ACLS

Question 1

When to call rapid response

Answer 1

airway compromise, RR less than 6 or more than 30, HR less than 40 or more than 140, systolic less than 90, symptomatic hypertension, decrease in level of consciousness, unexplained agitation, seizure, significant decrease in urine, concern

Question 2

high preformance teams need to focus on

Answer 2

timing, quality, coordination, administration

Question 3

compressors should be switched every

Answer 3

2 minutes

Question 4

acute coronary syndrome algorithm is for patients whose symptoms suggest

Answer 4

ischemia or infarction

Question 5

acute coronary syndrome algorithm preperation

Answer 5

assess ABCs, administer aspirin, consider O2, nitroglycerin, and morphine, 12 lead ECG

Question 6

acute coronary syndrome algorithm cath lab assessment

Answer 6

activate STEMI team, assess ABCs, establish IV access, physical exam, fibrinolytic checklist, cardiac marker levels and other labs, chest x ray

Question 7

acute coronary syndrome algorithm cath lab treatment

Answer 7

if O2 sat less than 90% then start at 4 L/min, aspirin 162 to 325 mg, nitroglycerin, morphine IV, consider P2Y12 inhibitors

Question 8

most common symptom of myocardial ischemia and infarction is

Answer 8

retrosternal chest discomfort - tightness or pressure

Question 9

assessing ABCs includes

Answer 9

monitoring vital signs and cardiac rhythm, CPR, using a defibrillator if needed.

Question 10

type of aspirin for ACS

Answer 10

162 mg - 325 mg of non-enteric-coated or chewed aspirin as long as there Is no evidence of GI bleed or apirin allergy

Question 11

use rectal aspirin for

Answer 11

pts with nausea, vomiting, active peptic ulcer disease

Question 12

nitroglycerin

Answer 12

reduces left ventricular and right ventricular preload through venous and arterial dilation. reduces chest discomfort.

Question 13

how much nitroglycerin?

Answer 13

1 sublingual tab every 3-5 minutes for a total of 3 doses if needed. watch vitals

Question 14

nitroglycerin can not be used in pts with

Answer 14

inadequate ventricular preload such as inferior wall MI and RV infarction, hypotension, bradycardia, or tachy, recent phosphodiesterase inhibitor use

Question 15

what should you consider using if chest pain does not go away with the use of nitroglycerin

Answer 15

morphine

Question 16

a patient’s response to nitrate therapy is not

Answer 16

diognostic of ACS

Question 17

what drugs should not be used during hospitalization with STEMI because of the increased risk of morality, reinfarction, hypertension, HF, or myocardial rupture?

Answer 17

dont use anti-inflammatory drugs (except fo aspirin)

Question 18

12 lead ECG is the only way to identify

Answer 18

STEMI

Question 19

Reperfursion goals in pts with STEMI

Answer 19

Percutaneous Coronary Intervention (PCI) should begin within 90 minutes from door to balloon.
Firbrinolytics should begin within 30 minutes of the arrival to the ED

Question 20

STEMI is charaxterized by

Answer 20

ST segment elevation in 2 or more contiguous or a new left bundle branch block

Question 21

Non ST-elevation acute coronary syndrome (NSTE-ACS) is characterized by

Answer 21

ischemic ST-segment depression or dynamic T- wave inversion with pain

Question 22

treat STEMI by providing

Answer 22

early reperfusion therapy achieved with primary PCI or fibrinolytic

Question 23

potential delays in hospital evaluation of ACS (the 4 Ds)

Answer 23

delays may occur in evaluation from door to data (ECG), data to decision, and decision to drug.

