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ACLS Flashcards

1
Q

When should the primary assessment occur before the BLS assessment?

A

If the pt is conscious

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2
Q

How should you maintain an open airway in an unconscious patient?

A
  • Head tilt-chin lift
  • oropharyngeal/nasopharyngeal airway
  • Advanced airway management
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3
Q

What are the types of advanced airway management?

A
  • Laryngeal mask airway
  • Laryngeal tube
  • Endotracheal tube
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4
Q

What should you confirm when using advanced airway management?

A
  • Proper integration of CPR and ventilation
  • Confirm proper placement
  • Secure the airway
  • Monitor airway placement
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5
Q

What is the best way to confirm/monitor airway placement?

A

Continuous waveform capnography

Note: Physical exam should be complimentary.

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6
Q

What % supplemental oxygen should be used in pts with cardiac arrest?

A

100%

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7
Q

What % supplemental oxygen should be used in pts undergoing a primary assessment and not in cardiac arrest?

A

Adjust oxygen level to achieve O2 saturation of 95% to 98%

Note: In acute coronary syndrome you should target an O2 saturation of 90%.

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8
Q

How should you monitor adequacy of ventilation?

A
  • Physical exam (look for chest rise and cyanosis)
  • Quantitative waveform capnography
  • Oxygen saturation

Note: Avoid excessive ventilation.

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9
Q

What value indicates adequate CPR quality when using quantitative waveform capnography?

A

10 mm Hg CO2 (at end expiration)

Note: If less than 10 mm Hg, attempt to improve CPR quality (rare to get ROSC in this situation).

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10
Q

While performing CPR, the end expiration CO2 rapidly increases to more than 25 mm Hg…

A

This may indicate ROSC (check for consciousness/pulse at next pulse check)

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11
Q

What should the intra-arterial diastolic pressure be during adequate quality CPR?

A

20 mm Hg or more

Note: If less than 20 mm Hg, attempt to improve CPR quality.

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12
Q

What are the components of the primary assessment?

A
  • Airway
  • Breathing
  • Circulation
  • Disability (consciousness, pupil dilation)
  • Exposure (trauma, bleeding, burns, medical alert bracelets)
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13
Q

What are the primary assessment levels of consciousness?

A

AVPU:

  • Alert
  • Voice
  • Pain
  • Unresponsive
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14
Q
A

1st degree heart block

Note: PR interval is greater than 0.2 seconds (1 big box).

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15
Q
A

2nd degree AV block (type 1), AKA Wenkebach

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16
Q
A

2nd degree AV block (type 2)

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17
Q
A

2:1 block (a subtype of 2nd degree type 2 AV block where every other QRS complex is dropped)

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18
Q
A

3rd degree AV block

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19
Q

Treatment for stable bradycardia

A
  • Identify and treat underlying cause
  • Monitor and observe
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20
Q

First line treatment for unstable bradycardia

A

Atropine (1 mg bolus, repeated as needed every 3-5 min to a max of 3 mg)

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21
Q

Second line treatment for unstable bradycardia

A
  • Transcutaneous pacing
  • Dopamine infusion
  • Epinephrine infusion

Note: Consider expert consultation and/or transvenous pacing.

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22
Q

When should bradycardia be considered unstable?

A
  • Hypotension
  • Acutely altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute heart failure
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23
Q

What is the adult dopamine dose for unstable bradycardia?

A

5-20 mcg/kg dopamine per minute (titrated to pt response)

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24
Q

What is the adult epinephrine dose for unstable bradycardia?

A

2-10 mcg epinephrine per minute (titrated to pt response)

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25
Q

Common causes of unstable bradycardia

A
  • Myocardial ischemia/infarction
  • Drugs
  • Hypoxia
  • Electrolyte abnormalities
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26
Q

What drug overdoses should you think about in the setting of unstable bradycardia?

A
  • Calcium-channel blockers
  • Beta blockers
  • Digoxin
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27
Q

What are examples of calcium channel blockers?

A
  • Amlodipine/nifedipine
  • Diltiazem
  • Verapamil
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28
Q

What electrolyte abnormality should you think about in the setting of unstable bradycardia?

A

Hyperkalemia

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29
Q
A

Sinus tachycardia (100-150 bpm)

30
Q
A

Supraventricular tachycardia (narrow complex and >150 bpm)

31
Q
A

Wide complex tachycardia (monomorphic V tach)

32
Q
A

Wide complex tachycardia (monomorphic V-tach)

33
Q
A

Irregular wide complex tachycardia (polymorphic V-tach)

34
Q

When should tachycardia be considered unstable?

A
  • Hypotension
  • Acutely altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute heart failure
35
Q

Treatment for unstable tachyarrhythmia

A

Synchronized cardioversion

Note: If regular, narrow complex, can consider adenosine.

36
Q

If persistent unstable tachyarrhythmia following synchronized cardioversion, whats the next step

A
  • Continue looking for underlying cause
  • Increase energy level for next cardioversion
  • Consider adding an anti-arrhythmic drug
  • Consider expert consultation
37
Q

What is considered a widened QRS complex?

