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Acute cardiac life support > Electrical therapy > Flashcards

Electrical therapy Flashcards

1
Q

Indications for defib

A

Pulseless monomorphic VT, sustained polymorphic VT, and VF

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2
Q

Shocks for defib and cardioversion are expressed in what units

A

Joules

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3
Q

Other functions for combination defib pads besides shock

A

ECG monitoring, pacing

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4
Q

3 general defib waveforms

A

Monophasic, biphasic, triphasic

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5
Q

What do the different types of waveforms indicate

A

Whether the current is delivered in 1 diretion, 2 or multiple directions

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6
Q

What waveform do most AEDs and manual defibrillators sold today use?

A

Biphasic

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7
Q

The energy deliver through the patients chest wall is determined by what?

A 
Transthoracic impedance (measured in Ohms)
aka resistance?
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8
Q

What affect do skin surface, fat, bone, and hair have on impedance

A

Increase

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9
Q

What do you do if a patient has excessive chest hair and you are trying to defib

A

Remove it (razor, if no razors place an extra set of electrodes on the quickly remove to rip the hair away)

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10
Q

For what weight and above should adult sized paddles

A

10 kg (22 lb)

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11
Q

General rule for what size paddles you should use

A

Largest pads that will fit on the pts chest w/ at least 1 inch separating each pad

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12
Q

A lack of good defib pad contact may cause what

A

Arcing of electricity and skin burns

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13
Q

Should you use alcohol or alcohol based cleaners to clean the skin before defib?

A

NO

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14
Q

When using a biphasic waveform defib, does body weight influence the energy delivered?

A

No

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15
Q

When preparing skin for pad placement, what SHOULDN’T you use to clean

A

Alcohol, tincture of benzoin, or antiperspirant

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16
Q

Typical paddle or pad placement in resuscitation

A

Sternum/apex position; aka anterolateral or apex-anterior position

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17
Q

Position of pads in the sternum-apex position

A

Sternal pad is right side of the sternum just below the clavicle

Apex pad is midaxillary line lateral to the pts left nipple

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18
Q

If the pt is a women, what should you do differently when placing the apex pad in the Sternum-apex position

A

Elevate the left breast and place the pad underneath the breast tissue

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19
Q

If you accidentally place the sternum pad in the apex position and the apex pad in the sternal position, what should you do?

A

Just keep going, as long as the heart is between them it’s cool

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20
Q

Do you need to apply conductive gel to combination pads?

A

No, they are pre-lubed

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21
Q

How much pressure should you apply to handheld pads when defib

A

About 25 pounds

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22
Q

How many joules should you use to shock if you are using a monophasic defibrillator

A

360 J

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23
Q

How many joules should you use to shock if it’s a biphasic defibrillator

A

Level recommended by the manufacturer (typically 120-200 J)

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24
Q

Who is the last person to “clear” the area when defibbing?

A

CPR guy; should maintain chest compressions until just before shock is given (until the defib has charged)

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25
Q

Should oxygen be turned off while shocking?

A

Yes

26
Q

How long between shocks?

A

5 cycles of CPR (about 2 minutes) and rhythm is assessed

27
Q

What do you do if the shock restores a rhythm

A

Check for a pulse; if pulse is present then check for BP and other vital signs

28
Q

If shock restores rhythm but you aren’t sure if there’s a pulse?

A

Continue CPR

29
Q

What if the defib is charged and the pts rhythm spontaneously converts to an organized rhythm or a nonshockable rhythm?

A

In most cases the defib will disarm if the discharge buttons are not pressed w/in 60 seconds of charging

30
Q

What should you do if a shock restores a rhythm but then converts back to the VF/VT?

A

Defib at the last successful energy level

31
Q

Can you shock a person with an ICD?

