ACLS Flashcards
Which two heart rhythms should be defibrillated?
Ventricular Tachycardia and Ventricular Fibrillation
What is the characteristics and treatment for Sinus Tachycardia?
ST: HR typically lower, P waves
Treat: dehydration, pain, fever
Can you have a pulse with ventricular fibrillation?
No, there is no cardiac output.
What is the drug of choice for a SVT?
Adenosine 6mg IV, may repeat with Adenosine 12 mg IV.
What is the first thing done for a patient with in pulseless VT?
CPR, defibrillate ASAP.
What causes of PEA may be rapidly reversed if immediately treated?
Hypovolemia, hypoxia, Cardiac tamponade, and tension pneumothorax.
What is the treatment for symptomatic sinus bradycardia?
Atropine 0.5 mg IV, if ineffective, consider pacing, dopamine drip or epinephrine drip.
In what situation should resuscitative efforts be extended for a patient in asystole?
Drug overdose or hypothermia.
What is the window of opportunity for using fibrinolytic agents in Acute MI vs Stroke?
From onset of symptoms:
MI: < 12 hours
Stroke: < 3 hours, can be unto 4.5 hours in select patients.
Which drugs may be given down the ET tube? What are the doses?
Navel: Narcan, atropine, Vasopressin, Epinephrine, Lidocaine. Administer 2-2.5 times the usual dose.
What is the treatment of choice for symptomatic tachycardias?
Cardio-version
What are the drugs of choice given during an arrest with ventricular fibrillation as the presenting rhythm?
Epinephrine and Amiodarone
How long should you stop compressions to do a pulse/ rhythm check?
No more than 10 seconds
You have just shocked your patient for Ventricular Fibrillation, what is your next step?
Chest compressions
What are the joule recommendations for Cardio-version?
50-100 joules Narrow regular
100-200 joules Narrow irregular
100 joules Wide regular
Why is waveform capnography now recommended in ACLS?
Monitor CPR quality, immediate knowledge of ROSC therefore minimizing pulse checks and ET tube monitoring.
Capnography
The monitoring of the concentration or partial pressure of carbon dioxide (CO. 2) in the respiratory gases. Its main development has been as a monitoring tool for use during anesthesia and intensive care. It is usually presented as a graph of expiratory CO.
What capnography measurement indicates that you should improve chest compression?
Less than 10.
What capnography measurement indicates ROSC (return of spontaneous circulation?
35-40.
When should you stop CPR to place an ET tube?
Only when absolutely necessary related to patient situation.
What is the first drug given in all pulseless algorithms?
Epinephrine 1 mg IV/IO (1: 10,000)
What is the dose of Amiodarone in the Cardiac arrest vs Stable Ventricular Tachycardia?
Arrest: 300 mg IV push
Stable VT: 150 mg IV over 10 minutes, may repeat prn.
What is the first thing you should do for a patient presenting with chest pain?
12 lead EKG.
What is the acronym that is commonly used for chest pain patients that helps guide treatment?
MONA: Morphine, Oxygen, Nitroglycerin, Aspirin (not in this order).
When giving arrest IV meds through a peripheral IV, what should you do?
Flush with fluid bolus and elevate extremity.
What are the presenting signs and symptoms of a stroke?
Altered LOC, intense headache, speech and vision disturbance, hearing loss, weakness, paralysis or sensory loss of one or more limbs.
What is the initial response to a patient presenting with a stroke?
Neuro exam (NIH stroke scale, alert stroke team/ stroke hospital, non-contrast CT head)
What are some conditions that mimic a stroke?
Hypoglycemia, head/neck trauma, brain tumor/hematoma, meningitis, encephalitis.
In which type of stroke can you use Fibrinolytic therapy?
Ischemic, contraindicated for hemorrhagic.
How do you open the airway in a patient with a suspected neck injury?
Jaw thrust maneuver while providing cervical stabilization.
How do you treat a choking victim that has become unresponsive before relieving the obstruction?
Initiate CPR: Lay victim or floor, activate EMS, start compressions, if object seen may remove via finger sweep.
What are the signs of a severe airway obstruction?
Weak, ineffective cough, cyanosis, high pitched noise with inspiration, no speech. Treat with abdominal thrusts.
When looking for a differential diagnosis, what are the “H’s” and “T’s” that you should consider?
H’s: hypoglycemia, hypothermia, hypovolemia, hypohyper K, H ion (acidosis), hypoxia.
T’s: toxins, tamponade, tension pneumothorax, thrombosis (coronary or pulmonary).
What is the order of response when finding a collapsed patient?
1- Check for responsiveness
2- Call for help
3-Check for pulse, breathing, start CPR/ respiratory assist
4- Defibrillate shockable rhythms.
What is the rate of compressions per minute for adults, children and infants?
All ages 100-120/minute.
What is the most important factor for successful resuscitation?
Providing high quality CPR.
Describe effective chest compressions during CPR.
Push hard and fast, allow complete chest recoil, change compressors every 2 minutes, minimize interruptions.
Why is it important to give slow rescue breaths?
Less air will enter the stomach decreasing gastric distention and vomiting.
What is the rate of rescue breathing per minute in adults, children, and infants?
Adults: 1 every 5-6 seconds (10-12 min)
Children/ Infants: 1 every 3 sec (20 min)
(If intubated 1 every 6 sec (10 min)
How does AHA recommend confirming ET tube placement?
1- Physical exam/Auscultation
2- Waveform capnography (colormetric CO2 or EED)
What is the correct hand position for compressions in adults, child and infant?
Adult: heel of both hands between nipples
Child: heel of 1-2 hands between nipples
Infant: 2 fingers, 1 finger below nipple line
What are the steps to the BLS survey?
1- Check responsiveness/ breathing
2- Activate EMS
3- Circulation (check pulse, compressions)
4- Defibrillate shockable rhythms
What are the steps to ACLS survey?
Airway: Patent, advanced needed
Breathing: Confirm airway, check for issues
Circulation: EKG, IV/IO, give fluids/drugs
Differential diagnosis: H’s and T’s
When the AED states “no shock advised,” what should you do?
Resume CPR, starting with compressions.
What are the 4 universal steps to AED operation?
1- power on
2- attach pads
3- analyze
4- Shock if indicated
How do you perform high-quality CPR
Provide 100-200 compressions/min., switch compressors every 2 minutes, allow for chest recoil, minimize interruptions, avoid hyperventilating, push hard and fast.
What do you do if you believe the team leader may have mistakenly called for the wrong drug?
Constructive intervention: “I believe Amiodarone is the next drug in the algorithm, not Adenosine. Do you agree?
What is the ratio’s for CPR on adults, children and infants?
Adult: 30:2 at all times
Children/ infants: 30:2 for 1 person, 15:2 for 2 persons.
