E ACLS Flashcards
What to do post defibrillation
get right back to CPR
What to do while AED charges
continue CPR
end tidal volume is 500ml of bag, while you ventilate there is a residual of 5ml left in your lungs every time you squeeze the bag, if it builds it can lead to things like bilateral pneumothorax — this is due to increase in thoracic pressure from over ventilating, what happens
Decreases Cardiac output
what is intubation prevent
prevent aspiration
Intubation is ___ open/closed loop circuit and what does it do?
Closed loop circuit and measures CPR efficacy in real time
With intubation how many seconds ventilation
every 6 seconds OR 10 times a minute with ventilation
How to measure oropharyngeal airway
place against side of face/cheek , measure mouth to mandible. Properly sized OPA results in proper alignment with glottic opening
What is purpose of end tidal Co2
CPR efficacy measurement - to ensure CPR efficacy
What does it mean if end tidal Co2 is decreasing
quality of CPR is decreasing, CPR performance dropping
What is diagnostic for ACS
12 lead EKG
What is needed to Dx STEMI
at least 2+ ST elevation in same lead
what is ASA dose
160-325po
when do caution nitroglycerin use
Right ventricle STEMI MI RV1, hold nitro or give with fluids
what is considered SICK pt
SOB, CP, hypotension
Best way to confirm/monitor the position of endotracheal tube?
End Tidal CO2
CXR= NOT answer
- Pt had stents placements 2 weeks ago can have reinfarction?
If they are not properly anticoagulated (ex:plavix)
: Patient with a lot of chest pain, couple days of ago went to ER, ended up at Cath lab, placed 2 stent, 2 days later recovered but now with CP and SOB, why is the patient having CP and SOB despite having stents 2 days ago?
Likely cause is re-infarct in same place, clots in the stent when you are not anticoagulated, having ACS again
Within how many hours to administer fibrinolyic therapy
3 hours of symptoms onset IF CT shows no bleeding or hemorrhage
Can you administer anticoagulant or antiplatelet 24 hours after rtPA
- Do not administer anticoagulants or antiplatelets for 24 hours after administration of rtPA, until a a follow up CT scan at 24 hrs show no intracranial hemorrhage
What are 5 steps to Vib Vtachy
- CPR
- Defibrillate
- Vascular access
- epi [1mg every 4 minutes]
5 amidarone [300mg first, 150mg second]
What rhythms does not need debrilliation
PEA and asystole
What to do when symptomatic bradycardia
atropine
Sick patient with CP, SOB, Hypotension with strip that shows monomorphic ventricular tachycardia, says nothing about 12 lead EKG or Trops in the question. Which Algorithm should be followed
Adult Tachycardia
- CP and SOB are not empirical data of ACS, only EKG and troponin can
What is empirical data of ACS
EKG and trop, NOT NOT NOT CP SOB
- Pt w/ chest pain, SOB, heart racing and sick :what to do?
cardioversion
what to give with torsades de pointe
Magnesium Sulfate
What are Cincinnati Pre-hospital stroke scale
- facial droop
- arm drift
- abnormal speech
Need to rule out what before giving lytics?
Bleed!
___ hours of symptoms onset to be able to administer fibrinolytics
3
ick pt CP SOB and HYPOTENSION
Monomorphic Ventricular Tachycardia strip
Describes sick nothing about 12 ECH or Trops
Which Adult Algorithm to check
CP and SOB are not empiral data of ACS - does not give ECG or Troponin.
Answer: Adult Tachycardia!
Unstable tachycardia with symptoms tx?
cardioversion
Wide stable tachycardia tx?
seek expert consultation
narrow stable tachy tx?
vagel manuever then adenosine
what timeframe for lytic
stroke w normal head CT, must be within 3*** hours, start lytic right away. 3 hours is time frame but answer RIGHT AWAY
5 steps to vtach v fib cardiac arrest
5 steps*******
- CPR [preserve heart and brain]
- defibrillate [corrects the rhythm] —- interrupt the correct heart and flatline/asystole, joule is a watt second of that delivery of electricity then more likely to be successful. Less joules are comfortable for alive pt. 200 joules. [charge and active CPR, then clear, then shock, resume CPR]
- vascular access IV/IO
- Epinephrine - always first drug we give during CPR every 4 minutes 1 mg with no max dose [every other cycle of CPR bc each CPR is 2 minutes]
- Amiodarone [ in between epi doses, epi Amiodarone 300, epi Amiodarone 150, then epi rest]
number 9 test
complete block thrid degree
what happens in shockable rhythm
Shockable Algorithm
- Start CPR, give oxygen, attach monitor/defibrillator [no pulse]
- Shockable cardiac VF/pVT , keep CPR while it charges
- Shock
- Resume CPR 2 minutes
- Vascular Access IO IV
- Rhythm analysis 2 minutes
- shockable - charge 200 J - shock 2nd time, CPR
- Give epi 1mg favorable retribution blood to heart
- CPR, shock, CPR charge
- Amio 300 IVIO
- CPR shock CPR charge
AHA, only 1 med at a time.
1
2nd degree type2
5
2nd degree type 1
9
3rd degree type complete block
what are steps to V. Fib ?
v fib #40 1. CPR
- defib
- vascular access
- epi
- amidarone
R longer and dropped beat
second degree block type 1 NUMBER 5
