ACLS Flashcards
Actions performed for an unconscious apneic patient who you are uncertain has a pulse
Begin cycles of compressions and ventilations
Of 30-2
Advantage of using hands free defibrillation pads
- Reduces transthoracic impedance, or resistance that chest structures have on electrical current
- Reduce the risk of arching, allowing monitoring of underlying rhythm and rapid defib
Problem associated with delivering high concentrations of O2 during ROSC
Avoid complications associated with oxygen toxicity
Avoid hyperventilation may lead to adverse hemodynamic effects when intra-thoracic pressures are increased because of potential decreases in cerebral blood flow when PaCO2 decreases
During post cardiac arrest the lowest level required to achieve an arterial oxygen saturation of
> _ 94%
In hospital Resuscitative efforts can be terminated if
Cannot identify reversible cause Patient fails to respond to BLS and ACLS surveys Time from collapse to CPR Time from collapse to defib Comorbid disease Perarrest state Initial arrest rhythm Response to resuscitative measures
Most reliable method of confirming and monitoring placement of Endotracheal tube
Continuous waveform capnography
What is the role of quantitative waveform in an intubated patient
Insures correct tube placement and monitoring
Monitors CPR quality, optimize chest compressions, and detect ROSC during compressions
Displays PETCO2 in mm of Hg on the vertical axis
Pharmacologic treatment for patient with stable SVT
6mg Adenosine rapid IV
20-50 mg of Procainamide IV
150 mg Amiodarone over 10 min
100mg Sotalol IV over 5 min
Significance of a PETCO2 level of 8 mmHg
- Need to improve CPR if less than 10
- In intubated patient it suggests that ROSC is unlikely normal value is 35-40
What is the desired post cardiac arrest PETCO2 range for a patient is ROSC
35-40 mmHg
What is the second dose of adenosine for a patient in refractory, but stable narrow complex tachycardia
12mg rapid IV push
Best strategy for performing high quality CPR on a patient with advanced airway
8-10 breaths per minute with continuous chest compressions
An organized rhythm without a pulse is defined as
PEA
PEA rhythms can include
IVR
Ventricular escape
Post defib IVR
Sinus rhythm
Rhythms which require synchronized cardioversion
Unstable SVT
Unstable atrial fib
Unstable atrial flutter
Unstable regular monomorphic tachycardia with pulses
Desired minimum systolic blood pressure in hypotensive post-cardiac arrest who has ROSC
> 90 mm Hg
Emergency departments priority for a patient with a positive prehospital stroke assessment
Door (appropriate triage to stroke center)
Data (rapid triage, evaluation, and management with ED)
Decision (stroke expertise and therapy selection)
Drug (fibrinolytic therapy, intra-arterial strategies)
Disposition (rapid admission to the stroke unit)
Out of hospital resuscitative efforts can be terminated when
Restoration of effective, spontaneous circulation and ventilation
Transfer of care to senior medical
Presence of reliable criteria indicating irreversible death
Unable to continue due to exhaustion or dangerous environment
Valid DNR
Online authorization from medical control
Identify the condition which is contraindication to hypothermia during the post cardiac arrest period for patient with ROSC
Patient must be responsive/conscious
Continued electrical rhythmicity of the heart in the absence of mechanical function
PEA
The actions in which increase the chance of successful conversion of ventricular fibrillation
Restoring a perfusing rhythm is optimized with early defibrillation and CPR
Treatment for patient for a patient with unstable wide complex tachycardia
Treat as V tachycardia until proven other Synchronized cardioversion 100 J CPR 5 cycles 1mg Epinephrine Analyze rhythm if same Cardioversion at 150 J
Actions of high quality chest compressions
Compress chest hard and fast >100 per min Allow complete chest recoil Minimize interruptions 10sec or less Switch providers every 2minutes Avoid excessive ventilation
List common mistakes in cardiac arrest management
Stopping CPR for more than 10sec
Over ventilation
Fatigue
Inadequate depth and rate
Treatment for PEA
CPR O2 Epinephrine Advanced airway Treat reversible causes
What do you do when AED doesn’t analyze heart rhythm
Resume compressions and ventilations
Check all connections between AED and patient
Identify second degree type 1 heart block
The electrical signals are delayed more and more with each heart beat until the heart skips a beat
Identify treatment for a patient in unstable second degree type 1 heart block
Atropine .5 mg
Transcutaneous pacing
Dopamine infusion 2-10 mcg/kg/min
Epinephrine infusion 2-10 mcg/min
Describe procedure for endotracheal tube suctioning
Use sterile technique to reduce contamination
Insert catheter into ET tube
Not deeper than the end of the ET tube
Apply suctioning by occluding the side opening only while withdrawing catheter with rotating motion
Suction attempts to not exceed 10sec
What is the preferred method of medication delivery during cardiac arrest
IV/IO
When a 12 lead EKG should be obtained for a patient with acute coronary syndrome
As soon as possible when signs and symptoms suggest ischemia or infarction
Analyze rhythm within 10 minutes of arrival of ED
Initial BLS treatment for patient in cardiac arrest
Tap shout are you alright Analyze breathing Activate emergency response get AED Check pulse CPR Check for shockable rhythm Defibrillate
Treatment for patient with unstable bradycardia
0.5 mg Atropine
Transcutaneous pacing
Dopamine infusion 2-10mcg/kg/min
Epinephrine infusion 2-10 mcg/min
Recommended action to help minimize interruptions in chest compressions during CPR
The team leader assigns roles and responsibilities and organizes interventions to minimize interruptions in chest compressions
What to do if a hospital does not have a CT scan available for the stroke patient you’re transporting
Stabilize and promptly transfer the patient to a facility with CT capability
Do not give aspirin, heparin, or rtPA until ruled out hemorrhage
Treatment for a patient with stable SVT
IV 12 lead Vagal maneuvers Adenosine 6mg Beta blocker or calcium channel blocker Consider expert consultation
List components of BLS survey
Check responsiveness Activate EMS Get AED Circulation Defibrillation
Pharmacologic agents/doses for patient in refractory V Fib
1mg epinephrine 3-5 min
300mg Amiodarone
40 U vasopressin
Appropriate interval for interrupting chest compressions during CPR
No more than 10 sec during defib
Advanced airway
Only in dangerous environments is more than 10 acceptable
Identify the lab values consistent with effective CPR
-End-tidal CO2 (PETCO2 35-40)
<30 improve compressions
Action that improves the quality of chest compressions
Compress chest hard and fast Allow complete recoil Minimize interruptions Switch providers Avoid excessive ventilation Monitor CPR on quantitative capnography
Primary purpose of medical emergency team or rapid response team
Improve patient outcomes by identifying and treating early clinical deterioration
Appropriate ventilation strategy for patient in respiratory arrest with a pulse
1 breath every 5-6 seconds (10-12 per min) check pulse every 2min
Pharmacologic treatment for patient in unstable bradycardia
0.5 Atropine Transcutaneous pacing Dopamine infusion 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Expert consultation
Dopamine dose for unstable bradycardia
2-10 mcg/kg/min
Treatment for patient with suspected stroke if no hemorrhage
may be candidate for
Fibrinolytic therapy
not candidate for therapy
Administer aspirin
Drugs for non hemorrhage stroke
Fibrinolytic therapy
rtPA
Aspirin
