ACLS Flashcards
1
Q
What should you do with a patient if they are not breathing but they have a pulse?
A
1 breath/5-6 seconds, if advanced airway, 1 breath/6 seconds
2
Q
when should you give your patient epinephrine during an emergnecy?
A
if they have no pulse (1.0mg 1:10,000)
3
Q
when should you give atropine to a patient in an emergency situation?
A
if they have a low HR (0.5mg)
4
Q
When should you give amiodarone in an emergency situatio?
A
antiarrythmic, use for pulseless arrest regractory VF/VT: 300 mg, 150 mg, IVP.
5
Q
When should you use adenosine in an emergency situatoin?
A
use to decrease hR in SVT; Diagnostic for stable regular VT
6
Q
What should you do if your patient is in VF/pVT
A
- defibrillate then immediate 2 min CPR
- 1 mg. epi after second shock, repeat Epi q 3 to 5 min
- 300 mg Amiodarone after third shock, then 150mg after 3 to 5 minutes
7
Q
When blood enters the atria of the heart, an electrical impulse is sent out from the ___ node that conducts through the atria causing them to contract
A
SA
8
Q
When the atrial contraction registers on an EKG strip, it is also known as a ____
A
P wave
9
Q
The impulse from the atrial contraction travels to the __ node
A
AV node
10
Q
The impulse from teh AV node sends out an electrical impulse that travels through what three things?
A
Bundle of His, bundle branches, and Purkinje fibers of the ventricles
11
Q
What is a ventricular contraction registered as on an eKG?
A
QRS complex
12
Q
repolarization is also known as what on the EKG strip/
A
t wave
13
Q
Can you observe the repolarization of the atria on an EKG strip?
A
No because it coincides with the QRS complex
14
Q
what is a sinus rhythem?
A
P wave, QRS complex, and T wave
15
Q
How do you determine heart rate on an EKG strip?
A
Count the QRS complexes on a six second strip and then multiple by 10 to give a rate per minute
16
Q
What is ventricular fibrillation?
A
it is the most common rhythm that occurs immediately after cardiac arrest. this is when ventricles quiver and are unable to uniformly contact to pump blood. Thus, we need to have early defibrillation
17
Q
What are the types of VF?
A
Fine and Coarse
18
Q
When does Coarse VF occur?
A
happens immediately after cardiac arrest and has better prognosis with defibrillation
19
Q
What happens with Fine VF?
A
Waves are nearly flat and similar to asystole. It often develops after more prolonged cardiac arrest and is more difficult to correct.
20
Q
What is the treatment for a patient with VT without a pulse?
A
defibrillation
21
Q
What is pulseless electrical activity?
A
When the heart is beating and has a rhythm, but the patient does not have a pulse.
22
Q
What should you give a patient who has a pulseless electrical activity?
A
epinephrine 1mg 1:10,000
23
Q
What are H’s and T’s?
A
- hypovolemia, hypoxia, acidosis (hydrogen ion), hypo/hyperkalemia, hypothermia
- tension pneumothorax, tamponade, cardiac, toxins, thrombosis (pulomonary), thrombosis (coronary)
24
Q
What is asystole?
A
When there is no detectable cardiac activity on EKG.
25
When can asystole occur?
can occur immediately after cardiac arrest or may follow VF or PEA, or third degree heart block
26
How do you treat asystole?
The same as PEA, can give epinephrine (1mg 1:10,000)
27
What does the AHA recommend if the patient has been in asystole for 15 minutes?
can call code but involve the family in the decision if they are available
28
What is bradycardia?
less than 50 beats per minute
29
What is the treatment for systematic bradycardia?
- provide oxygen
- give atropine 0.5mg
- call for transcutaneous pacemaker
30
What happens to electrical impulses when the patient is experiencing sinus bradycardia?
SA node fires at a rate slower than normal for a person's age.
31
What is first degree AV block?
all P waves conducted through AV node, but delayed.
32
How would a first degree AV block appear?
prolonged PR interval. It seems that all components of the EKG are normal except the PR interval. What happens is that the SA node is delayed at the AV node.
33
What is second degree AV Block type?
This is when some P waves conducted through the AV node, others are blocked, this is progressive lengthening of the PR interval with dropped QRS complexes
34
Where does the delay in second degree AV block type I occur?
