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Final FA review > ACLS > Flashcards

ACLS Flashcards

1
Q

Initial stabilizing/diagnostic measures for suspected MI?

A

VS, IV, O2, monitor

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2
Q

dose of nitroglycerin

A

400 mcg q3-5min

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3
Q

dose of morphine

A

2-4mg q5min

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4
Q

Four diagnostic categories for EKG interpretation in setting of suspected MI:

A
  1. normal
  2. STEMI
  3. ischemia
  4. non-specific T wave changes
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5
Q

EKG normal - next step?

A

trend trops

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6
Q

EKG = non-specific T wave changes - next step?

A

repeat EKG in 20 min

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7
Q

EKG = ischemia - next step?

A

O2, nitroglycerin

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8
Q

Unstable angina Dx made, what 2 meds do you give continuously?

A

heparin drip, nitroglycerin

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9
Q

Someone starts to code, what are initial steps?

A
  1. Call 911/Code Blue
  2. Start CPR
  3. Assign roles
  4. AED
  5. Bag Valve Mask
  6. monitor
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10
Q

When should the first drug in every pulse-less arrest be given? What’s the drug, dose and interval?

A

2nd round or ASAP

-epi 1mg q3min

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11
Q

Where do you place AED pads?

A

sternum and apex

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12
Q

How do you manage airway for first 2 min?

A

Bag valve mask

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13
Q

CPR - once pt has a pulse, what do you do?

3 steps:

A
  1. BP check
  2. 500cc NS bolus
  3. IV bicarb
    * also do EKG/ABG/labs/CXR
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14
Q

Pt recovers, how do you prevent another run of vfib?

A

amio 150mg

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15
Q

Dose and drip rate for amio for pt with pulse:

A

150mg IV over 8-10 min loading dose

  • 1mg/min x6 hrs
  • 0.5mg/min x18hrs
  • avoid decrease in BP
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16
Q

Refractory vfib: which drug do you give during 2nd cycle of CPR that will facilitate successful defib?

A

amio 300mg

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17
Q

lidocaine:

  • bolus dose:
  • drip dose:
A
  • 100mg IV push

- 2-4mg IV drip

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18
Q

2nd round CPR

-which 2 additional airway management considered?

A
  • ETT

- larygneal mask airway

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19
Q

First step after placing ETT or LMA?

A

listen to epigastrium for gurgles

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20
Q

Gold standard for documenting ETT placement?

A

End Tidal CO2

*ETCO2

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21
Q

ROSC

-why is pt tachy? 2 reasons:

A
  • epi

- acidosis

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22
Q

ROSC

-why hypotension? 2 reasons:

A
  • acidosis

- stunned mycocardio = CHF

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23
Q

ROSC

-Sinus w/occasional PVCs. What to do?

A

amio drip

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24
Q

ROSC

-What to do about hypotension? 2 things:

A
  • 1-2L bolus

- dopamine drip: 10mcg/kg/min for hypotension SBP <90 but > 70.

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25
Q

dopamine drip dose:

A

10mcg/kg/min for hypotension SBP <90 but > 70.

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26
Q

ROSC

-2 ways to treat metabolic acidosis:

A
  • bicarb IV

- increase vent rate

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27
Q

ROSC

-even if it doesn’t show STEMI - do you still take to cath lab?

A

yes

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28
Q

NRM - non rebreather

-how many L?

A

15L

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29
Q

In prep for ETT placement, what 3 things should you do?

A
  1. pre-oxygenate
  2. prepare suction
  3. BVM assist
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30
Q

Causes of ACS: mnemonic:

A

6Hs and 5Ts

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31
Q

Causes of ACS:

-What are 6 H’s?

A
  • hypovolemia
  • hypoxia
  • hydrogen ion = acidosis
  • hyper/hypokalemia
  • hypothermia
  • hypoglycemia
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32
Q

Causes of ACS:

-What are the 5T’s?

A
  • tablets (drug OD)
  • tamponade
  • tension ptx
  • thrombosis (coronary)
  • thrombosis (PE)
  • trauma
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33
Q

First pressor to start?

A

levophed

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34
Q

No pulse: whats rate have to be to cardiovert?

A

150+

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35
Q

BP: 80/50 not responsive to fluids

  • which pressor do you start?
  • dose?
A

between SBP 90 and 70 use dopamine drip
-10mcg/kg/min

*SBP < 70 then levophed

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36
Q

PEA due to tamponade:

-resuscitation measures?

A
  • IV x2
  • dobutamine
  • pericardiocentesis
  • ETT/BVM
  • epi 1mg q3-5min
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37
Q

Pericardiocentesis

  • how much fluid to remove?
  • how should pt’s vitals respond?
A
  • 30cc

- BP increase

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38
Q

What does POLST stand for?

A

Physician’s Orders for Life-Sustaining Treatment

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39
Q

aflutter

-3 characteristics:

A
  • lack of normal P waves
  • x:1 = abnormal P waves : QRS
  • regular rhythym (vs afib which is irregular)
40
Q

what limits aflutter and afib from transmitting every impulse to the ventricles?

A

refractory cells of the AV node

41
Q

afib v aflutter

-which one is regular? which irregular?

A

afib = irregular
aflutter = regular
*regular means equal intervals btwn QRS complexes

42
Q

AV nodal reentrant tachy

  • is every impulse sent to ventricles?
  • regular or irregular?
A

yes

-regular

43
Q

Vtach

  • wide or narrow?
  • p waves present?
A
  • wide

- no p waves

44
Q

Vtach

-regular or irregular?

45
Q

Vfib

-regular or irregular?

A

-irregular

46
Q

Vtach vs Vfib

-which has varying amplitudes?

