ACLS Flashcards
Pre-Arrest intervention
initiation of Rapid Reponse Team
“No Flow” intervention
Prompt initiation of BLS
“Low Flow” intervention
high quality chest compressions for myocardial and cerebral perfusion
“Postresuscitation” intervention
Temperature management, blood pressure management (no hypotension); preserve neurologic function
A “General Impression” is…
ABCs–Appearance, (Work of) Breathing, Circulation
Primary Survey is
rapid hands on assessment. “See it and treat it”
AVPU for assessing responsiveness
Alert
Responds to Verbal stimuli
Responds to Painful stimuli
Unresponsive
For responsive patients, primary survey starts with..
ABC
For unresponsive patients, primary survey starts with…
CAB
Seconday Survey
Airway (artificial) Breathing (intubating) Circulation (IV/IO) Differential Diagnosis (PATCH4MD) Evaluate interventions Facilitate family
Intubation 2-step verification
- Color change in colorimetric CO2 detector
2. Bilateral breath sounds
Normal End-Tidal CO2 range
35-40
Low levels of CO2 indicates
hyperventilation or hypotension
High levels of CO2 indicates
hypoventilation
Nasal Cannulas provide
1-5 L/min
23-32% oxygen
High Flow Nasal Cannulas provide
up to 10 L/min
Partial Rebreather Masks provide
35-60% oxygen with flow rates of 6-10 L/min
Nonrebreather Masks provide
60-80% oxygen with flow rates of at least 10 L/min
Oral Airway measurement
measure from mouth to angle of the jaw
Nasal Airway measurement
from septum to tip of ear…Stop if it does not slid gently
Leads II, III, AVF show
inferior aspects of the heart
Leads I, AVL, V5, V6 show
lateral aspects of the heart
Leads V1 and V2 show
septal aspects of the heart
Leads V3 and V4 show
anterior aspects of the heart
PATCH-4-MD—-“P”
Pulmonary embolism–anticoagulants?Surgery?
PATCH-4-MD—-“A”
Acidosis–ventilation, correct acid-base disturbances (sodium bicarb)
PATCH-4-MD—-“T”
Tension pneumothorax–needle decompression
PATCH-4-MD—-“C”
Cardiac Tamponade–pericardiocentesis
PATCH-4-MD—-“H”s
Hypovolemia–replace intravascular volume
Hypoxia–ensure adequate oxygenation and ventilation
Heat/cold–cooling/warming methods
Hypo/Hyperkalemia–monitor serum glucose levels and correct disturbances
PATCH-4-MD—-“M”
Myocardial Infarction–reperfusion therapy
PATCH-4-MD—-“D”
Drug overdose/accidents–antidote/specific therapy
Pacemaker placement can cause
cardiac tamponade
Epinephrine is the
1st line dead person drug
Epinephrine is given IV push in amounts of
1mg every 3-5 minutes
Amiodarone is used in
pVT/VF
Amiodarone IVP amount
300mg, followed by dose of 150mg
Most common cause of PEA
hypovolemia
Joules amount used in a code at Wilson
200/300/360j
During cardiac arrest, follow each drug with a
20mL fluid flush
Post-Cardiac Arrest temperature management between
32-36 degrees Celsius
Key questions for tachycardia
- Asymptomatic? Symptomatic but stable? Symptomatic and unstable? Pulseless?
- QRS wide or narrow?
- Ventricular rhythm regular or irregular?
Monomorphic wide QRS drug given 1st
adenosine..administered to try to identify the origin of the tachycardia. No effect if the rhythm is VT
Amiodarone
150mg IV bolus over 10 minutes
repeat every 10 minutes as needed
Most common side effects of amiodarone
hypotension and bradycardia
Amiodarone may
prolong the QT interval
Procainamide dosing
20mg/min IV infusion or 100mg every 5 minutes
TdP drug is
magnesium
TdP is caused by
QT interval becoming too long
SVT and AFlutter joules for cardioversion
50 joules
Afib joules for cardioversion
120 joules
“Other” rhythms joules for cardioversion
100 joules
Bradycardia first drug
Atropine
Atropine dosing
0.5mg IVP every 3-5 minutes for a total of 3mg
Atropine must be given with…
confidence or it will cause rebound bradycardia
Epinephrine infusions need to run at
2-10mcg/min…run through central line (due to risk of tissue sloughing)
Dopamine infusion needs to run at
2-10 mcg/kg/min
Electrical Capture is
Spike QRS
Mechanical Capture is
Pulse R side of the body
Pacing pads are good for
24 hours on skin, 8 hours for for pacing
Unstable Angina and NSTEMI is differentiated by
troponin level
ECG “STEMI” findings
elevated in 2 contiguous leads and elevated biomarkers
ECG “NSTEMI” findings
ST elevation not present but biomarkers elevated
ECG “UA” findings
ST elevation not present, cardiac biomarkers not elevated
Inferior wall infarctions need a
Right Sided ECG
Nitroglycerin used to
deal with cause of chest pain
Give Nitro only after
12-lead ECG done, blood pressure taken
Do not give nitro if
BP is less than 90 or 30 less than baseline, phosphodiesterase inhibitors, suspected RVI
Morphine Sulfate dosage for NSTEMI
1-5mg IV repeat every 5-30 minutes
Morphine Sulfate dosage for STEMI
4-8mg IV every 5-15 minutes as needed
Morphine Sulfate causes patients to
feel relaxed with no pain
Aspirin dosage for chest pain
325 mg chewed
Stroke Chain of Survival (D)
Detection Dispatch Delivery Door Data Decision Drug Disposition
Most common type of stroke is
ischemic
IV tPA must be administered within
3 hours of Last Known Well
Stroke “FAST” test
Facial droop
Arm drift
Speech
Time of onset
Non contrast CT must be done within how many minutes for a stroke?
25 minutes
Adenosine IVP dosage
6mg IV SLAM, followed by 12mg IVP and 12mg IVP
Cardizem dosage
.25mg/kg IV bolus over 2 minutes, .35mg/kg over 2 minutes after 15 minutes
Never given cardizem with
WIDE QRS tachycardias…may cause Vfib, can worsen hypotension