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Interventions 3 > ACLS > Flashcards

ACLS Flashcards

1
Q

BLS Primary Survey What is The First things You Do

A

Scene Safety

Check Response

Check for Breathing

Activate the emergency response system

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2
Q

BLS-Circulation

A

Feel for carotid pulse for 5-10 seconds

Begin CPR if you do not feel a pulse

30 compressions

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3
Q

BLS-Breathing

A

Give Two Breaths

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4
Q

BLS-DEFIBRILLATION

A

if no pulse attach AED/manual defibrillator as soon as it arrives

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5
Q

BLS Primary Survey

A

BLS survey focuses on early CPR and early defibrillation

Remember to assess and perform the appropriate action

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6
Q

BLS-Activation of the Emergency Response System

Adults and Adolescence

A

If you are alone with no mobile phone leave the victim to activate the response system and get the AED before beginning CPR

Otherwise send someone and begin CPR immediately use the AED as soon as it is available

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7
Q

BLS-Activation of the Emergency Response System

Infants and Children where the arrest has been witnessed

A

If you are alone with no mobile phone leave the victim to activate the response system and get the AED before beginning CPR

Otherwise send someone and begin CPR immediately use the AED as soon as it is available

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8
Q

BLS-Activation of the Emergency Response System

Infants and Children where the arrest has not been witnessed

A

Give 2 minutes of CPR, then leave the victim to go activate the emergency response system.

Return to the child or infant and resume CPR use the AED as soon as it is available

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9
Q

BLS Compression to Ventilation Ratio With an Advanced Airway

A

Continuous compression at a ratio of 100-120 beats/min

Give 1 breath every 6 seconds (10 breath/min)

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10
Q

BLS Compression to Ventilation Ratio Without an Advanced Airway

Infants and Children

A

1 Rescuers-30:2

2 Rescuers-15:2

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11
Q

BLS Compression to Ventilation Ratio Without an Advanced Airway

Adults and Aldoscents

A

1 or 2 rescuers

30:2

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12
Q

What should your compression rate be with CPR

A

100-120/ min

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13
Q

Compression depth for adults

A

2 inches

5 cm

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14
Q

Compression depth for Children

A

At least one third AP diameter of chest

About 2 inches (5 cm)

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15
Q

Compression Depth for Infants

A

At least one-third AP of the chest

About 1 1/2 inches (4 cm)

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16
Q

Respiratory Arrest

A

Patient has a pulse but is not breathing

10-12 bpm (1 every 5-6 seconds)

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17
Q

Cardiac Arrest BVM

A

30 compression to 2 breaths

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18
Q

Cardiac Arrest- Advanced Airway

A

100 compression per minute with minimal interruptions (<10 seconds)

8-10 bpm (~1 breath every 6-8 seconds)

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19
Q

Why do we only give breath at a slow rate with an advanced airway

A

We are trying to avoid excessive ventilation so that we can ensure that the patent has enough oxygen well also avoiding vasoconstriction

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20
Q

ACLS Survey-Breathing

A

When indicated give oxygen

Assess the adequacy of oxygenation/ventilation

Waveform capnography

Look for adequate chest rise

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21
Q

ACLS Survey-Airway

A

Maintain airway patency (open airway, OPA, NPA)

Advanced airway when indicated

Airway confirmation

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22
Q

ACLS-Circulation

A

Begin with 30 compression before you begin breaths in order to improve blood flow

Monitor CPR Quality

Obtain IV/IO access

ECG monitoring; rhythm assessment

Give drugs/fluid bolus as indicated

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23
Q

ACLS-Differential Diagnosis

A

Search for and treat reversible causes (Hs and Ts)

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24
Q

Quality of Chest Compression

A

Push hard and fast-If you are pushing hard and fast and getting effective chest compression you should have some CO2 on the capnography

Aim for a rate between 100-120 bpm

The depth you are aiming for is 2 inches (5 cm) but not more than 2.4 inches (6 cm)

Allow for full recoil

Switch providers every 2 minutes

Avoid interruptions

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25
Q

Is An Advanced Airway Indicated?

A

An advanced airway should only be used when indicated not as an automatic response

An advanced airway is considered any type of artificial airway (LMA, ETT)

Do not interrupt chest compression to establish an advanced airway

Confirmation of airway-Waveform capnography

Securing

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26
Q

PetCO2 and CPR

A

If PetCO2 is <10 mmHG you need to improve your CPR

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27
Q

Airway for Unconscious Patient

A

OPA

NPA

Head Tilt Chin Lift

Jaw Thurst

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28
Q

Breathing for cardiac arrest

A

100% O2

This may change in the future

Titrate O2 for SpO2 ≥ 94

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29
Q

Avoid Excessive Ventilation

A

Will push air into the stomach

May result in vasoconstriction which will reduce blood flow

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30
Q

Breathing With Advanced Airway

A

When an advanced airway is in place you can give breath one every 6-8 seconds

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31
Q

H with Differential Diagnosis

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen Ion (acidosis)
  • Hyper/Hypokalemia
  • Hypoglycemia
  • Hypothermia
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32
Q

