BLS and ACLS

Question 1

BLS SURVEY

Answer 1

– Check responsiveness
– Activate 911 and get the AED
– Circulation
• Check for carotid pulse < 10 seconds
• Start CPR
– Defibrillation
• If no pulse assess shock able rhythm / AED
• Provide shock if indicated
• Resume CPR following shocks

Question 2

ACLS SURVEY

Answer 2

Airway
• Airway patent
• Is an advanced airway indicated
• Confirm and secure tube
– Breathing
• Adequate oxygenation and ventilation?
• Arrest 100% O2 –Non arrest O2 if SPO2 <94%
– Circulation
• Adequate chest compressions if in arrest
• Rhythm interpretation / 12 lead
• Is defibrillation, cardioversion, pacing indicated
• Has IV/IO been established
• Administer fluids and medications
– Differential diagnosis
• Why did patient develop symptoms or arrest
• Is there a reversible cause that can be treated

Question 3

OPENING THE AIRWAY

• No evidence of trauma

Answer 3

Head tilt chin lift)

Question 4

OPENING THE AIRWAY

• Evidence of trauma

Answer 4

(Jaw thrust)

Question 5

Oropharyngeal Airway

Answer 5

Keeps tongue from blocking the airway
– Indications
• Unconscious patient
• Absence of a gag reflex

Question 6

Oropharyngeal Airway

Sizing

Answer 6

Corner of the mouth to the angle of the mandible

Question 7

Oropharyngeal Airway Insertion

Answer 7

• Upside down to uvula then rotate to fully insert
• Sideways to uvula then rotate to fully insert
• Must be flush with the mouth

Question 8

NASOPHARANGEAL Indications

Answer 8

Indications
– Conscious or semi conscious patient
– Patient with a gag reflex

Question 9

NASOPHARANGEAL Sizing

Answer 9

Nose to tragus of the ear

Question 10

NASOPHARANGEAL Insertion

Answer 10

Lubricate well
– Choose the largest nostril
– Gently use a spiral motion to insert
– Check patient ventilation
– If resistance is encountered remove and try the
other nostril

Question 11

NASOPHARANGEAL Caution

Answer 11

Do not use on patients with serious head injuries

– Contraindicated with basilar skull fractures

Question 12

ADVANCED AIRWAYS

• SUPRAGLOTIC

Answer 12

– Combitube
– King airway
– LMA (laryngeal mask airway)
– SALT airway

Question 13

Meds that can be given ET (NAVEL)

Answer 13

Narcan
• Atropine
• Vasopressin
• Epinephrine
• Lidocaine

Question 14

Rules for ET administration

Answer 14

• Use 2-2.5 times the IV dose (except
vasopressin)
• Stop compressions
• Use 10 ml total volume (dilute with N.S. or
sterile water)
• Ventilate several times
• Resume compressions

Question 15

EPINEPHERINE Dose

Answer 15

1-3 mg every 3-5 minutes

Question 16

EPINEPHERINE

Answer 16

Mix 8 mg /500ml in D5W or N.S.
• Infuse at 2-10 mcg/min for bradycardia
• Infuse at 8-40 mcg / min for hypotension

Question 17

AMIODARONE (CORDARONE)

Indications

Answer 17

Indications
• VT/VF
• Rapid atrial arrhythmias

Question 18

AMIODARONE (CORDARONE)

Dosage (IV/IO)

Answer 18

Cardiac arrest- 300 mg in 10 ml Repeat 150 mg 3-5 min

• Perfusing patients 150 mg over 10 min. Repeat in 10 min.

Question 19

LIDOCAINE Indications

Answer 19

• VT, VF, PVC’S

Question 20

LIDOCAINE Dosage

Answer 20

Cardiac arrest- 1-1.5 mg/kg repeat half dose to 3mg/kg

• VT /PVC’S 0.5-0.75 mg/kg @ 5-10 min as needed

Question 21

• ATROPINE Indication

Answer 21

Symptomatic bradycardia

Question 22

ATROPINE Dosage

Answer 22

0.5 mg Repeat every 3-5 minutes

• Maximum dose 3 mg

Question 23

ADENOCARD (ADENOSINE)

Indications

Answer 23

– SVT (Specifically atrial tachycardia)

– Wide complex undiagnosed tachycardia

Question 24

ADENOCARD (ADENOSINE)

Dosage

Answer 24

– 6mg rapid IV push followed by a saline flush

– 12 mg IV rapid push followed by a saline flush

Question 25

CARDIZEM (DILTIAZEM)

Indications

Answer 25

SVT (Especially A-fib and A- flutter)

Question 26

CARDIZEM (DILTIAZEM)

Dosage

Answer 26

Give 0.25 mg/kg over 2 minutes (15-20 mg)
– May repeat 0.35 mg/kg in 15 minutes
– Infuse 125 mg/100ml at 5-15 mg/hr

Question 27

MAGNESIUM SULFATE

Indiations

Answer 27

Refractory dysrhythmias
– Torsades
– Hypomagnesemia

Question 28

MAGNESIUM SULFATE

Dosage

Answer 28

VF /pulseless VT – 1-2 gm over 1-2 minutes
– VT with pulse – 1-2 gm in 10 ml over 1-2 minutes
– Hypomagnesemia w/o ectopy 0.5-1 mg/hr infusion

Question 29

DOPAMINE Indications

Answer 29

Symptomatic hypotension (SBP70-100 Shock)
– Refractory bradycardia

Question 30

DOPAMINE Dosage

Answer 30

2-20 mcg/kg/min (usual start dose -5mcg/kg/min)

– Estimate start dose as 10% of the patient’s weight