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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
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?
First choice: Amiodarone Backup: Lidocaine
26
How do you administer amiodarone?
300mg IV push** repeat in 3-5min at 150mg IV bolus** Circulate dose, reanalyze rhythm, shock, resume CPR
27
After you resume NSR, what is the continuous infusion rate of amiodarone?
1mg/min for 6hr then 0.5mg/min for 18hr
28
You do not have amio. What is your next anti-arrhythmic of choice? Describe how to administer.
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
What medication do you add on if you suspect hypomagnesium? And why?
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
Describe the steps of post resuscitation after VT/VF
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
What is PEA? What must you never do?
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
Describe the PEA algorithm.
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
5 H's of PEA?
``` Hypothermia Hypoxia Hypovolemia Hydrogen ion (acidosis) Hyper/hypokalemia ```
34
5 T's of PEA?
``` Tablets/toxins Tamponade Tension PTX Thrombosis - acute MI Thrombosis - massive PE ```
35
What must you check with asystole and how is the prognosis?
- 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
How would you manage asystole?
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
When do you intervene with a bradycardic patient?
**Must be symptomatic** Sxs: CP, SOB, altered LOC, weakness, dizzy or lightheaded, presyncope or syncope
38
Describe the bradycardia algorithm.
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
What do you administer if you suspect opioid ingestion?
Naloxone 2mg intranasal or 0.4mg IM
40
Atropine is indicated for symptomatic bradycardia. However, what do you need to be careful about?
Use cautiously in setting of ischemia or MI Do not rely on atropine if Mobitz II or complete heart block
41
Describe transcutaneous pacing?
- 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
In regards to ACS, what is bolded regarding triage for early reperfusion?
**Cardiac markers not needed if STEMI evident**
43
Describe the ACS algorithm.
1. Relieve CP 2. Consult Cardio for PCI 3. Fibrinolytics
44
How do you relieve CP during ACS?
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
What is the door to balloon goal for PCI?
90 minutes
46
What are tachycardia HR correlations?
100-130: generally sinus tachy, *do NOT cardiovert* >150: sxs likely present
47
What is the algorithm for tachycardia with pulse?
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
What is the difference between unsynchronized and synchronized cardioversion?
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
When is synchronized cardioversion indicated? How do you do it?
- 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
**Unsynchronized shock is the default mode** for cardioversion. When is this indicated?
- pulseless | - polymorphic VT
51
What is the algorithm for narrow complex tachycardia?
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
You address your patient with narrow complex tachycardia. a) they convert b) do not convert
a) start on long acting slowing agent - CCB (diltiazem) or BB b) seek expert opinion*
53
Describe post arrest care for a patient.
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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