ACLS notes

Question 1

What are the two indications that CPR is ineffective?

Answer 1

PETCO2 is less than 10 mmHg

DBP is less than 20 mmHg

Question 2

What are the components of the ACLS survey?

Answer 2

Airway (need to establish one?)
Breathing (oxygenation and ventilation adequate)
Circulation (CPR effective)
Differential (Search for a cause)

Question 3

What are the things that should be assessed for in ensuring adequate circulation? (3)

Answer 3

• IV access
• Cardiac rhythm/need for defibrillation
• Meds/fluids needed?

Question 4

What are the two major reasons for understanding team member roles?

Answer 4

Knowledge of how to communicate and work as a member of a team

Question 5

What are the components of the BLS survey? (4)

Answer 5

• Check responsiveness
• Activate EMS/ AED
• Breathing and circulation (CPR)
• Defibrillator

Question 6

How long should interruptions in CPR be?

Answer 6

No more than 10 seconds

Question 7

How often should providers be switched while performing CPR?

Answer 7

2 minutes

Question 8

What are the three ways of monitoring oxygenation during CPR?

Answer 8

Clinical criteria (cyanosis, chest rise)
Quantitative waveform capnography
Oxygen sat

Question 9

What is the main role of the team leader?

Answer 9

Ensuring comprehensive patient care

Question 10

Who “closes the loop” in closed loop communication?

Answer 10

The team member performing the action

Question 11

What is the oxygen saturation that should be achieved post arrest?

Answer 11

94%

Question 12

Why is it necessary to avoid over ventilating a patient? (2)

Answer 12

• Decreased cerebral blood flow with PaCO2 decreases

- Increase risk of aspiration if air in stomach

Question 13

What is the rate of ventilation post cardiac arrest?

Answer 13

10-12 / min

Question 14

What is the goal PETCO2 post cardiac arrest?

Answer 14

35-40 mmHg

Question 15

Can PCI be done in patients that are cooled?

Answer 15

Yes

Question 16

What is the goal BG levels post arrest?

Answer 16

144-180 mg/dL

Question 17

What is the frequency and duration of the pulse checks in respiratory arrest?

Answer 17

Recheck every 2 minutes

5-10 secs for checks

Question 18

What are the components of the ACLS survey for respiratory arrest?

Answer 18

1. Check responsiveness
2. Activate EMS/AED
3. Circulation
4. Defibrillation PRN

Question 19

What is the rate of breaths given during CPR wwo an advanced airway for cardiac arrest? For respiratory arrest?

Answer 19

CPR w/o = 30:2
CPR w/ = 1 vent / 6-8 secs
Respiratory arrest = 1 / 5-6 seconds

Question 20

The benefit of an advanced airway is always weight against what?

Answer 20

Stopping compressions

Question 21

What is the general order of the ACLS survey for respiratory arrest?

Answer 21

ABCD

Question 22

What is the appropriate tidal volume delivery for bag masks (in mLs)?

Answer 22

600 mL

Question 23

How do you select the proper OPA?

Answer 23

tip of OPA should reach the angle of the mandible

Question 24

How is an OPA inserted?

Answer 24

Curve upwards, then turn down

Question 25

Which can be used in conscious patients: NPAs or OPAs?

Answer 25

NPAs

Question 26

How is the appropriate diameter of the NPA selected?

Answer 26

Should not blanch the nostril (pinky rule)

Question 27

How is the appropriate length of an NPA selected?

Answer 27

Tip of nose to earlobe

Question 28

What should always be assessed for immediately after placement of an OPA or NPA?

Answer 28

Spontaneous return of breathing

Question 29

What are the indications for soft vs hard suction tubing respectively?

Answer 29

Soft - Intratracheal or through an airway Hard - Thick particulate matter

Question 30

How far should a suction catheter be inserted?

Answer 30

No further than the distance from the tip of the nose to the earlobe

Question 31

How is suction applied appropriately?