A

0.12 seconds or greater

38
Q

Treatments to consider for stable wide complex tachyarrhythmia

A
  • Adenosine (ONLY if regular and monomorphic)
  • Antiarrhythmic infusion
  • Expert consultation
39
Q

Treatment for stable narrow complex tachyarrhythmia

A
  • Vagal maneuvers (if regular)
  • Adenosine (if regular)
  • Beta blocker or calcium-channel blocker
  • Expert consultation
40
Q

Adult adenosine dose for tachyarrhythmia

A

6 mg rapid IV push (followed by a normal saline flush)

followed by

12 mg IV push + flush (if needed)

41
Q

What are the common antiarrhythmic infusions used for stable wide-QRS complex tachycardia?

A
  • Procainamide
  • Amiodarone
  • Sotalol
42
Q

Adult procainamide dose for stable wide-QRS tachycardia

A

20-50 mg per minute until endpoint is reached

then

1-4 mg per minute maintenance

43
Q

What is the maximum dose of procainamide for stable tachyarrhythmia?

44
Q

What are the endpoints for procainamide when you should switch to maintenance infusion?

A
  • Hypotension ensues
  • QRS duration increases by 50% or more
  • Maximum dose given (17 mg/kg)
45
Q

When should procainamide be avoided?

A
  • Prolonged QT
  • CHF
46
Q

Adult amiodarone dose for stable wide-QRS tachyarrhythmia

A

150 mg over 10 minutes (repeated as needed if V-tach recurs)

then

1 mg per minute maintenance (for the first 6 hours)

47
Q

Adult sotolol dose for stable wide-QRS tachyarrhythmia

A

100 mg over 5 minutes

48
Q

When should sotalol be avoided?

A

Prolonged QT

49
Q

What are the shockable rhythms?

A
  • Ventricular fibrillation
  • Monomorphic V-tach
50
Q

What are the non-shockable rhythms in the setting of cardiac arrest?

A
  • PEA (pulseless electrical activity)
  • Asystole
51
Q
A

Ventricular fibrillation

52
Q
53
Q

How far should each compression depress the sternum?

A

At least 2 inches (5 cm)

54
Q

How frequently should compressors switch?

A

Every 2 minutes (or sooner, if fatigued)

55
Q

What should the compression:ventilation ratio be during CPR?

A

30:2 (no advanced airway)

Note: 1 breath every 6 seconds if there is an advanced airway (with continuous compressions).

56
Q

What charge strength should the defibrillator adminster?

A

120-200 J (if biphasic)

360 J (if monophasic)

57
Q

What drugs are routinely administered during ACLS?

A
  • Epinephrine
  • Amiodarone
  • Lidocaine
58
Q

Adult epinephrine dose during CPR

A

1 mg (every 3-5 minutes)

59
Q

Adult amiodarone dose during CPR

A

300 mg (first dose)

then

150 mg (second dose)

60
Q

Adult lidocaine dose during CPR

A

1-1.5 mg/kg (first dose)

then

0.5-0.75 mg/kg (second dose)

61
Q

CPR algorithm for shockable rhythm

A
  1. Start 30:2 CPR
  2. Shock as soon as possible
  3. CPR (2 min)
  4. Shock again (if shockable)
  5. Administer epinephrine during next 2 min CPR
  6. Shock again (if shockable)
  7. Administer amiodarone or lidocaine during next 2 min CPR

Note: Repeat steps 4-7 (stop meds when maximum doses reached).

62
Q

Reversible causes for cardiac arrest

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypokalemia or hyperkalemia
  • Hypothermia
  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary
63
Q

CPR algorithm for nonshockable rhythm

A
  1. Start 30:2 CPR
  2. Apply pads as soon as available and check rhythm
  3. Administer epinephrine immediately (if not shockable) and do 2 more min CPR
64
Q

What are the components of the initial stabilization phase after ROSC is achieved?

A
  • Manage airway
  • Manage respiratory parameters
  • Manage hemodynamic parameters
  • Get 12-lead ECG
65
Q

How should you manage the airway after ROSC?

A

Early placement of an endotracheal tube is recommended

66
Q

How should you manage respiratory parameters after ROSC?

A
  • Increase breaths to 10 breaths per minute
  • Target SpO2 of 92-98%
  • Target PaCO2 of 35-45 mm Hg
67
Q

How should you manage hemodynamic parameters after ROSC?

A
  • Target systolic BP > 90 mm Hg
  • Target mean arterial pressure > 65 mm Hg
68
Q

When should you consider emergent cardiac intervention after ROSC?

A
  • STEMI
  • Unstable cardiogenic shock
  • Pt requiring mechanical circulatory support
69
Q

Targeted temperature management

A

Cooling pts to 32-36 degrees celsius for 24 hours after ROSC to preserve brain function

70
Q

What are the main components of continued management following ROSC for pts that are unable to follow commands?

A
  • Targeted temperature management
  • Head CT
  • EEG monitoring

BLS/ACLS (2 decks)

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