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ACLS > ACLS Systematic Approach > Flashcards

ACLS Systematic Approach Flashcards

1
Q

What are the parts of the “Initial Assessment”?

A

Visualize the scene for safety and then approach the patient to determine the pt’s LOC.

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2
Q

What 3 things are stressed in the BLS assessment?

A
  1. Early CPR
  2. Basic Airway Management
  3. Difibrillation
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3
Q

Name the steps of the BLS Assessment.

A
  1. Check responsiveness
  2. Shout for nearby help, activate EMS & get the AED/Defibrillator
  3. Check for breathing & pulse
  4. Defibrillate (If appropriate).
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4
Q

What are critical concepts of “High Quality” CPR?

A

-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

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5
Q

What happens when compressions stop?

A

-Blood flow to the heart & brain stop.

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6
Q

How is ETCO2 R/T ROSC?

A

-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!

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7
Q

Name the parts of the “Primary Assessment”.

A

-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.

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8
Q

Why is continuous waveform capnography an indirect measurement of cardiac output?

A

-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!!

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9
Q

What does a sudden increase in ETCO2 to >25 mm HG indicate?

A

-ROSC!!

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10
Q

What does the “Secondary Assessment” include?

A

-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.

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11
Q

Name the parts of the SAMPLE mnemonic:

A

-Signs & Symptoms
-Allergies
-Medications
-PMH
-Last meal consumed
-Events (leading to present condition)

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12
Q

What needs to be assessed for the S in Sample

A

-Breathing Difficulty
-Tachypnea, Tachycardia
-Fever, HA
-Abdominal Pain
-Bleeding

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13
Q

What to ask for the A in SAMPLE:

A

Allergies—meds, food, latex (including reactions)

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14
Q

What does the M in SAMPLE as for?

A

Medications
-Rx and OTC including Last Dose taken
-Vitamins, Inhalers & Herbal Supplements
-Also include medications that can be found in the pt’s home.

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15
Q

What are questions to ask regarding the P in SAMPLE?

A

-Past Medical Hx—especially R/T current illness
-Health Hx (previous illnesses & Hospitalizations)
-Significant underlying medical problems
-Past surgeries
-Immunization status

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16
Q

What does the E in SAMPLE stand for?

A

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)

17
Q

Why is it important to identify the underlying cause of cardiac arrest?q

A

Addressing the underlying cause & treating it may result in achieving ROSC.

18
Q

What can be done to identify the underlying cause of cardiac arrest?

A

-Consider the H’s & T’s
-Analyze EKG for clues to underlying cause
-Recognize Hypovolemia
-Recognize drug OD/Poisoning

19
Q

What is the classic physiologic response to PEA caused by Hypovolemia?

A

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.

20
Q

What are 2 common non traumatic causes of hypovolemia?

A

-Occult Internal Hemorrhage
-Severe Dehydration

21
Q

What should be done for PEA w/ a narrow complex tachycardia?

A

IVF Bolus

22
Q

What cardiac condition can present as PEA, VF, pVT or Asystole?

A

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).

23
Q

What type of shock would be caused by ACS w/ a large amount of heart muscle involvement?

A

-Cardiogenic shock that can rapidly progress to cardiac arrest & PEA.

24
Q

What is a cause of acute Right Heart Failure?

A

Massive or saddle PE that obstructs flow to the pulmonary vasculature.

25
Q

What can be given to patients in cardiac arrest due to presumed or known PE?

A

Fibrinolytics

26
Q

Where are the needle insertion sites for needle decompression for tension pneumothorax?

A

-2nd intercostal space mid-clavicular line
-3rd, 4th, 5th intercostal space anterior mid-axillary line

27
Q

Name 3 cardiac & pulmonary conditions that need to be recognized quickly.

A

-Cardiac Tamponade
-Tension Pneumothorax
-Massive PE

28
Q

How can cardiac tamponade, tension pneumothorax & massive PE be recognized?

A

Bedside U/S by skilled clinician.

29
Q

Name the 5 H’s

A

Hypovolemia->give IVF
Hypoxia->Give O2
Hydrogen Ion (Acidosis)
Hypo/Hyperkalemia
Hypothermia

30
Q

Name the 5 T’s

A

Tension Pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)

31
Q

What are the 2 most common underlying & potentially reversible causes of PEA?

A

Hypovolemia
Hypoxia
LOOK FOR THESE & TREAT IMMEDIATELY!!!

32
Q

Why is it important to identify the underlying cause of cardiac arrest?

A

Addressing the underlying cause & treating it may result in achieving ROSC.

33
Q

Why is it important to treat poisoning and overdose patients aggressively?

A

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.

34
Q

What supportive treatment can be provided in poisoning and overdose?

A

-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

35
Q

What must be done if the pt shows S/O ROSC?

A

Post cardiac arrest care

ACLS (9 decks)

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