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Methods of Anesthesia I > ACLS Concepts > Flashcards

ACLS Concepts Flashcards

1
Q

ACS

A

acute coronary syndrome

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2
Q

ALS

A

advanced life support

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3
Q

AMI

A

acute myocardial infarction

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4
Q

CCF

A

chest compression fraction

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5
Q

CPSS

A

cincinnati prehospital stroke scale

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6
Q

CQI

A

continued quality improvement

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7
Q

CT

A

computed tomography

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8
Q

DNAR

A

do not attempt resuscitation

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9
Q

ECC

A

emergency cardiovascular care

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10
Q

ED

A

emergency departement

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11
Q

EMS

A

emergency medical services

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12
Q

IHCA

A

in hospital cardiac arrest

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13
Q

what is the average survival rate for an in hospital cardiac arrest?

A

24%

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14
Q

what are more than half of IHCA due to?

A

respiratory failure or hypovolemic shock

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15
Q

MACE

A

major adverse cardiac events

  • death
  • nonfatal MI
  • need for urgent revascularization
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16
Q

MET

A

medical emergency team

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17
Q

NIH

A

national institutes of health

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18
Q

NINDS

A

national institute of neurological disorders and stroke

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19
Q

NSTE-ACS

A

non-ST elevation acute coronary syndrome or NSTEMI

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20
Q

OHCA

A

out of hospital cardiac arrest

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21
Q

what is the most common cause of cardiac arrest?

A

ischemia from CAD

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22
Q

what may be the first indicator of cardiac arrest?

A

brief generalized seizures

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23
Q

PCI

A

percutaneous coronary intervention

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24
Q

ROSC

A

return of spontaneous circulation

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25
Q

pts that display one of what have ROSC? 3

A

1 pulse and adequate BP
2 abrupt increase in etCO2 >40mmHg
3 spontaneous arteral BP waves via aline

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26
Q

RRT

A

rapid response team

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27
Q

rtPA

A

recombinant tissue plasminogen activator

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28
Q

what is rtPA used for?

A

fibrinolytic used to treat pts with STEMI

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29
Q

STEMI

A

st elevation MI

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30
Q

TCP

A

transcutaneous pacing

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31
Q

TTM

A

targeted temperature management

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32
Q

UA

A

unstable angina

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33
Q

agonal breathing

A

more than half cardiac arrest pts experience “gasps”, gurgling, moaning, snorting, or labored breathing

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34
Q

agonal rhythm

A

slow complex rhythms that immediately precede asystole

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35
Q

what should be initiated when agonal rhythms are incountered?

A

chest compressions bc agonal rhythms do not produce life sustaining cardiac output

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36
Q

what is the definition of CCF and what is the correct fraction

A

proportion of time spent performing chest compressions

at least 60% but ideally >80%

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37
Q

neonate

A

0-28 days

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38
Q

infant

A

1 month-1 year

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39
Q

child

A

1 year to puberty (breast development or axillary hair in males)

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40
Q

adult

A

puberty or older

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41
Q

lay person or lay provider definition

A

no specialized/professional knowledge of a subject

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42
Q

mild respiratory distress

A

change in airway sounds

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43
Q

severe respiratory distress

A

deterioration in color

changes in mental status

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44
Q

hypoventilation RR

A

<6

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45
Q

bradypnea RR

A

<12

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46
Q

normal RR

A

12-16

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47
Q

tachypnea RR

A

> 20

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48
Q

stable

A

normal BP and signs of good perfusion

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49
Q

what are the signs of good perfusion

A 
good color
good pulse
good capillary refill
warm
awake and alert
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50
Q

unstable

A

hypotension and signs of poor perfusion

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51
Q

what are the signs of poor perfusion

A 
blue or pale
weak pulse
delayed capillary refill
cold
altered or depressed consciousness
sick
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52
Q

triage

A

process of deciding which pt should be treated first and where they should go based on how sick they are

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53
Q

name the 6 person high performance teams (in order)

A 
1- team leader
2- compressor
3- AED/monitor/defibrillator
4- airway
5- IV/IO/Medication
6- timer/recorder
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54
Q

what does the team leader do

A

assigns roles to team members, makes decisions, provides feedback and responsible for unassigned roles

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55
Q

how often does the compressor alternate? and with who do they alternate with?