47
Q

1st deg AV block

-definition?

A

PR interval > 200ms

48
Q

Symptomatic bradycardia

-atropine dose?

A

0.5 mg IV q3-5min

49
Q

Diltiazem (AV nodal blocking drug)

  • 1st dose:
  • 2nd dose:
A
  • 20mg IVP

- 30mg ivp

50
Q

Adenosine (AV nodal blocking drug)

  • 1st dose:
  • 2nd dose:
A
  • 6mg IVP

- 12mg IVP

51
Q

AV nodal blocking drugs

-name 3

A

diltiazem, adenosine, metoprolol

52
Q

Metoprolol (AV nodal blocking drug)

-doses:

A

5mg IVP

-up to 3 doses

53
Q

O2

-how many liters NC for ACS?

54
Q

Morphine

  • dose
  • rate
A

2mg IVP q3-5min for chest pain unrelieved by NTGx3 and SBP > 100.

55
Q

Following STEMI Dx:

-Clopidogrel dose:

56
Q

Following STEMI Dx:

-Heparin dose:

A

1) 60 units/kg IV bolus for acute ischemia
- max 4000 units
2) then 12 units/kg/hr
- max 1000units/hr

57
Q

Procainamide

  • dose:
  • drip:
A
  • 17mg/kg IV load over 40 min

- drip: 1-4mg/min

58
Q

Lidocaine

  • dose:
  • drip:
A
  • 100mg IVP in cardiac arrest or symptomatic vtach

- drip: 2-4mg IV

59
Q

Dopamine

-drip:

A

10mcg/kg/min for hypotension SBP btwn 70 and 90

60
Q

Norepi

-drip:

A

2-20mcg/kg/min for hypotension SBP < 70

61
Q

Epi

-drip:

A

2-10mcg/min

62
Q

Sodium bicarb

  • when to administer?
  • dose?
A

-50 meq IVP after ROSC

63
Q

IV Fluids in cardiac arrest

-how much?

A

1 liter wide open to start cardiac arrest resuscitation, 500cc IV bolus for hypotension.

64
Q

Cardioversion

  • when to use?
  • sequence of voltages?
A
  • when you have perfusing rhythm with a pulse

- 100J biphasic => 150J => 200J if no cardioversion.

65
Q

Mnemonic for organs first damaged by hypotension:

A

SLK BH

  • SLK in Beverly Hills
  • Skin, Lungs, Kidneys, Brain, Heart.
66
Q

Symptomatic bradycardia

  • whats your goal HR when first treating?
  • what device do you grab next?
A

60 bpm

-transcutaneous pacer

67
Q

Transcutaneous pacer

-rate/energy/mode:

A

60-70
20-200J
demand mode

68
Q

Which benzos to use before trans-cutaneous pacer (which hurts).

A

valium or versed

69
Q

How to determine if transcutaneous pacer is successful?

A

mechanical capture

  • pulse/BP
  • vital organ perfusion
70
Q

Electrical capture - look for what?

Mechanical capture - look for what?

A
  • QRS

- pulse

71
Q

contraindications to adenosine use:

  • which 2 drugs?
  • what could happen if you used?
A

tegretol (carbamazepine)
dipyramidole
-asystole

72
Q

What do you expect to see on monitor after giving adenosine?

73
Q

What is considered a “wide” QRS?

74
Q

Narrow QRS complexes always have origin from where?

A

supraventricular

-you know bc you know its going through proper conduction pathway from atria down through AV node.

75
Q

Before cardioversion, what drugs should you give pt?

-be cautious about what?

A

valium/versed, fentanyl

-watch for decreasing BP.

76
Q

Two common causes of Vtach:

A

ischemia, electrolyte probs

77
Q

Evaluation method for stroke:

A

Cincinnati stroke scale

78
Q

3 components of Cincinnati stroke scale

A

face, arms, speech

79
Q

Time frame for thrombolytic therapy?

80
Q

Contraindications to tPa therapy?

A
  1. trauma
  2. hx of hemorrhagic stroke
  3. ischemic stroke last 3 mo.
  4. aneurysm
  5. avm
  6. INR >1.7
  7. active bleeding
  8. metastatic tumor
  9. melena
81
Q

Acute stroke: if you decide not to give tPa, which med should you give?

82
Q

Rate of symptomatic intracranial hemorrhage with tPA is used for stroke?

A

6.4% in literature

83
Q

What % improvement in neuro outcomes if tPa given?

84
Q

BP necessary to give tPa?

-how to reach if over? which drugs?

A

< 185/110

-metop or nicardipine

85
Q

Where is transvenous pacer placed?

A

apex of R ventricle

86
Q

do “unstable” pts have a pulse?

A

yes but w/poor circulation.

87
Q

Is there ever a pulse w/vfib?

88
Q

is FB(+) contra to tPa?

A

no but melena is.

89
Q

rhythm strips:
Inverted P wave w/rate of ~50
Normal QRS

A

junctional rhythm

90
Q

If you see QRS w/o preceding P wave, what should you think?

A

ectopic rhythm

91
Q

sinus brady w/unifocal pvc vs. ventricular bigeminy

A

Ventricular bigeminy there is a PVC following every sinus beat.

92
Q

rhythm strips:

A sinus beat is shortly followed by a PVC, a pause, another normal beat, and then another PVC.

A

Ventricular bigeminy,

93
Q

rhythm strips:

Rate of 30 - whats first thing to think of?

A

3rd degree block

-ventricular escape rhythm is 30 bpm.

94
Q

valium dosage

95
Q

versed dosage

96
Q

Cardioversion

-sequence of doses:

A

100J biphasic => 150J => 200J

Final FA review (52 decks)

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