP

consider coronary reperfusion therapy if stemi or AMI

256
Q

goal BP after ROSC

A

MAP > 65
Sys P>90
hypotension treated with fluids or pressor

257
Q

is TTM considered in conscious pts?

258
Q

post ROSC lab and diagnositic tests

A

`look for electrolyte abnormalities

look for pulm,cariac, or neurologic precipitants of arrest

259
Q

prophylactic antiarrhythmic therapy after ROSC

A

following vtach/vfib
consider beta blockers
consider lidocaine

260
Q

when can you consider terminating resuscitative efforts?

A

unable to get etCO2 >10mmHg after 20 min of CPR in intubated pts
DNAR order presented
dangerous environment

261
Q

when should you consider prolonging resuscitative efforts? >20min

A

cause of cardiac arrest is reversible (hypotherm, drugs)

ROSC at any time throughout attempt

262
Q

why is resuscitation in hypothermic pts different?

A

may be unresponsive to drugs, defib and pacing (drugs could accumulate)
should concentrate on rewarming (extracorporeal circulation)

263
Q

protocol for severe <30C hypothermic vfib/vtach

A

single defib then hold until >30C

264
Q

protocol for moderate <34C hypothermic vfib/vtach

A

defib but wait longer intervals

265
Q

when should termination of resuscutative efforts happen for hypothermic pts?

A

core temp is at least 30C before terminate

266
Q

7 things you must say to do after ROSC

A

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
Q

what is the most common cause of cardiac arrest?

A

ischemia from CAD

268
Q

how do you assess neurologic function

A

check blood sugar
check pupil response
AVPU peds scale
Glascow coma scale

269
Q

hypoglycemia can cause

A

somnolence

270
Q

normal glucose range

A

80-110 mg/dL

271
Q

pupil exam

272
Q

PERRL

A

pupils
equal
round
reactive to
light

273
Q

what can be indicated by unequal pupil size

A

incr ICP
brain stem injury

274
Q

AVPU scale

A

Alert
Voice
Pain
Unresponsive

275
Q

who can use an AVPU scale

276
Q

Glascow coma scale assesses

A
  1. eye opening
  2. verbal response
  3. motor function
277
Q

GCS low score

278
Q

GCS high score

279
Q

GSC intubation indication

280
Q

GCS mild head injury

281
Q

GCS mod head injury

282
Q

GCS sev head injury

283
Q

respiratory arrest treatment

A

rescue breathing
consider narcan

284
Q

bradycardia rhythms

A

sinus brady
type 1 and type 2 block
3rd deg heart block
afib w/slow ventricular
escape rhthyms

285
Q

bradycardia treatment

A

atropine
epi
dopamine
transcutaneous pacing

286
Q

SVT

A

HR>150bpm
normal QRS
may look like junctional tachycardia

287
Q

ACLS/PALS assumes all SVT is

288
Q

SVT treatment: Stable

A

slow conduction in AV
- vagal maneuvers
- adenosine

289
Q

SVT treatment: unstable

A

synchronized cardioversion

290
Q

afib ectopy

A

atrial myocardium

291
Q

SVT ectopy

292
Q

Afib/Aflutter treatment: stable

A

monitor/observe
seek consult

293
Q

AFib/Aflutter treatment: unstable

A

synchronized cardioversion

294
Q

monomorphic VTACH w/pulse treatment: stable

A

amiodarone
procainamide
sotalol
lidocaine

295
Q

monomorphic VTACH w/pulse: unstable

A

synchronized cardioversion

296
Q

Vfib/pulseless VTACH

A

CPR
Epi
defibrillation
lidocaine
amiodarone

297
Q

epi dosing

A

1mg ever 3-5 mins

298
Q

polymorphic Vtach (Torsades) (pulseless)

A

CPR
epi
defibrillation
lidocaine
magnesium

299
Q

is amiodarone better than lidocaine

A

both are equal

300
Q

what does epi do

A

incr myocardial blood flow
stimulated myocardial contraction

for pulseless rhythm

301
Q

when is epi recommended in ACLS algorithm

A

after 2 defib attempts

(although typically given immediately)

