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Internal Med > ACLS > Flashcards

ACLS Flashcards

1
Q

Narrow QRS Complex (SVT) Tachycardia - causes

A

qrs <.12

sinus tach, a fib, a flutter, AV nodal reentry

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2
Q

Wide QRS Complex Tachy - causes

A

qrs>0.12

monomorphic or polymorphic VT

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3
Q

Adult Tachycardia algorithim, first three steps

A

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

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4
Q

Adult Tachycardia: if tachyarrythmia is not causing symptoms, next step

A

evaluate QRS

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5
Q

Stable Tachycardia, wide qrs; next step….

A

IV access, 12 lead
adenosine of regular and monomorphic
antiarrhythmmic infusion
expert consult

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6
Q

Stable Tachycardia, narrow qrs; next step….

A 
IV, 12 lead
vagal manuevers
adenosine if regular
BB or CCB
expert
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7
Q

adenosine dose

A

6 mg

can give second dose - 12 mg

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8
Q

can adenosine be used in pregnancy?

A

yes

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9
Q

adenosine AE

A

bronchospasm (don’t give to pts with asthma)

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10
Q

antiarrythmics for stable wide qrs tachycardia

A

procaineamide
amiodarone
sotalol

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11
Q

unstable tachycardia, step after seeing signs of hypotension,etc

A

synchronized cardioversion!
consider sedation
if regular narrow complex, adenosine

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12
Q

unsychnoized shocks for

A

VF/VT

pulseless

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13
Q

use sychncronized shocks for

A

unstable SVT
unstable a fib
unstable a flutter
unstable regular monomorphic tachycardia with pulses

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14
Q

unstable a fib cardioversion dose

A

200 J

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15
Q

unstable monomorphic VT cardioversion dose

A

100 J

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16
Q

other unstable SVT/a flutter cardioversion dose

A

50 to 100 J

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17
Q

polymorphic VT and unstable, cardioversion dose

A

treat as VF, high energy dose

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18
Q

Adult Suspected Stroke First 5 Steps

A

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?

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19
Q

Stroke: CT showing Hemorrhage

A
  • consult neurologist/neurosurgeon/transfer

- begin stroke/hemorrhage pathway and admit to stroke/ICU unit

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20
Q

Stroke: CT no hemorrhage next step

A

consider fibrinolytic therapy

  • check for exclusions
  • repeat neuro exam to see if improvement
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21
Q

Stroke: not a candiate for fibrinolytic therapy, next steps

A

administer aspirin

- begin stroke/hemorrhage pathway and admit to stroke/ICU unit

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22
Q

Stroke: canidate for fibrinolytic therapy, next steps

A

give tpa (no anticoag for 24 hrs)
–>
post tpa pathway

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23
Q

post tpa pathway

A

aggresively monitor BP, neurologic deterioration

admission to stroke/ICU

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24
Q

cincinnati prehospitial stroke scale

A

facial drop
arm drift
abnormal speech *you can’t teach an old dog new tricks)

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25
Q

fibrinolytic therapy inclusion criteria

A

ischemic stroke with measurable deficit

onset or = 18

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26
Q

general stroke care

A

monitor glucose, bp, temp
dysphagia screening
stroke/fibrinolytic complications screening

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27
Q

stroke care, bp > 185/110

A

labetalol

nicardipine

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28
Q

Respiratory Arrest Case, pt

A

have pulse but not breathing

unconscious, unreponsive

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29
Q

ventilations during resp arrest

A

1 vent every 5-6 seconds (both bag mask, advanced airway)

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30
Q

ventilations during cardiac arrest

A

bag mask 2/30 comp

advanced airway 1 vent evey 6-8 seconds

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31
Q

Resp Arrest – Assessing Airway

A

maintain airway patency - head tilt-chin lift, OPA, NPA
use advanced airway management
monitor airway placement with continuous quantitative waveform capnography

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32
Q

Resp Arrest - Breathing

A

give supplement o2
monitory: watching chest, waveform capno, oxygen sat
avoid excess ventilation

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33
Q

Resp Arrest - Circulation

A

monitor CPR quality
attach monitor/def
iv/io access, fluids, drugs

34
Q

when to insert OPA or NPA

A

unconscious with no cough or gag reflex

35
Q

soft flexible catheter for suctioning

A

mouth, nose

36
Q

rigid catheter for suctioning

A

oropharynx

37
Q

suction attempt - time

A

no more than 10 seconds

38
Q

trauma patients

A

jaw thrust without head extension

manual spinal motion restriction better than immobilization

39
Q

is the rhythm shockable?

