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Residency > ACLS > Flashcards

ACLS Flashcards

1
Q

ABCDE of primary assessment

A

Airway Breathing Circulation Disability Exposure

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2
Q

What does AVPU stand for in the disability portion of the primary survey?

A

Alert, voice, painful, unresponsive.

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3
Q

What does sample stand for in secondary assessment?

A

Signs and symptoms, allergies, medication, past medical history, last meal, events.

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4
Q

What are the 5 Hs of cardiac arrest?

A

Hypovolemia, hypoxia, hydrogen ion (acidosis), hypokalemia/hyperkalemia, hypo, thermia

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5
Q

What are the five Ts of cardiac arrest?

A

Tension pneumothorax, Tamponade, cardiac, toxins, thrombosis - pulmonary, thrombosis - coronary

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6
Q

What are the two most common underlying and potentially reversible causes of PEA?

A

Hypovolemia and hypoxia

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7
Q

What is the average respiratory rate for an adult?

A

12 to 16 breaths per minute

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8
Q

Define tachypnoea and bradypnea

A

Tachypnoea is a respiratory rate above 20 breaths per minute and bradypnea is a respiratory rate below 12 breaths per minute.

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9
Q

What respiratory rate requires assisted ventilation with a bag mask or advanced airway?

A

Less than six breaths per minute, (hypoventilation)

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10
Q

What title volume should be supplied to an adult in respiratory arrest

A

500 to 600 mL

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11
Q

In BLS how often do you deliver ventilations?

A

5-6s

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12
Q

Excessive ventilation can be harmful because

A

It increases, intrathoracic pressure, decreases venous return to the heart and diminishes, cardiac output. It may also cause gastric inflation and predispose a patient vomiting, an aspiration of gastric contents. In addition, hyperventilation make a cerebral vasoconstriction reducing blood flow to the brain.

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13
Q

What is the most common cause of upper airway obstruction in an unconscious patient

A

Loss of tone in the throat muscles

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14
Q

How much suction force is generally necessary to suction the airway

A

80 to 120 mmHg is generally necessary

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15
Q

What kind of aspirin should a patient have for suspected myocardial infarction

A

A dose of 160 to 325 mg of non-enteric coated aspirin

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16
Q

What is the mechanism of action of aspirin?

A

Aspirin causes immediate and near total inhibition of thromboxane A production by inhibiting platelet cyclooxygenase one (COX1)

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17
Q

What are two contraindications to taking aspirin

A

A true aspirin, allergy or recent G.I. bleeding

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18
Q

Is it better to swallow or chew aspirin?

A

True, because the absorption is better, particularly when morphine has been used recently

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19
Q

What is the physiological effects of nitrates like nitroglycerin?

A

Nitroglycerine causes a reduction in left and right ventricular preload through peripheral arterial and venous dilation

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20
Q

What is the dosing for nitroglycerine in myocardial infarction

A

One sublingual nitroglycerine tablet or spray dose every 3 to 5 minutes for ongoing symptoms healthcare providers may repeat the dose twice or for a total of three doses

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21
Q

When would you not want to use nitroglycerin?

A

Situations where there is inadequate ventricular preload, such as an inferior wall MI or right ventricular infarction, hypotension, bradycardia, or tachycardia and recent phosphodiesterase inhibitor use

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22
Q

What is the time in goals of reperfusion therapy for STEMI?

A

Fibrinolytics within 30 minutes of arrival or PCI within 90 minutes of arrival

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23
Q

For agents that may be considered in patients with ischaemic type chest discomfort (OANO)

A

Oxygen, if hypoxemic, aspirin, nitroglycerin, and opiates

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24
Q

STEMI is characterized by

A

ST segment elevation in two or more contiguous leads or a new left bundle branch block 

25
Q

Three examples of fibrinolytic drugs

A

rtPA, reteplase, tenecteplase

26
Q

What is the recommended time for initiation of fibrinolytic medication’s?

A

Fibrinolytics are generally not recommended for patients, presenting more than 12 hours after the onset of symptoms, but may be considered. Do not give fibrinolytics to patients who present more than 24 hours after the onset of symptoms. 

27
Q

What are the two treatment goals of using IV nitroglycerin?