A

alternates with AED person every 5 cycles (2min) or when fatigue sets in

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56
Q

what does the AED/monitor/defibrillator person do?

A

obtains and operates defib and places monitor so team leader can see
rotates with compressor

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57
Q

what does the airway person do?

A

ventilates and intubates if necessary

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58
Q

what team member establishes access and pushes drugs?

A

IV/IO/medications member

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59
Q

what does the timer/recorder do?

A

records times of interventions/medications
announces when next drug is due
records frequency and duration of interruptions in compressions

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60
Q

what if you have less than 6 people?

A

multiple providers can take higher priority tasks

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61
Q

at what number of providers should there be a team leader?

A

2 or more

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62
Q

cardiac arrest teams

A

code blue teams

do NOT prevent, only respond after arrest has occured

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63
Q

RRT or METS purpose

A

identify and treat early clinical deterioration BEFORE arrest

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64
Q

what percent of IHCA pts have abnormal vitals documented for up to 8 hours?

A

80%

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65
Q

what are the three components of a rapid response team?

A

1 -event detection and activating response (by nurse, family, doc)
2- planned response arm (RRT) (hosp sets criteria as trigger)
3- quality monitoring and administrative support

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66
Q

8 steps to successful team dynamics

A 
1- have clear roles
2- know your limits
3- have constructive intervention
4- share knowledge
5- summarize and re-evaluate
6 have a closed loop communication
7- give clear messages
8- have mutual respect
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67
Q

what is the most important role of a team member?

A

being proficient in skills according to your scope of practice

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68
Q

what should you do if you are assigned a task you do not feel proficient in?

A

ask for a new task

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69
Q

what are the 3 steps to knowing your limits

A

1- call for assistance EARLY
2- don’t initiate unfamiliar therapy without advice
3- don’t take on too many tasks

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70
Q

should you suggest an alternative drug, dose or question someone if they are about to make a mistake?

A

YES but do so tactfully so it is a CONSTRUCTIVE INTERVENTION

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71
Q

how do you share knowledge 3

A

1 avoid fixation error (fixating on one thing when there are more important ones)
2 encourage environment of sharing
3 ask if anything has been overlooked

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72
Q

how do you summarize and re-evaluate during a code? 3

A
  • keep records of drugs/therapy
  • monitor and reassess after treatments
  • inform arriving personnel of status/plans
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73
Q

can you give a drug without confirming verbally with your team leader?

A

NO

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74
Q

explain closed loop communication

A

team leader gives order
confirms it was heard
listens to confirmation from team member before assigning another task

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75
Q

3 steps to giving clear messages during a code

A

speak clearly no shout/mumble
repeat if necessary
question if there is any doubt

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76
Q

what are examples of systems of care

A

community (lay providers)
out of hospital (EMS)
hospital systems (code team, RRT, CCT, stroke team)

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77
Q

OCHA chain of survival 5

A

1- recognition/ activation of emergency response
2- immediate CPR
3- rapid defibrillation
4- basic and advanced EMS/transport
5- advanced life support and postarrest care

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78
Q

IHCA chain of survival 5

A 
1- hosp providers monitor/prevent arrest
2- arrest witnessed EMS activated
3- CPR started
4- Defibrillation ASAP
5- ACLS and postarrest care
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79
Q

what two things should you do before approaching the pt?

A

use universal precautions (gloves)

make sure scene is safe (if in field)

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80
Q

what assessment do you do if the pt is unconscious?

A

BLS RACD

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81
Q

RACD

A
  • Responsiveness
  • Activate EMS and get AED
  • Circulation check (pulse and breathing simutaneously)(CPR)
  • Defibrillation
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82
Q

during RACD you check the circulation and there is no pulse what do you do?

A

begin chest compressions

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83
Q

during RACD you check the circulation and there is a pulse but no breathing what do you do?

A

give two rescue breaths

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84
Q

does BLS assessment include intubation or starting an IV?

