ACLS Flashcards
What should you do with a patient if they are not breathing but they have a pulse?
1 breath/5-6 seconds, if advanced airway, 1 breath/6 seconds
when should you give your patient epinephrine during an emergnecy?
if they have no pulse (1.0mg 1:10,000)
when should you give atropine to a patient in an emergency situation?
if they have a low HR (0.5mg)
When should you give amiodarone in an emergency situatio?
antiarrythmic, use for pulseless arrest regractory VF/VT: 300 mg, 150 mg, IVP.
When should you use adenosine in an emergency situatoin?
use to decrease hR in SVT; Diagnostic for stable regular VT
What should you do if your patient is in VF/pVT
- 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
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
SA
When the atrial contraction registers on an EKG strip, it is also known as a ____
P wave
The impulse from the atrial contraction travels to the __ node
AV node
The impulse from teh AV node sends out an electrical impulse that travels through what three things?
Bundle of His, bundle branches, and Purkinje fibers of the ventricles
What is a ventricular contraction registered as on an eKG?
QRS complex
repolarization is also known as what on the EKG strip/
t wave
Can you observe the repolarization of the atria on an EKG strip?
No because it coincides with the QRS complex
what is a sinus rhythem?
P wave, QRS complex, and T wave
How do you determine heart rate on an EKG strip?
Count the QRS complexes on a six second strip and then multiple by 10 to give a rate per minute
What is ventricular fibrillation?
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
What are the types of VF?
Fine and Coarse
When does Coarse VF occur?
happens immediately after cardiac arrest and has better prognosis with defibrillation
What happens with Fine VF?
Waves are nearly flat and similar to asystole. It often develops after more prolonged cardiac arrest and is more difficult to correct.
What is the treatment for a patient with VT without a pulse?
defibrillation
What is pulseless electrical activity?
When the heart is beating and has a rhythm, but the patient does not have a pulse.
What should you give a patient who has a pulseless electrical activity?
epinephrine 1mg 1:10,000
What are H’s and T’s?
- hypovolemia, hypoxia, acidosis (hydrogen ion), hypo/hyperkalemia, hypothermia
- tension pneumothorax, tamponade, cardiac, toxins, thrombosis (pulomonary), thrombosis (coronary)
What is asystole?
When there is no detectable cardiac activity on EKG.
When can asystole occur?
can occur immediately after cardiac arrest or may follow VF or PEA, or third degree heart block
How do you treat asystole?
The same as PEA, can give epinephrine (1mg 1:10,000)
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
What is bradycardia?
less than 50 beats per minute
What is the treatment for systematic bradycardia?
- provide oxygen
- give atropine 0.5mg
- call for transcutaneous pacemaker
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.
What is first degree AV block?
all P waves conducted through AV node, but delayed.
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.
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
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.
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
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
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
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
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.