A

Relief of ischaemic chest discomfort and improvement in pulmonary oedema and hypertension

28
Q

The two major types of stroke are

A

Ischaemic and hemmorhagic

29
Q

Ischemic, stroke accounts, for what percentage of all strokes

A

87%

30
Q

Hemorrhagic, stroke accounts, for what percent of all strokes

A

13%

31
Q

For acute ischaemic stroke IV fibrinolytic treatment should be provided generally within what timeframe of onset of symptoms

A

Ideally within three hours of onset of symptoms

32
Q

Endovascular therapy for ischaemic stroke can be given up to how far from the onset of symptoms

A

Six hours from the onset of symptoms

33
Q

What are the eight Ds of stroke care?

A

Detection, dispatch, delivery, door, data, decision, drug and device, disposition

34
Q

If a stroke patient with a CT scan that does not show haemorrhage is not a candidate for fibrinolytic therapy. What is the next move?

A

Administer aspirin at admit to stroke unit or intensive care unit

35
Q

What is the fibrinolytic of choice for stroke?

A

rtPA

36
Q

What three components are evaluate it on the Cincinnati prehospital stroke scale

A

Facial droop, arm drift, and abnormal speech

37
Q

If a patient wakes up from sleeping with symptoms of a stroke when is times zero

A

The last time that that person was seen to be normal

38
Q

What is the maximum blood pressure appropriate for use of rtPA

A

185/1,10 mmHg

39
Q

What are two drugs that we can use to lower blood pressure in hypertensive patient that our candidates for acute reperfusion therapy for ischaemic stroke

A

Labetalol and nicardipine

40
Q

Which two rhythms are treated with high energy unsynchronized shocks or defibrillation’s

A

Pulseless ventricular, tachycardia, and ventricular fibrillation
PVT and VF

41
Q

During CPR what level of capnography and intra-arterial pressure indicate that the CPR quality needs to be improved?

A

Capnography of less than 10 mmHg and diastolic pressure of less than 20 mmHg suggest that you need to improve the CPR quality

42
Q

What is the drug of choice for asystole or pulseless electrical activity?

A

Epinephrine 1 mg iv/io every 3 to 5 minutes

43
Q

What energy does would you want to use for a monophasic defibrillator?

A

360 J

44
Q

What is the initial dose of energy when using biphasic defibrillator?

A

120 to 200 J

45
Q

How often should you conduct a rhythm tractor in CPR?

A

Every two minutes and it shouldn’t last any longer than 10 seconds

46
Q

Which medication is used for its beta adrenergic effects in resuscitation

A

Epinephrine

47
Q

What effect does epinephrine have on vasculature and how is that helpful during resuscitation?

A

Upper nephron causes vasoconstriction, which increases cerebral in coronary blood flow by increasing mean arterial pressure and aortic diastolic pressures.

48
Q

What is the first line antiarrhythmic medication used during resuscitation?

A

Amiodarone 300 mg bolus and then consideration of an additional 150 mg once

49
Q

What is the mechanism of action for amiodarone?

A

Amiodarone is a class three antiarrhythmic drug that blocks sodium channels at rapid pacing frequencies and exerts non-competitive anti-sympathetic action. One of the main effects of amiodarone is lengthening of the cardiac action potential.

50
Q

If amiodarone is not available, what is the second best option?

A

Lidocaine a second line to amiodarone for resuscitation

51
Q

What is the dosing for lidocaine in a resuscitation situation?

A

Lidocaine 1 to 1.5 mg per kilogram IV for the first dose and then 0.5 to 0.75 mg per kilogram IV for the second dose at 5 to 10 minute intervals to a maximum dose of 3 mg per kilogram.

52
Q

What is the mechanism of IV lidocaine in resuscitations?

A

Lidocaine suppresses the automaticity of conduction tissue in the heart by increasing the stimulation threshold of the ventricle

53
Q

What medication should be considered in torsades de points associated with a long QT interval?

A

Magnesium sulphate one to 2 g IV Dilaudid and 10 mL of fluid typically over 5 to 20 minutes

54
Q

What is the mechanism of magnesium sulphate in resuscitation?

A

It is a sodium potassium pump agonist, and it suppresses atrial calcium channels and ventricular after depolarization’s

55
Q

What is the dosage for naloxone use?

A

2 mg intranasally or 0.4 mg intramuscular or IV which may be repeated every four minutes if necessary.

56
Q

Symptomatic bradycardia first line treatment

A

Atropine first dose 0.5mg bolus. Repeat every 3-5mins. Maximum 3mg.

57
Q

Three second line options for Atropine for management of bradycardia resus

A

Transcutaneous pacing, dopamine infusion, epinephrine infusion

58
Q

Do not rely on atropine in which bradycardias

A

Mobitz type II or third degree AV block

59
Q

Initial demand rate for transcutaneous pacing

A

60/min

Residency (1 decks)

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