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ACLS > ACLS > Flashcards

ACLS Flashcards

1
Q

List the four steps of the BLS survey?

A
  1. Check for responsiveness
  2. Activate emergency response and get AED
  3. Check respirations and pulse (5-10s)
    - no pulse = start CPR
    - regains pulse, but not breathing = give 1 breath q 5-6s, recheck pulse q 2min
  4. Defibrillate if indicated, resume CPR immediately after shock w/compressions
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2
Q

What is the ACLS survey?

A

ABCDE

Airway - advanced airway prn, confirm with waveform capnography

Breathing - goal pulse ox >94%

Circulation - determine rhythm, appropriate meds/fluids

Disability - AVPU (alert, verbal, pain, unresponsive)

Exposure

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3
Q

What is the SAMPLE secondary assessment?

A 
S/S
Allergies
Meds
PMH
Last meal consumed
Events
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4
Q

What is normal respiration rate? What is tachy and brady?

A

10-16 = normal

>20 = tachypneic
<6 = bradypnea
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5
Q

You are first on scene, what do you do after establishing safety and checking for response?

A

Check pulse

CAROTID: 5-10s

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6
Q

If pulse is present, but respirations are poor or slow, you should begin rescue breathing. What is the frequency?

A

One breath q 5-6s

Recheck pulse q 2min

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7
Q

If advanced airways are present and practical, place it. What is the frequency of breaths now? How do you assess?

A

One breath q 6-8s if AA in place

Assess with waveform capnography*

Avoid hyperinflation

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8
Q

Trauma patient - what should you assume if there is a head or facial injury or multiple injuries?

A

Assume C-spine injury

  • use jaw thrust WITHOUT HEAD EXTENSION (if possible)
  • DO NOT PLACE C-COLLAR or immobilization devices, unless transporting
    [immobilization makes it more difficult to get air in and perfuse pt]
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9
Q

If you don’t know the last normal time (prior to stroke), can you give fibrinolytics?

A

NO

Must be given w/in 3hours* of onset of sxs

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10
Q

What 3 things are included in the Cincinnati Prehospital Stroke scale?

A
  1. facial droop
  2. arm drift
  3. abnormal speech “you can’t teach an old dog new tricks”
  • 1 abn = 72% cva probability
  • 3 abn = 85% cva probability
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11
Q

What is important timeframe regarding stroke?

A

10min: ER/stroke team assessment, order NC CT
25min: neuro assessment and CT performed
45min: CT interpretation

Initiation of fibrinolytic therapy w/in 1hr of arrival, within 3hr of sxs onset (possible up to 4.5hr)

Door to admission = 3hr

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12
Q

You’ve done your ABCs. CT comes back and what do you do if:

a) hemorrhage
b) no hemorrhage

A

a) consult neuro

b) eval for fibrinolytics

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13
Q

Describe how you would manage HTN in a stroke patient?

A
  1. IV labetalol 10-20mg IV over 1-2min repeat 1x
  2. IV nicardipine 5mg/hr (titrate as necessary)

Considerations:

  • NTG paste, hydralazine, enalapril
  • IV nitroprusside
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14
Q

What is the BP goal, if patient is not a candidate for fibrinolytics?

A

10-15% reduction in BP > 220/120

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15
Q

What is the BP goal for a patient who has received fibrinolytics?

A

Treat to goal of < 180/110

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16
Q

You are admitting your stroke patient. List a few things to monitor?

A
  • hyperglycemia (consider insulin drip)
  • anticonvulsants for seizure
  • tx fever
  • repeat CT if deterioration

Control BP to less than 140/90, check q15 min x 8, q30 x 12, q1hr x 16

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17
Q

What must you not administer in a stroke patient for 24 hours post tx?

A

Anticoag or antiplt therapy

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18
Q

What is the progression of ventricular arrhythmia?

A

Pulseless Vtach –> Vfib –> Asystole

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19
Q

Waveform capnography monitors correct placement of ET tube and effective CPR. Tell me two important cutoff values to be aware of.

A

PETCO2 < 10mmHg = Improve CPR! **

PETCO2 goal 35-40 mmHg
- predictive of recovery of spontaneous circulation

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20
Q

What is the general algorithm for Vfib/Pulseless VT?

