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PMPR 430 > Advanced Cardiac Life Support (ACLS) > Flashcards

Advanced Cardiac Life Support (ACLS) Flashcards

1
Q

What is cardiac arrest, what are signs it is present

A

Abrupt loss of heart function/ absence of pulse, unresponsiveness, apnea (no breathing)

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2
Q

Why do patients develop cardiac arrest

A

Coronary artery disease, cardiomyopathy, structural abnormality, electrical abnormality, asthma, trauma

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3
Q

What is the chain of survival for cardiac arrest

A

Immediate recognition and activation of the emergency response system, early CPR (emphasis on chest compressions), Rapid defibrilation, effective advanced life support, intergrated post cardiac arrest care

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4
Q

When giving CPR for cardiac arrest what is the target compression per minute, depth

A

100-120 compressions per minute, 2-2.4 inches (rotate compressions every two minutes if needed to meet target)

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5
Q

What is acronym for Basic Life Support for Cardiac Arrest

A

Circulation: chest compressions through CPR (little interruptions)
Airway: Open and secure airway (endotracheal intubation)
Breathing: Rescue breaths (endotracheal intubation)
Defibrillation: AED (automatic external defibrillator)/Rapid defibrillation if necessary

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6
Q

If there is a break in compressions what is the longest it should last

A

10 seconds

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7
Q

What are the best routes of administration for cardiac arrest

A

Intravenous (central or peripheral), Intraosseous, Endotracheal (not preferred)

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8
Q

What drugs can be administered endotracheal

A

Naloxone, Atropine, Versed/Vallium/Vasopressin, Epinephrine, Lidocaine

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9
Q

How must the dose be changed if given Endotracheal

A

2-2.5 times the normal dose, followed by 10 ml normal saline flush

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10
Q

What are the intraosseous lines placed, how

A

Femoral head or tibia, Drill

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11
Q

What are the various rhythms that indicate Cardiac arrest

A

Ventricular fibrillation (VF), Pulseless ventricular tachycardia (VT), Asystole (flatline), Pulseless electrical activity (PEA)

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12
Q

What are the Hs that cause PEA

A

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia

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13
Q

What are the Ts that cause PEA

A

Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or coronary)

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14
Q

When a person goes into cardiac arrest what is the first thing that should be done

A

Give CPR and attach monitor/defibrillator

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15
Q

What are the rhythm shockable states of Cardiac Arrest

A

Ventricular Fibrillation and Pulseless ventricular Tachycardia

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16
Q

What are the non rhythm shockable states of cardiac arrest

A

Asystole and Pulseless electrical Activity

17
Q

If a patient is giving CPR and they have VF/pVT what should be done

A

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) while also searching for IV/IO access

18
Q

If after giving CPR for 2 mins after the first shock what should be done next if rhythm shockable

A

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) PLUS give Epinephrine 1 mg Every 3 to 5 minutes
(consdier advancerd airway and capnography)

19
Q

If after giving CPR for 2 minutes after the 2nd shock plus Epinephirne what should be done next if rhythm shockable

A

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) PLUS either Amiodarone 300 mg bolus AND 150 mg second dose OR Lidocaine 1-1.5 mg/kg for the first dose AND 0.5-0.75 mg/kg for the second dose while also fixing the underlying problem

20
Q

What should be done if a patient is NOT rhythm shockable since they are in asystole or pulseless electrical activity

A

CPR for 2 minutes with IV/IO accest found, Epinephrine 1 mg every 3 to 5 minutes (consider advanced airway,capnography)

21
Q

What should be done if the patient still is not rhythm shocable after epinipherine dose

A

CPR for 2 minutes then treat reversible causes

22
Q

T/F: If the patient never becomes rhythm shockable they should not receive Lidocaine or Amiodarone

A

True

23
Q

What are ways of knowing the CPR quality

A

If PETCO2 is less than 10 mmHg improve CPR quality, If diastolic pressure is less than 20 mmHG improve CPR quality

24
Q

When advanced airway is in place how many breaths is given per minute

A

10 breaths per min

25
Q

What is a good return of spontaneous circulation

A

Abrupt sustained increased PETCO2 (typically greater than 40 mmHg)

26
Q

What are the drugs that can be given if a patient is in cardiac arrest

A

Epinephrine, Amiodarone, Lidocaine

27
Q

What drugs can be given as infusions and when is that circumstance

A

Norepinephrine, epinephrine, dopamine, and phenylephrine BUT only if Return of spontaneous criculation occurs

28
Q

What is the goals of using epinephrine in cardiac arrest

A

Reduce vascular resistance, increase cerebral and coronary perfusion pressure, reduction of blood flow to muscle and visceral tissues

29
Q

T/F: If a patient achieves ROSC epinephrine can be given as a continous infusion

A

True

30
Q

T/F: Epinephrine is indicated for any type of cardiac arrest that occurs

A

True

31
Q

What are the goals of using antiarrhythimic drugs

A

blocking sodium, potassium, and calcium channels crital to the cardiac conduction in order to achieve return of spontaneous criculation and further suppress arrhythmias

32
Q

What is amiodarone indicated for in cardiac arrest

A

Ventricular fibrillation, pulseless ventricular tachycardia, recurrent atrial and ventricular tachycardias

33
Q

What is the dosing of amiodarone in pulseless ventricular tachycardia, Ventricular Fibrillation, if ROSC occurs

A

300 mg rapid IV bolus, may repeat with 150 mg IV bolus, 150 mg in 50 ml IV over 10 minutes (rate 300 ml/hour), 1mg/min for 6 hours, then 0.5 mg/min for 18 hours

34
Q

What types of cardiac arrest is lidocaine indicated for

A

Pulseless VF/VT, prevention of arrhythmias after ROSC

35
Q

What is the dose for lidocaine to treat Pulseless VF/VT, After ROSC

A

First dose: 1-1.5 mg/kg, Second dose: 0.5-0.75 mg/kg/ 1-4mg/min in a continous infusion

36
Q

When would Sodium bicarbonate be used in cardiac arrest, dose

A

If the cause is hyperkalemia, TCA overdose or preexisting acidosis/ 1 amp= 50 mEq (flush line since not compatible with catecholamines)

37
Q

When would dextrose be used in hear failure, dose

A

Hypoglycemia OR if insulin is used to treat hyperkalemia/ 1 amp of 50% = 25 grams

38
Q

When is magnesium sulfate indicated in cardiac arrest

A

Treatment of polymorphic ventricular fibrillation (Torsades) and arrhythmias 2nd to digoxin or hypomagnesemia

39
Q

When magnesium sulfate is used to treat cardiac arrest what is the dose for pulseless arrest, pulse present

A

1-2 grams in 10ml D5W IV over at least 5 minutes (5-20 minutes recommended)/ 1-2 grams in 50-100 ml D5W over 60 minutes

PMPR 430 (21 decks)

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