A

no

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85
Q

what is probable if you see a patient collapse

A

sudden cardiac arrest

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86
Q

what is probably if you see a patient drown

A

hypoxic cause of arrest

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87
Q

what do you do if you are lone rescuer and pt with hypoxic arrest

A

2 min CPR

then activate EMS

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88
Q

what do you do if you are lone rescuer and pt with probable cardiac arrest

A

activate EMS and get AED
then start CPR
bc defibrillation is needed to treat

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89
Q

what assessment should you do if the patient is conscious?

A

primary assessment (ABCDEs)

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90
Q

what if you are unsure if the patient is conscious?

A

start RACD (check responsiveness)

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91
Q

what is ABCDEs?

A 
PRIMARY ASSESSMENT
airway
breathing
circulation
disability
exposure
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92
Q

A of primary assessment

A

airway

check patency and consider advanced airway placement

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93
Q

B of primary assessment

A

breathing

consider supplementary oxygen and advanced airway placement, monitor oxygenation and ventilation

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94
Q

C of primary assessment

A

circulation
assessing pulse, EKG, BP (stable vs unstable), CPR effectiveness, temp and glucose, need for fluid or drugs, need for cardioversion/defib

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95
Q

D of primary assessment

A

disability
check neurologic function (responsive, conscious level, pupil dilation)
AVPU

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96
Q

AVPU

A

alert, voice, painful, unresponsive

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97
Q

E of primary assessment

A

exposure
remove clothing to perform quick physical exam
look for signs of trauma, bleeding, burns, medical alert bracelet

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98
Q

initial steps on conscious pt what things do you want to verbilize?

A

1- oxygen placed on pt (A and B)
2- monitors placed, 12 lead ECG, SpO2, BP (C)
3- IV placed (C)

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99
Q

once you have a SpO2 monitor on what do you want to titrate the SpO2 to?

A

94-99%

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100
Q

after you verbilize the first 3 steps what should you do?

A

auscultation and check patency of airway
check BP/pulse (stable?)
check ECG (rhythm?)
neurologic fxn and physical exam

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101
Q

what makes up the secondary assessment?

A

SAMPLE and H’s & T’s

searches for cause of problem

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102
Q

SAMPLE

A 
signs and symptoms
allergies
medications
past medical history
last meal
events
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103
Q

when should you verbalize SAMPLE?

A

conscious pt

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104
Q

when should you verbalize Hs and Ts

A

unconscious pt

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105
Q

how many hypos, hypers and H+ are in the H’s?

A

5 hypos
1 hyper
1 H+

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106
Q

what are the 7 H’s of pulseless arrest?

A 
hypovolemia
hypoxemia
hypothermia
hypoglycemia
hypokalemia
hyperkalemia
acidosis (H+)
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107
Q

what are the 5 T’s of pulseless arrest?

A 
tamponade
thrombosis (coronary/pulm)
tension pneumothorax
trauma
toxins
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108
Q

how is cardiac tamponade diagnosed and treated

A

diagnosed with ultrasound

treated with pericardiocentesis

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109
Q

in pts with cardiac arrest due to presumed or known PE what is it reasonable to do?

A

administer fibrinolytics

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110
Q

what is the diagnosis for a tension pneumothorax

A 
unilateral absent breath sounds
deviated trachea
hypotension
CXR
bedside ultrasound
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111
Q

treatment for tension pneumo

A

needle decompression

then chest tube

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112
Q

needle decompression

A

2nd intercostal space

mid clavicular line

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113
Q

chest tube

A

6th intercostal space

mid axillary line

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114
Q

what can toxins or drug overdose lead to? ECG

A

prolonged QT on ECG

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115
Q

how do you treat toxins or drug OD?

A 
monitor blood sugar (beta blocker or alcohol can lead to hypoglycemia)
gastric lavage (wash out stomach)
charcoal tablets
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116
Q

what should wall suction be capable of ?

A

-80 to -120 mmHg

usually >-300

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117
Q

effective suction technique

A

<10 sec, <10 attempts

follow with short period of O2

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118
Q

what should you do if suctioning thick material?

A

squirt 1-2cc N/S before suctioning

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119
Q

what type of suction goes down ETT and is better for thin secretions

A

soft suction catheter

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120
Q

in trauma pts how should the airway be opened? what should be avoided and why

A

jaw thrust

avoid chin lift bc of potential cervical instability

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121
Q

for trauma pts should manual spinal motion restriction or immobilization devices be used?

