ACLS Flashcards
1
Q
Initial stabilizing/diagnostic measures for suspected MI?
A
VS, IV, O2, monitor
2
Q
dose of nitroglycerin
A
400 mcg q3-5min
3
Q
dose of morphine
A
2-4mg q5min
4
Q
Four diagnostic categories for EKG interpretation in setting of suspected MI:
A
- normal
- STEMI
- ischemia
- non-specific T wave changes
5
Q
EKG normal - next step?
A
trend trops
6
Q
EKG = non-specific T wave changes - next step?
A
repeat EKG in 20 min
7
Q
EKG = ischemia - next step?
A
O2, nitroglycerin
8
Q
Unstable angina Dx made, what 2 meds do you give continuously?
A
heparin drip, nitroglycerin
9
Q
Someone starts to code, what are initial steps?
A
- Call 911/Code Blue
- Start CPR
- Assign roles
- AED
- Bag Valve Mask
- monitor
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
11
Q
Where do you place AED pads?
A
sternum and apex
12
Q
How do you manage airway for first 2 min?
A
Bag valve mask
13
Q
CPR - once pt has a pulse, what do you do?
3 steps:
A
- BP check
- 500cc NS bolus
- IV bicarb
* also do EKG/ABG/labs/CXR
14
Q
Pt recovers, how do you prevent another run of vfib?
A
amio 150mg
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
16
Q
Refractory vfib: which drug do you give during 2nd cycle of CPR that will facilitate successful defib?
A
amio 300mg
17
Q
lidocaine:
- bolus dose:
- drip dose:
A
- 100mg IV push
- 2-4mg IV drip
18
Q
2nd round CPR
-which 2 additional airway management considered?
A
- ETT
- larygneal mask airway
19
Q
First step after placing ETT or LMA?
A
listen to epigastrium for gurgles
20
Q
Gold standard for documenting ETT placement?
A
End Tidal CO2
*ETCO2
21
Q
ROSC
-why is pt tachy? 2 reasons:
A
- epi
- acidosis
22
Q
ROSC
-why hypotension? 2 reasons:
A
- acidosis
- stunned mycocardio = CHF
23
Q
ROSC
-Sinus w/occasional PVCs. What to do?
A
amio drip
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.
25
dopamine drip dose:
10mcg/kg/min for hypotension SBP <90 but > 70.
26
ROSC
| -2 ways to treat metabolic acidosis:
- bicarb IV
| - increase vent rate
27
ROSC
| -even if it doesn't show STEMI - do you still take to cath lab?
yes
28
NRM - non rebreather
| -how many L?
15L
29
In prep for ETT placement, what 3 things should you do?
1. pre-oxygenate
2. prepare suction
3. BVM assist
30
Causes of ACS: mnemonic:
6Hs and 5Ts
31
Causes of ACS:
| -What are 6 H's?
- hypovolemia
- hypoxia
- hydrogen ion = acidosis
- hyper/hypokalemia
- hypothermia
- hypoglycemia
32
Causes of ACS:
| -What are the 5T's?
- tablets (drug OD)
- tamponade
- tension ptx
- thrombosis (coronary)
- thrombosis (PE)
- trauma
33
First pressor to start?
levophed
34
No pulse: whats rate have to be to cardiovert?
150+
35
BP: 80/50 not responsive to fluids
- which pressor do you start?
- dose?
between SBP 90 and 70 use dopamine drip
-10mcg/kg/min
*SBP < 70 then levophed
36
PEA due to tamponade:
| -resuscitation measures?
- IV x2
- dobutamine
- pericardiocentesis
- ETT/BVM
- epi 1mg q3-5min
37
Pericardiocentesis
- how much fluid to remove?
- how should pt's vitals respond?
- 30cc
| - BP increase
38
What does POLST stand for?
Physician's Orders for Life-Sustaining Treatment
39
aflutter
| -3 characteristics:
- lack of normal P waves
- x:1 = abnormal P waves : QRS
- regular rhythym (vs afib which is irregular)
40
what limits aflutter and afib from transmitting every impulse to the ventricles?
refractory cells of the AV node
41
afib v aflutter
| -which one is regular? which irregular?
afib = irregular
aflutter = regular
*regular means equal intervals btwn QRS complexes
42
AV nodal reentrant tachy
- is every impulse sent to ventricles?
- regular or irregular?
yes
| -regular
43
Vtach
- wide or narrow?
- p waves present?
- wide
| - no p waves
44
Vtach
| -regular or irregular?
-regular
45
Vfib
| -regular or irregular?
-irregular
46
Vtach vs Vfib
| -which has varying amplitudes?
Vfib
47
1st deg AV block
| -definition?
PR interval > 200ms
48
Symptomatic bradycardia
| -atropine dose?
