ACLS & BLS Flashcards
What is the first patient assessment
• Responsiveness/Level of consciousness • Call for help: Code, Rapid Response or Medical Emergency Team or 911 • Bring BVM and Defibrillator • Primary CABD Assessment
What are you assessing in circulation ?
Hint :
- ) when to start CPR
- ) depth of CPR
- ) how many compressions per min.
assess pulse/regular breathing, if none or unsure, start CPR ‘push hard, push fast’ 2” to 2.4”, minimum 100 comps/min, Maximum 120 Use CPR board on patient beds, don’t delay CPR to place
What intervention is done in VF arrest AFTER CPR?
Defibrillation
What is the procedure of utilizing defibrillation and what is the motto used to remind us what to do for an unstable patient?
• Edison before medicine!
• Expose patient’s chest, apply self-adherent pads
(faster defib than paddles) to patients chest
• Confirm VF/pulseless VT (or Torsades), look head- to-toe, clear all personnel while charging to 360j monophasic or 200j biphasic
• Clear compressor, Deliver defibrillation
What should be done following defibrillation ?
• Now is not the time to assess pulse or rhythm! – Immediate return to CPR following all defib attempts
When would you use synchronized cardioversion ? R
for tachycardias (rate >150) with serious signs and symptoms related to rate
VT with a pulse; PSVT; Atrial Flutter
Every dead person deserves what ? Give the dosage and directions for use.
- Every Dead Person deserves EPI
- Indications – All cardiac arrests (VF/VT, Asystole, PEA)
- Bradycardia and Hypotension with signs of shock drip only
• 1 mg
• 10ml of a 1:10,000 solution
• Repeat every 3 to 5 minutes for the duration of the arrest
When would you give Atropine ? Dosage and directions ?
• Alive patients:
Indications – Symptomatic sinus bradycardia, AV block, Idioventricular rhythms
0.5 mg
• Repeat every 3 to 5 minutes to a max of 3 mg
Indication for Amiodarone and the appropriate dosage(s)and time:
- Amiodarone 300 mg for VF/VT
- Repeat at 150 mg once after 3 to 5 minutes
- Amiodarone 150 mg over 10 minutes for perfusing rhythms
What are the treatable causes for ventricular arrhythmias? (Hint Hs and Ts)
- Hypoxia
- Hypovolemia
- Hypothermia
- Hyper/Hypokalemia • Hydrogen Ion
- Hypomagnesemia
- Tablets/Toxins
- Tension Pneumothorax • Tamponade
- Thrombosis (ACS)
- Thrombosis
What is the “ non arrest mantra “
• “O2-IV-MONITOR”
When would you give oxygen ?
saturation <94% (O2 toxicity
Indications for Dopamine ( directions,dosage and route)
• Indications:
• Bradycardia (after Atropine) (class I)
• Normovolemic hypotension (> 70 to 100mmHg systolic) with signs and symptoms of shock.
• Dose and Route – Continuous infusion 2 to 20microgram/kg/min. Low dose: 2 to 5microgram/kg/min dilates renal and mesenteric arteries ?
Indications ( dosage and route ) for magnesium sulfate
- Indications: cardiacarrest–TorsadesdePointe (Polymorphic V-Tach) or suspected hypomagnesemia
- non arrest – Torsades; Ventricular dysrhythmias due to dig toxicity
- Dose and Route: arrest – 1 to 2grams diluted in 10ml IV
- Non arrest – loading dose: 1 to 2grams mixed in 50 to 100ml D5W IV over 5 to 60 min, follow with 0.5 to 1grams/h
Indications for Adenosine ( dosage and route too)
• Indications - Narrow complex PSVT
(does not convert A-fib, A-flutter or VT, but should be considered for regular Wide
Complex Tach of unknown origin)
• Dose and Route (After Vagal Maneuvers)
• 6mg rapid IV push with 20ml “chaser” 12mg rapid IV push with 20ml “chaser”
• Adenosine ‘Disrupts
If patient is in VF or pulseless V-tach what do you do ?
SHOCK
If patient has PULSELESS ELECTRICAL ACTIVITY should should you NOT do?
Do not shock in pulseless electrical activity or a-systole.
If return of spontaneous circulation, what do you do next ?
Post arrest care
What does post arrest care consist of ?
▪ Pulse, BP, maintain 94% oxygen, consider intubation
▪ Treat hypotension w bolus/vasopressor, get 12 lead ekg*** (coronary reperfusion if needed)
▪ If unable to follow commands, consider targeted temperature mgmt
If patient has no pulse, No breathing, hypotensive, signs of shock, altered mental status, acute heart failure. Vtach or vfib then they are__________
Unstable
If patient has a pulse and they are breathing then they are most likely _________
Stable
True or false : tachycardia or bradycardia are always unstable.
False: tachycardia and bradycardia can be stable
Synchronized cardioversion is indicated in which situation?
For PERSISTANT tachycardia with hypotension, AMS, shock, ischemic chest pain, or acute heart failure, but WITH A PULSE
What dose used in cardioversion and what is it based on
5-200 joules based on narrow or irregular
If narrow and regular tachy, you can give what medication ? What dosage and route?
adenosine -> 6mg IV push, second dose 12mg IV push
If patient is in VF or pulseless v-tach then you can do what ?
Defibrillation
Antiarrhythmics are given for what ?
Tachycardia with wide QRS but STABLE.
What should you do prior to giving an antiarrhythmic drug ?
12 lead EKG
If the rhythm is regular and monomorphic you should consider what drug ?
Adenosine
If rhythm is not regular or monomorphic, what other three drugs along with their dosages would be appropriate?
- procainamide IV 20-50mg,
- amiodarone 150mg IV over 10 min
- sotolol 100mg IV over 5 min
What medication and dose can you give for refractory vfiba and pulseless vtach
Amiodarone 300mg 1st, then 150mg 2nd dose
When to begin CPR with chest compressions ? ( BLS)
No pulse, gasting, with snorting noises
Compressions at what ratio?
30:2
Compressions at what rate?
100-120 per min
Rotate compressions with someone every ___ min
2 min
If suspected neck trauma do what do open the airway ?
Jaw thrust
If patient is an adult or child older than 8 use what kind of defib?
Automated
If patient has a pacemaker, avoid what ?
Placing pad directly over it.
True or false: naloxone is an opioid.
False
Heroine, hydrocodone, and morphine are all what ?
Opioids
What to do if unresponsive, not breathing, but pulse present ?
Rescue breaths: one breath every 5 min.
What to do if patient not breathing, no pulse and has a suspected overdose?
One person gets the AED and naloxone while you start compressions.
What to expect in a mild foreign body obstruction ?
Wheezing between coughs
Severe foreign body obstruction ?
Patient can’t talk, they have cyanosis and there’s a high pitch sound when inhaling.
Abdominal thrusts are given to who ?
Average sized people.
Abdominal thrusts are NOT given to who ?
Pregnant, obese, or infants.
If patient becomes unresponsive while giving abdominal thrusts you should do what ?
Start compressions and scream for help immediately.
