BLS and ACLS COPY Flashcards
question
answer
VF cardiac arrest survival rates decrease how much per minute delay in defibrillation WITHOUT CPR
7-10%
survival rates decrease how much per minute delay in defibrillation WITH CPR
3-4%
Rescue breathing cycle
1 breath every 5-6 seconds
or 10-12 breaths/min
CPR Cycles
30 compressions and 2 breaths
CPR compression rate
100 - 120 per min
CPR compression depth
2” adult
5cm child
What two condition do you shock patients?
VF/pVT
In ACLS what medicine do you give every 3-5 minutes
Ephinephrine
in ACLS what medicine do you give for VF/pVT
Amiodarone
In cardiac arrest algorithm, after BLS what are the two main branches?
VF/VT
PEA/Asystole
In cardiac arrest algorithm, What do you do after determining it is VF/VT?
Shock 360/200 + CPR > SAS
Shock 360/200 + CPR + Epinephrine 1 mg > SAS
Shock 360/200 + CPR + Amiodarone 300mg
In cardiac arrest algorithm, What do you do after determining it is PEA/Asystole?
CPR + Epinephrine 1mg
In cardiac arrest algorithm, how much epinephrine is administered?
1mg
In cardiac arrest algorithm, how much amiodarone is administered?
300mg
What is the acronym for cardiac arrest algorithm?
SCREAM
Shock CPR Rhythm Check Epinephrine Amiodarone
What are the Hs that need ACLS (5)
hypoxia hypovolemia hydrogen ion hyper/hypokalemia hypothermia
What are the Ts that need ACLS (5)
tension pneumothorax tamponade toxins thrombosis, pulmo thrombosis, coronary
In bradycardia algorithm, what are the two main branches after BLS?
Unstable
Stable
In bradycardia algorithm, what are the steps for unstable?
atropine So4 0.5mg TIV > trancutaneous pacing > dopamine/epinephrine infusion > transvenous pacing
In bradycardia algorithm, how much atropine is administered?
0.5mg TIV
In bradycardia algorithm, what are the steps for stable?
observe and monitor
In tachycardia algorithm, what are the two main branches?
stable and unstable
In tachycardia algorithm, how are the two main branches subdivided?
wide (VT)
narrow
In tachycardia algorithm, what are the steps for untable wide (VT)?
Sedate + Cardiovert 100J
In tachycardia algorithm, what are the steps for unstable narrow?
Regular (SVT) > sedate + cardiovert 50-100J + Adenosine
Irregular (AF) > sedate + cardiovert 120-200J
In tachycardia algorithm, what are the steps for stable wide (VT)?
. Adenosine
. Amiodarone
. Sotalol
. Procainamide
In tachycardia algorithm, what are the steps for stable narrow?
. Vagal maneuvers
. Adenosine
. Bb/ccb
. Expert consultation
In tachycardia algorithm, what is the common medicine?
Adenosine
In what two conditions are amiodarone administered in ACLS?
cardiac arrest VF/VT
tachycardia stable wide VT
In what two conditions are adenosine administered in ACLS?
tachycardia unstable narrow regular svt
tachycardia stable wide VT
Which tachycardia state receives cardiovert 100J?
tachycardia unstable wide vt
which tachycardia state receives cardiovert 50-100J?
tachycardia unstable narrow regular svt
which tachy cardia state receives cardiovert 120-200J?
tachycardia unstable narrow irregula af
In SCA, which is more important?
Chest compression
Maintain O2 and eliminate CO2
Chest compressions
In SCA, when is maintaining O2 and eliminate CO2 more important than chest compressions?
prolonged VF in SCA and asphyxial arrest
Why is 100% oxygen optimised oxyhemoglobin content important?
hopoxemia leads to anaearobic metabolism which may blunt benefits of chemical and electrical therapy
What underlying conditions could be a cause of hypoxia in the SCA patient?
. Underlying respiratory disease
. low cardiac output
. intrapulmonary shunting
. ventilation-perfusion mismatch
What is the oxygen level in exhaled air for rescue breathing?
16-17%
What is the best practice for bag-valve device in ventilation?
2 operators: 1 to hold mask, 1 to ventilate
a 1-2 L of O2 bag capacity delivers how much O2?
600ml
oral airways are used for what type of patient?
unconscious
nasal airways are used for what type of patient?
with trismus and biting
What is a considering of using advance airways in ACLS?
minimal interruption of cardiac compression
what are the advantages of laryngeal mask airway (LMA) in ACLS?
. more secure and reliable than BVM
. LMA equavalent ventilation than ET
. LMA not require larygonscopy and visualization of vocal cords
Whare are the advantages of ET intubation in ACLS?