A

manual spinal motion restriction bc the collars can complicate airway management

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122
Q

mild choking classification

A

pt can cough
good air exchange
NO HEIMLICH
activate EMS if obstruction persists

123
Q

severe choking classification

A

pt canNOT cough
unable to speak
treatment differs

124
Q

severe choking in responsive adult protocol

A

heimlich (above navel below breastbone)

examined post heimlich to rule out damage

125
Q

severe choking in responsive child protocol

A

heimlich maneuver or abdominal thrusts below xyphoid

126
Q

severe choking in responsive infant protocol

A

prone in one arm and 5 back blows

flip supine in other arm and 5 downward chest thrust two fingers (exactly where compressions would be)

127
Q

severe choking in unresponsive pts protocol

A

immediately start CPR (even if pulse palpable)

each time you open airway for breaths look for object in mouth

128
Q

choking pt after the obstruction is relieved protocol

A

place in recovery position (on side)

129
Q

drowning protocol

A

immediate CPR

if in icy water then rewarming core temp to at least 30C is recommended before abandoning CPR

130
Q

what is the most rapid and effective technique for rewarming hypothermic cardiac arrest

A

extracorporeal circulation

131
Q

what should your caution be when securing the ETT?

A

potential danger of obstructing venous return from brain with tube tie

132
Q

is cricoid recommended in ACLS?

A

not recommended

133
Q

what is the preferred method of confirming ETT placement

A

etCo2 continuous waveform

as in exact co2

134
Q

what is used if continuous etco2 waveform is not available?

A

colorimetric capnography

135
Q

what type of capnography is colorimetric

A

semi-qualitiative
confirms there is etco2 but not exactly what it is
may fail to detect co2 when ETT is correctly placed

136
Q

purple colorimetric capnography

A

<2.28mmHg

137
Q

beige colorimetric capnography

A

3.8-7.6mmHg

138
Q

yellow colorimetric capnography

A

> 15.2mmHg

GOLD=GOOD

139
Q

should an advanced airway be placed?

A

AHA recommends that rescuers provide assisted ventilation with BVM or advanced airway

140
Q

oxygen therapy during arrest and initial resuscitation

A

high flow oxygen 100%

141
Q

oxygen therapy after ROSC

A

titrated to spo2 of 94=99 for non ACS

>90% fot ACS

142
Q

mouth to mouth breathing adults protocol

A

pinch nose chin lift

143
Q

what is the FiO2 of mouth to mouth? CO2?

A

17% fiO2

4% CO2

144
Q

mouth to mouth breathing kids protocol

A

place mouth over victims mouth and nose

145
Q

which should be performed with one rescuer? two rescuer?

mouth to mouth
bag mask

A 
one= mouth to mouth
two= bag mask
146
Q

what are the 4 disadvantages to excessive ventilation

A

1 gastric inflation (regurg/aspiration)
2 decreases venous return and CO (increased intrathor pressure)
3 decreases cerebral BF
4 lowers survival

147
Q

what is the best way to avoid excessive ventilation?

A

give breath until chest rise is observed

148
Q

what is the goal tidal volume for adults during arrest

A

500-600mL

149
Q

what is the breathing rate if compressions are required? (cardiac arrest)

A

LOWER 10 breaths/min

venous return more important

150
Q

what is the breathing rate if compressions are not required?(resp arrest)

A

HIGHER 10-12 breaths/min

venous return less important

151
Q

what is the breathing rate for mask ventilated pts (resp arrest)?

A

10-12 breaths/min (every 5-6 sec)

bc breath not as effective

152
Q

what is the breathing rate for intubated pt? (resp or cardiac arrest)

A

10breath/min

bc breaths are more effective

153
Q

what should agonal breaths be treated the same as?

A

apnea

154
Q

ratio of compressions to breath mask ventilation cardiac arrest

A

30:2

155
Q

when you check pulse and breathing for RACD how long should you do it?

A

5-10 sec and recheck every 2 min

156
Q

if there is no breathing but there is a pulse how many breaths per minute?

A

10-12 breaths/min
every 5-6 sec
each breath over 1 sec

157
Q

what is the priority for establishing vascular access?