Answer 31

With withdrawal

Question 32

How long (in seconds) should suction attempts be made with ET tubes? Do the tubes have to be sterile?

Answer 32

No more than 10 seconds | Need sterile tubing

Question 33

What should always be monitored for with suctioning an ET tube?

Answer 33

Heart rate and breathing

Question 34

True or false: you must still pause for ventilations while during CPR when an advanced airway is in place

Answer 34

False

Question 35

Should the pulse be assessed for prior to, or after calling for an AED?

Answer 35

After

Question 36

Why is CPR started immediately after a shock?

Answer 36

Heart needs time to resume

Question 37

What are the three indications for an AED?

Answer 37

1. No response 2. Absent or abnormal breathing 3. No pulse

Question 38

Are agonal gasps adequate breathing?

Answer 38

No

Question 39

Do you turn on the AED before or after hooking it up to the patient?

Answer 39

Before

Question 40

Should AEDs be used in patients with defibrillators?

Answer 40

Yes, but ensure that you're not placing the AED pad over the defibrillator, and allow time for it to shock

Question 41

What is the equation for coronary perfusion pressure?

Answer 41

Aortic DBP - Right atrial DBP

Question 42

Why is Epi used in the treatment of VF/VT or asystole/PEA?

Answer 42

Alpha adrenergic causes vasoconstriction, which increases cerebral and coronary perfusion

Question 43

What is the MOA of vasopressin?

Answer 43

Causes vasoconstriction

Question 44

What are the doses of Epi/Vasopressin?

Answer 44

1 mg of epi | 40 units of vasopressin

Question 45

What is the role of antiarrhythmics given during cardiac arrest? What is the drug of choice?

Answer 45

Not been shown to help | Amiodarone

Question 46

What is the dosing of amiodarone?

Answer 46

300 mg IV bolus

Question 47

What is the drug of choice if amiodarone is not available? Dose?

Answer 47

Lidocaine--1 - 1.5 mg/kg

Question 48

When is MgSO4 given? Dosage?

Answer 48

TdP | 1-2 g loading dose in 10 mL

Question 49

How far should the chest recoil with compressions?

Answer 49

2 inches (5 cm)

Question 50

What are the 5 H's of reversible causes of cardiac arrest?

Answer 50

``` Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/hyperkalemia Hypothermia ```

Question 51

What are the five Ts of reversible causes of cardiac arrest?

Answer 51

``` Tension pneumothorax Tamponade Toxins Thrombosis, pulmonary Thrombosis, cardiac ```

Question 52

Values of PETCO2 of less than what in intubated patients indicates that ROSC is unlikely?

Answer 52

10 mmHg

Question 53

How often should epi be administered during a cardiac arrest?

Answer 53

1 mg q 3-5 minutes

Question 54

What should be done following administration of epi?

Answer 54

Give a 20 mL flush of IVF and elevate the extremity above the level of the heart for 10-20 seconds

Question 55

What is the role of MgSO4 in the treatment of TdP?

Answer 55

Prevents recurrence--still needs shock

Question 56

Flat neck veins in a cardiac arrest pt = ?

Answer 56

Dehydration--give IVF

Question 57

What are the EKG findings of a dehydration pt?

Answer 57

Narrow complexes and rapid rate

Question 58

What are the EKG findings of hypoxia?

Answer 58

Slow rate

Question 59

What are the EKG findings of acidosis?

Answer 59

Smaller amplitude QRS complexes

Question 60

What are the EKG findings of Hypokalemia?

Answer 60

- U waves | - Flattened T waves

Question 61

What are the EKG findings hyperkalemia?

Answer 61

Peaked T waves

Question 62

What are the EKG findings of tension pneumothorax?

Answer 62

Narrow complexes and slow rate

Question 63

What are the EKG findings of tamponade?

Answer 63

Narrow complexes | Rapid rate

Question 64

Is volume infusion appropriate for treating cardiac tamponade?

Answer 64

Yes--should be given