ACLS Stuff Flashcards
What does the BLS Assessment entail? (4)
- Check Pt responsiveness
- Activate Code (blue/66)
- Check for breathing/pulse
- Start BVM and CPR if indicated
- 30:2 (depth 6cm)
- 1 breath every 6 seconds if pulse present
- agonal gaps are not real breaths
How would you check Pt responsiveness on a prone patient?
Tap and shout “are you okay””
How long do you check for breathing/pulse?
5 - 10 secs
When you start BVM and CPR, what ratio of compressions and breaths do you give?
- 30:2 (depth 6cm)
- 1 breath every 6 seconds if pulse present
ABC(DE) primary assessment consists of?
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Primary assessment: what do you check on the airway assessment?
Patency/obstruction
- ETT required? confirmed? secured?
Primary assessment: What do we check for breathing?
Check for Adequate ventilation and oxygenation via
- ETCO2 and SpO2
Primary assessment: Exposures?
- Trauma
- Bleeding
- Burns
- Hypothermia
- Medical alert braclets
Primary assessment: Disabilities
- Neurological function
- LOC
- Pupil dilation
Primary assessment: What do we look for in circulation?
- Effective CPR
- Shockable rhythm? Defib vs cardioversion?
- IV/IO?
- ROSC?
- Volume resuscitation?
- Meds for rhythm or BP?
What 6 things are apart of the secondary assessment [SAMPLE]?
- Signs and symptoms
- Allergies
- Meds
- Past med history
- Last meal
- Events
What do we consider during the secondary assessment for: Events?
- Sudden onset or gradual?
- Scene hazards?
- Time of onset?
What do we consider during the secondary assessment for: Past med history
- Illness/hospitalizations
- Family hx
- surgeries/immunization status
What do we consider during the secondary assessment for: Signs and Symptoms?
- Breathing concerns
- Fever, headaches
- Tachypnea and tachycardia
- Bleeding
Purpose of code 66?
Codes are called to intervene/prevent pt from becoming unstable.
- prevent code blue
Positions for a 6-person high performance team?
- team formation basically for optimal resuscitation
Res. triangle
- Compressor
- AED/monitor/defib
- Airway
Leadership roles
- team lead
- iv/io meds
- time/recorder
What are common rhythms of acute coronary syndrome support?
- Sudden cardiac death
- VTs
- Hypotensive bradycardias
Difference between STEMI and NSTEMI?
- STEMI = (ST-Elevation Myocardial Infarction)
- NSTEMI (Non ST-Elevation MI)
How does acute coronary syndrome develop?
What does ABCDE describe for acute coronary syndrome?
Development of clots that lead to coronary issues.
What is a good indicator that there is a coronary issue?
- aka symptomatic vs asymptomatic
Troponin
- When heart muscles become damaged, troponin is sent into the bloodstream. As heart damage increases, greater amounts of troponin are released in the blood.
Suggested plan for ischemia/infarction?
Look at the diagram and get an idea of the workflow
Therapies:
- What are oxygen goals for acute coronary syndrome?
SpO2 >= 90%
What phrenological treatments are there for acute coronary syndrome
- what drugs are given?
- Give brief description
- Aspirin (stop clot formation)
- Nitroglycerin (reduce LV and RV preload via peripheral arterial and venous dilation)
- morphine (reduces chest pain if nitro can’t)
- Fibrinolytic therapy (clot busters)
3 Indications for CPR
- Unresponsiveness: If a person is unresponsive and not breathing normally, CPR should be started immediately.
- Absence of Pulse: If a person is unresponsive and not breathing normally, check for a pulse. If there is no pulse, CPR should be started immediately.
- Cardiac Arrest: If a person is experiencing cardiac arrest (a sudden loss of heart function), CPR should be started immediately
3 indications for BVM
- Inadequate Breathing: If a person is breathing inadequately (e.g., gasping for air, breathing very slowly), a BVM may be used to assist with breathing until advanced medical care arrives.
- Respiratory Arrest: If a person is in respiratory arrest (i.e., not breathing at all), a BVM should be used to provide artificial ventilation until advanced medical care arrives.