AV node. results in a progressively lengthening PR interval and then there will be a P wave that is not followed by a QRS complex.
35
What is Second Degree AV Block Type II
Some P waves conducted through the AV nodes, but others are blocked. This is different than the other second degree AV block type because the PR interval stays the same, but there are dropped QRS complexes
36
Where does the delay for a second degree AV block type II occur?
Below the AV node at the Bundle of His or bundle branches
37
What is third degree or complete AV block
No P waves conducted through the AV node. There is no communication between the SA and AV nodes
38
What is the pathology of a third degree or complete AV block?
Impulse originating in the SA node is completely blocked. It can happen either at the AV node, bundle of His or bundle branches. In response, the heart may develop a secondary pacemaker in order to stimulate the ventricles to contract. The location of this "escape pacemaker" will determine if the QRS complexes are wide or narrow
39
If a patient is experiencing Third degree or complete AV block, what does it mean if they have a junctional escape?
Narrow QRS complex, rhythm may be possible and stable with ventricular rate of more than 40 bpm.
40
If a patient is experiencing third degree or complete AV block, what does it mean if they have a ventricular escape pacemaker rhythm?
Wide QRS complex that is usually unstable with a heart rate of less than 40 bpm.
40
If a patient is experiencing third degree or complete AV block, what does it mean if they have a ventricular escape pacemaker rhythm?
Wide QRS complex that is usually unstable with a heart rate of less than 40 bpm.
41
When do heart blocks occur?
in result of cardiac damage following a MI
42
If the patient has a junctional escape rhythm, what should you provide the patient if they ahve high degree blocks characterized by poor perfusion?
Atropine 0.5mg
43
If the patient has complete AV blocks, how should you treat the patient?
transcutaneous packing
44
What are the three basic groups of tachycardia?
sinus tachycardia, supraventricular tachycardia, and ventricular tachycardia.
45
What are the key factors to note if your patient is experiencing tachycardia?
- stable vs. unstable
- pulse vs. no pulse
- narrow QRS vs Wide QRS
- regular vs. irregular
46
What is the pathology for sinus tachycardia?
SA node is firing at a rate that is faster than normal for a person's age, rate is usually 100 to 150 bpm
47
What is the key to knowing whether or not your patient is experiencing sinus tachycardia on an EKG?
All components of a normal EKG are present.
48
What are the symptoms a patient can experience if they have sinus tachycardia?
pain, fever, or agitation
49
What is supraventricular tachycardia?
rhythms that begin above the bundle branches, these rhythms begin in the SA node, atrial tissue, or the AV junction
50
What is the characteristic of a supraventricular tachycardia on an EKG?
Narrow QRS complexes
51
Is supraventricular tachycardia the name of a specific arrhythmia?
It is used to describe a category of regular arrhythmias that cannot be identified more accurately because they have indistinguishable P waves due to their very fast rate, usually greater than 150bpm
52
What are the primary pacemakers of the heart?
SA node and AV nodes
53
What is the name of an atrial tachycardia that suddenly arrises from a very irritable automaticity focus?
Paroxysmal supraventricular tachycardia
54
What is multifocal atrial tachycardia?
chaotic and irregular rhythm due to multiple foci, each with their own rates, stimulating the atria
55
What is juntional tachycardia?
the AV junctoin becomes irritable and begins firing rapidly leading to a very rapid heart rate
56
what does the EKG look like for a patient with junctional tachycardia?
If P waves are present, they would be inverted. The reason that P waves are inverted in junctional rhythms is because the impulse is being conducted backwards through the atria.
57
What is atrial fibrillation?
Blood pools in the heart where a blood clot can form.
58
What is the rate of AF?
400-600 impulses per minute triggered by the AV node.
59
What medication can you give the patient if they are experiencing atrial fibrillation/
calcium channel blockers
60
What is an atrial flutter?
impulse circles around a large area of atrial tissue create multiple P waves
61
How do you determine whether or not the rhythm is regular if the patient has atrial flutter
If the AV nodes blocking the rapid impulses coming to it fires at a regular rate
62
When is the rhythm irregular if a patient has Atrial Flutter?
