ACLS Flashcards
ventilation:compression ratio- CA (bag-mask)
30:2
ventilation in RA
10-12 per minute (1 ventilation every 5-6 seconds ). True with advanced airway or bag-mask
ventilation in CA with advanced airway
8-10 breaths per minute (1 every 6-8 seconds)
Steps of ACLS survey when pt is in cardiac arrest (VF or pulseless VT)
- BLS survey (check responsivness/breathing, activate emergency response, assess pulse, CPR, defibrillation)
- Give oxygen, attach monitor
- Reassess rhythm (VF/VT)
SHOCK! - CPR 2 mins + Establish IV/IO access
- Recheck rhythm (VF/VT)
SHOCK! - CPR 2 mins + Epinephrine (every 3-5 mins)- capnography? airway?
- Assess rhythm (VF/VT)
SHOCK! - CPR 2 min + Amiodarone + find reversible causes
How much Epinephrine?
1 mg (1:10) every 3-5 mins
How much Amiodarone?
300 mg IV bolus (over 2nd dose (3-5 mins later)- 150 mg (bolus)
How do you follow administration of peripheral meds?
with 20 mL flush of IV saline and elevate extremity above heart for 10-20 seconds
When should you give Mg Sulfate?
torsades de pointes (VT following prolonged QT)
What is ROSC?
Pulse and BP or
PETCO2 > 35-40 or
spontaneous arterial pressure waves are seen
What are two indications of BAD chest compressions?
PETCO2 < 10 or
“diastolic” pressure <20 mmHg
What if the patient is in VF AND hypothermic?
Proceed as usual, but allow MORE time between medication admin and engage in active reheating simultaneously
How long should a rhythm check take?
5-10 seconds
What are the steps after ROSC?
- Optimize ventilation (>=94%)- consider advanced airway and capnography
- Treat hypotension (SBP90 (or >65 MAP), consider treatable causes, 12-lead EKG
- Can pt. follow commands? - if Yes, either STEMI or critical care, if NO consider induced hypothermia, then STEMI or critical care
How do you “optimize” ventilation?
begin ventilator with 10-12 breaths per min and titrate up until patients oxyHg is >94% OR PETCO2 of 35-40%
and how are you treating hypertension after ROSC?
- bolus 1-2 L NS or Ringer’s
2. Epinephrine (0.1-0.5 mcg/kg per minute)
When do you use Norepinephrine?
if SBP < 70 and low total peripheral resistance that failes to respond to dopamine, phenylephrine, or mehtoxamine (so basically never, I guess)
When do you use Dopamine?
Patient has low BP that cannot be corrected with Epinephrine and bolus alone
One of the interns collapses in the trauma bay and you don’t find a pulse or breathing. On rhythm check you find asystole, what now?
- CPR, dummy - 2 minutes!
- IV/IO access»advanced airway (unless bag-mask is ineffective)
- Epinephrine (1 mg every 3-5)
- Rhythm, CPR, Epi, over and over. unless ROSC or shockable rhythm appear…unless you discover the cause!
What are the reversible causes of PEA and Asystole (Hs and Ts)? How does each look on EKG?
Hypovolemia- narrow comples
Hypoxia- slow rate
Hydrogen ion (acidosis)- small amplitude QRS
Hyperkalemia- Peaked T waves, smaller Ps. Sine wave PEA
Hypokalemia- Flat T waves, prominant U waves, wide QRS, long QT
Hypothermia
Tension pneumothorax (hypoxic)
Tamponade (narrow complex)
Toxins
Thrombosis- lungs (narrow complex, rapid rate)
Thrombosis-heart (Q waves, ST changes, T wave inversions)
What do you give to all patients you suspect of ACS (before EKG interpretation)?
Obtain EKG - (EMS will have notified you of STEMI and may have sent this over already) Oxygen (4L/min) if O2 sat is <94% Aspirin Nitroglycerin (sublingual or spray) Morphine (if still in pain)
If EKG reveals STEMI…
Suggests acute injury- If time from onset <= 12 hrs, PCI or Fibrinolysis. Goal time from door-to-balloon is 90 mins, and from door-to-needle is 30 mins.
how frequently should the team member delivering chest compressions be switched?
About every 2 minutes or 5 CPR cycles.
What is the AHA definition of hypotension?
SBP < 90
When should chewable aspirin be deferred in suspected ACS?
True aspirin allergy, no evidence of recent GI bleed.
Use rectal suppository (300 mg) for patients with nausea, vomiting, active peptic ulcer, or other upper GI disease.
Never give aspirin <24 hours after heparin thrombolysis.
when is nitroglycerine contraindicated?
Hemodynamically unstable (SBP100; Inferior MI or RV MI; recent use of PDE inhibitor (sildenifil, vardenifil- 24 hours, tadalafil within 48 hrs).
When should Morphine be used with caution?
NSTEMI or UA- associated with increased mortality
what are the next steps for a suspected ACS patient who has had a 12 lead suggesting unstable angina or NSTEMI? What would this look like?
ST depressions and T wave inversions. Determine whether patient is “high” or “low” risk. Send high risk
High-risk = Elevated troponin or 1. Refractory anginal pain, 2. persistent ST deviation (>0.5mm); 3. VT; 4. hemodynamic instability; or 5. signs of heart failure
Low risk: ST segment deviation <=2mm.