- Anesthesia: During anesthesia, a BVM may be used to assist with breathing and maintain adequate oxygen levels in the body.1
What is percutaneous coronary interventions?
Angioplasty with stent
2 types of stroke?
Ischemic and hemorrhagic
Ischemic stroke is caused by?
Occlusion of an artery
Hemorrhagic stroke is caused by?
Sudden Blood vessels rupture in the brain.
- Avoid clot busters
Stroke plan?
- hint determine if it thrombotic or hemorrhagic
Alteplase use?
Clot buster
- fibrinolytic therapy
Drugs for bradycardia?
- Atropine
Less commonly used:
- Dopamine
- Epinephrine
Traits for a symptomatic bradycardia?
HR < 50 bpm
normally brady is < 60bpm
ECG Rhythms for bradycardia
- Sinus brady
- First degree AV block
- Second degree AV block (Mobitz I & II)
-Third degree AV block
Does atropine work for mobitz II or 3rd degree heart blocks?
unlikely
Bradycardia is a sign of what?
- Hypoxia
- Elevated ICP
- Check if its hypo or hypertension
What helps a unstable bradycardia?
Transcutaneous pacing (stimulate contraction and rhythm)
- must confirm electrical and mechanical capture
Things to consider for transcutaneous pacing?
Sedation of the pt
Starting rate (should be 60-80)
Things to consider for transcutaneous pacing?
Sedation of the pt
Starting rate (should be 60-80)
Bradycardia workflow
Which HR range should be cardioverted right away?
HR >= 150 BPM
Rhythms associated w/tachycardia?
Sinus tach
A fib
A flutter
SVT
Monomorphic VT
Polymorphic VT
Wide-complex tachy
Drug admin order for a tachycardia?
- Vagal maneuver (if reg)
- Adenosine (if reg)
- Beta blockers or Calcium Channel blockers
Drugs usually associated w/Stable and wide QRS tachycardia?
- Procainamide (Wide tachy)
- Amiodarone
- Beta blockers or calcium channel blockers
Drug usually associated w/synchronized cardioversions?
Adenosine
Signs of respiratory distress?
edit
- Increased HR
- Increased RR
- Decreased LOC
(add more)
Signs of respiratory failure?
edit
- Severely decreased LOC
- Absent air movement
(add more)
Respiratory arrest is also known as?
Apnea
How do you manage resp. arrest/apnea?
- Avoid excessive ventilation
- Deliver 1 breath every 6 seconds if pulse present and recheck every 2 mins.
- Open airway (OPA, O2, head tilt, suction)
What does Amiodarone do?
Slows HR and reduces electrical activity in the heart.
- For VF and VT
What is Adenosine is used to treat?
SVT; temporarily blocks electrical conduction in the AV node
- Admin via intravenous bolus
Atropine use?
Treats Bradycardia by increasing HR
factors that prevent excessive ventilation?
- Increased intrathoracic pressure
- Decreased venous return
- Decreased CO
- Cerebral vasoconstriction
Ask someone
Drugs for cardiac arrest
- Epinephrine every 3-5 mins (vasopressor)
- Amiodarone (antiarrhythmic)
- Lidocaine (antiarrhythmic)
- Magnesium sulfate (torsades de pointes - ecg rhythm, )
- Dopamine
- O2
What are indicators that a pt is in shock?
- If in VF/pVT
- Agonal resp
Understand the workflow
Post Cardiac Arrest Care
- Still need to consider Hs & Ts
- Manage the ABCs
- Targeted Temp Management
- Monitor EtCO2 – May be one of the first signs the patient is arresting again!
- Treat hypotension (drugs or volume)
- Neuroprognostication – Hypoxic-ischemic injury
How can hyperventilation be detrimental?
- Increased intrathoracic pressure
- Decrease venous return to the heart
- Diminished CO
When do you cardiovert?
- Atrial fibrillation (AF),
- Atrial flutter
- Stable ventricular tachycardia;
when medications have failed to convert the rhythm, or when the patient is becoming unstable and the rhythm must be immediately terminated.
