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ACLS > ACLS Cases > Flashcards

ACLS Cases Flashcards

1
Q

Assess Airway

A

is the airway patent?
is an advanced airway indicated?
is proper placement of airway device confirmed?
is tube secured and placement reconfirmed frequently?

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2
Q

What advanced airways can be placed WHILE chest compressions are happening?

A

laryngeal mask airway, laryngeal tube, or esophageal-tracheal tube

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3
Q

Assess Breathing

A

are ventilation and oxygenation adequate?

are quantitative waveform capnography and oxyhemoglobin saturation monitored?

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4
Q

For cardiac patients, how much oxygen do you give?

A

100%

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5
Q

for non-cardiac arrest patients, how much oxygen do you give?

A

titrate oxygen to achieve o2 sats greater than 94%

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6
Q

Assess circulation

A 
what is the cardiac rhythm?
is the patient with a pulse unstable?
is defib or cardioversion indicated?
are chest compressions effective?
Is ROSC present?
has IV/IO access been established?
Are meds needed for rhythm or BP?
Does the patient need fluids?
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7
Q

What PETCO2 indicates CPR is inadequate?

A

< 20 mm Hg

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8
Q

what is PETCO2?

A

the partial pressure of end-tidal CO2, a measure of the amount of CO2 present in the expired air.

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9
Q

Why is excessive ventilation bad?

A

increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output. It may also cause gastric inflation and predispose the patient to vomiting and aspiration of gastric contents.

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10
Q

what is the most common cause of upper airway obstruction?

A

loss of tone in the throat muscles, allowing the tongue t fall back and occlude the airway

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11
Q

when do you insert a OPA or NPA?

A

when patient is unconscious with no cough or gag reflex

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12
Q

When DONT you use an OPA?

A

if the patient is conscious or semiconscious because it may induce choking or laryngospasm

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13
Q

When do you use an NPA?

A

may be used when gag/cough reflexes are intact (conscious or semi-conscious). The NPA is indicated when insertion of an OPA is technically difficult or dangerous. Often can use the pinky finger to determine proper size of NPA to use.

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14
Q

Suctioning

A

should not exceed 10 seconds, hyperventilate before and after

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15
Q

when do you use laryngeal mask airway?

A

it is an advanced airway alternative to ET intubation.

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16
Q

NAVEL

A 
Meds that can be administered with ET tube:
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
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17
Q

What rhythms are shockable?

A

VF and pulseless VT

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18
Q

What do you do if the AED says the rhythm is NOT shockable?

A

resume CPR immediately for two minutes if still no pulse. Check rhythm q2mins

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19
Q

What is the purpose of defibrillation?

A

Defibrillation does not restart the heart. Defibrillation stuns the heart and briefly terminates all electrical activity. If the heart is still viable, its normal pacemaker may resume electrical activity (return of spontaneous rhythm) that ultimately results in a perfusing rhythm.

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20
Q

Cardiac Arrest

A

a nonresponsive patient with agonal gasping who has no pulse is in cardiac arrest

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21
Q

Epinephrine

A

after second VF/VT shock; 1 mg q3-5 mins, Vasopressin IV/IO 40 units can replace first or second dose of EPI

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22
Q

Amiodarone

A

Give after third VF/VT shock (EPI 1 mg already given); first dose is 300 mg bolus, second dose is 150 mg

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23
Q

Asystole/PEA drugs

A

EPI 1mgq3-5 mins

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24
Q

Adult Cardiac Arrest Flow Chart

A

Start CPR (start oxygen, set up defibrillator)
Shockable rhythm? shock or don’t
CPR 2 mins, IV/IO access (if no shock, consider EPI 1mg and need for advanced airway with capnography)
Shockable rhythm?
Give EPI 1 mg, CPR 2 mins, consider airway/capnography
Shockable rhythm?
CPR, amiodarone (300 mg bolus first dose/150 mg second dose)

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25
Q

reversible causes of cardiac arrest (5H5T)

A

hypovolemia: fluids (and oxygen and vent if hypoxic too)
hypoxia: oxygen and ventilation
hydrogen ion (acidosis): oxygen and vent
hypo/hyperkalemia: tall peaked T wave vs flat T wave
hypo/hyperthermia
hypoglycemia: check sugars once vascular access
Tension pneumo
tamponade
tablets/toxins
Thrombosis pulmonary: get an early 12 lead
Thrombosis coronary: get an early 12 lead

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26
Q

What PETCO2 indicates ROSC?

