ACLS notes Flashcards
What are the two indications that CPR is ineffective?
PETCO2 is less than 10 mmHg
DBP is less than 20 mmHg
What are the components of the ACLS survey?
Airway (need to establish one?)
Breathing (oxygenation and ventilation adequate)
Circulation (CPR effective)
Differential (Search for a cause)
What are the things that should be assessed for in ensuring adequate circulation? (3)
- IV access
- Cardiac rhythm/need for defibrillation
- Meds/fluids needed?
What are the two major reasons for understanding team member roles?
Knowledge of how to communicate and work as a member of a team
What are the components of the BLS survey? (4)
- Check responsiveness
- Activate EMS/ AED
- Breathing and circulation (CPR)
- Defibrillator
How long should interruptions in CPR be?
No more than 10 seconds
How often should providers be switched while performing CPR?
2 minutes
What are the three ways of monitoring oxygenation during CPR?
Clinical criteria (cyanosis, chest rise)
Quantitative waveform capnography
Oxygen sat
What is the main role of the team leader?
Ensuring comprehensive patient care
Who “closes the loop” in closed loop communication?
The team member performing the action
What is the oxygen saturation that should be achieved post arrest?
94%
Why is it necessary to avoid over ventilating a patient? (2)
- Decreased cerebral blood flow with PaCO2 decreases
- Increase risk of aspiration if air in stomach
What is the rate of ventilation post cardiac arrest?
10-12 / min
What is the goal PETCO2 post cardiac arrest?
35-40 mmHg
Can PCI be done in patients that are cooled?
Yes
What is the goal BG levels post arrest?
144-180 mg/dL
What is the frequency and duration of the pulse checks in respiratory arrest?
Recheck every 2 minutes
5-10 secs for checks
What are the components of the ACLS survey for respiratory arrest?
- Check responsiveness
- Activate EMS/AED
- Circulation
- Defibrillation PRN
What is the rate of breaths given during CPR wwo an advanced airway for cardiac arrest? For respiratory arrest?
CPR w/o = 30:2
CPR w/ = 1 vent / 6-8 secs
Respiratory arrest = 1 / 5-6 seconds
The benefit of an advanced airway is always weight against what?
Stopping compressions
What is the general order of the ACLS survey for respiratory arrest?
ABCD
What is the appropriate tidal volume delivery for bag masks (in mLs)?
600 mL
How do you select the proper OPA?
tip of OPA should reach the angle of the mandible
How is an OPA inserted?
Curve upwards, then turn down
Which can be used in conscious patients: NPAs or OPAs?
NPAs
How is the appropriate diameter of the NPA selected?
Should not blanch the nostril (pinky rule)
How is the appropriate length of an NPA selected?
Tip of nose to earlobe
What should always be assessed for immediately after placement of an OPA or NPA?
Spontaneous return of breathing
What are the indications for soft vs hard suction tubing respectively?
Soft - Intratracheal or through an airway
Hard - Thick particulate matter
How far should a suction catheter be inserted?
No further than the distance from the tip of the nose to the earlobe
How is suction applied appropriately?
With withdrawal
How long (in seconds) should suction attempts be made with ET tubes? Do the tubes have to be sterile?
No more than 10 seconds
Need sterile tubing
What should always be monitored for with suctioning an ET tube?
Heart rate and breathing
True or false: you must still pause for ventilations while during CPR when an advanced airway is in place
False
Should the pulse be assessed for prior to, or after calling for an AED?
After
Why is CPR started immediately after a shock?
Heart needs time to resume
What are the three indications for an AED?
- No response
- Absent or abnormal breathing
- No pulse
Are agonal gasps adequate breathing?
No
Do you turn on the AED before or after hooking it up to the patient?
Before
Should AEDs be used in patients with defibrillators?
Yes, but ensure that you’re not placing the AED pad over the defibrillator, and allow time for it to shock
What is the equation for coronary perfusion pressure?
Aortic DBP - Right atrial DBP
Why is Epi used in the treatment of VF/VT or asystole/PEA?
Alpha adrenergic causes vasoconstriction, which increases cerebral and coronary perfusion
What is the MOA of vasopressin?
Causes vasoconstriction
What are the doses of Epi/Vasopressin?
1 mg of epi
40 units of vasopressin
What is the role of antiarrhythmics given during cardiac arrest? What is the drug of choice?
Not been shown to help
Amiodarone
What is the dosing of amiodarone?
300 mg IV bolus
What is the drug of choice if amiodarone is not available? Dose?
Lidocaine–1 - 1.5 mg/kg
When is MgSO4 given? Dosage?
TdP
1-2 g loading dose in 10 mL
How far should the chest recoil with compressions?
2 inches (5 cm)
What are the 5 H’s of reversible causes of cardiac arrest?
Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/hyperkalemia Hypothermia
What are the five Ts of reversible causes of cardiac arrest?
Tension pneumothorax Tamponade Toxins Thrombosis, pulmonary Thrombosis, cardiac
Values of PETCO2 of less than what in intubated patients indicates that ROSC is unlikely?
10 mmHg
How often should epi be administered during a cardiac arrest?
1 mg q 3-5 minutes
What should be done following administration of epi?
Give a 20 mL flush of IVF and elevate the extremity above the level of the heart for 10-20 seconds
What is the role of MgSO4 in the treatment of TdP?
Prevents recurrence–still needs shock
Flat neck veins in a cardiac arrest pt = ?
Dehydration–give IVF
What are the EKG findings of a dehydration pt?
Narrow complexes and rapid rate
What are the EKG findings of hypoxia?
Slow rate
What are the EKG findings of acidosis?
Smaller amplitude QRS complexes
What are the EKG findings of Hypokalemia?
- U waves
- Flattened T waves
What are the EKG findings hyperkalemia?
Peaked T waves
What are the EKG findings of tension pneumothorax?
Narrow complexes and slow rate
What are the EKG findings of tamponade?
Narrow complexes
Rapid rate
Is volume infusion appropriate for treating cardiac tamponade?
Yes–should be given
