ACLS Systematic Approach Flashcards
What are the parts of the “Initial Assessment”?
Visualize the scene for safety and then approach the patient to determine the pt’s LOC.
What 3 things are stressed in the BLS assessment?
- Early CPR
- Basic Airway Management
- Difibrillation
Name the steps of the BLS Assessment.
- Check responsiveness
- Shout for nearby help, activate EMS & get the AED/Defibrillator
- Check for breathing & pulse
- Defibrillate (If appropriate).
What are critical concepts of “High Quality” CPR?
-Compress the chest hard & fast at least 2” at a rate of 100-120/min (30:2 or another advanced protocol that maximizes CCF).
-Allow complete recoil of the chest after each compression
-Switch compressors about every 2 minutes (the switch should only take 5 seconds
-Minimize interruptions in compressions to 10 seconds or less
-Avoid excessive ventilation
What happens when compressions stop?
-Blood flow to the heart & brain stop.
How is ETCO2 R/T ROSC?
-ETCO2 is R/T cardiac output w/ chest compressions during cardiac arrest
-ROSC is similarly unlikely w/ a persistent of ETCO2 of <10 mm HG
-BETTER CHEST COMPRESSIONS=IMPROVED ETCO2=BETTER PATIENT OUTCOME!
Name the parts of the “Primary Assessment”.
-Airway
-Breathing
-Circulation
-Disability-check neuro function, responsiveness, LOC, pupil dilation, AVPU
-Exposure-Remove clothing to look for S/O trauma, bleeding, burns, medical alert bracelets.
Why is continuous waveform capnography an indirect measurement of cardiac output?
-The amount of CO2 exhaled is associated w/ the amount of blood that passes through the lungs
-An ETCO2 <10 mm Hg during chest compressions rarely results in ROSC
THEREFORE GOOD CHEST COMPRESSIONS ARE KEY TO GOOD PATIENT OUTCOME!!
What does a sudden increase in ETCO2 to >25 mm HG indicate?
-ROSC!!
What does the “Secondary Assessment” include?
-Getting a focused Medical Hx
-Differential diagnosis
-Treating underlying causes based on Medical Hx (consider H’s & T’s)
Ask specific questions R/T the pt’s presentation.
Name the parts of the SAMPLE mnemonic:
-Signs & Symptoms
-Allergies
-Medications
-PMH
-Last meal consumed
-Events (leading to present condition)
What needs to be assessed for the S in Sample
-Breathing Difficulty
-Tachypnea, Tachycardia
-Fever, HA
-Abdominal Pain
-Bleeding
What to ask for the A in SAMPLE:
Allergies—meds, food, latex (including reactions)
What does the M in SAMPLE as for?
Medications
-Rx and OTC including Last Dose taken
-Vitamins, Inhalers & Herbal Supplements
-Also include medications that can be found in the pt’s home.
What are questions to ask regarding the P in SAMPLE?
-Past Medical Hx—especially R/T current illness
-Health Hx (previous illnesses & Hospitalizations)
-Significant underlying medical problems
-Past surgeries
-Immunization status
What does the E in SAMPLE stand for?
Events
-Events leading to current illness or injury
-Hazards at the scene
-Treatment interval from onset of disease/injury until evaluation
-Estimated time of onset (if our of hospital onset)
Why is it important to identify the underlying cause of cardiac arrest?q
Addressing the underlying cause & treating it may result in achieving ROSC.
What can be done to identify the underlying cause of cardiac arrest?
-Consider the H’s & T’s
-Analyze EKG for clues to underlying cause
-Recognize Hypovolemia
-Recognize drug OD/Poisoning
What is the classic physiologic response to PEA caused by Hypovolemia?
Rapid, narrow complex tachycardia (sinus tach) & typically increased diastolic pressure and decreased systolic pressure. As the loss of blood continues, B/P drops, eventually becoming undetectable, but the narrow QRS complexes & the rapid rate continue (PEA).
ALWAYS CONSIDER VOLUME INFUSION FOR PEA W/ NARROW COMPLEX TACHYCARDIA.
What are 2 common non traumatic causes of hypovolemia?
-Occult Internal Hemorrhage
-Severe Dehydration
What should be done for PEA w/ a narrow complex tachycardia?
IVF Bolus
What cardiac condition can present as PEA, VF, pVT or Asystole?
ACS w/ occlusion of Left Main or Proximal Left Anterior Descending Coronary Artery can involve a large amount of heart muscle (of the L ventricle which has the thickest muscle because it must contract against the most pressure (systemic vascular resistance).
What type of shock would be caused by ACS w/ a large amount of heart muscle involvement?
-Cardiogenic shock that can rapidly progress to cardiac arrest & PEA.
What is a cause of acute Right Heart Failure?
Massive or saddle PE that obstructs flow to the pulmonary vasculature.
What can be given to patients in cardiac arrest due to presumed or known PE?
Fibrinolytics
Where are the needle insertion sites for needle decompression for tension pneumothorax?
-2nd intercostal space mid-clavicular line
-3rd, 4th, 5th intercostal space anterior mid-axillary line
Name 3 cardiac & pulmonary conditions that need to be recognized quickly.
-Cardiac Tamponade
-Tension Pneumothorax
-Massive PE
How can cardiac tamponade, tension pneumothorax & massive PE be recognized?
Bedside U/S by skilled clinician.
Name the 5 H’s
Hypovolemia->give IVF
Hypoxia->Give O2
Hydrogen Ion (Acidosis)
Hypo/Hyperkalemia
Hypothermia
Name the 5 T’s
Tension Pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)
What are the 2 most common underlying & potentially reversible causes of PEA?
Hypovolemia
Hypoxia
LOOK FOR THESE & TREAT IMMEDIATELY!!!
Why is it important to identify the underlying cause of cardiac arrest?
Addressing the underlying cause & treating it may result in achieving ROSC.
Why is it important to treat poisoning and overdose patients aggressively?
Certain drug overdoses & toxic exposures may lead to peripheral vascular dilation and/or myocardial dysfunction w/ resultant hypotension & cardiovascular collapse. Toxic effects may progress rapidly but during this time, the myocardial dysfunction & arrhythmias may be reversible.
What supportive treatment can be provided in poisoning and overdose?
-Prolonged basic CPR in special resuscitative situations (such as accidental hypothermia)
-ECMO
-Intra-aortic balloon pump therapy
-Renal dialysis
-IV lipid emulsion for lipid soluble toxins
-Specific Drug Antidotes (Digibind, Glucagon, Bicarbonate)
-Transcutaneous pacing
-Correction of severe electrolyte disturbances (K+, Mg, Ca++, Acidosis)
-Specific adjunctive agents
What must be done if the pt shows S/O ROSC?
Post cardiac arrest care