. Isolates the airway, keeping it patent
. reduce risk of aspiration
. provides conduit for suctioning secretions
. delivers high concentration of oxygen
. provides route for drug administration
. ensures delivery of selected tidal lung volume to maintain lung inflation
What are the drugs for ACLS that are administered thru ETT?
. Naloxone . Atropine . Vasopressin . Epinephrine . Lidocaine
What is the size of the ETT for adult male?
8.0-8.5 mm ID
What is the size of the ETT for adult female?
7.0-7.5 mm ID
What is are parts of postintubation care in ACLS?
. Record the depth of the ET
. Secure the ET using tapes
. Chest X-Ray for confirm position
What are the 4 arrest rythms?
. VF
. VT
. Pulseless Electrical Activity
. Asystole
Jugular, Subclavian femoral, Supraclavicula
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
a. Centeral IV access
Rapid arrival of drug at site of action
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
a. Centeral IV access
Increase risk of complications : subcutaneous emphysema, pneumothorax
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
a. Centeral IV access
Antecubital or external jugular
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
b. Peripheral IV access
Antecubital or external jugular
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
b. Peripheral IV access
Easier to learn, few complications
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
b. Peripheral IV access
No interruption CPR
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
b. Peripheral IV access
Venous access is not achieved
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
c. Intraoseaous access
Jamshidi needle
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
c. Intraoseaous access
proximal tibia below the tuberosity or at the distal femur
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
c. Intraoseaous access
Pediatric patients
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
c. Intraoseaous access
osteomyelitis
a. Centeral IV access
b. Peripheral IV access
c. Intraoseaous access
c. Intraoseaous access
What are IV fluid expanders? Which are given to pediatric patients?
. Fresh Whole Blood
. Crystalloid solutions - pedia
. Colloid Solutions - pedia
What type of IV fluid is preferred for CPR?
Plain NSS or LR
What is volume administration recommeded in routine cardiac arrest?
indication of volume depletion
Which has a worse neurologic outcome? What is MOA? Hyperglycemia or hypoglycemia
Hyperglycemia due osmotic diuresis
Sodium overload is rare/common
rare
What is the dose for volume expanders in neonates?
Dose 10 ml / kg
What are the IV fluids given to neonates?
Plain NSS or LR
Lidocaine
• Amiodarone
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
a. control heart rhythm and rate
- Adenosine
- Beta-Blockers
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
a. control heart rhythm and rate
- Procainamide
- Atropine
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
a. control heart rhythm and rate
• Verapamil/ Diltiazem
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
a. control heart rhythm and rate
Epinephrine
• Norepinephrine
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
b. improve cardiac output and blood pressure
- Dopamine
- Dobutamine
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
b. improve cardiac output and blood pressure
- Sodium Nitroprusside
- Nitroglycerine
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
b. improve cardiac output and blood pressure
- Digitalis
- Diuretics
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
b. improve cardiac output and blood pressure
- Morphine SO4
- Oxygen
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
c. myocardial infarction
- Nitroglycerine
- Aspirin
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
c. myocardial infarction
• Thrombolytic agents : Streptokinase, r- TPA, Heparin
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
c. myocardial infarction
- Glycoprotein IIb/IIIa inhibitors
- Beta Blockers
a. control heart rhythm and rate
b. improve cardiac output and blood pressure
c. myocardial infarction
c. myocardial infarction
Steps of post cardiac arrest care
Insertion of an NGT > decompress the stomach of air due BVM ventilation • Insertion of foley catheter > measure urine output • Take a 12 lead ECG • Do portable chest radiographs • Therapeutic hypothermia • Antibiotics • Nutrition
In post cardiac arrest care what is the purpose of insertion of an NGT?
decompress the stomach of air due BVM ventilation
In post cardiac arrest care what is the purpose of insertion of foley catheter?
measure urine output
question
answer
What are the regions of the abdominal area
right/left hypochondraic region, epigestric region
right/left lumbar region, umibilical region
right/left iliac region, hypogastric region
Hepatitis
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
right hypochondraic region
cholecystitis
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
right hypochondraic region
peptic ulcer
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
epigestric region
pancreatitis
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
epigestric region
splenic injury
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
left hypochondraic region
renal and uretic pain
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
right lumbar region
left lumbar region
(back) bowel obstruction
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
umibilical region
aortic aneurysm
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
umibilical region
appendicitis
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
right iliac region
pelvic pain
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
hypogastric region
diverticulitis
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
left iliac region
Where does peptic ulcer and pacreatic pain refer to?