If the AV node blocks the rapid impulses coming to it at an irregular rate
63
What is ventricular tachycardia?
When an irritable automaticity focus on either ventricle begins firing. It overridesthe higher pacemaker sites and takes control of the heart. Ventricles begin firing prematurely and at an abnormal manner.
64
What does the EKG look like if a patient has Ventricular Tachycardia?
QRS complex is wide
65
What is monomorphic ventricular tachycardia?
when the QRS complexes are of the same shape and amplitude.
66
What is polymorphic ventricular tachycardia?
When QRS complexes are of different shape and amplitude.
67
How do we treat polymorphic ventricular tachycardia?
The same as VF= defibrillation
68
What does torsades de pointes look like on an EKG?
When the QRS complexes are of different shape and amplitude.
69
What causes torsades de pointes?
low potassium or quinidine toxicity
70
What is the treatment for torsades de pointes?
magnesium
71
What is one of the earliest signs of MI on an EKG?
When there is ST elevation
72
How do you determine if there is an ST elevation?
Use an isoelectric line that goes rom the beginning to the endof the QRS complex. If the line is level, then it is normal, but if hte ST segment exists the complex prior to returning to the isoelectric line, then the ST segment is elevated
73
If an MI is mild, does that mean that the ST segment has to be elevated?
No, an ST elevation does not need to happen if mI has occurred.
74
What can indicate ischemia on an EKG?
Inversion of the T wave
75
What is the compression to ventilation ratio?
30:2
76
What is the rate for compression?
100-120/min
77
What should the depth of a compression be?
2 inches
78
If there are two people present, what is the rotation time limit?
2 minutes to prevent fatigue and improve quality of chest compressions
79
What happens if after 30 compressions, patient is not breathing effectively?
head tilt-chin to open the airway when there is NO suspected cervical spine injury
80
If you need the cervical spine to be immobilzied, what can you do instead of the usual technique?
jaw-thrust with cervical spine immobilization. Do not tilk the head or the neck if neck injury is expected.
81
How many breaths should you give to your patient?
2 breaths, with a bag valve mask (2 people) or a face mask (1 person)
82
If the patient is gasping for breath or is demonstrating agonal breaths after cardiac arrest, what should you do?
resume rescue breathing
83
What should you do if a patient has a pulse but is not breathing?
1 breath ever 5-6 seconds (10-12 breaths perminute)
84
What is the best way to relieve severe choking in a responsible adult or child?
abdominal thrust
85
When should you use a nasopharyngeal airway?
use in a semi-conscious person, selecting the appropriate size by comparing the outer circumference of the nPA with the inner aperture of the nares, the length should be determined by measuring from nose tip to the earlob
86
When should you use the oral pharyngeal airway?
use in an unconscious person with no gag reflex, select the appropriate size by placing the tip of the OPA at the corner of the mouth and then the flange should be at the angle of the mandible
87
When is it recommended to use a laryngeal mask airway?
if the provider is inexperienced with ETT
88
When should you use a king airway or combitube?
If the provider is inexperienced or has difficulty placing an ETT
89
What is the preferred airway to ensure that it is adequate an dprotected?
endotracheal tube
90
How do you placed an endotracheal tube?
using a laryngoscope, or fiber optic device, looking for the triangular vocal cords, and placing the ETT through them .
91
How long should an attempt be for endotracheal tube?
30 seconds
92
when should you insert the advanced airway?
several minutes into the attempted resuscitation since airway insertion requires an interruption in chest compressions for many seconds
93
What is the benefit of placing an ETT placement?
allows for the most effective PETCO2 monitoring
94
What is recommended for intubated patients as the best way to confirm ET placement, effectiveness of CPR, and detecting ROSC?
Having continuous quantitative waveform capnography
95
How long should you suction through an ETT?
10 seconds
96
How much oxygen is given to a patient that is being resuscitated with a facemask with reservoir?
provides 100% oxygen with 10 to 15 L/min
97
How do you confirm E.T. Tube placement?
- Chest rise
- mist in the tube
- auscultation of lungs for bilateral breath sounds
- auscultation of the gastric area-no gurgling should be heard that would indicate intubation of the esophagus
- continuous quantitative waveform capnography
