ACLS Flashcards
do well in class
how do you clear the airway of a person who is laying down?
head tilt chin lift maneuver
how do you clear the airway of a person with a suspected head of neck injury?
jaw thrust
how do you properly measure an OPA (orophaharengial airway) airway adjunct
from the corner of the mouth to the corner of the mandible
how do you properly measure for a nasal pharengial airway adjunct or NPA?
tip of the patients nose to the earlobe
which airway adjunct can be used I patients that are conscious and have a gag reflex
NPA
what are two things to remember when inserting an NPA?
use lubricating jelly, bevel to the septum
accidentally inflating the stomach after incorrect placement of an ET tube is called what?
gastric insufflation
what is the recommended method of ET tube placement confirmation?
waveform capnography
an abrupt increase in end tidal CO2 or waveform capnography may indicate what?
ROSC
when a CO2 detector detects CO2, what is the color change
from purple to yellow
what are the 8 D’s of stroke care?
detection dispatch delivery door data decision drug/device disposition
what is the time window for rTPA?
3 hours. It can be extended to 4.5 hours for some patients under certain conditions.
what should you do while a patient is receiving rtpa?
BP and neuro checks Q 15 minutes.
what are two contraindications to giving chewable aspirin?
allergy, active GI bleeding
what is PCI?
percutaneous coronary intervention or cardiac catheterization
when doing compressions, you should be pushing down __ inches
2
what is the indication for the use of magnesium in cardiac arrest?
Pulseless ventricular tachycardia-associated torsades de pointes
a patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? atropine 1 mg IV Epinephrine 1 mg IV Lidocaine 1 mg IV Sodium Bicarb 50 mEq IV
Epinephrine 1 mg IV
a patient with sinus bradycardia and a heart rate of 42/min had diaphoresis and a blood pressure of 80/60 mmHg. What is the initial dose of atropine?
0.5 mg
which intervention is most appropriate for the treatment of a patient in asystole? atropine defibrillation epinephrine transcutaneous pacing
epinephrine
a patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? adenosine 6 mg amiodarone 300 mg epinephrine 3 mg lidocaine 0.5 mg/kg
amiodarone 300 mg
what is the maximum interval for pausing chest compressions?
10 seconds
how often should you provide BVM respirations to a patient in respiratory arrest?
every 5 - 6 seconds
what is the recommended compression rate for high quality CPR?
100 - 120 compressions per minute
defibrillation within __ to __ minutes of collapse is associated with high rates of survival
3 to 5 minutes.
Interruptions in compressions should be limited to events like rhythm analysis, intubation and shock, and should last no longer than __ seconds
10
__% of hospitalized patients with cardiorespiratory arrest had abnormal vital signs documented for up to __ hours before the actual arrest.
80%
8 hours
the reasonable goal for MAP in a post cardiac arrest patient is __ mmHg
65
The survival rate for IHCA is approximately __%
24
some of the criteria for an RRT are (3)
heart rate below 40
RR below 6
systolic BP lower than 90
how often should the compressor alternate and with whom?
with the AED operator.
Every 5 cycles or 2 minutes
what do you do if you are unsure about the presence of a pulse?
start compressions and rescue breaths anyway, compressions are less harmful than delay of resuscitation
when doing compressions, how often should you check for a pulse?
about every 2 minutes.
what should you do after shocking the patient?
immediately continue with compressions
how deep and how fast should you do your compressions?
2 inches deep and 100 to 120 compressions per minute
if Petco2 is below __mmHg than you should improve your CPR quality
10mmHg
the secondary assessment consists of asking questions about the underlying cause, consider the memory aid SAMPLE, which stands for what?
Signs and symptoms Allergies Medications Past medical Hx Last oral intake Events leading up to arrest.
the most common causes of cardiac arrest are presented as the H’s and T’s, what are the H’s? (5)
Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-/Hyperkalemia Hypothermia
the most common causes of cardiac arrest are presented as the H’s and T’s, what are the T’s?
Tension pneumothorax Tamponade Toxins Thrombosis (cardiac) Thrombosis (pulmonary)
what are the 4 rhythms associated with cardiac arrest?
VF
pVT
asystole
PEA
which one of the H’s is most associated with PEA?
Hypovolemia
the normal respiratory rate is __ - __, and with a RR lower than __, assisted ventilation or an advanced airway is warranted.
