ACLS for Anesthesiologists Flashcards
Two ways to check ventilation once a patient is intubated
- Listen to their chest (make sure bilateral airway exists)
- etC02
How many times per minute to ventilate an intubated patient?
10x. Don’t hyperventilate that will mess with venous return and have the opposite effect that you want
V-fib
Heart has electricity going in a thousand different directions. It is pumping but it is uncoordinated. The only effective treatment is to SHOCK. No drug or CPR is going to matter unless you electrically shock the patient. In a perfect world, you put the paddles right on the heart, but we don’t have that luxury therefore we put the paddles on the patient. The electricity has to cross the heart. That means a pad on front and a pad in the back to sandwich the heart, but that’s difficult in a code.
Why is defibrillation a misnomer?
You actually want to create Asytole when you shock. All electrical activity stops and you stop the chaos allowing the heart to sit there, asytolic. Then you hope that the hearts native pacemaker picks up again. When you’re doing defibrillation, what you’re really doing is Asytolization.
What to shock someone at to create Asytole?
In Biphasic machine: 200J
In Monophasic machine (this should be phased out): 360J
Cardioversion vs Shocking with Paddles
With cardioversion, you need to allow the pads to read the rhythm. You’re doing this for something like A-fib or SVT or V-tach that’s unstable. Remember you need to press the paddles and hold them for a little bit until you read the rhythm. Press and hold until they fire.
When would you Pace?
Bradycardia only
6H’s and 5T’s
There’s a cause for the bad rhythm. Something happened to the patient to trigger this. No matter the scenario, think of WHY!
Think of blood, what’s in it? It has a certain volume
1. Hypovolemia
The primary thing blood carries is Oxygen. If there’s no oxygen in the blood
2. Hypoxia
Blood has a certain temperature
3. Hypothermia
Blood has a certain amt of acid that it needs
4. H+ Acidemia
Blood has a certain amount of glucose in it
5. Hypoglycemia
Blood has a certain amount of potassium in it
6. Hypo or Hyper kalemia
If you think of blood in those terms you’ll always remember the above
Now 5Ts:
Think of Procoagulant Coated Lead bullet going right through middle of patient. If you think of this you’ll be able to think of the 5Ts
1. Trauma
2. Toxins (Lead is a toxin). Could also be drugs etc
3. Tension PTX
4. Cardiac Tamponade
5. Thrombosis (Pulmonary or Coronary Embolus)
Signs of coronary thrombosis
Chest pain, SOB, N/V, pain down arm, pain up chest. Get them to medical therapy ASAP.
MONA or ONAM: Oxygen, Nitroglycerin, ASA, Morphine
Check BP before Nitro
Send patient to hospital immediately
How do you assess for stroke?
Cincinnati Pre Hospital Stroke Survey: hold hands out in front of them with eyes closed if they see hand fall down, that’s one point. Loss of neural fxn. Ask patient to smile, if they droop. Loss of neural fxn. Ask patient to repeat sentence “rolling stone gathers no moss” .. broca’s area is affected if they mumble.
SVT
High heart rate
With tachycardia, the key element to figure out is this stable or unstable.
HR of 176 is fast, especially in older sicker patients. Someone has SVT, first determine if stable or unstable. Patient might say they’re dizzy, have CP, SOB, hypotension, confusion, etc. Signs that we’re having problems with perfusion. If there is unstable SVT, you will right away need to CARDIOVERT. Shock them. synchronous!
SVT could be sinus, a-fib, atrial flutter. If it’s stable SVT, whether it’s sinus, a-fib, or a flutter, it doesn’t matter. Any way you slice it, it’s a fast heart rate from above the ventricles. You might give adenosine, CCB, Beta blocker.
Bradycardia
Crucial element is “are they symptomatic?”
Ask the patient how they’re doing and if they have bradycardia and have symptoms – signs of inadequate perfusion. There’s medical and electrical treatment. Electrical is putting pads on and pacing them from the outside (remember this is uncomfortable).The other option is to give Atropine (0.5mg), repeat it up to 6 times for a total of 3mg.
Signs of inadequate perfusion to head
N/V, ALOC, difficulty talking/speaking, confusion
Signs of inadequate perfusion to heart
chest pains, SOB, sitting up for air
Vowel Mnemonic
AEIOUY
If you remember this, you’ll always remember how to take care of someone no matter what’s going on
A: Assessment
E: EKG
I: IV
O: Oxygen
U: You go for help!
Y: Why is this happening? Go back to 6 Hs, 5 Ts