302
Q

Course Vfib

A

higher waves
higher chance of conversion

303
Q

Fine Vfib

A

smaller waves
lower chance of conversion

AFTER course vfib

304
Q

does Vfib have a pulse

305
Q

torsades

A

R wave alternate polarity/amplitude
prolonged QT

306
Q

PEA

A

no pulse
organized rhythm

307
Q

PEA causes

A

hypovolemia
hypoxia

(most common w/slowish rhythms)

308
Q

asystole/PEA tratment

A

CPR
epi
treat any reversible causes

309
Q

do you defibrilalte pts in asystole or PEA

310
Q

lone rescuer: respiratory arrest

A

CPR for 2 mins FIRST
then call for help/activate EMS/get AED

311
Q

lone rescuer: did not witness arrest

A

CPR for 2 mins FIRST
then call for help/activate EMS/get AED

312
Q

lone rescuer: witnessed cardiac arrest/collapse

A

call for help/activate EMS/get AED FIRST
then start CPR

313
Q

what change should you make for hypothermic patients during resuscitation?

A

give medications at longer spaced intervals

314
Q

when should you terminate CPR efforts on hypothermic patients

A

rewarm to 30C prior to terminating efforts

315
Q

severe hypothermic pt (<30c)

A

single defibrillation attempt
delay additional attempts until temp > 30C

316
Q

moderately hypothermic pt (<34c)

A

defibrillate as normal
longer intervals between drug doses

317
Q

defibrillator pads for children >8 years old

A

AED w/adult pads

318
Q

defibrillator pads for 1-8 year old

A
  1. AED w/peds pads and ped dose attenuator
  2. manual defib w/peds pads
  3. adult AED pads
319
Q

<1 year old defibrillator pads

A
  1. manual defib w/peds pads
  2. AED w/peds pads and dose attenuator
  3. adult AED pads
320
Q

narrow complex tachycardia

321
Q

wide complex tachycardia

A

> 0.12 s
ventricular tachycardia

322
Q

what can help differentiate between SVT or afib/aflutter

323
Q

if rhythm is SVT, adenosine will

A

convert to sinue

324
Q

if rhythm is afib/aflutter, adenosine will

A

not convert rhythm
will slow ventricular rate

325
Q

SVT

A

regular rhythm
narrow complex tachycardia

326
Q

Afib

A

irregular rhythm
narrow complex tachycardia

327
Q

what can help differentiate between SVT and VTACH

328
Q

if rhythm is VTACH, adenosine will

A

wont convert rhythm
wont slow down rhythm
(no change)

329
Q

ECMO

A

heart lung machine used for both cardiac arrest and resipratory arrest

330
Q

what patients should you consider ECMO?

A

reversible causes of cardiac arrest that have not responded to initial CPR

331
Q

most common cause of OHCAs in adults

A

ischemia from CAD

332
Q

more than 1/2 of IHCAs are due to

A

respiratory failure
or
hypovolemic shock

333
Q

what double the delivery of victims chance of survival from cardiac arrest

A

prompt CPR delivery

334
Q

what is the leading cause of death in infants

335
Q

survival rate for shockable rhythm

336
Q

survival rate for asystole

337
Q

survival rate for bradycardia

338
Q

what might be the first indicator of cardiac arrest in adults

A

brief generalized seizures

339
Q

when is VFIb most likely to develop

A

within 4 hours of ACS symptoms

340
Q

what are major factors that determine survival after cardiac arrest

A

brain injury
cardiovascular instability

341
Q

when to withhold or terminate resuscitation

A
  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
Q

rigor mortis

A

stiffening of limbs after death

343
Q

lividity

A

black and blue discoloration of skin resulting from an accumulation of deoxy blood in subQ vessels

344
Q

when to consider prolonging resuscitation

A
  1. cause if cardiac arrest is reversible
  2. if you achieve ROSC

Sp: Methods 1 (15 decks)

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