ACLS Flashcards
Practice Advanced Cardiac Life Support
Which four therapies are managed during post-cardiac arrest treatment?
- Target Temperature Management: Maintain between 32-36°C for at least 24 hours.
- Oxygen: Aim for SpO2 94% or greater.
- Ventilation: Start VR at 10 breaths/min; ETCO2 35-45mmHg
- Pressure: Keep MAP at 65 mmHg or greater.
What are the tasks of the team leader?
- Clearly define roles for each person.
- Ask that a new intervention be performed if it is a greater priority.
- Seek input for diagnoses.
- Confirm actions and be provide clear instructions.
List the key roles involved in cardiac arrest.
- Airway manager
- Chest compressor
- Defibrillator operator
- Team leader
- Medication administrator
- Time/recorder
What is the role of a team member.
- Ask for a new task or role if unable to perform assigned task.
- Suggest an alternative drug dose in a confident manner.
- Question a colleague who is about to make a mistake.
What should you do if you are unsure about detecting a pulse?
start CPR
What is coronary perfusion pressure?
Aortic relaxation
diastolic
What is a quality chest compression?
Includes:
- at least 2 inches in depeth
- full chest recoil
- 100-120 compressions/min
Fill in the blank.
If ETCO2 is <10 mmHg, you should reassess _____ of CPR.
quality
List the H’s
- Hypovolemia
- Hypoxia
- Hydrogen ion
- Hypo-/Hyperkalemia
- Hypothermia
What is the normal tidal volume of an adult?
8-10 ml/kg
Define:
Respiratory Failure
Inadequate oxygenation
Define:
Respiratory Arrest
Absent breathing
What is bad about excessive ventilation?
- Increases thoracic pressure
- Decreases venous return to the heart
- Decreases cardiac output
What is the tidal volume you give for a patient not breathing?
6-7 ml/kg
What is a common airway obstruction?
tongue
Treatment
Unresponsive airway obstruction
- Begin CPR immediately.
- Every two minutes, check the mouth before giving ventilations.
- Remove visible obstructions with fingers.
- Use direct laryngoscopy with Magill forceps if trained.
How much pressure should be applied when squeezing a BVM during ventilations?
Until you see the chest rise.
What suctioning pressure (mmHg) should be used?
80-120 mmHg
What are the reperfusion goals?
Hint: duration in minutes
- door to balloon: 90 minutes
- door to needle: 30 minutes
Fill in the blank.
- A rigid suction should be measured the same as an ____.
- Suctioning should not exceed ____ seconds.
- OPA
- 15
List the ACS algorithm.
- Assess ABCs and obtain a 12-lead ECG.
- Administer O2 if saturation is below 90% and give aspirin.
- Provide nitroglycerin.
- Administer morphine if pain persists despite nitroglycerin.
What is the dosage for aspirin?
Acute myocardial infarction
160-325 mg
What is the dosage for Nitroglycerine
400 mcg Q 3-5 minutes
What medication should be avoided in patients who have recently used Phosphodiesterase Inhibitors?
nitroglycerine
Why is morphine given for chest discomfort?
It decreases pain which also decreases myocardial oxygen demand.
What is an NSTEMI?
It is characterized by:
- ST depression indicating injury; or
- Dynamic T wave inversion
Why is heparin given?
It is given as an adjunct to PCI therapy.
What type of medication is streptokinase?
fibrinolytic
Fill in the blank.
Fibrinolytic therapy should be initiated within ____ of hospital arrival time.
30 - 60 minutes
List the types of strokes.
- Ischemic 87%
- Hemorrhagic 23%
What are the signs/symptoms of stroke?
- confusion
- trouble speaking
- sudden weakness
- dizziness
- trouble walking
- severe headache
What are the three components of the Cincinnati Stroke Scale?
- facial droop
- arm drift
- abnormal speech
If one of these signs is identified, there is a 72% chance the patient is having a stroke.
When should you provide oxygen to a stroke patient?
< 94% SPO2
What type of medication is rTPA?
recombinant tissue plasminogen activator
alteplase
A clot buster used for stroke patients.
What is the defibrillation shock dosage?
200j-300j-360j
What is the rate of decline in survival chances for patients without CPR?
For every minute without CPR, survival chances decrease by 7-10%.
Mechanism of action.
Amiodarone
It blocks sodium and potassium channels.
What is the dosage for Lidocaine?
Cardiac arrhythmias
- 1 - 1.5mg/kg bolus
- 0.5 - 0.75mg/kg, MAX of 3mg/kg
Indication:
Magnesium Sulfate
Torsades in patients with long QT interval.
Termination of CPR
- If ETCO2 <10 mmHg after 20 minutes
- No bystander during CPR
- No defibrillations
What conditions are considered indicative of symptomatic unstable bradycardia?
- hypotension
- AMS
- ischemic chest pain
- shock
What are the signs/symptoms of symptomatic bradycardia?
- dizziness
- weakness
- datigue
- light headed
- syncope
Indication:
Transcutaneous Pacing
- hypotension
- AMS
- shock
- ischemic chest discomfort
What rhythms are commonly treated with cardioversion?
- Atrial fibrillation/flutter with RVR
- V-tachycardia
- SVT
Treatment
Symptomatic/Stable SVT
- Vagal maneuvers
- Adenosine
- Amiodarone
make sure pathological
At what point does the monitor synchronize a rhythm?
Highest point of the R wave.
Treatment
symptomatic but stable A-fib with RVR
- Vagal maneuvers
-
Diltiazem (Cardiazem):
Initial dose: 0.25 mg/kg
If needed, a subsequent dose: 0.35 mg/kg - Maintenance infusion: 5-15 mg/hr
List some key components of post-cardiac arrest care.
- Avoid excessive ventilation: 10 breaths/min, maintain PaCO2 at 35-40 mmHg.
- Keep oxygen saturation >94%.
- Consider advanced airway and capnography.
- Treat hypotension (SBP < 90 mmHg):
IV/IO fluid bolus (1-2 liters).
Vasopressor infusion. - Address reversible causes.
- Perform a 12-lead ECG.
- Implement temperature management (32-36°C).
What is the dosage for post-arrest vasopressor infusion?
- Epinephrine: .1-.5 mcg/kg/min
- Dopamine: 5-10 mcg/kg/min
What is the dosage for epinephrine infusion in unstable bradycardia?
2-10 mcg/min
What is the dosage for epinephrine infusion in persistent hypotension?
.1 - .5 mcg/kg/min
What are the T’s of reversible causes for cardiac arrest?
- Tension pneumothorax
- Cardiac tamponade
- Toxins
- Thrombosis (coronary and pulmonary embolism)