A

IV first
OP (intraosseous) second
ETT last resort

158
Q

what should you do when injecting medication IV during code?

A

dose followed by N/S bolus 5 mL for peds 20mL for adults

extremity elevated for 10-20 sec

159
Q

how fast can IO access be achieved?

A

30-60 sec

160
Q

is dosing in the IO the same as IV?

A

yes

161
Q

where is the best IO access? confirmation?

A

anterior tibia

fluids can flow freely without local soft tissue swelling

162
Q

ETT access for meds protocol

A

inject drug in ETT
5-10mL N/S flush
5 rapid PP ventilations
compressions temporarily interrupted to avoid regurg of drug

163
Q

what can low dose epo via ETT cause?

A

beta 2 effects
hypotension
decrease chance for ROSC

164
Q

ETT access dose epi adults

A

2-3 times IV

165
Q

ETT access dose epi children

A

10 times IV

166
Q

ETT access dose epi neonates

A

same as IV

167
Q

what is the acronym for possible ETT drugs adults

A 
NAVEL
narcan
atropine
vasopressin
epi
lidocaine
168
Q

what is the acronym for possible ETT drugs peds

A 
LEAN
lidocain
epi
atropine
narcan
169
Q

what is the indication for compressions adults

A

no pulse

170
Q

what is the indication for compressions children up to puberty

A

HR<60

171
Q

what is the indication for compression “larger children”

A

HR<40

172
Q

what is the rate for compressions

A

100-120 per min

173
Q

how many compressions does it take before good blood flow?

A

20-25

174
Q

how will you know if you are pushing too fast for compressions?

A

special monitors are available to alert you

175
Q

5 steps for chest compression technique

A 
1 use hard flat surface
2 press down on lower half of breastbone
3 push to adequate depth
4 allow complete chest recoil
5 switch providers every 2 min( or 5 cycles)
176
Q

adequate compression depth adults? children?

A

adult 2-2.4 inches

child 1/3 to 1/2 depth of chest or 1.5 inches

177
Q

high quality CPR pneumonic

A

CPR
Chest recoil
Push hard/fast
Rotate rescuer

178
Q

when do you use a two hand CPR technique?

A

adults and adolescents

179
Q

when do you use a one hand CPR technique

A

alternative to two hand for children 1-8 yrs

180
Q

when do you use 2 finger CPR technique

?

A

infants with one responder

181
Q

two finger CPR technique

A

2 fingers below nipples above xyphoid

182
Q

when do you use thumb encircling CPR technique?

A

neonates and infants when 2 responders

183
Q

CPR in mask ventilated pts

A

compressions are interrupted when performing breaths

CPR in 5 cycles over 2 min

184
Q

cycle ratio of CPR mask vent adults

A

30:2

185
Q

cycle ratio of CPR mask vent infant/children

A

1 provider
30:2
2 provider
15:2

186
Q

cycle ratio of CPR mask vent neonate

A

respiratory arrest
3:1
cardiac arrest
15:2

187
Q

CPR in intubated pts

A

chest compressions are not interrupted during breaths

CPR performed in two min increments NOT cycles

188
Q

CPR intubated adults

A

100-120 compressions/min

10 breaths/min

189
Q

CPR intubated kids

A

100-120 compressions/min

breathing rate is faster depending on age

190
Q

4 goals for chest compressions

A

1 etco2 of at least 20mmHg
2 diastolic BP on aline of at least 20mmHg
3 mixed venous saO2 of at least 30% (norm is 60-80%)
4 coronary perfusion pressure of 10mmHg

191
Q

starting compressions takes priority over everything except

A

calling for help

defibrillating vfib/vtach when pads are on and ready

192
Q

can chest compreswsions continue when defib is charging

A

yes

193
Q

what is continuous chest compressions?

A

EMS setting
3 periods of 200 chest compressions (2 min each period)
advanced airway is postponed
passive oxygen insufflation replaces positive pressure until 3 periods are done

194
Q

are the compressions in continuous chest compressions interrupted for anything?

A

yes rhythm analysis and defibrillation

195
Q

4 times to withhold CPR?