12 - 20
6
a patient in a state characterized by an altered RR, nasal flaring, use of accessory muscles, increased effort, agitation, pale/ cool skin, abnormal lung sounds, is said to be in what state?
respiratory distress
the clinical state of inadequate oxygenation, ventilation, or both is called what?
respiratory failure, often said to be the end stage of respiratory distress.
what is the difference between respiratory distress and failure?
respiratory failure requires intervention to prevent deterioration to cardiac arrest.
the absence of breathing is called what
respiratory arrest.
when ventilating with a BVM in respiratory arrest what are three things that you should be sure of?
breath every 5-6 seconds
about 1 second per breath
achieve visible chest rise.
hyperventilation may cause what, in reference to brain perfusion?
cerebral vasoconstriction
the length of an oropharyngeal airway or OPA should be what
tip of the mouth to the corner of the mandible
nasopharyngeal airway should be how long?
tip of the patients nose to the earlobe.
what should the deciding factor be on deciding whether to use an OPA or an NPA?
the presence of a gag reflex
a suction force of __ - __ mmHg is generally necessary and may not be possible with a portable device. Wall mounted suction should reach __ mmHg when clamped
80 - 120
300
suctioning an ET tube should not exceed __ seconds
10
what are the 3 ECG categories that are used when diagnosing patients with ACS?
ST-segment elevation suggesting ongoing acute injury,
ST- segment depression suggesting ischemia, and nondiagnostic or normal ECG
balloon angioplasty / stenting is referred to as PCI. What does PCI stand for?
Per cutaneous intervention
what are the contraindications to giving the prehospital chest pain patient chewable aspirin?
allergies, recent Hx of GI bleed
why do we give patients chewable aspirin? What are the doses?
it is an immediate COX-1 inhibitor, patients should be given 160 - 325mg, and chewing the aspirin causes it to be absorbed faster than swallowing it
How many times can you give nitro (SL and spray)?
3, 3-5 minutes apart
when shouldn’t you give nitro?
4
if systolic BP is lower than 90mmHg or lower than 30mmHg of baseline, or if the HR is below 50.
Patients with inferior wall MI or RV infarction, inadequate preload, recent use of erectile dysfunction drugs
if the nitrates don’t work, what else can you try?
Morphine
Morphine can be used in the management of ACS because it…
-produces CNS analgesia, which reduces catecholamine release and myocardial O2 demand
produces venodialation
- decreases vascular resistance reducing LV afterload
- redistributes blood volume
what are the timeframes for ECG, fibrinolytics, and PCI?
ECG within 10 minutes of arrival,
fibrinolytics within 30 minutes of arrival, and PCI within 90 minutes of arrival
what are the two types of stroke?
ischemic
hemorrhagic
what are some of the exclusion criterial for using rTPA in an ischemic stroke?
(9)
significant head trauma in the past three months
- recent intracranial or intraspinal surgery
- platelet count of <100,000
- heparin received within 48 hours
- current use of anticoagulant with INR >1.7 or PT >15 seconds
- blood glucose less than 50
- pregnancy
- GI bleed in the last 21 days
- AMI in the last 3 months
- spontaneous resolve of symptoms
name two nonshockable rhythms
asystole
PEA
can you shock VF?
yes
do VF and pVT have similar treatments? How?
yes
they are both shocked with an unsynchronized and high energy shock
in a cardiac arrest, when should you give epinephrine and what is the dose?
1mg IV/IO during CPR after the second shock
after starting CPR, when should the first shock be delivered?
after the first round of 2 minute CPR, shock, then another 2 monute CPR, shock, then Epinephrine
Epinephrine is used during resuscitation primarily for its ______ quality
vasoconstrictive.
what is the first line antiarrhythmic that can be given during cardiac arrest? and at what point is it given?
can be given before of after the shock.
first line is amiodarone
dose is 300mg IV/IO, then can consider another 150mg later
if amiodarone is not available, providers may administer what?
lidocaine
what is the dose for lidocaine?
1 to 1.5 mg/kg IV/IO for the first dose, then 0.5 - 0.75 mg/kg IV/IO at 5 - 10 minute interval, to a maximum dose of 3 mg/kg
Magnesium can be classified as what?
a Na - K pump agonist
when is the only time you use Magnesium during cardiac arrest?
torsade’s de pointes
if petco2 is lower than __mmHg, ROSC is unlikely. However, if petco2 is at a normal value of __ to __, it may be an indicator of ROSC
10
35
40
how often should you give epinephrine during cardiac arrest?
every 3 to 5 minutes 1 mg
what is the definition of PEA?
any organized rhythm without a pulse, including sinus rhythm, idioventricular rhythms, ventricular escape rhythms. Pulseless rhythms that are excluded by definition are VF, pVT, and asystole
the patient is in PEA and you have a shockable rhythm, that means your rhythm is ____ or ____. You shock once and give 2 min of CPR. You shock again and give ______. You give another 2 minutes of CPR and give _______.