A

> 40 mm Hg

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27
Q

Biphasic Shock Energy

A

first shock should be 120-200J, use maximum available. Subsequent shocks should be equivalent and higher doses may be considered

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28
Q

Monophasic shock energy

A

360J

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29
Q

If the initial shock terminates VF, but the arrhythmia recurs later in the resuscitation attempt, what shock strength do you then deliver?

A

the shock strength previously successful

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30
Q

how many cycles of CPR are typically performed in two minutes?

A

5 cycles

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31
Q

If a nonshockable rhythm is present and the rhythm is organized, what do you do next?

A

check for a pulse. If there is any doubt about the presence of a pulse, resume CPR immediately, consider EPI 1 mg and investigate need for advanced airway. If there is a pulse with an organized rhythm, proceed to post cardiac care

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32
Q

What if amiodarone is unavailable during a persistent VF/ pulseless VT code?

A

use lidocaine 1-1.5 mg/kg IV/IO first dose, then 0.5-0.75 mg/kg IV/IO at 5-10 minute intervals. Max dose of 3 mg/kg

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33
Q

Torsades des pointes (long QT interval)

A

mag sulfate 1-2 g IV/IO diluted in 10 mL D5W or NS over 5-20 mins if asymptomatic. If symptomatic, defib at 200J

34
Q

Central Venous Oxygen Saturation (SCVO2)

A

should be 60-80%; if less than 30%, try to improve compressions and vasopressor (EPI) therapy

35
Q

the typical dose of drugs delivered via endotracheal tube is

A

2-2.5 times greater than the IV route dose. DIlute the doses in 5-10 mL of sterile water or NS

36
Q

what do you do after each peripheral dose of a rescue med is delivered?

A

flush with 20 mL NS and elevate extremity for 10 seconds.

37
Q

diminished/absent lung sounds; look at chest rise: is it symmetric or asymetric? Person venting should say, “Im meeting resistance.”

A

tension pneumo: tracheal deviation are late/ominous signs

38
Q

no reversal agents for

A

meth and cocaine

39
Q

3 attempts at a PIV within 90 s

A

if unsuccessful, go to IO

40
Q

IO is designed for

A

short duration-only 24 hours

41
Q

hesitate to run what through an IO?

A

adenosine: half life is too short. If IO is in LE, it wont be active by the time the drug circulates to the heart.

42
Q

0.5 mg with a max of 3 mg for bradycardia

A

atropine for bradycardia: reassess q 3-5 mins; consider pacing or dopamine or EPI infusion (EPI 2-10 mcg for initial dose. Dopamine is weight-based 2-10 mcg/kg/min)

43
Q

sinus tachy 100-150 bpm

A

treat underlying causes, but not the rhythm

44
Q

Vtach

A

tombstone. No vagals. regular/monomorphic: give 6 mg adenosine (if it works, SVT with a aberancy) If that doesn’t work, try amiodarone drip 150 mg over 10 min follow by maintenance infusion of 1mg/min for first 6 hours. If symptoms appear–> cardioversion.

45
Q

5 things that can make a person SYMPTOMMATIC

A 
chest pain
diaphoresis
SOB
altered LOC
hypotension
46
Q

narrow

A

QRS complex less than 3 boxes (.12mm); indicates an atrial issue

47
Q

wide

A

QRS complex greater than .12 mm. wide indicates a vertricular issue

48
Q

unstable AF

A

monophasic cardiovert @ 200 J

49
Q

unstable monomorphic VT

A

monophasic cardiovert @ 100 J

50
Q

Other unstable SVT/Atrial flutter

A

monophasic cardiovert @ 50-100 J

51
Q

polymorphic VT

A

monophasic debrillate

52
Q

no adenosine for

A

patients with a Hx of asthma

53
Q

Post cardiac arrest care (what you do once you have ROSC)

A 
optimize hemodynamic and vent status
initiate therapeutic hypothermia
provide immediate PCI for coronary reperfusion (STEMI or AMI)
institute glycemic control
provide neuro interventions
54
Q

how do you induce hypothermia?

