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methods 1 > 8. ACLS Scenarios > Flashcards

8. ACLS Scenarios Flashcards

1
Q

PEA

A

no pulse
ECG shows organized rhythm

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2
Q

ACS

A

pt exhibiting symptoms of MI due to partial or complete block of coronary artery

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3
Q

ACS symptoms

A

chest pain
pressure

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4
Q

drugs for respiratory arrest

A

narcan
- nasal: 2-4 mg
- IM: 0.4mg

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5
Q

narcan can be repeated after

A

4 mins

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6
Q

drugs for bradycardia

A

atropine: 1mg
epi: 2-10 mcg/min
dopmine: 5-20 mcg/kg/min

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7
Q

atropine can be repeated

A

every 3-5 mins

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8
Q

max dose of atropine

A

3mg

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9
Q

drugs for SVT

A

adenosine: 6mg/12mg
sotalol: 100mg or 1.5mg/kg

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10
Q

how many doses of adenosine can be given

A

1st: 6mg
2nd: 12mg
3rd: 12 mg

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11
Q

adenosine mechanism

A

slows conduction through AV node by stopping heart for a few seconds

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12
Q

sotalol mechanism

A

beta blocker
antiarrythmic

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13
Q

sotalol CI

A

prolonged QT syndrome
(torsades)

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14
Q

drugs for monomorphic VTACH with pulse

A

amiodarone: 150 mg over 10 min
lidocaine: 1-1.5 mg/kg
sotalol: 100 mg or 1.5mg/kg
procainamide: 20-50mg/min

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15
Q

procainamide mx infusion

A

1-4 mg/min

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16
Q

drugs for Vfib/pulseless VTACH

A

epi: 1 mg
lidocaine: 1-1.5 mg/kg
amiodarone: 300mg bolus

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17
Q

lidocaine Vfib/pulseless VTACH first/second doses

A

1st: 1-1.5mg/kg
2nd: 0.5-0.75 mg/kg

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18
Q

how often can lidocaine be redosed

A

5-10 mins

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19
Q

amiodarone vfib/pulseless vtach 1st/2nd doses

A

1st: 300 mg
2nd: 150 mg

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20
Q

amiodarone post-ROSC doses

A

1st 6 hrs: 1mg/min
next 18 hrs: 0.5 mg/min

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21
Q

amiodarone CI

A

sinus node dysfunction
2nd degree heart block
3rd degree heart block
torsades

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22
Q

when are amiodarone and lidocaine recommended to be given for vfib/pulseless VTACH

A

after 3rd shock

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23
Q

drugs for torsades

A

epi: 1mg
magnesium: 1-2 g over 10-20 mins
lidocaine: 1-1.5 mg/kg

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24
Q

drugs for Asystole/PEA

A

epi; 1 mg

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25
Q

drugs for ACS

A

NTG: 3 tablets
aspirin: 160-325 mg PO

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26
Q

NTG can be repeated

A

3-5 mins up to 3 total doses

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27
Q

drugs for post-ROSC hypotension

A

NE: 0.1-0.5 mcg/kg/min
Epi: 2-10 mcg/kg/min
Dopa: 5-20 mcg/kg/min

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28
Q

Respiratory Arrest protocol

A
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29
Q

bradycardia protocol

A
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30
Q

SVT protocol

A
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31
Q

Afib/Aflutter protocol

A
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32
Q

monomorphic VTACH w/Pulse protocol

A
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33
Q

monomorphic VTACH: pulseless

A

CPR
defibrillation
Epi
Amiodarone (300mg)

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34
Q

Monomorphic VTACH: Pulse and Stable

A

antiarrythmics
- amiodarone (150mg)
- lidocaine (1.5mg/kg)

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35
Q

monomorphic VTACH: pulse and unstable

A

synchronized cardioversion

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36
Q

Vfib/Pulseless VTACH protocol

A
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37
Q

Asystole/PEA protocol

A
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38
Q

polymorphic VTACH (torsades) protocol

A
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39
Q

ROSC protocol

A
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40
Q

ACS etiology

A

plaque in CA
plaque becomes unstable
plaque ruptures
PLTs cover ruptured plaque
PLT-rich thrombus

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41
Q

hos is coronary ischemia diagnosed

A

12 lead ECG

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42
Q

ACS ECG types

A

normal
STEMI
NSTE w/T wave inversion
NSTE w/ST depression

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43
Q

STEMI diagnosis

A

ST elevation on ECG

44
Q

STEMI

A

completely blocke CA that leads to heart attack

45
Q

highest risk ECG

A

STEMI

46
Q

NSTEMI diagnosis

A

ST depression
or
T wave inversion

47
Q

NSTEMI

A

partially blocked CA

48
Q

unstable angina

A

normal ECG

49
Q

what should adults do if they have chest pain

A

chew aspirin

50
Q

most important step for pt with chest pain

A

12 lead ECG

51
Q

only way to ID STEMI

A

12 lead ECG

52
Q

ACS treatment

A

O2
Aspirin
NTG
Morphine

heparin/plavix
reperfusion therapy

53
Q

what pts should not receive morphine

A

NSTEMI does not get morphine

54
Q

what pts should not receive fibrinolytics

A

NSTEMI does not get fibrinolytics

55
Q

reperfusion therapy includes

A

PCI
fibrinolytics

56
Q

when do ACS pts need O2

A

SpO2 < 90%

57
Q

when should NTG be avoided

A

SBP < 90 mmHg or 30mmhg less than baseline
PDE inhibitors
milrinone
viagra

58
Q

if pt becomes hypotensive after NTG, what action should be taken?