VF or pVT
epinephrine
amiodarone
the 2 most common underlying causes of PEA are what
hypovolemia and hypoxia
you may have adequate contractility and still have a rhythm of PEA if you also have this condition
hypovolemia
if you are using a biphasic AED how powerful of a shock do you give, and what are the subsequent shocks?
go by the manufacturer recommendations, which will probably be 120 - 200 joules. If you don’t know the recommendations use the maximum amount and all subsequent shocks should be equal of greater.
if you are using a monophasic AED how powerful of a shock should you give?
360 joules
in the case of asystole, IV/IO access is priority over advanced airway unless why?
unless BVM is ineffective or the cardiac arrest is caused by hypoxia
consider stopping resuscitation efforts if etco2 is less than __ after __ minutes of CPR
etco2 = 10
20 minutes
what is the recommendation for TCP (transcutaneous cardiac pacing) in a patient with asystolic cardiac arrest
the AHA does not recommend TCP in patients with asystole after several randomized controlled tests showed no benefit
the first drug of choice for intervention of symptomatic bradycardia is what
atropine
a person who has a heart rate in the normal range, but the rate is insufficient for them, is said to have what condition?
For example, the person may have a HR of 70 but be in cardiogenic or septic shock.
functional bradycardia or
relative bradycardia
a symptomatic bradycardia exsists clinically when 3 criteria are present, what are they?
1 the heart rate is slow
2 the patient has symptoms
3 the symptoms are due to a slow heart rate.
what are the signs and symptoms (8) of symptomatic bradycardia?
symptoms: chest pain or discomfort, SOB, decreased level of consciousness, weakness, fatigue, light-headedness, dizziness, presyncope or syncope
signs: hypotension, orthostatic hypotension, diaphoresis, pulmonary congestion on physical examination or CXR, frank CHF or PE, PVC’s or VT
what should you look for first if you suspect symptomatic bradycardia in a patient? (6)
signs of poor perfusion and SOB
hypotension, acutely altered mental status, S/S of shock, ischemic chest discomfort, acute heart failure
if your patient has bradycardia without symptoms, what should you do?
observe and monitor
if your patient has bradycardia with symptoms such as hypotension, AMS, chest discomfort, acute heart failure, what should you do? (drugs and doses)
atropine 0.5mg bolus, repeat Q 3-5 minutes, max 3mg
Dopamine IV infusion 2-20mcg/kg per minute, titrate
Epinephrine IV infusion 2-10mcg per minute infusion, titrate
a patient has a normal HR but inadequate perfusion, what is this called?
functional or relative bradycardia
the difference between symptomatic and asymptomatic bradycardia lies on what?
does the patient have adequate perfusion or poor perfusion?
what is the first line treatment for symptomatic bradycardia?
atropine 0.5 mg IV Q 3-5 minutes to a max of 3 mg
what is the second line treatment for symptomatic bradycardia if atropine is ineffective?
transcutaneous pacing or Dopamine 2-20mcg/kg per minute
or
epinephrine 2 to 10 mcg/min
when should you not rely on atropine for the treatment of bradycardia?
in patients with type II second degree or third degree AV block or in patients with third degree AV block with a new wide QRS complex
pg 125
what should you do if your patient has symptomatic bradycardia but does not have IV access?
transcutaneous pacing
also when a patient does not respond to atropine
if transcutaneous pacing does not work as a second line treatment for symptomatic bradycardia what should you do?
begin infusion of either dopamine or epinephrine and prepare for possible trans venous pacing
what should also be considered when proceeding to initiate TCP?
sedation with either parenteral benzodiazepine for anxiety and muscle contractions and narcotic for analgesia
what does a chronotrophic drug do?
change the heart rate and rhythm by affecting the electrical conduction system of the heart and the nerves that influence it
what does an inotrophic drug do?
modifies the speed or force of contraction of the heart muscle
what type of drugs are epi and dopamine?
chronotropes and vasopressors
what are the indications for TCP?
hemodynamically unstable bradycardia, Mobitz type II or third degree AV block, new BBB
is atropine a chronotroph or an inotroph?
a chronotroph
atropine increases conduction and heart rate, it does not contribute to contractility or the force of the heart muscle as an inotroph
what is the recommended intervention for unstable tachycardia?
cardioversion, drugs are not generally used to manage patients with unstable tachycardia
Many experts suggest that when a heart rate is less than ___/min, it is unlikely that symptoms of instability are caused by the tachycardia unless there is impaired ventricular function.
150
what are some S/S of unstable tachycardia?
hypotension acutely altered mental status signs of shock ischemic chest discomfort acute heart failure
name 3 underlying causes of sinus tachycardia
fever
anemia
hypoxia
when should you consider adenosine when treating tachycardia?
what are the doses
if it is regular and monomorphic
6 mg rapid push, second dose 12 mg if needed
S/S are thought to be cause by tachycardia when the rate is greater than ___, if less the tachycardia may likely be a physiological response to an underlying cause.
150
