Advanced Cardiac Life Support Flashcards
Chain of survival
- Early recognition + call
- Early CPR
- Early defibrillation
- Early advanced care
Diagnosis of cardiac arrest
Unconscious + absence of normal breathing
- Call for help, start CPR
- Pulse check unreliable in indicating adequate myocardial and cerebral perfusion
When to use precordial thump
Ventricular tachycardia if defibrillator not immediately available
Why do you continue CPR for 2 mins after shock?
- Allow recovery from myocardial stunning
- Maintains myocardial perfusion pressure until ROSC
What are shockable rhythms?
- Ventricular fibrillation
- Bizarre, irregular waveforms
- No recognisable QRS wave - Ventricular tachycardia
- Rapid
- Constant QRS morphology
What are non-shockable rhythms?
- PEA (pulseless electrical activity)
- Electrical activity without a pulse
- Cardiac arrest - Asystole
- Absent QRS activity
Hazards to defibrillation
- Water
- Oxygen
- Jewellery
Safe method for defibrillation
C: compressions continue O: oxygen away A: all others clear C: charging defibrillator H: hands off E: evaluating rhythm D: difibrillate
What are the reversible causes of cardiac arrest? ***
Hypoxia
- Treatment: advanced airway, capnography
Hypovolaemia
- Causes: haemorrhage, surgical drains, wounds, trauma, sepsis
- Treatment: blood, fluids
Hypo/hyperkalaemia
- Causes: diuretic use, D+V, medications, kidney disease
- Treatment: lab, drugs, fluids
Hypo/hyperthermia
- Causes (hyper): exercise, dehydration, GA, drug toxicity
- Signs (hyper): seizure, rhabdomyolysis, metabolic acidosis
- Treatment (hyper): active cooling, 0.5’C/hr, fluid electrolyte replacement
Tension pneumothorax (air in intrapleural space)
- Cause: trauma, procedure, asthma
- Signs: decreased chest rise/fall, decreased breath sounds, tracheal deviation, tube position
- Treatment: needle decompression, thoracotomy, chest drain
Tamponade (blood in pericardial space)
- Cause: trauma, procedure, cardiac surgery
- Signs: chest pain, anxiety, relief by sitting forward, hypertension, LOC
- Treatment: pericardiocentesis
Toxin
- Cause: overdose, recreational drug, medication
- Treatment: antidote
Thrombus
- Cause: DVT
- Signs: SOB, chest pain, hypoxia, arrhythmia
- Treatment: fibrinolytic e.g. heparin
Common cardiac arrest drugs
- Adrenaline
- MOA: a+b adrenergic agonist -> vasoconstriction + contraction
- Admin: IV push
- Dose: 1mg
- Use: VF, VT, PEA, AS - Amiodarone
- MOA: anti-arrhythmia -> prolongs action potential, slows SR
- Admin: IV push
- Dose: 300mg, 150mg
- Use: VF, VT
Cardiac drug routes of administration
- CVC if insitu - rapid
- PVC
- IO
- ET
Post resus care
- A-G re-evaluation
- Precipitating causes
- ECG, BSL, Pathology
- Temp management
- Oxygenation
- Optimise cerebral perfusion
- Resus injuries (ribs, tension ptx, tamponade)
Nursing responsibilities in ACL
- Team leader
- Airway management
- Compression
- Defibrillator
- Drugs
- Runner
- Scribe
- Ward
- Family
Nursing responsibilities post resus
- Monitoring
- Care planning
- Documentation
- Family support
ACLS components/algorhythm
- Start CPR - attach defibrillator - assess rhythm
SHOCKABLE: 1st shock - CPR 2mins - assess rhythm, 2nd shock - CPR 2mins - assess rhythm - Adrenaline 1mg, 3rd shock - CPR 2mins - assess rhythm - Amio 300mg
NON-SHOCKABLE: Adrenaline immediately - CPR 2mins - assess rhythm - CPR 2 mins - assess rhythm - adrenaline etc.