A

use 4 degree C fluids such as LR or NS

55
Q

what is the EPI flow rate for treating hypotension once you have ROSC?

A

0.1-0.5 mcg/kg/min titrated to SBP >90 mm Hg or MAP > 65

56
Q

what is dopamine flow rate for treating hypotension on you have ROSC?

A

5-10 mcg/kg/min until 90>SBP or MAP >65

57
Q

What is NE flow rate for treating hypotension if you have ROSC?

A

0.1-0.5 mcg/kg/min until SBP > 90 or MAP > 65

58
Q

Once you have ROSC, and your patient fails to follow commands, the HCP should consider implementing

A

therapeutic hypothermia to protect the brain and other organs. Target temp is 32-34 degrees C for 12-24 hours.

59
Q

hypovolemia

A

narrow complex, rapid rate
signs of dehydration
volume infusion

60
Q

Hypoxia

A

slow rate
cyanosis, ABG’s, airway probs
vent, oxygenation, advanced airway

61
Q

Hydrogen ion (acidosis)

A

smaller amplitude QRS
Hx diabetes, renal failure
vent, give sodium bicarb

62
Q

Hyperkalemia

A

Tall, peaked T waves, smaller P waves, wide QRS
Hx renal failure, diabetes, recent dialysis, dialysis fistulas, meds
give calcium chloride, sodium bicarb, glucose with insulin, possibly albuterol

63
Q

Hypokalemia

A

T waves flatten, Prominent U waves, wide QRS, QT prolongs, wide complex tachycardia
diuretic use, n/v
add mag sulfate if in cardiac arrest

64
Q

Hypothermia

A

J or Osborne waves (camel hump)
cold exposure, core body temp decreased
rewarm according to protocol

65
Q

tension pneumo

A

narrow complex, slow rate
no pulse, neck vein distention, tracheal deviation, unequal breath sounds, difficult to vent pt
needle decompression, tube thoracostomy

66
Q

Tamponade, cardiac

A

narrow complex, rapid rate
no pulse, vein distention
pericardiocentesis

67
Q

Toxins

A

prolonged QT interval
bradycardia, empty bottles at the scene, pupils, neuro exam
intubation, specific antidotes and agents per toxidrome

68
Q

Thrombosis, lungs; massive pulmonary embolism

A

narrow complex, rapid rate
no pulse, distended neck veins, prior + test for DVT or PE
surgical embolectomy, fibrinolytics

69
Q

Thrombosis, heart; acute, massive MI

A

Abnormal 12 lead EKG

cardiac markers, good pulse with CPR

70
Q

PEA with narrow complexes is more likely to have a

A

noncardiac cause: consider volume infusion

71
Q

STEMI

A

current injury

72
Q

ST depression

A

indicates ischemia

73
Q

PCI

A

balloon dilation or stent placement for an occluded coronary artery

74
Q

ACS ED assessment

A 
VS, O2 sat, 12 Lead EKG (within 10 mins of arrival)
Establish IV access
physical assessment
fibrinolytic checklist
labs (cardiac markers, electrolytes, coags)
CXR
If O2 sat < 94%, O2 via NC @ 4L/min
ASA 160-325 mg (fi not given by EMS)
Nitro
Morphine
75
Q

Chest pain may indicate

A

AMI, Aortic Dissection, PE, pericardial effusion with tamponade, and tension pneumo

76
Q

STEMI Treatment

A

give fibrinolytics within 30 mins of arrival to ED and perform PCI within 90 mins

77
Q

contraindications to ASA

A

allergy and active/recent GI bleed

78
Q

What rhythms result in bradycardia?

A

Sinus brady, AV Blocks

79
Q

block most likely to cause cardiovascular collapse and require immediate pacing

A

third degree or complete AV block

80
Q

STEMI and NSTEMI heparin dosing

A

Bonus 60 Units/kg IV not to exceed 4,000 units

Infusion 12 Units/kg/hr not to exceed 1,000 units

81
Q

STEMI and NSTEMI lovenox dosing

A

Lovenox 1mg/kg sub cut round down!!

ACLS (1 decks)

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