ACLS Flashcards
Narrow QRS Complex (SVT) Tachycardia - causes
qrs <.12
sinus tach, a fib, a flutter, AV nodal reentry
Wide QRS Complex Tachy - causes
qrs>0.12
monomorphic or polymorphic VT
Adult Tachycardia algorithim, first three steps
1) hr > 150
2) id/treat underyling causes (airway, oxygen, check rhythm/bloodpressure/o2 sat)
3) signs of hypotension/ams/shock/ischemic chest discomfort/AHF
Adult Tachycardia: if tachyarrythmia is not causing symptoms, next step
evaluate QRS
Stable Tachycardia, wide qrs; next step….
IV access, 12 lead
adenosine of regular and monomorphic
antiarrhythmmic infusion
expert consult
Stable Tachycardia, narrow qrs; next step….
IV, 12 lead vagal manuevers adenosine if regular BB or CCB expert
adenosine dose
6 mg
can give second dose - 12 mg
can adenosine be used in pregnancy?
yes
adenosine AE
bronchospasm (don’t give to pts with asthma)
antiarrythmics for stable wide qrs tachycardia
procaineamide
amiodarone
sotalol
unstable tachycardia, step after seeing signs of hypotension,etc
synchronized cardioversion!
consider sedation
if regular narrow complex, adenosine
unsychnoized shocks for
VF/VT
pulseless
use sychncronized shocks for
unstable SVT
unstable a fib
unstable a flutter
unstable regular monomorphic tachycardia with pulses
unstable a fib cardioversion dose
200 J
unstable monomorphic VT cardioversion dose
100 J
other unstable SVT/a flutter cardioversion dose
50 to 100 J
polymorphic VT and unstable, cardioversion dose
treat as VF, high energy dose
Adult Suspected Stroke First 5 Steps
1) ID signs, activate emergency response
2) critical EMS assessment
3) general assessment/stabilize in ED
4) neurologic assessment by stroke team
5) CT show hemorrhage?
Stroke: CT showing Hemorrhage
- consult neurologist/neurosurgeon/transfer
- begin stroke/hemorrhage pathway and admit to stroke/ICU unit
Stroke: CT no hemorrhage next step
consider fibrinolytic therapy
- check for exclusions
- repeat neuro exam to see if improvement
Stroke: not a candiate for fibrinolytic therapy, next steps
administer aspirin
- begin stroke/hemorrhage pathway and admit to stroke/ICU unit
Stroke: canidate for fibrinolytic therapy, next steps
give tpa (no anticoag for 24 hrs)
–>
post tpa pathway
post tpa pathway
aggresively monitor BP, neurologic deterioration
admission to stroke/ICU
cincinnati prehospitial stroke scale
facial drop
arm drift
abnormal speech *you can’t teach an old dog new tricks)
fibrinolytic therapy inclusion criteria
ischemic stroke with measurable deficit
onset or = 18
general stroke care
monitor glucose, bp, temp
dysphagia screening
stroke/fibrinolytic complications screening
stroke care, bp > 185/110
labetalol
nicardipine
Respiratory Arrest Case, pt
have pulse but not breathing
unconscious, unreponsive
ventilations during resp arrest
1 vent every 5-6 seconds (both bag mask, advanced airway)
ventilations during cardiac arrest
bag mask 2/30 comp
advanced airway 1 vent evey 6-8 seconds
Resp Arrest – Assessing Airway
maintain airway patency - head tilt-chin lift, OPA, NPA
use advanced airway management
monitor airway placement with continuous quantitative waveform capnography
Resp Arrest - Breathing
give supplement o2
monitory: watching chest, waveform capno, oxygen sat
avoid excess ventilation
Resp Arrest - Circulation
monitor CPR quality
attach monitor/def
iv/io access, fluids, drugs
when to insert OPA or NPA
unconscious with no cough or gag reflex
soft flexible catheter for suctioning
mouth, nose
rigid catheter for suctioning
oropharynx
suction attempt - time
no more than 10 seconds
trauma patients
jaw thrust without head extension
manual spinal motion restriction better than immobilization
is the rhythm shockable?
VF or pulseless VT
how to check circulation
cartoid pulse for 5-10 seconds
Adult BLS flow chart:
1) unresponsive, no breathing or no normal breathing
2) activate emergency/get AED
3) check pulse
Adult BLS flow chart, if patient has pulse
give 1 breath every 5-6 seconds
recheck pulse every 2 minutes
Adult BLS flow chart, patient has no pulse
30 compressions, 2 breaths
AED arrives
check rhythm
adult bls flow chart, shockable rhythm
1 shock
resume cpr for 2 minutes
adult bls flow chart, not shockable
resume cpr for 2 minutes
recheck rhythm every 2 minutes
VT goes into
VF, which goes into asystole
Adult Cardiac Arrest flow chart
start CPR (can also give o2, attach monitor) check rhythm
VF/VT rhythm, flow chart
1) shock
2) CPR 2 minutes, IV/IO access
3) recheck rhythm
VF/VT rhythm, first shock
CPR
VF/VT rhythm, second shcok
CPR + epinephrine every 3-5 minutes
VF/VT rhythm, third shock
CPR + amiodarone
return of spontaneous circulation
pulse and blood pressure!
2 minutes = how many cycles of cpr
5
if amiodarone is not available
can use lidocaine
PETco2
<10 mmHg suggest ROSC unlikely
normal value 35-40
central venous oxygen sat
normal 60-80
<30 improve chest compression and vasopressors
after epinephrine give
20 mg flush of IV fluid
elevated extremity abov eheart for 10-20 sec
Post Care Cardiac Arrest
1) ROSC
2) optimize vent and o2 (>94%)
3) treat hypotnsion
4) follow commands
post care cardiac arrest - treating hypotension
IV/IO bolus
vasopressor infusion
treatble causes
12 lead
post care cardiac arrest - patient follows commands
STEMI or high suscision AMI –> coronary repursion
post care cardiac arrest - patient does NOT follow commands
consider induced hypothermia –> STEMI/AMI –> coronary reperfussion
IV bolus
1-2 L normal saline or lactate ringers
vasopressors
epineprhine
dopamine
norepinephrine
induced hypothermia
at least 12 hours
Adult Cardiac Arrest, CPR, rhythm shows PEA
cpr 2 mins, IV/IO access, epinephrine ever 3-5 min
recheck rhythm to see if it’s shockable
PEA, not shockable rhythms
CPR for 2 minutes, keep checking rhythm
5 H’s
hypovolemia hypoxia hydrogen ion (acidosis) hyper/hypokalemia hypothermia
5 T’s
tension pneumothorax
tamponade
toxins
thrombosis - pulmonary, coronary
common causes of reversible pea
hypovolemia and hypoxia
aspirin, give
160-325 to chew
300 mg rectal
when not to give nitroglycerin
inferior wall or RV MI
hypotension/bradycardia/tachycardia
recent PPEI use
fibrinolytic therapy goal
30 minutes
PCI goal
90 minutes
rhythms for bradycardia
sinus
1/2/3 degree AV block
bradycardia def
rhythm disorder with <50
Adult Bradycardia Algorithm
1) hr <50
2) cause: airway, oxygen, cardiac monitor, IV, ecg
3) signs of bradyarrhythmia
signs of bradyarrythmia
hypotension ams shock ischemic chest discomfort acute heart failure
no signs of bradyarryhtmia
monitor observe
signs of bradyarrhytmia
atropine
if ineffective, TCP, dopamine or epinephrine
sedation before pacing
benzo
narcotic
chronotropic infusion
TCP contradicated in
severe hypothermia, asystole
