ACLS Concepts Flashcards
What is agonal breathing?
What is an agonal rhythm, should you initiate CPR?
Chest compression fraction?
6-person High Performance Team
- Team Leader
–Doesn’t necessarily perform the tasks, but rather assigns roles to team members, makes decisions, provides feedback, and is responsible for roles not assigned
- Compressor (first priority)
–Alternates with AED person every 5 cycles (or two minutes), or when fatigue sets in
- AED/Monitor/Defibrillator (second priority)
–Obtains & operates the defibrillator, places the monitor so the team leader can see it, and rotates with the compressor
- Airway (third priority)
–Ventilates and intubates (if appropriate)
- IV/IO/Medications
–Establishes access and pushes the drugs
- Timer/recorder
–Records the times of interventions & medications, announces when the next drug is due, and records the frequency and duration of interruptions in compressions
Difference between Cardiac Arrest Teams & Rapid Response Teams?
What are the Rapid Response Team (Medical Emergency Team) Components?
What are team dynamics (8)?
- Have clear roles
- The most important role of a team member is being proficient in skills according to your scope of practice - Know your limits
- Have constructive intervention
- Share knowledge
- Avoid “fixation error” - Summarize & re-evaluate
- Have “closed loop” communication
- Give clear messages
- Have mutual respect
What are systems of care?
Out of Hospital (OHCA) Chain of Survival
BLS Assessment (RACD)
Lone Rescuers
Initial Steps On Conscious Patients
What The Primary Assessment (ABCDEs) Consists Of
- Airway
- Check patency and consider advanced airway placement - Breathing
- Consider supplementary oxygen & advanced airway placement, monitor oxygenation & ventilation, and avoid excessive ventilation - Circulation
- Assessing the pulse, ECG, BP (stable vs. unstable), CPR effectiveness, temperature & glucose, the need for fluid and drug administration, and the need for cardioversion/defibrillation - Disability
- Check for neurologic function
- Responsiveness, level of consciousness, and pupil dilation)
- AVPU (Alert, Voice, Painful, Unresponsive) - Exposure
- Remove the patient’s clothing to perform a quick physical exam
- Look for obvious signs of trauma, bleeding, burns, unusual markings, or medical alert bracelets
Initial Steps On Conscious Patients (ABCDEs)
So remember, if you encounter a conscious patient, just say, “Let’s place some oxygen and monitors on the patient, and start an IV.”
Secondary Assessment
7 H’s of Pulseless Arrest
5 T’s of Pulseless Arrest
- Tamponade (cardiac tamponade)
–Cardiac tamponade occurs when fluid accumulation within the pericardial sac compresses the heart - Thrombosis (coronary and pulmonary)
–In patients with cardiac arrest due to presumed or known PE, it is reasonable to administer fibrinolytics - Tension pneumothorax
- Trauma
–Can obviously lead to hypotension and exsanguination - Toxins (drug overdose)
–Can lead to a prolonged QT interval on the ECG
Treatment for a drug overdose?
First step - Severe Choking In A Responsive Infant
Second Step - Severe Choking In A Responsive Infant
Severe Choking In Unresponsive Patients
After the Obstruction is Relieved
Drowning Protocol
Colorimetric Capnography
Breathing Rates In ACLS - Compressions vs. no Compressions
Breathing Rates in ACLS - Intubated vs. Mask Ventilated
Breathing Rate Summary in ACLS
Breathing Protocol
Intravenous (IV) vs. Intraosseous (IO) vs. Endotracheal (ETT) Access
Best place for intraosseous access?
ETT access protocol for delivering emergency drugs?
Possible ETT drugs?
Chest compressions
Chest compression technique
High Quality CPR Pneumonic
One hand CPR Technique
“Two Finger” CPR Technique
“Thumb Encircling” CPR Technique
CPR in Mask Ventilated (Not Intubated) Patients
“Cycles” Of CPR In Mask Ventilated Patients
CPR in Intubated Patients
CPR Summary Based on the Ventilation Technique
Goals for Chest Compressions
Chest Compression Priority
Continuous Chest Compressions
Chest Compression Fraction
Lay Rescuer vs. Highly Trained CPR Delivery
When to Withhold CPR
CPR Protocol When Defibrillating
When can ECMO be implemented for cardiac arrest?
