ACLS Flashcards
Advanced life support
What are agonal gasps an indication of
Cardiac arrest
What does ACLS stand for
Advanced cardiac life support
Airway
Airway is adequate and protected, insert advanced airway
Breathing
Give O2, Confirm placement of Endotracheal toube, Monitor waveform capnography, Don’t over ventilate
Circulation
IV/IO access, treat hr/rythm, monitor CPR quality, defibrillate, vitals
Differential diagnosis and disability
Determine problem, h and t, mental status, Glasgow coma scale
ACE
Angiotensin-converting enzyme
ACS
Acute Coronary syndromes
AED
Automated external defibrillator
AHF
Acute heart failure
AIVR
Accelerated idioventricular rhythm
AMI
Acute myocardial infarction
aPTT
Activated partial thromboplastin time
AV
Atrioventricular
CARES
Cardiac arrest registry to enhance survival
CCF
Chest compression fraction
CPR
Cardiopulmonary resuscitation
CPSS
Cincinnati prehospital stroke scale
CQI
Continuous quality improvement
CT
Computed tomography
DNAR
Do not attempt resuscitation
ECG
Electrocardiogram
ED
Emergency department
EMS
Emergency medical services
ET
Endotracheal
FDA
Food and drug administration
FIO2
Fraction of inspired oxygen
GI
Gastrointestinal
ICU
Intensive care unit
INR
International normalized ratio
IO
Intraosseous
IV
Intravenous
LV
Left ventricle/ventricular
mA
Milliamperes
MACE
Major adverse cardiac events
MET
Medical emergency team
MI
Myocardial infarction
mm Hg
Millimeters of Mercury
NIH
National institutes of health
NIHSS
National institutes of health stroke scale
NINDS
National institute of neurological disorders and stroke
NPA
Nasopharyngeal airway
NSAID
Nonsteroidal anti-inflammatory drug
NSTE-ACS
Non-ST-segment elevation acute coronary syndromes
NSTEMI
Non-ST-segment elevation myocardial infarction
OPA
Oropharyngeal airway
Paco2
Partial pressure of carbon dioxide in arterial blood
PCI
Percutaneous coronary intervention
PE
Pulmonary embolism
PEA
Pulses electrical activity
PETCO2
Partial pressure of end-tidal carbon dioxide
PT
Prothrombin time
pVT
Pulseless ventricular tachycardia
ROSC
Return of spontaneous circulation
RRT
Rapid response team
rtPA
Recombinant tissue plasminogen activator
RV
Right ventricle/ventricular
SBP
Systolic blood pressure
STEMI
ST-segment elevation myocardial infarction
SVT
Supraventricular tachycardia
TCP
Transcutaneous pacing
TTM
Targeted temperature management
UA
Unstable angina
VF
Ventricular fibrillation
VT
Ventricular tachycardia
How do you optimize ACLS
A team leader effectively integrates high-quality CPR w/minimal interruptions of compressions/advanced life support strategies (defibrillation, meds, advance airway)
What should intervals be between compressions and shock delivery for increased predicted shock success
10 seconds or less
BLS survey is for people who are
Unconscious
ACLS survey is for people who are
Conscious
BLS survey
Check responsiveness, call for help, check carotid/ chest rise, assess pulse/breathing 5-10 sec, pulse present but no breath assist ventilation, no pulse no breathing CPR, defibrillate
Where do narrow QRS complexes originate
Syria near av node
Where do wide complexes originate
Ventricles
What is the most common rhythm to occur immediately after cardiac arrest
Ventricular fibrillation
What is happening during vfib
Ventricles quiver and cant pump blood
What are the 2 types of vfib
Coarse and fine
Which type of vfib is more easily corrected with defibrillation
Coarse
What type of vfib is seen more in a pt with cardiac arrest
Fine vf
What is vtach
Ventricular focus takes over control of heart and fires at tachy rate
In vtach what does the QRS complex look like and why
Wide because it originates in the ventricles
What is treatment for vfib and pulseless vtach
Defibrillate, Cpr for 2 minutes, check rhythm/pulse, shock again if needed, repeat until rhythm not shockable, meds admin with CPR/defibrillation