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
right lumbar region
left lumbar region
umibilical region
(from epigestric region)
Where does aortic aneurysm pain refer to?
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
to back
Where does peptic ulcer and pacreatic pain refer to?
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
back
Where does diverticulitis pain refer to?
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right iliac region
left iliac region
hypogastric region
left lumbar region
Where does pelvic pain refer to?
right hypochondraic region
left hypochondraic region
epigestric region
right lumbar region
left lumbar region
umibilical region
right region
left iliac region
hypogastric region
right iliac region
left iliac region
lung bugs
stomach
foregut
midgut
hindgut
foregut
upper abdominal pain
foregut
midgut
hindgut
foregut
periumbilical pain
foregut
midgut
hindgut
midgut
mesophrenic duct
cloaca
foregut
midgut
hindgut
hindgut
lower abdominal pain
foregut
midgut
hindgut
hindgut
abdominal wall
autonomic nerves
somatic nerves
somatic nerves (SPW)
parietal peritonium
autonomic nerves
somatic nerves
somatic nerves (SPW)
abdominal organs
autonomic nerves
somatic nerves
autonomic nerves (AVO)
visceral peritonium
autonomic nerves
somatic nerves
autonomic nerves (AVO)
inflammatory causes of acute abdominal pain
appendicitis diverticulitis cholecystitis PID pancreatitis pyelonephritis intra-abdominal abcess
perforation/rupture causes of acute abdominal pain
peptic ulcer
diverticular disease
ovarian cyst
aortic aneurysm
obstruction causes of acute abdominal pain
intestinal obstruction
biliary colic
ureteric colic
severe pain
triage level 1
level 2
level 3
level 2
abdominal pain with stable vitals
triage level 1
level 2
level 3
level 3
history taking abbreviation
SOCRATES
site onset character radiation associated symptoms time exacerbating factors severity (subjective pain)
What are the steps of abdominal examination?
inspection
palpation
percussion
auscultation
What are you looking for in auscultation of the abdomen?
bowel sounds
bruit
Signs for appendititis
rovsing’s sign
point sign (McBurney’s)
psoas sign
obturator sign
ddx for pain/vomiting ± rigidity
acute pancreatitis
diabetic gastric paresis
dka
incercerated hernia
ddx for pain/vomiting/distention
bowel obstruction
celcal volvulus
ddx pain (±vomiting)
acute diverticulitis adnexal torsion mesenteric ischemia myocardial ischemia testicular torsion
ddx pain/shock
abdominal sepsis aortic dissection hemorrhagic pancreatitis leaking/ruptured abdominal aortis aneurysm mesenteri ischemia (late) MI ruptured ectopic pregnancy
abdominal pain which later shifts to right iliac fossa
acute appendicitis
periumbilical or loin bruising
acute pancreatitis
blood in stool
acute diverticulitis
murphy’s sign
acute cholecystitis
pain in right hypochondrium radiating to should or scapula
acute cholecystitis
asymmetrical femoral pulses
ruptured aortic aneurysm
lab test for pancreatitis
lipase (amylase if lipase not available)
lab test for mesenteric ischemia
lactate
question
answer
how many newborns require assistance to begin breathing?
it is 10%
What 3 questions used to identify neonate who do not need resuscitation?
Term?
Tone?
Breathing or crying?
What are the initial steps in stabilizing neonate needing resusciation?
warm and maintain normal temp clear secretions (only if copious and/or obstructing the airway dry stimulate position infant in "sniffing" position
After the stabilization of neonate requiring resuscitation, what other steps maybe taken?
ventilate and oxygenate
initiate chest compressions
admnister epinphrine and/volume
What determines if there is need for additional steps for neoatal resuscitation?
respirations heart rate (<100/min)
What is target heart rate for neonate?
> 100/min
What serious morbidities are there with hypothermia in neonates?
IVH, respiratory issues, hypoglacemia, late-onset sepsis
Possible complications of using suction immediately after birth?
deterioriating pulmonary compliance, oxygenation, and cerebral blood flow
What is the most rapid and accurate way to meansure heart rate of neonate?
3 lead ECG
When are chest compressions indicated for neonate?
HR <60/min despite ventilation
How are chest compression performed on neonate?
lower third of sternum
one thirs of the AP diameter of chest
What medication can be used for neonate needing resuscitation?
epinephrine
When is volume expansion indicated for neonate needing resusitation?
blood loss known or suspected
hr non responsive to other methods
What is a possible complication of volume expansion in neonates?
IVH (intraventricular hemorrhage)
What may be used for volume expansion in neonates?
isotonic crystalloid solution
blood
What is guideline for discontinuing resuscitative efforts in neonates?