T with Differential Diagnosis

A

Toxins

Tampnade (cardiac)

Tension pneumothorax

Thrombosis-Coronary and pulmonary

Trauma

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33
Q

What are the Different Routes of Administration for Medication

A

In order of how they should use

  1. IV
  2. IO
  3. ETT
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34
Q

IV Route of Administration

A

Peripheral

Most preferred route of access

Give by bolus injection unless otherwise specified

Follow with 20 cc bolus NS; raise extremity

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35
Q

IO Route of Administration

A

Sternal (FAST)/ Tibial

Preferred over ETT route

Any drug that can be given IV can be given IO

When you go through the sternum IO route it will make it hard to do chest compression

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36
Q

ETT Route of Access

A

NAVEL drugs

Optimal dosage not known

Typical dose: 2 to 2.5 times the IV dose

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37
Q

Navel Drugs

A

Naloxon

Atropine

Valium

Epinephrine

Lidocaine

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38
Q

Epinephrine

A

This is a vasopressor

Will improve initial ROSC but does not affect overall survival and discharge rates

39
Q

Amiodarone vs. Lidocaine

A

Amiodarone will increase short term survival when compared to a placebo or lidocaine

Amiodarone can cause amiodarone lung which is a restrictive lung disease and will also cause smurf syndrome

40
Q

Atropine Vs. Pacing

A

Atropine is the first line drug used for acute symptomatic bradycardia

Failure to respond is an indication for TCP, even though the use of epi and dopamine may be successful and can be used to temporarily until pacing is started

41
Q

When should you not use Atropine

A

Do NOT rely on Atropine in Mobitz Type II or 3° heart blocks

42
Q

Transcutaneous Pacing should be started immediately when

A

There is no response to atropine

Atropine is unlikely to be effective or IV access is not quickly available

The patient is severely symptomatic

43
Q

TCP-How to Adjust

A

Place the pads on the patient

If able you should sedate the pt

Set the rate

Set the current

44
Q

When may you not be able to sedate the pt

A

When they are already very hypotensive

45
Q

TCP-Setting the Rate

A

60/min to start and can be adjusted once pacing has been established

Most patients will improve with rates of 60-70 ppm

46
Q

Setting the Current (mA) for TCP

A
  • Incrementally increase until capture has been noted and then increase by 2 mA further for a safety margin
  • Assess for mechanical capture has been notes
    • Check via the femoral pulse
      • We check through the femoral pulse because if we check with the carotid pulse we pay just be feeling the large muscle contracting with the electricity
  • Assess response to the treatment/clinical status
    • If BP is still low try to increase set rate
47
Q

Mechanical Capture

A

When you have mechanical capture you will have a pulse with every single beat

48
Q

Stable Vs. Unstable Pt

A

When a patient is stable we will tend to not do anything and instead consult will cardiology

When a patient is unstable (symptomatic) we will begin treatment

49
Q

What is the first thing you should do when a patient is pulseless

A

CPR

50
Q

Which rhythms are shockable

A

VF

pVT

51
Q

What Should You Do after you give the shock

A

Do CPR for 2 min

Give epinephrine every 3-5 min

Consider advanced airway

Check capnogrphy

52
Q

You Have given the shock a second time

A

do CPR for 2 min

amiodarone- You first give a vasopressor (epi) and then you give an antiarrhythmic (amiodarone)

53
Q

The rhythm is not shockable

A

Continue CPR for 2 min before you do another rhythm check

Give epinephrine

Consider advance airway

Think and reversible causes

54
Q

CPR and Intra arterial pressure

A

If diastolic pressure is <20 mmHg then you should improve CPR quality

55
Q

Shock Energy for Defibrillation

BiPhasic

A

Manufacturer recommendation

Initial dose 120-200 J

If unknown use max available

56
Q

Shock Energy for Defibrillation

Monophasic

A

360 J

57
Q

Epinephrine IV/IO Dose

A

1 mg every 3-5 min

58
Q

Amiodarone IV/IO dose

A

First dose is 300 mg

Second dose is 150 mg

59
Q

Return of Spontaneous Circulation (ROSC)

A

Pulse and blood pressure

Abrupt sustained increase in PET (typically >40 mmHg)