Question 24

most common form of PCI is

Answer 24

coronary angioplasty with stent placement

Question 25

fribrinolytics are generally not recommended for patients who are

Answer 25

presenting more than 12 hours after onset of symptoms

Question 26

do not give fibrinolytics to patients who

Answer 26

present more than 24 hours after onset of symptoms or those with ST segment depression unless a true posterior MI is suspected

Question 27

iv nitroglycerin is used in patients with

Answer 27

ischemic syndrome and not that often in STEMI

Question 28

goal door to needle time in stroke patients

Answer 28

60 minutes

Question 29

goal door to device time in stroke patients

Answer 29

90 minutes

Question 30

fibrinolytic therapy for stroke should be provided

Answer 30

as early as possible but should be within 3 hours of onset of symptoms

Question 31

Stroke chain of survival

Answer 31

rapid recognition and reaction to stroke warning signs, rapid use of 911, Rapid EMS recognition and transport, rapid diagnosis and treatment in the hospital

Question 32

8 D's of stroke care (where delays can occur)

Answer 32

detection, dispatch, delivery, door, data, decision, drug/device, disposition

Question 33

upon arrival to the hospital of a stroke patient what needs to be done

Answer 33

assessment within 10 minutes, stroke team activation, prepare for CT, assess ABCs, give O2 if needed, IV access, lab assessment and glucose check, onset of symptoms and history

Question 34

time period for immediate general assessment for stroke pts

Answer 34

10 minutes

Question 35

time period for immediate neurologic assessment for stroke pts

Answer 35

within 20 minutes

Question 36

time period to get CT or MRI of head in stroke pts

Answer 36

within 20 minutes

Question 37

time period to get interpretation of CT or MRI of head in stroke pts

Answer 37

within 45 minutes

Question 38

time period to administer fibrinolytic therapy in stroke pts after arriving to the ED

Answer 38

within 60 minutes

Question 39

time period to administer fibrinolytic therapy in stroke pts from time of onset

Answer 39

within 3 hours

Question 40

time period to administer EVT therapy in stroke pts

Answer 40

up to 24 hours with patients who have large vessel occlusion

Question 41

time period from admission to bed in stroke pts

Answer 41

3 hours

Question 42

major complication of IV alteplace for stroke is

Answer 42

intracranial hemorrhage

Question 43

do not administer what after administration of alteplase

Answer 43

do not give anticoagulants or antiplatelet treatment for 24 hours after alteplase

Question 44

main steps in life support

Answer 44

check for responsiveness shout for help, activate emergency response system, find defibrilator check for breathing and pulse no more than 10 seconds! begin CPR if no pulse is detected if pulse present - begin rescue breathing

Question 45

how many compressions per minute

Answer 45

100-120 per minute

Question 46

1 respiration every

Answer 46

5-6 seconds

Question 47

consider giving ________ to ischemic stroke patients if glucose level is greater than 180

Answer 47

IV or sub q insulin

Question 48

if pt is eleigable for fibrinolytic therapy BP must be

Answer 48

185 mm Hg of less systolic and 110 mmHg or less diastolic

Question 49

Mobitz type I AV block also known as wenckebach phenomenon

Answer 49

characterized by successive prologation of the PR interval. P wave is not followed by a QRS

Question 50

Mobitz type II second degree AV block

Answer 50

characterized by 2 P waves to 1 QRS complex

Question 51

heart block that is mostly likely to cause cardiovascular collapse

Answer 51

complete (third degree) AV block

Question 52

an unstable bradycardia exists clinically when

Answer 52

1. HR is slow 2. patient has symptoms 3. symptoms are due to the slow HR

Question 53

s/s of bradycardia

Answer 53

hypotension, altered mental status, signs of shock, ischemic chest discomfort, acute heart failure

Question 54

primary assessment (ABCDE)

Answer 54

A: maintain patent airway B: assist breathing as necessary/give O2 C: monitor blood pressure, O2, HR, IV access, 12 lead D and E: conduct focused history and physical

Question 55

bradycardia associated with hypertension can be a sign of

Answer 55

life threatening intracranial pressure

Question 56

s/s of tachycardia

Answer 56

hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute HF

Question 57

if patient has unstable tachycardia should you wait to cardiovert until the 12 lead EKG

Answer 57

NO

Question 58

a RR below what requires assisted ventilation

Answer 58

below 6

Question 59

excessive ventilation can cause

Answer 59

gastric inflation and complications such as aspiration

Question 60

during CPR you check pulse every

Answer 60

2 minutes

Question 61

techniques for opening airway

Answer 61

tilt the head and lift the chin or jaw thrust technique in neck injury pts

Question 62

depth of compressions should be

Answer 62

at least 2 inches and let the chest recoil

Question 63

CCF

Answer 63

actual chest compression time / total code time