ACLS

Question 1

atria and ventricles are depolarizing independtly

Answer 1

3 degree AV block

Question 2

how to approach bradycardic pt…

Answer 2

HISTORY AN DPHYSICAL (see if it is symptomatic bradycardia)…do not treat ASYMPTOMATIC brady

iv access, o2, monitor, EKG

Question 3

rx bradycardia

Answer 3

atropine, dopamine, epi, transcutaneous/transvenous pacing

Question 4

AHA tachy

Answer 4

greater than 150 bpm

Question 5

narrow QRS (SVTs) rx

Answer 5

• vagal manuvers (for stable patients) like bearing down, valsalva carotid massage,
• adenosine (1st dose 6 mg, 12 mg, 12 mg)

Question 6

stable tachy cardia with wide QRS, regular

Answer 6

vtach

give amiodarone

Question 7

how to treat irregular wide qrs

Answer 7

this is TORSADES

mg sulfate 2g IV

Question 8

how to treat unstable tachy that is regular

Answer 8

SHOCK (100 J synchronized

Question 9

how to treat unstable irregular that is irregular

Answer 9

200 J synch/defib (if wide)

Question 10

which ACLS intervention has been shown to improve surivival

Answer 10

high quality CPR

early defib

Question 11

team dynamics of high quality CPR

Answer 11

clearly defined roles with code leader
monitoring and providing feedback
CLOSED LOOP COMMUNICATION
knowing limits

Question 12

how to quantify CPR

Answer 12

waveform capnography (PET CO2 > 100 mHG) = good CPR

Question 13

for defibrillation….hands free pads or paddles?

Answer 13

hands free pads are faster than paddles

Question 14

what to do while defib is charging

Answer 14

COMPRESSIONS!

Question 15

how to treat pulseless electrical activity

Answer 15

DON”T SHOCK

Question 16

only shock for pulseless vtach/ vfib

Answer 16

YES

Question 17

shock asystole (flat line)

Answer 17

NO

Question 18

shockable rhythms (2)
non shockable rhytms (2)

Answer 18

vtach vfib shock

pulseless EA, asystole DO NOT SHOCK

Question 19

after shock patient, now what?

Answer 19

resume compressions, then do combined pulse/rhythm check

Question 20

where preferred site for IV meds in a shockable rhythm

Answer 20

antecubital vein

Question 21

if you can’t get IV where to go?

Answer 21

intraosseous (IO)

Question 22

when to give epi

Answer 22

1 mg epinephrine every 3-5 min/every 2 cycles of cpr

Question 23

after epi what to give?

Answer 23

amiodarone (300 mg first dose

Question 24

when to give drugs?

Answer 24

rapidly during compressions

Question 25

cricoid pressure to prevent aspiration in arrest?

Answer 25

NOT RECOMMENDED DON’T DO IT

Question 26

purpose of rapid response teams

Answer 26

fix patients before they crash

Question 27

after return of spontaneous circ (ROSC), what to assesst

Answer 27

ABCD
airway first
breathing...look for PET CO2 35-40 if intubated, don't overventilate since can reduce cerebral blood flow)
Circulation
Disability

Question 28

goal to fix hypotension

Answer 28

SBP ? 90 mmHg

Question 29

what to do first for hypotension

Answer 29

first try 1-2L IV Bolus of NS or LR

then try epi/norepi

Question 30

disability means…

Answer 30

if patient is following commands?

Question 31

if patient cannot follow commands…

Answer 31

cto hypothermia protocol

35-40 degrees C goal

Question 32

if you have a stroke suspected…

Answer 32

triage to stroke center with WORKING CT

Question 33

cincinatti pre-hospital stroke scale

Answer 33

facial droop
arm drift
abnormal speech

if any one of these is abnormal…stroke probability is 72%

Question 34

first imaging to get in suspected stroke

Answer 34

CT with no contrast

Question 35

symptoms of possible ACS

Answer 35

chest pain/pressure

EPIGASTRIC PAIN IS MORE ATYPICAL (elderly, women, diabetics)

Question 36

suspect MI in ED? important first step

Answer 36

12 lead EKG!!!

Question 37

immediate ED rx for ACS supsected

Answer 37

325 mg ASA if not already given
nitro for chest pain
morphine IV if discomfort not relieved by nitro

Question 38

contraindications to nitro

Answer 38

PDE 5 inhibitor (i.e. sildenafil)
hypotension
right sided MI
allergy to nitro