A
  1. Start CPR
  2. Shock/defibrillate - 200J biphasic (360J monophasic)
  3. 5 cycles of CPR (2min) - obtain IV access
  4. Analyze rhythm, brief cessation of CPR (10s)
    - if rhythm, check pulse
  5. If pulse, recovery management
  6. Shockable rhythm?
    - CPR –> charge defib –> clear and repeat 200J or higher
  7. Resume CPR
  8. Meds
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21
Q

Describe what’s happening during defibrillation.

A

Does not ‘restart’ heart - terminates electrical activity to allow for spontaneous rhythm to return if possible

** Initial returning rhythm does not perfuse. Therefore, CPR must be continued before checking for a pulse **

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22
Q

You can give meds via ET route if unable to obtain IV access. Which 3 meds and dose?

A

Double the dose!

ALE

Atropine
Lidocaine
Epinephrine

23
Q

You need to give meds for your pulseless Vtach/Vfib patient. What do you start with?

A

Epinephrine 1 mg IV/IO (repeat q 3-5min)

Double dose down ET tube.

Follow with 20cc flush

24
Q

What do you do after giving epinephrine for VT/VF patient?

A

Circulate

  • Continue CPR for 5 cycles
  • reanalyze rhythm/pulse
  • shock again - same or higher J
  • resume CPR for 5 cycles
  • consider anti-arrhythmic medication
25
Q

VT/VF patient. You gave epi. 5 cycles CPR. Shock. 5 cycles CPR. You are now considering an anti-arrhythmic medication. What are the two options?

A

First choice: Amiodarone

Backup: Lidocaine

26
Q

How do you administer amiodarone?

A

300mg IV push**

repeat in 3-5min at 150mg IV bolus**

Circulate dose, reanalyze rhythm, shock, resume CPR

27
Q

After you resume NSR, what is the continuous infusion rate of amiodarone?

A

1mg/min for 6hr then 0.5mg/min for 18hr

28
Q

You do not have amio. What is your next anti-arrhythmic of choice? Describe how to administer.

A

Lidocaine

1-1.5 mg/kg IV bolus

  • may repeat dose at 5-10min intervals
  • after initial bolus, cut dose in half (0.5-0.75 mg/kg)

Max dose: 3 mg/kg

NSR established: continuous infusion at 1-4 mg/hr

29
Q

What medication do you add on if you suspect hypomagnesium? And why?

A

Magnesium Sulfate

  • may terminate or prevent recurrent TdP
  • 1-2mg IV diluted in 10mL D5W over 5-20min

RF pt: alcohol abuse, renal failure, malnutrition

30
Q

Describe the steps of post resuscitation after VT/VF

A
  1. Start appropriate infusion and fluids
  2. Consult - EP, cardio, neuro, resp
  3. Labs - BMP, trop, CBC, Mg, dig if applicable
  4. ICU transfer
  5. Consider induced hypothermia protocol
  6. Notify family/significant others
31
Q

What is PEA? What must you never do?

A

Pulseless electrical activity
- too weak off a contraction to generate a pulse/perfuse/no effective CO

** NEVER SHOCK PEA **

Requires CPR, ID and correct underlying condition

32
Q

Describe the PEA algorithm.

A
  1. CPR
  2. Epinephrine 1mg IV repeat q 3-5min
  3. Circulate for 5 cycles, 10s rhythm and pulse check
  4. Switch algorithms if necessary
33
Q

5 H’s of PEA?

A 
Hypothermia
Hypoxia
Hypovolemia
Hydrogen ion (acidosis) 
Hyper/hypokalemia
34
Q

5 T’s of PEA?

A 
Tablets/toxins
Tamponade
Tension PTX
Thrombosis - acute MI
Thrombosis - massive PE
35
Q

What must you check with asystole and how is the prognosis?

A
  • r/o lead disconnection, power off, and low signal gain
  • prognosis very poor –> occurs in the most severely ill pts and prolonged resuscitative efforts may be futile

*hypothermia or drug OD - special situations that may be potentially reversible

36
Q

How would you manage asystole?

A
  1. CPR, IV access
  2. Epinephrine or Vasopressin

Do NOT shock or pace asystole

  • if at pulse check, rhythm is established, follow that algorithm
  • if unsure if it is fine Vfib, shock one time
37
Q

When do you intervene with a bradycardic patient?