A

DNR request
threat to safety of rescuers
rigor mortis (stiffening of limbs)
lividity (black and blue discoloration)

196
Q

CPR protocol when defibrillating 6

A

1 check the pulse (no longer than 10 sec)
2 perform CPR until AED arrives
3 defib ASAP
4 resume 2 min of CPR
5 reanalyze rhythm (and check pulse if organized rhythm present) within 10sec
6 repeat cycle as needed

197
Q

where do you check the pulse adults? infants?

A

adult carotid

infant brachial

198
Q

why do we continue CPR for 2 min before reanalyzing

A

be rhythms dont usually create perfusion in the first few min

199
Q

when should IV/IO meds be given during CPR protocol/defib

A

immediately before or after shock delivery, so there is time to circulate before next check

200
Q

ECMO for arrest?

A

may be considered in select cardiac arrest pts who havent responded to conventional CPR

201
Q

abilities of the AED/AED pads

A 
sense and analyze vfib/vtach
can defibrillate (auto energy dose)
202
Q

limitations of AED/AED pads

A

does not produce ECG strip (cannot sense anything except vfib/vtach
cannot pace
cannot perform synchronized cardioversion

203
Q

automated external defibrillator (AED)

A

automated means semi or fully
semi= advises if shock is indicated and provider pushes button
fully= shocks for you if indicated

204
Q

AED protocol

A 
power on AED
attach electrode pads
clear the victim
analyze rhythm
charge and shock if advised
205
Q

manual defibrillator extra abilities on top of AED

A

show ECG strip
can perform synchronized cardioversion
can perform transcutaneous pacing

206
Q

manual defib vs AED

A

manual defib is preferred if the providers skills are adequate

207
Q

when is the analyze button used on a defibrillator

A

when BLS provider cannot analyze rhythm

208
Q

energy select button on defib

A

adjusts the energy you shock with

209
Q

how long should the clear and shock process take

A

<5 sec

210
Q

knob set to monitor

A

3 tracing screens

211
Q

knob set to defib

A

allows defib and synchronized cardioversion

212
Q

knob set to pacer

A

allows the defib to pace

213
Q

pacing with manual defib

A

output button controls current delivered
rate button controls heart rate
4:1 button causes 3 of 4 pacer impulses to be suppressed so we can analyze the rhythm

214
Q

are most defib today mono or bi phasic?

A

biphasic
they are more effective at defibrillating
waveform is up and down

215
Q

sync button for synchronized cardioversion does what

A

ensures shock wave occurs during R wave not during T wave

216
Q

indications for synchronized cardioversion

A

unstable supraventricular rhythms (SVT, afib, aflutter

unstable monomorphic vtach with pulse

217
Q

how to perform synchronized cardioversion 6

A

1 place pads in posterior, left anterior (ventricular) right anterior (atrial)
2 knob to defib
3 sync button prior to each shock attempt
4 select 75-120 J energy
5 hit charge
6 hit shock

218
Q

when is defibrillation indicated?

A

all ventricular rhythms that are pulseless and/or irregular (vfib, vtach, torsades)

219
Q

when is defibrillation NOT indicated

A

supraventricular rhythms
asystole
pulseless electrical activity (PEA)

220
Q

is sedation necessary with defibrillation

A

no

221
Q

how to perform defibrillation 5

A 
1 place pads posterior-anterior or anterior-anterior
2 knob to defib
3 select 200J energy
4 charge
5 shock
222
Q

adult defib biphasic energy dose

A

120-200 J

223
Q

adult defib monophasic energy dose

A

360J

224
Q

pediatric defib biphasic 1st,2nd,up-to doses

A

2J/kg
4J/kg
up to 10J/kg

225
Q

synchonized cardioversion biphasic irregular SVT (afib) energy dose?
monophasic?