**Medication sequence for vfib and pulselss vtach
Epi 1mg 1:10,000 IV/IO every 3-5 min, **(persistent vf) amiodarone 300mg IV/IO 1st dose amiodarone 150mg last dose
Asystole
No detectable activity on EKG
***Pulseless electrical activity
Heart not beating and no pulse but rhythm still present on EKG
Treatment for asystole
CPR, epinephrine 1mg 1:10,000 IV/IO 3-5 min, consider H and T
Hypovolemia
Volume depletion: excessive loss of body water/blood
Hypoxia
Oxygen depletion
Hydrogen ion
Excess of acid in blood/alkali. drop in ph
Hypo/hyperkalamia
Low/high potassium
Hypoglycemia
Low blood sugar
Tamponade, cardiac
Fluid build-up around heart
Tension pneumothorax
Air in the pleural space
Thrombus, coronary
Clot in coronary artery causing block of blood flow
Thrombus, pulmonary
Clot/material in artery of lungs
What are the h’s and t’s to consider for asystole and PEA
Hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypoglycemia, toxins, Tamponade cardiac, tension pneumothorax, thrombosis coronary, thrombosis pulmonary
What are the bradycardic rhythms
Sinus Bradycardia, 1st degree AV block, 2nd degree block type 1, 2nd degree block type two, 3rd degree block
1st degree AV block
Conduction through AV node slowed ( long PR wave inteval) Less than 5 boxes no treatment needed but may indicate higher degree in future
2nd degree block type one
Increase delay AV node conduction until failure of P wave
2nd degree block type 2 mobitz
Occurs below AV node. P waves regular but QRS drops. Atrial contractions not followed by ventricular contractions. Pacing recommended
3rd degree block
Complete heart block. No communication between SA and AV
Treatment for symptomatic blocks
O2, atropine .5mg 3-5min till 3mg***, transcutaneous pacing for high degree, airway maneuvers and ventilation for airway/breathing complications
TCP alternative
Dopamine IV infusion 2-20mcg/kg/min, epinephrine IV infusion 2-20 mcg/min
Tachycardic rhythms
Sinus tachycardia, supraventricular tach, monomorphic ventricular tach, polymorphic ventricular tach, torsades de pointes
How many beats per min would be considered tachycardic
101-150
SVT
Indistinguishable P wave due to HR greater than 150. Narrow QRS, P runs into T.
SVT rhythms
Atrial tach, junctional tach, atrial flutter, a-fib, and sinus tach
Treatment for stable supraventricular tach
Vagal maneuvers, adenosine 6mg rapid IVP, adenosine 12mg IVP 2nd dose, beta blocker or calcium channel blocker
Treatment for unstable supraventricular tach
Sedate, cardioversion (6mg adenosine if have IV at beginning of signs if meds are ready)
Monomorphic ventricular tach with pulses
ORS complex same size and shape
Treatment for stable monomorphic v-tach
Expert consult, adenosine 6mg rapid IVP, adenosine 12mg, amiodarone infusion 150mg over 10 min
Treatment for unstable monomorphic v-tach
Sedate, cardioversion
Polymorphic v-tach with pulse
QRS complex different size and shapes
Treatment for polymorphic v-tach
Defibrillate and CPR
Torsades de pointes
Twisting pattern. QRS diff size and shapes, treat with magnesium
Types of electrical therapy
Defibrillation, cardioversion, transcutaneous pacing
What shouldn’t be happening during shock for safety
Oxygen should not be blowing over pt chest
Do you have to move a pt when defibrilating if they are on water or snow
No only if water is on chest
High quality compressions immediatly before and after shock increase chance of what
Conversion from vf
Difference between defibrillation and cardioversion
Defibrillation: random shocks during cardiac cycle Cardioversion: delivery of energy that is synchronized to QRS complex
Recommended initial cardio version dosages
Narrow regular: 50 - 100 J biphasic
Narrow irregular: 120 - 200 J biphasic/200 J monophasic Wide regular: 100 J biphasic Wide irregular: defibrillation dose (do not sync)
How to perform transcutaneous pacing
Consider sedation, place electrodes on patient, turn on pacer, set the pace rate, slowly increase MA until capture achieved with corresponding pulse.