Apgar score of 0 at 10 minutes (determine if HR is detectable or not)
question
answer
pulmonary etiologies of DOB
COPD asthma restrictive lung disorder hereditary lung disorder pneumonia pneumo-thorax
cardiac etiologies of DOB
CHF Coronary artery disease (CAD) MI cardiomyopathy valvular dysfunction left ventricular hypertrophy pericarditis arrythmias
mixed cardiac/pulmonary etiology of DOB
chronic pulmonary emboli
pleural effusion
deconditioning
COPD with HTN and/or cor pulmonale
noncardiac or nonpulmonary etiology of DOB
metabolic disorders pain trauma neuromuscular disorders functional cheminal exposure
< 20 yo
asthma
COPD
asthma
worse during night or early morning
asthma
COPD
asthma
lung function normal between symptoms
asthma
COPD
asthma
variable airflow limitation
asthma
COPD
asthma
CXR normal
asthma
COPD
asthma
> 40 yo
asthma
COPD
COPD
daily symptoms and exertional dyspnea
asthma
COPD
COPD
persistent airflow limitation
asthma
COPD
COPD
lung function abnormal between symptoms
asthma
COPD
COPD
CXR shows severe hyperinflation
asthma
COPD
COPD
possible clinical features of severe asthma
tachypnea tachycardia silent chest cyanosis accesssory muscle use altered consciouness
Why use PEF for asthma dx
more convinient and cheaper than FEV1
What SpO2 level do you seek to maintain withoxygen therapy
92% O2
When is ABG necessary for DOB?
patients with SpO2 <92% or features of life threatening asthma
Management of asthma accronym
ASTHMA
Adrenergics (beta 2 agonists - Albuterol) Streoids Theophylline Hydration (IV) Mask O2 Anticholinergics
digital clubbing + DOB
COPD
pursing of lips + DOB
COPD
COPD airflow obstruction level
FEV1/FVC ratio <0.7 post-bronchodilator
What is performed to diagnose COPD
spirometry, post-bronchodilator
COPD spirometry is performed (pre/post) bronchodilator
post bronchodilator
COPD exacerbations mangement
O2 bronchodilators (SABA with or without short-acting anticholinergics) systemic corticosteroids (40 mg prednisone per day for 5 days)
Type 1 pneumonias (2)
lobar and bronchopneumonia
Type 2 pneumonia (2)
CAP and HAP
patch consolidation usually in bases of both lungs
what type of pneumonia?
bronchopneumonia
What is the point criteria for treatment of penumonia? Acryonym and scoring
CURB 65
Confusion Uremia Respiratory Rate >30 Blood pressure low 65 yo or greater
Uses structure for classification
ACCF/AHA stages of HF
NYHA functional
ACCF/AHA stages of HF
Cardiogenic shock. Hypotension, peripheral vasoconstriction
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage IV
Severe HF. Frank pulmonary edema with rales
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage III
HF. Rales, S3 gallop and pulmonary venous hypertention
Kilip classification Stage I
Stage II
Stage III
Stage IV
Stage II
Acute HF management
SpO2 95-98%
patent airway and FiO2 can be increased
diuretics (secondary to fluid retension)
MC cause of dyspnea in AHF
pulmonary edema
In AHF, morphine induced the following
venodilation
mild aterial dilation
redude HR
In AHF, what is a potential adverse effect?
increasing need for inasive ventilation
reduce LV-preload and after-load wo imparing tissue perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
nitrates
hypertensive HF or MR, severe HR with predominantly increased after-load
nitrates
sodium nitroprusside
nesiritide
inotropes
sodium nitroprusside
reduce preload and after-load, increase CO wo direct inotropic effects
nitrates
sodium nitroprusside
nesiritide
inotropes
nesiritide
Pts with severely reduced cardic output compromised vital organ perfusion
nitrates
sodium nitroprusside
nesiritide
inotropes
inotropes
When are vasopressors indicated?
combination inotropic agent and fluid challenge fails to restore adequate arterial pressure and organ perfusion
HVS causes (increase/decrease) pCO2 which leads to (metabolic/respiratory) (alkalosis/acidosis)
HVS causes DECREASE pCO2 which leads to RESPIRATORY alkalosis
common ddx for HVS
acute coronary syndrome
pulmonary embolism
CO2 poisoning
HVS has (abnormal/normal) pH with (high/low) PaCO2 and a (high/low) bicarbonate level
HVS has NORMAL pH with LOW PaCO2 and a LOW bicarbonate level
Pharmaco therapies for HVS
benzodiazepines
lorazepam (ativan)
diazepam (valium)
paroxetine (paxil)