Spontaneous arterial pressure waves with intra-arterial monitoring

60
Q

Adult Tachycardia with Pulse Algorithm

Is the Persistent Tachycardia Causing

A

Hypotension

Altered mental status

Signs of shock

Ischemic chest discomfort

Acute heart failure

61
Q

Adult Tachycardia with Pulse Algorithm

1st Steps

A

Identify and Treat Underlying Cause

Maintain airway and assist breathing if needed

Oxygen is needed

Cardiac monitor, BP, and oximetry

62
Q

Adult Tachycardia with Pulse Algorithm

Treatment for Symptomatic Tachycardia

A

Synchronized Cardioversion

Consider sedation

If regular and narrow complex consider adenosine

63
Q

Adult Tachycardia with Pulse Algorithm

Not Symptomatic and Has a narrow QRS

A

QRS is <0.12

IV Access and ECG

Vagal manuver

Adenosine-if regular and monomorphic

beta blockers and calcium blockers

expert consultation

64
Q

Adult Tachycardia with Pulse Algorithm

Not Sympomatic and Has a Wide QRS

A

QRS is >0.12

IV Access and ECG

Adenosine0if regular and monomorphic

Antiarrhythmic infusion

expert consultation

65
Q

Synchronized Cardioversion Doses

Wide Irregular

A

Defibrillation dose (not synchrnized)

66
Q

Synchronized Cardioversion Doses

Wide Regular

A

100 J

67
Q

Synchronized Cardioversion Doses

Narrow Irregular

A

120-200 J Biphasic

200 J Monophasic

68
Q

Synchronized Cardioversion Doses

Narrow Regular

A

50-100J

69
Q

Adenosine IV Dose

A

The first dose is 6 mg rapid infusion

Follow with NS flush

Second dose is 12 mg if required

70
Q

What are your option for an antiarrhythmic infusion for stable wide QRS Tachycardia

A

Procainamide

Amiodarone

71
Q

Procainamide Dose

A

20-50 mg/min

72
Q

When to stop Procainamide

A

arrhythmia has been supressed

hypotension

QRS increase >50%

Max dose of 17 mg/kg has been reached

73
Q

Maintanence infusion of Procainamide

A

1-4 mg/min

74
Q

When to Avoid Procainamide

A

Prolonged QT or CHF

75
Q

Amiodarone IV

A

First dose is 150 mg over 10 min

Repeat as needed

Maintanence infusion or 1 mg/min for first 6 hour

76
Q

Cardioversion for Unstable Monomorphic VT

A

Biphasic

120-200J

77
Q

Cardioversion for Polymorphic Vt

A

Defibrillation Dose

78
Q

Cardioversion for Unstable SVT Atrial Flutter

A

Biphasic

120-200J

79
Q

Cardioversion for Unstable Atrial Fibrillation

A

Biphasic

120-200J

80
Q

Bradycardia with a pulse algorithm

What to do when symptomatic and atropine is ineffective

A

Dopamine

Epinephrine

Expert consultation

Tranvenous pacing

81
Q

Bradycardia with a pulse algorithm

What to do when symptomatic

A

Atropine

82
Q

Bradycardia with a pulse algorithm

What to do when not symptomatic

A

Monitor and observe

83
Q

Dopamine IV Dose

A

infusion rate of 2-20 mcg/kg per min

Titrate to response

Taper slow

84
Q

Atropine IV Dose

A

First dose is 0.5 mg bolus

Repeat every 3-5 min

max 3 mg

85
Q

Epinephrine IV Infusion

A

2-10 mcg per min

titrate to response

86
Q

Early Defibrillation

A

Will not restart the heart

Will temporarily stun the heart and terminate all electrical activity including VF and VT

If the heart is still viable the normal pacemakers may resume electrical activity

87
Q

Why is Early Defib so important?

A

The interval from collapse to defib is one of the most important determinants of survival from cardiac arrest!

The shock is more likely to work than the vasopressor so it is a higher prority

88
Q

Cardioversion vs. Defibrillation

A

With synchronized cardioversion we are delivering the shock before the down slope of the T wave

On the upslope is the refractory phase and on the down slope if another action potential came the heart muscle could depolarize but it would not be optimal

89
Q

Post-cardiac Arrest Algorithm

A

Optimize Ventilation and Oxygenation

Maintain SpO2 of 94%

Consider advanced airway and waveform capnography

Do not hyperventilate

90
Q

Post Cardiac Arrest Algorithm

Hypotension

A

Want to treat hypotension (SBP <90mmHg)

give IV/IO bolus

Vasopressor infusion

Consider treatable causes

91
Q

Post Cardiac Arrest Algorithm

Was a STEMI or AMI suspected

A

Consider coronary reprefusion

92
Q

Post Cardiac Arrest Algorithm

Do they follow commands

A

Yes-Continue to advanced critical care

No-Initiate targeted temperature management

93
Q

Acute Coronary Syndrome

Immediate ED General Treatment

A

If SpO2 is <90% start oxygen at L/min and titrate

Aspirin 160-325 mg

Nitroglycerin sublingual or spray

Morphine IV is pt is in discomfort that is not relieved through nitroglycerin

Interventions 3 (34 decks)

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