A

VF or pulseless VT

40
Q

how to check circulation

A

cartoid pulse for 5-10 seconds

41
Q

Adult BLS flow chart:

A

1) unresponsive, no breathing or no normal breathing
2) activate emergency/get AED
3) check pulse

42
Q

Adult BLS flow chart, if patient has pulse

A

give 1 breath every 5-6 seconds

recheck pulse every 2 minutes

43
Q

Adult BLS flow chart, patient has no pulse

A

30 compressions, 2 breaths
AED arrives
check rhythm

44
Q

adult bls flow chart, shockable rhythm

A

1 shock

resume cpr for 2 minutes

45
Q

adult bls flow chart, not shockable

A

resume cpr for 2 minutes

recheck rhythm every 2 minutes

46
Q

VT goes into

A

VF, which goes into asystole

47
Q

Adult Cardiac Arrest flow chart

A 
start CPR (can also give o2, attach monitor)
check rhythm
48
Q

VF/VT rhythm, flow chart

A

1) shock
2) CPR 2 minutes, IV/IO access
3) recheck rhythm

49
Q

VF/VT rhythm, first shock

A

CPR

50
Q

VF/VT rhythm, second shcok

A

CPR + epinephrine every 3-5 minutes

51
Q

VF/VT rhythm, third shock

A

CPR + amiodarone

52
Q

return of spontaneous circulation

A

pulse and blood pressure!

53
Q

2 minutes = how many cycles of cpr

A

5

54
Q

if amiodarone is not available

A

can use lidocaine

55
Q

PETco2

A

<10 mmHg suggest ROSC unlikely

normal value 35-40

56
Q

central venous oxygen sat

A

normal 60-80

<30 improve chest compression and vasopressors

57
Q

after epinephrine give

A

20 mg flush of IV fluid

elevated extremity abov eheart for 10-20 sec

58
Q

Post Care Cardiac Arrest

A

1) ROSC
2) optimize vent and o2 (>94%)
3) treat hypotnsion
4) follow commands

59
Q

post care cardiac arrest - treating hypotension

A

IV/IO bolus
vasopressor infusion
treatble causes
12 lead

60
Q

post care cardiac arrest - patient follows commands

A

STEMI or high suscision AMI –> coronary repursion

61
Q

post care cardiac arrest - patient does NOT follow commands

A

consider induced hypothermia –> STEMI/AMI –> coronary reperfussion

62
Q

IV bolus

A

1-2 L normal saline or lactate ringers

63
Q

vasopressors

A

epineprhine
dopamine
norepinephrine

64
Q

induced hypothermia

A

at least 12 hours

65
Q

Adult Cardiac Arrest, CPR, rhythm shows PEA

A

cpr 2 mins, IV/IO access, epinephrine ever 3-5 min

recheck rhythm to see if it’s shockable

66
Q

PEA, not shockable rhythms

A

CPR for 2 minutes, keep checking rhythm

67
Q

5 H’s

A 
hypovolemia
hypoxia
hydrogen ion (acidosis)
hyper/hypokalemia
hypothermia
68
Q

5 T’s

A

tension pneumothorax
tamponade
toxins
thrombosis - pulmonary, coronary

69
Q

common causes of reversible pea

A

hypovolemia and hypoxia

70
Q

aspirin, give

A

160-325 to chew

300 mg rectal

71
Q

when not to give nitroglycerin

A

inferior wall or RV MI
hypotension/bradycardia/tachycardia
recent PPEI use

72
Q

fibrinolytic therapy goal

A

30 minutes

73
Q

PCI goal

A

90 minutes

74
Q

rhythms for bradycardia

A

sinus

1/2/3 degree AV block

75
Q

bradycardia def

A

rhythm disorder with <50

76
Q

Adult Bradycardia Algorithm

A

1) hr <50
2) cause: airway, oxygen, cardiac monitor, IV, ecg
3) signs of bradyarrhythmia

77
Q

signs of bradyarrythmia

A 
hypotension
ams
shock
ischemic chest discomfort
acute heart failure
78
Q

no signs of bradyarryhtmia

A

monitor observe

79
Q

signs of bradyarrhytmia

A

atropine

if ineffective, TCP, dopamine or epinephrine

80
Q

sedation before pacing

A

benzo
narcotic
chronotropic infusion

81
Q

TCP contradicated in

A

severe hypothermia, asystole

Internal Med (23 decks)

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