A

120-200J

mono= 200J

226
Q

synchronized cardioversion biphasic regular SVT energy dose

A

50-100J

227
Q

synchronized cardioversion biphasic monomorphic vtach energy dose

A

100J

228
Q

transcutaneous pacing biphasic energy dose

A

40-80mA

229
Q

anterior/anterior pad placement

A

anterior upper right chest above nip

apex/lateral pad left anterior mid axillary of 5th intercostal space

230
Q

posterior, left anterior pad placement

A

posterior pad under left scapula

anterior pad left of sternum under left breast

231
Q

posterior, right anterior pad placement

A

posterior pad under left scapula

anterior pad right of sernum above right breast

232
Q

what is the pad placement for AED

A

anterior- anterior (most common)

posterior and left anterior

233
Q

pad placement for transcutaneous pacing

A

posterior, left anterior (under left breast) {most common}

anterior, anterior

234
Q

placement for defibrillation and cardioversion of vtach

A

posterior, left anterior (best)

anterior, anterior

235
Q

pad placement for cardioversion of atrial rhythms

A

posterior, right anterior (recommended)

anterior, anterior

236
Q

what is the most common paddle placement adult

A

anterior, anterior

post, ant can be used but harder to clear and takes longer

237
Q

paddle placement for infant

A

anterior anterior

238
Q

paddle placement for children over 1 year

A

anterior anterior OR

posterior anterior

239
Q

what is needed if you are using defibrillation paddles?

A

conducting gel

240
Q

anterior anterior placement is recommended for:

A

AED

defib paddles

241
Q

posterior left anterior placement is recommended for:

A

pacing

defib/ syn CV of ventricular rhythms

242
Q

posterior right anterior placement is recommended for:

A

atrial rhyhtms

243
Q

anterior anterior placement can also be used for (second choice):

A

defib with defib pads
syn cardioversion of atrial rhythm
pacing

244
Q

posterior left anterior placement can also be used for (second choice)

A

AED pads

Defib paddles

245
Q

what are pediatric manual defibrillator pads

A

used on children less 1 year old

bc can use lower energy doses than AED

246
Q

pediatric AED pads

A

used on 1-8 yr old

placed so they dont touch eachother

247
Q

does the AED automatically deliver pediatric dose

A

some have a key or switch that can deliver a child shock dose

248
Q

adult AED pads

A

used on kids >8 yr

acceptable in infants if no peds are available

249
Q

defibrillator safety 6

A

1 do not place pads on top of medication patch or pacemaker
2 it is safe to perform multiple defib attempts in hypothermic pts
3 make sure oxygen is not blowing across chest during defib
4 dry chest if sweat or water
5 pads placed flat at least 2 inches apart
6 do not allow pads to touch

250
Q

if the pt has a ICD how far away should you place the pad?

A

1 inch to the side

251
Q

if the pt is laying in water can you shock them

A

move to dry area then shock

252
Q

electrical arcing

A

flow of current through air between electrodes can induce fire, explosion, and thermal injury

253
Q

how many shocks are given at once?

A

1 shock at a time

254
Q

how long should the time from arrival to first shock be?

A

<90sec

255
Q

what is priming the pump

A

when EMS performs a period of CPR before defib, not recommended

256
Q

post cardiac arrest syndrome includes

A 
postarrest brain injury
postarrest myocardial dysfunction
systemic ischemia
reperfusion response
pathology that might have precipitated the arrest
257
Q

4 goals of post resuscitation care

A

optimize ventilation and hemodynamic status
initiate targeted temperature management (TTM)
provide immediate coronary reperfusion with PCI
provide neurologic care and prognostication and other structured interventions

258
Q

what is the first priority for someone who achieves ROSC?

A

oxygenation and ventilation

259
Q

airway management for unconscious pt with ROSC

A

advanced airway usually

potentially head at 30 degrees to decrease cerebral edema, aspiration, and vent pneumonia

260
Q

what is the only post ROSC intervention demonstrated to improve neurologic recoveru?

A

TTM

261
Q

are TTM and PCI at the same time safe?

A

yes feasible and safe

262
Q

when should TTM be administered

A

comatose and unresponsive after ROSC

263
Q

what is the goal temp for TTM

A

32-36 C for 24 hr
bleeding risk may not tolerate
seizures and cerebral edema have worse outcomes with higher temsp

264
Q

what sites should be used for core temp measurement

A

esophageal

bladder

265
Q

earliest neurologic status check not treated with TTM

A

72 hr

266
Q

earliest neurologic status check with TTM

A

72 hr after return of normothermia

267
Q

methods of initiating TTM

A

rapid infusion of ice cold isotonic non glucose fluid (30mL/kg) =best for fast not for targeted temp
surface cooling devices
ice bags

268
Q

spO2 after ROSC

A

titrate Fio2 to lowest level to maintain spo2 >94%

269
Q

capnography after ROSC

A

ventilation 10breaths per min

etCO2 35-40mmHg

270
Q

cardiovascular care after ROSC

A

12 lead ECG ASAP

consider coronary reperfusion therapy if stemi or AMI

271
Q

goal BP after ROSC

A

MAP > 65
Sys P>90
hypotension treated with fluids or pressor

272
Q

is TTM considered in conscious pts?