0.5 mg IV q3-5min
49
Diltiazem (AV nodal blocking drug)
- 1st dose:
- 2nd dose:
- 20mg IVP
| - 30mg ivp
50
Adenosine (AV nodal blocking drug)
- 1st dose:
- 2nd dose:
- 6mg IVP
| - 12mg IVP
51
AV nodal blocking drugs
| -name 3
diltiazem, adenosine, metoprolol
52
Metoprolol (AV nodal blocking drug)
| -doses:
5mg IVP
| -up to 3 doses
53
O2
| -how many liters NC for ACS?
4-6L
54
Morphine
- dose
- rate
2mg IVP q3-5min for chest pain unrelieved by NTGx3 and SBP > 100.
55
Following STEMI Dx:
| -Clopidogrel dose:
600mg PO
56
Following STEMI Dx:
| -Heparin dose:
1) 60 units/kg IV bolus for acute ischemia
- max 4000 units
2) then 12 units/kg/hr
- max 1000units/hr
57
Procainamide
- dose:
- drip:
- 17mg/kg IV load over 40 min
| - drip: 1-4mg/min
58
Lidocaine
- dose:
- drip:
- 100mg IVP in cardiac arrest or symptomatic vtach
| - drip: 2-4mg IV
59
Dopamine
| -drip:
10mcg/kg/min for hypotension SBP btwn 70 and 90
60
Norepi
| -drip:
2-20mcg/kg/min for hypotension SBP < 70
61
Epi
| -drip:
2-10mcg/min
62
Sodium bicarb
- when to administer?
- dose?
-50 meq IVP after ROSC
63
IV Fluids in cardiac arrest
| -how much?
1 liter wide open to start cardiac arrest resuscitation, 500cc IV bolus for hypotension.
64
Cardioversion
- when to use?
- sequence of voltages?
- when you have perfusing rhythm with a pulse
| - 100J biphasic => 150J => 200J if no cardioversion.
65
Mnemonic for organs first damaged by hypotension:
SLK BH
- SLK in Beverly Hills
- Skin, Lungs, Kidneys, Brain, Heart.
66
Symptomatic bradycardia
- whats your goal HR when first treating?
- what device do you grab next?
60 bpm
| -transcutaneous pacer
67
Transcutaneous pacer
| -rate/energy/mode:
60-70
20-200J
demand mode
68
Which benzos to use before trans-cutaneous pacer (which hurts).
valium or versed
69
How to determine if transcutaneous pacer is successful?
mechanical capture
- pulse/BP
- vital organ perfusion
70
Electrical capture - look for what?
| Mechanical capture - look for what?
- QRS
| - pulse
71
contraindications to adenosine use:
- which 2 drugs?
- what could happen if you used?
tegretol (carbamazepine)
dipyramidole
-asystole
72
What do you expect to see on monitor after giving adenosine?
asystole
73
What is considered a "wide" QRS?
120ms
74
Narrow QRS complexes always have origin from where?
supraventricular
| -you know bc you know its going through proper conduction pathway from atria down through AV node.
75
Before cardioversion, what drugs should you give pt?
| -be cautious about what?
valium/versed, fentanyl
| -watch for decreasing BP.
76
Two common causes of Vtach:
ischemia, electrolyte probs
77
Evaluation method for stroke:
Cincinnati stroke scale
78
3 components of Cincinnati stroke scale
face, arms, speech
79
Time frame for thrombolytic therapy?
4.5 hrs
80
Contraindications to tPa therapy?
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
Acute stroke: if you decide not to give tPa, which med should you give?
ASA
82
Rate of symptomatic intracranial hemorrhage with tPA is used for stroke?
6.4% in literature
83
What % improvement in neuro outcomes if tPa given?
30%
84
BP necessary to give tPa?
| -how to reach if over? which drugs?
< 185/110
| -metop or nicardipine
85
Where is transvenous pacer placed?
apex of R ventricle
86
do "unstable" pts have a pulse?
yes but w/poor circulation.
87
Is there ever a pulse w/vfib?
no
88
is FB(+) contra to tPa?
no but melena is.
89
rhythm strips:
Inverted P wave w/rate of ~50
Normal QRS
junctional rhythm
90
If you see QRS w/o preceding P wave, what should you think?
ectopic rhythm
91
sinus brady w/unifocal pvc vs. ventricular bigeminy
Ventricular bigeminy there is a PVC following every sinus beat.
92
rhythm strips:
| A sinus beat is shortly followed by a PVC, a pause, another normal beat, and then another PVC.
Ventricular bigeminy,
93
rhythm strips:
| Rate of 30 - whats first thing to think of?
3rd degree block
| -ventricular escape rhythm is 30 bpm.
94
valium dosage
5mg
95
versed dosage
2mg
96
Cardioversion
| -sequence of doses:
100J biphasic => 150J => 200J