A

Must be symptomatic

Sxs: CP, SOB, altered LOC, weakness, dizzy or lightheaded, presyncope or syncope

38
Q

Describe the bradycardia algorithm.

A
  1. Airway, O2, monitor, IV, EKG
  2. Review Hs and Ts
  3. Atropine 0.5mg IV - may repeat q 3-5min up to 3mg
  4. Transcutaneous pacing - indicated if no response to atropine or severely sx
  5. Consider Epi at 2-10mcg/min OR dopamine at 2-10mcg/kg/min while waiting for pacer
  6. Call EP or cardiology for transvenous pacer
39
Q

What do you administer if you suspect opioid ingestion?

A

Naloxone

2mg intranasal or 0.4mg IM

40
Q

Atropine is indicated for symptomatic bradycardia. However, what do you need to be careful about?

A

Use cautiously in setting of ischemia or MI

Do not rely on atropine if Mobitz II or complete heart block

41
Q

Describe transcutaneous pacing?

A
  • painful
  • use only when hemodynamically unstable and unresponsive to atropine
  • C.I. w/severe hypothermia
  • not advised for asystole
  • rate = 60, program output with a safety margin of 2mA above capture
42
Q

In regards to ACS, what is bolded regarding triage for early reperfusion?

A

Cardiac markers not needed if STEMI evident

43
Q

Describe the ACS algorithm.

A
  1. Relieve CP
  2. Consult Cardio for PCI
  3. Fibrinolytics
44
Q

How do you relieve CP during ACS?

A

MOAN

  • morphine (if unresponsive to nitro)
  • O2 (maintain Pox > 90%)
  • Nitro - 1 dose q 5min, use unless:
  • BP drops 30mmHg
  • SBP < 90, P < 50 or > 120
  • PDE5i use w/in 24-48hr
  • inferior wall / RV infarction
  • Aspirin
45
Q

What is the door to balloon goal for PCI?

A

90 minutes

46
Q

What are tachycardia HR correlations?

A

100-130: generally sinus tachy, do NOT cardiovert

> 150: sxs likely present

47
Q

What is the algorithm for tachycardia with pulse?

A
  1. determine if pulse is present
    - if not, start CPR and follow pulseless VT algorithm
  2. ABCs, O2, VS
  3. Determine if stable:
    - YES: place IV, obtain ECG
    - NO: synchronized cardioversion
48
Q

What is the difference between unsynchronized and synchronized cardioversion?

A

Unsynchronized:

  • random, not correlated to QRS
  • higher energy

Synchronized:

  • analyze QRS, shock delivers at R wave peak
  • avoids falling on T wave, which may precipitate VF
  • lower energy
49
Q

When is synchronized cardioversion indicated? How do you do it?

A
  • symptomatic stable tachycardia
  • unstable tachy w/pulse indicating VT
  • SVT or stable monomophoric VT
  • unstable AF and Aflutter

Start 100J –> move to 200J for AF and VT

Start 50J –> move to 100J for Aflutter

Do not use w/junctional tachycardia or MAT

50
Q

Unsynchronized shock is the default mode for cardioversion. When is this indicated?

A
  • pulseless

- polymorphic VT

51
Q

What is the algorithm for narrow complex tachycardia?

A

Regular? Yes.

  1. Vagal maneuvers - bear down, cough, or carotid massage
  2. Adenosine 6mg IV push
  3. No conversion, repeat Adenosine 12mg IV push in 1-2min x2 [total of 3 doses]
52
Q

You address your patient with narrow complex tachycardia.

a) they convert
b) do not convert

A

a) start on long acting slowing agent
- CCB (diltiazem) or BB

b) seek expert opinion*

53
Q

Describe post arrest care for a patient.

A
  1. optimize ventilation and oxygenation
  2. treat hypotension
    - IV bolus 1-2L NS
    - NE 0.1-0.5 mcg/kg/min
    - Epi 0.1-0.5 mcg/kg/min
    - DA 5-10 mcg/kg/min
  3. obtain ECG
  4. Refer to PCI if neurologically intact
  5. Initiate hypothermia protocol if not
  6. ICU care

ACLS (1 decks)

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