A

administer fluid bolus

59
Q

aspirin mechanism

A

plt inhibitor
decr coronary reocclusion after fibrinolytics

60
Q

when should you consider rectal aspirin

A

N/V
PUD
upper GI disorders

61
Q

rectal aspirin dosing

A

300mg

62
Q

do you give aspirin to pts with ASA/NSAID allergy

A

no

63
Q

heparin

A

given early to STEMI pts
adjunct to PCI/fibrinolytics

64
Q

P2Y12 inhibitor mechanism

A

antiplatelet

65
Q

most common P2Y12

A

plavix

66
Q

PCI

A

balloon angioplasty and stenting of coronary artery

67
Q

best treatment for ACS

A

PCI

68
Q

when does PCI need to be accomplished?

A

within 90 mins of first medical contact

(120 mins if transfer required)

69
Q

when are fibrinolytics considered for PCI

A

if PCI will not be able to be initiated within 90-120 mins

70
Q

fibrinolytics are considered for what pts

A

STEMI only

71
Q

timeline for fibrinolytics

A

30 mins of arrival

72
Q

fibrinolytics are not given if ACS symptoms have been present for _____ hrs

A

12 hrs

73
Q

fibrinolytic CI

A

NSTEMI
HTN (>180/100 mmHg)
recent head trauma (3 months)
GI bleed
blood thinners
stroke symptoms > 3 hrs
ACS symptoms > 12 hrs

74
Q

STEMI/NSTEMI protocol

A
75
Q

ACS protocol

A
76
Q

ischemic stroke

A

blood clot blocks blood flow to brain

77
Q

hemorrhagic stroke

A

weakened vessel ruptures and bleeds into brain

78
Q

subarachnoid stroke

A

blood vessel outside brain ruptures

79
Q

time zero

A

last time patient was “normal”

80
Q

ischemic stroke is ____% of strokes

A

87%

81
Q

hemorrhagic stroke is ___% of strokes

A

10%

82
Q

subarachnoid stroke is ___%

A

3%

83
Q

ischemic stroke treatments

A

IV fibrinolytics
aspirin
surgical endovascular
intra arterial fibrinolytics
insulin

84
Q

preferred treatment for ischemic stroke

A

fibrinolytics
- rtPA (alteplase)

85
Q

timeline for ischemic stroke fibrinolytics

A

1 hr of arrival
3 hr of symptoms

86
Q

when is apirin given for ischemic stroke

A

if fibrinolytics are CI

87
Q

timeline for surgical endovascular therapy

A

90 mins after arrival
(up to 6 hrs)
(up to 24 hrs if penumbral imaging is required)

88
Q

when is penumbral imaging required

A

symptoms > 6 hrs

89
Q

when are intra arterial fibrinolytics administerd for ischemic stroke

A

if IV fibrinolytics are CI

90
Q

timeline for intra arterial fibrinolytics

A

within 24 hrs of symtoms

91
Q

can you take aspirin and fibrinolytics

A

no - delay aspiring for 24 hrs post fibrinolytics

92
Q

treatment for hemorrhagic/subarachnoid stroke

A

STAT neurology consult
avoid fibrinolytics

93
Q

stroke recognition

A

Facial drooping
Arm weakness
Speech difficulty
Time to call 9-1-1

94
Q

cincinatti prehospital stroke schedule

A

determines if stroke is occuring

95
Q

NIHSS

A

quantifies severity of stroke

96
Q

one abnormal finding

A

72% of stroke

97
Q

3 abnormal findings

A

85% of stroke

98
Q

NIHSS higher score

A

bad

99
Q

NIHSS timeline

A

within 10 mins of ED arrivalk

100
Q

how are stroke diagnosed

A

CT scan

101
Q

CT scan timeline

A

within 20 mins of arrival

102
Q

acute stroke protocol EMS

A
103
Q

acute stroke protocol ED

A
104
Q

stroke managment in ICU

A

treat blood glu > 185
prevent HTN
urgent CT if neuro deteriorates

105
Q

protocol for cardiac arrest in pregnancy

A
106
Q

LVADs

A

chest compression if MAP <50 mmHg or EtCO2 < 2o mmHg

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