What are airway adjuncts
Nasopharyngeal airway, oropharyngeal airway
When can you use a nasopharyngeal airway
Semi conscious patient
When is a nasopharyngeal airway contraindicated
In head injuries
When is an oropharyngeal airway used
In unconscious patients with no gag reflex
What are the advanced airways
Endotracheal tube, Laryngeal mask Airway
Which airway is the most ideal
Endotracheal
Things to watch out for using an Endotracheal tube
Suction during with draw 10 seconds or less, No tube ties obstructing veins in neck, Monitor capnography to confirm ET tube placement
Why is a laryngeal mask airway used
Used by providers not familiar with ET tube intubation
After advanced airway is placed what happens
A 100 compressions per minute Do not stop for breaths, ventilate Once every 6 seconds
If oxygen is delivered through a BVM what should O2 be set at
10 - 15LPM
Where should oxygen be kept post cardiac arrest
Between 94 and 99%
What can be caused by excess ventillation
Increased chest pressure and decrease cardiac output
What does Capnography measure
Partial pressure of end-tidal CO2
Where does normal capnography range
35 - 40MMHG
What allows for monitoring of CPR quality
Quantitative capnography
What will indicate that chest compressions may not be effective
PETCO2 readings of less than 10MMHG
What are signs and symptoms of a stroke
Loss/difficulty speaking, loss of vision, sudden severe headache, difficulty standing/walking, Weakness/numbness of face extremities or one side of body
How to treat stroke
Support ABC’s, eval using Cincinnati pre-hospital stroke scale, check blood sugar, establish stoke time, transport to stroke center, CT scan Priority
What is the Cincinnati pre hospital stroke scale
Facial droop, arm drift, slurred speech
What will a CT scan possibly show in a stroke victim
Intracranial hemorrhaging
After a CT If there are no signs of hemorrhaging what do you do
Begin fibrinolytic therapy ASAP
What are the 3 groups of ACS
Unstable angina, ST segment elevation MI cama non-ST-segment elevation MI
What are signs and symptoms of ACS
Chest pain to jaw/left arm
Signs of ACS are typically more subtler in who
Women and diabetic patients
What should you do if you are unsure a patient is having ACS
Perform 12 lead ECG
Treatment for ACS stable
ABC’s, 12 lead, O2, aspirin, nitroglycerin, morphine, labs, chest X-ray
Treatment of ACS unconscious and not breathing
CPR and defibrillate
After how long in a systole should you stop CPR and medication
25 minutes or more
How quickly should CPR be performed on victims they have no pulse and no normal breathing
Within 10 seconds
What is a common mistake in cardiac arrest management
Prolonged interruptions in chest compressions
It’s there is no suspected neck injury what is the best way to open the airway
Head tilt chin lift
When an infant’s pulse rate reaches less than ___ beats per minute you should start CPR
60
What is hand placement for adult CPR
2 hands on the lower half of the breastbone
What is hand placement for infant CPR
One rescuer - 2 fingers on center of chest, Two rescuer - encircleing thumbs technique
How many breaths a minute Should you give someone with a pulse but poor breathing
Adults - 1 every 5-6 seconds, children- 1 every 3-5 seconds
Best place to check infants pulse
Brachial artery
How many compressions do you deliver per minute
100 - 120
How often should you switch compressors
Every 2 minutes or 5 cycles of CPR
Compression depth for adults
At least 2”
Compression depth for children and infants
At least 1/3 the depth of the chest
Compression and breath rates after advanced airway placed
Compressions - 100 per minute continuous, breaths - 1 every 6 seconds
What is the best way to relieve severe choking in responsive infants
5 back slaps followed by 5 Chest thrusts
What is the highest priority for patients in respiratory failure with rapidly dropping heart beats
Assist with ventillation and simple airway maneuvers
Airway for those who have achieved ROSC
Optimize ventillation and oxygenation
Breathing for those who have achieved ROSC
A PETCO2 range of 35-40MMHG
Circulation for those who have achieved ROSC
For hypotensive A122L Bullis of IV fluid, Systolic BP of 90MMHG, Epinephrine drip .1 - .5 mcg/kg/min, Differential diagnosis
At what temperature would be considered therapeutic hypothermia
32 to 36ﾟC
When is their pubic hypothermia not indicated
When the patient is responding to verbal command
What might be beneficial to a patient Who are comatose
Therapeutic hypothermia for at least 24 hours
