ACLS Flashcards by Avery Smith

The best indicator that a patient has stopped perfusing is to check _____ because they do not have to have a ______ to have cardiac arrest

Pulses
Bad rhythm

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What will be the first indicator your pt is arresting?

End tidal CO2

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ACLS algorithm

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First vital sign to get after a code?

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What can you use an ultrasound for post arrest?

To see if the heart is squeezing or if an artery is pulsing

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Who is someone you can ask to do CPR during surgery?

The surgeon!

We have to delegate compressions/ventilations to lead the code

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What rhythms do we shock?

Vfib
Pulseless vtach

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Treatment for stable vs unstable SVT

Stable: adenosine
Unstable: Cardiovert

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If you have biphasic equipment, how many joules do you start with to defibrillate?

200 J

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If you have monophasic equipment, how many joules do you start with to defibrillate?

360 J

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After defibrillation, what should you immediately do?

Restart CPR

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After a pulse check, normal etCO2 could be due to:

Amazing compressions
Return of perfusion

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What is an alternative route to give meds if you didn’t have an IV? What meds can you give this way?

ET tube
Lido, epi, narcan, atropine (LEAN)

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First med we give for pulseless rhythm?

Epi 1 mg

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How often do you repeat Epi 1mg during ACLS?

3-5 minutes

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After epi, what would your next medication be for ventricular arrhythmias?

Lido or amio

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What is the dose for amio during ACLS?

300 mg initally
Second dose: 150 mg

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What is the dose for lido during ACLS?

1-1.5 mg/kg

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What are the H&Ts?

Hypoxia
Hypovolemia
Hypothermic
Hydrogen ions (acidosis)
Hyper/hypokalemia
Toxins
Tamponade (cardiac)
Tension pneumo
Thrombosis

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What are the 2 most common causes of cardiac arrest?

Hypoxia and hypovolemia

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If pt is hypovolemic, how do you treat?

Crystalloids
Blood

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How do you treat acidosis?

Bicarb
Good (hyper)ventilation
Replace volume

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What are the 2 common rhythms in someone who is hypothermic?

Bradycardia or vfib

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How to treat hyperkalemia?

Stabilize cells (calcium)
Insulin/D50
Bicarb
Volume
Albuterol
HD if needed

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How do treat tension pneumothorax?

Needle decompression Chest tube

We will see JVD in tension pneumo due to:

Increased thoracic pressure

What is beck's triad? What do we see this in?

Tamponade Hypotension, JVD, narrowed pulse pressure

What are potential different toxins? How do you treat each?

Opiods: narcan; focus on ventilation Tylenol: hard to treat, kills liver Benzos: flumazenil Beta blockers: usually accidental - glucagon: 3-5mg - If unstable, may need to pace Psych meds - tricyclics: causes acidosis and messes up heart - treat with bicarb

How do treat PE or cardiac thrombosis?

Systemic anti-thrombotic (tPA) IR (thombectomy) Catheter directed therapy for localized tPA

Asystole/PEA causes:

Hypoxemia: get an airway Hypovolemia: replace volume

What 2 rhythms have a worse prognosis?

Asystole PEA

Bradycardia algorithm

Basic treatment for bradycardia

If unstable: start with electrical therapy If no access to electrical therapy, start with epi gtt; if no epi, use dopamine

What is considered as unstable bradycardia?

Hypotensive Decreased LOC

What is the dose for an epi gtt?

2-10 mcg/min

What is the dose for a dopamine gtt?

5-20 mcg/kg/min (more like 10-20)

Adult tachycardia with a pulse algorithm

If you have unstable tachycardia, what is the first treatment?

Cardioversion

What is the electricity dose for cardioversion?

1-2 J/kg

If you have stable and narrow QRS tachycardia, what is the treatment?

Adenosine 6 mg

What medications can you use for narrow AND wide QRS tachycardia?

Amio Cardizem

If you have stable and wide QRS tachycardia, what is the treatment?

Lidocaine: 150 mg over 10 min

Lido gtt dosing

1-4 mg/kg

Amio gtt dosing

1 mg/min for 6 hours 0.5 mg/min after

How to preform vagal stimulation? In kids?

Rub on carotid "bear down" In kids, put ice on their face

What is the risk with vagal stimulation?

If they are at risk for plaque, it could break a clot off

Pediatric ACLS algorithm

What is usually the number one cause of arrest in pediatrics? What is one exception?

Respiratory complications Unknown heart issues

What is different with pediatric dosing from adult dosing?

You have to adjust your doses based on weight

What are common vfib/vtach causes in kids?

Underlying cardiac issue Electrocution

Pediatric dosing of atropine

0.02 mg/kg

Pediatric dosing of epi

0.01 mg/kg

Causes of cardiac arrest in kids:

Accidental OD Drowning Trauma Choking "Pill parties" in HS students

Pediatric defibrillation is ______ based

Weight

What is the defibrillation pad placement in kids?

Anterior and posterior

Pediatric bradycardia algorithm

Pediatric bradycardia is usually caused by:

Hypoxia

In kids, if the heart rate is less than 60, what do you do?

Start compressions

What is the initial treatment for unstable bradycardia in kids?

Epi

What other meds can you use for unstable bradycardia in kids?

Atropine Glycopyrrolate (onset 10 min) Atropine (onset 30 sec - 1 min)

What medication that we use in OR has bradycardia has a side effect in kids?

Succs *Have atropine available

If you give TOO low of a dose of atropine in adults, what can this cause?

Reflex bradycardia

Pediatric tachycardia algorithm

A normal "cut off" for HR in a 2-8 yr old would be:

180 bpm

A normal "cut off" in a child <2 for HR would be:

220 bpm

Biggest cause of tachycardia in kids:

Volume depletion Elevated temp

Treatment for pediatric tachycardia is more directed at:

Treating the underlying issue

It is _____ to have to cardiovert a pediatric patient

Rare

Neonatal resuscitation algorithm

Common causes of neonatal arrest:

From C-section with complications to baby Airway issues

Post C-section, it's important to keep baby ___ and ____

Warm Dry

What 3 questions do we ask if we suspect neonatal code?

Are they breathing? Are they gasping? What is the HR?

One way to stimulate newborn:

Push nail bed onto the heal

If the heart rate is less than ____ in a newborn, start ventilation

100 bpm

What 2 things (if done appropriately) are enough to bring a newborn back if HR <100?

Ventilation Good suction

If a newborn HR is <60, what do you do?

Start CPR

What is something that can cause volume depletion in babies immediately after birth?

If baby is still connected to mom via umbilical cord, and you pick baby up Volume will leave baby and go to mom!

Cardiac arrest in pregnancy algorithm

Causes of cardiac arrest in pregnant women?

Trauma Thrombotic events