A

no

273
Q

post ROSC lab and diagnositic tests

A

`look for electrolyte abnormalities

look for pulm,cariac, or neurologic precipitants of arrest

274
Q

prophylactic antiarrhythmic therapy after ROSC

A

following vtach/vfib
consider beta blockers
consider lidocaine

275
Q

when can you consider terminating resuscitative efforts?

A

unable to get etCO2 >10mmHg after 20 min of CPR in intubated pts
DNAR order presented
dangerous environment

276
Q

when should you consider prolonging resuscitative efforts? >20min

A

cause of cardiac arrest is reversible (hypotherm, drugs)

ROSC at any time throughout attempt

277
Q

why is resuscitation in hypothermic pts different?

A

may be unresponsive to drugs, defib and pacing (drugs could accumulate)
should concentrate on rewarming (extracorporeal circulation)

278
Q

protocol for severe <30C hypothermic vfib/vtach

A

single defib then hold until >30C

279
Q

protocol for moderate <34C hypothermic vfib/vtach

A

defib but wait longer intervals

280
Q

when should termination of resuscutative efforts happen for hypothermic pts?

A

core temp is at least 30C before terminate

281
Q

7 things you must say to do after ROSC

A

1- 12 lead EKG
2- consider hypothermia
3- maintain normal BP (1-2L crystalloid bolus)
4- frequent lab work
5- maintain spO2 94-99%
6- consider intubation and maintain etCo2
7- consider lidocaine or BB

282
Q

bradycardia therapy

A

atropine
epi
dopamine

283
Q

atropine dose

A

0.5mg every 3-5 min

max 3mg

284
Q

epi dose

A

2-10mcg/min

285
Q

dopamine dose

A

2-20mcg/kg/min

286
Q

SVT therapy

A

adenosine (slowing AV node)
sotalol (slowing AV node)
calcium channel blockers (“)

287
Q

adenosine dose

A 
6mg bolus (N/S flush)
2 additional dose of 12mg
288
Q

sotalol dose

A

100mg or 1.5mg/kg

289
Q

when should sotalol be avoided?

A

QT syndrome

290
Q

treatment for afib/aflutter

A

unstable synchronized cardioversion

stable= consult

291
Q

why would you use adenosine for afib/aflutter

A

when you need to slow the HR so you can diagnose the rhythm

292
Q

when do you give epi

A

(vtach/vfib,PEA,asystole)
pulseless rhythms 1 mg every 3-5min
does not fix the problem, keeps alive so defib can fix

293
Q

indications for amiodarone

A

monomorphic vtach (with or without a pulse) or vfib

294
Q

when is amiodarone avoided?

A

pts with prolonged QT interval or torsades

295
Q

amiodarone monomorphic vtach awake or still has pulse dose

A

150mg over 10min

296
Q

amiodarone vfab/pulseless vtach dose

A

300mg bolus

150mg second dose

297
Q

post resuscitation infusion dose amiodarone

A

1mg/min 1st 6 hr
0.5mg /min next 18 hr
loading dose of 150mg if not already given

298
Q

when is procainamide used? dose?

A

vfib or monomorphic vtach
20-50mg/min until:
arrhythmia gone, hypotension ensues, or QRS duration decreases 50%

299
Q

maintenance infusion procainamide

A

1-4mg/min

300
Q

procainamide max dose

A

27mg/kg

301
Q

when is procainamide avoided?

A

prolonged QT or CHF

302
Q

when is magnesium indicated? dose

A

torsades

1-2g

303
Q

steroids and arrest

A

use of methylprednisolone during arrest and

hydrocortisone after ROSC has shown improved survival

Methods of Anesthesia I (10 decks)

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