Ablities of AED pads?
Limitations of AED pads?
Difference between “semi-automated” and “fully-automated” Automated External Defibrillator (AED)?
AED Protocol
A manual defibrillator can do everything an AED can, and has the following “extra” abilities:
Which is preferred, a manual defibrillator or AED?
Controlling the Manual Defibrillator
Three modes of the manual defibrillator?
Pacing With The Manual Defibrillator
Monophasic vs. Biphasic Defibrillators
“Sync” Button for Synchronized Cardioversion
Indications for Synchronized Cardioversion
How to Perform Synchronized Cardioversion - Pad placement
How to Perform Synchronized Cardioversion - Steps after pad placement
Indications for Defibrillation (Unsynchronized Cardioversion)
Defibrillation (Unsynchronized Cardioversion) is not indicated in these situations
How to Perform Defibrillation - Pad placement
How to Perform Defibrillation - Steps after pad placement
Biphasic Defibrillator Energy Doses
Anterior-Anterior Pad Placement
(Also Known as “Anterior-Lateral/Apex” Placement)
Posterior, Left Anterior Pad Placement
Posterior, Right Anterior Pad Placement
Pad Placement for an AED - Most common
Pad Placement for an AED - Second option
Prefferred Placement for Transcutaneous Pacing
Pad Placement for Transcutaneous Pacing - Second option
Placement for Defibrillation &
Cardioversion of Ventricular Tachycardia
Which Pad Placement is Best for Defibrillation and Cardioversion of Ventricular Tachycardia?
Pad Placement for Cardioversion of Atrial Rhythms
Pad Placement for Cardioversion of Atrial Rhythms - Second option
Paddle Placement For Adults - Most common
Paddle Placement For Pediatric Patients
Purpose of Electrode Gel For Defibrillation Paddles
Anterior-Anterior Placement is recommended for, but could also be used for?
Posterior, Left Anterior Placement is recommended for, but also could be used for?
Posterior, Right Anterior Placement recommended for?
Pediatric Manual Defibrillator Pads used for what age? Why?
What age are Pediatric AED Pads indicated for?
What is a Pediatric AED Pads & Pediatric Dose Attenuator?
Adult AED Pads indicated for what age?
Defibrillator Pads for Pediatrics
Defibrillator Safety
Defibrillator Safety - What to do if patient is wet?
Defibrillator Safety - What can happen if pads are placed to close together?
The time from arrival to the first shock should be?
Patients who achieve ROSC after cardiac arrest may develop post-cardiac arrest syndrome, which may include:
First goal of Post Resuscitation Care
Second goal of Post Resuscitation Care
Third goal of Post Resuscitation Care
Fourth goal of Post Resuscitation Care
Targeted Temperature Management (TTM)
An appropriate amount of time should pass before assessment of neurologic status after TTM, how long?
Methods of Initiating TTM
Oxygenation & Ventilation After ROSC
Cardiovascular Care After ROSC
Post Arrest Resuscitation Guidelines - Blood pressure and temperature management
Post Arrest Resuscitation Guidelines - Labs and diagnosement tests
Prophylactic Antiarrhythmic Therapy After ROSC
- Lidocaine
- Beta blockers
Overall Resuscitative Efforts - Terminating or prolonging?
Resuscitation in Hypothermic Patients
Resuscitation in Hypothermic Patients from drowning in icy water?
What to Say in the Algorithms
Drug therapy for bradycardia
Drug therapy for SVT
- Adenosine
- 6mg initial bolus followed with saline flush - Sotalol
- 1.5mg/kg or 100mg - Calcium Channel Blockers (Cardizem, etc)
- Amiodarone and Procainamide*
*Not part of ACLS algorithym but can be used in rare forms of SVT originating in myocardium
How does adenosine work and what is the recommended dose?
How does sotalol work, and what is the recommended dose?
How does calcium channel blockers work?
Indication for Amiodarone and Procainamide
Afib/atrial flutter treatment in ACLS
Adenosine for Afib or Atrial Flutter?
Indication for epinephrine, dose?
Epinephrine For Pulseless Rhythms
Indications for Amiodarone
Amiodarone Dosing Situations
Procainamide indications and dosing?
Amiodarone & Procainamide Summary
Magnesium indication and dosing?
Steroids and Arrest