A

Yes, but make sure the pads aren’t on the device; pt should have ICD checked after defib to make sure it still works

32
Q

Explain tiered-therapy as it applies to ICDs

A

They can deliver a range of treatments; defib, antitachycardia pacing, cardioversion, and bradycardia pacing. The therapies used in a pt are determined by the physician who placed it.

33
Q

If an AED is semi-automated, do you need to press a button to shock?

A

Yes

34
Q

What kind of AED do you use for someone who is unresponsive, apneic, pulseless, and 8 years or older?

A

Standard

35
Q

If the pt is an infant who needs shocked, use what?

A

Manual defibrillator is preferred to AEDs

36
Q

Steps in using an AED

A

Turn on power
Attach the device
Analyze the rhythm
Deliver a shock if indicated and safe

37
Q

How far away from ICD should AED pads be placed?

A

At least 3 inches

38
Q

If an ICD is delivering shocks to a pt and you want to shock them, what do?

A

Wait 30-60 s for it to complete it’s cycle

39
Q

Shock that is timed or programmed for delivery during ventricular depolarization

A

Synchronized cardioversion

40
Q

What does a synchronized cardioverter search for to synchronize

A

Highest (R wave) or lowest (Q or S waves) part of the QRS complex

41
Q

What kind of rhythms does a cardioverter treat

A

Rhythms w/ identifiable QRS complexes and a rapid ventricular rate

42
Q

What kind of rhythms can cardioverters NOT treat

A

Polymorphic VT (disorganized rhythm) and VF (no clear QRS complexes)

43
Q

Cardioverter indications

A

Unstable afib
Unstable aflutter
Unstable MONOmorphic VT
Unstable narrow-QRS tachycardia

44
Q

Do you need to place gel on a standard defibrillator

A

Yes (conductive gel)

45
Q

Which lead should you sync the cardioverter to?

A

The one with the highest QRS amplitude

46
Q

Indications for defibrillation

A

Pulseless VF/VT

Sustained polymorphic VT

47
Q

What should you do if you are unsure if it’s monomorphic or polymorphic VT and the pt is unstable

A

Give unsynchronized shocks; don’t delay tx to try to figure out rhythm

48
Q

Why should you make sure O2 sources are away from the pt while shocking?

A

Possibly can allow ignition of flammable materials nearby

49
Q

Complications of electrical therapy

A 
Skin burns
Risk of fire
Myocardial damage or dysfunction
Embolic episodes
Dysrrhythmias including asystole, AV block, bradycardia, VF 
Injury to the operator or team
50
Q

Electrical stimulation through pacing pads on a patients torso to stimulate contraction of the heart

A

Transcutaneous pacing (TCP), aka temporary external pacing or non-invasive pacing

51
Q

What is the stimulating current for TCP measured in

A

Milliamperes (mA); considerably less than what is used for cardioversion or defib (measured in Joules)

52
Q

For an TCP, what should you set the initial rate at

A

60-80 bpm

53
Q

What is the electrical capture usually seen as in a pt with TCP

A

Wide-QRS and a broad T wave

54
Q

What is mechanical capture in TCP?

A

Pacing produces a response that can be measured like a palpable pulse and blood pressure

55
Q

Why should you avoid checking pulse in the neck or left side of a patient on a TCP

A

TCP may cause skeletal muscle contractions in these areas which may be confused for pulses

56
Q

After you achieve capture with a TCP, what should the pacing level be set at

A

Slightly higher (~2mA) than the threshold of initial electrical capture

57
Q

What is the main limitation to TCP

A

Patient discomfort from skeletal muscle contraction and electrical stim of cutaneous nerves (pain)

58
Q

Complications of TCP

A

Cough
Skin burns
Interferes with sensing from pt agitation or muscle contraction
Pain from electrical stimulation
Failure to recoqnize the the pacemaker is not capturing
Tissue damage including 3rd degree burns
Prolonged pacing leads to pacing threshold changes leads to capture failure

59
Q

TCP dysfunctions

A

Failure to …
Pace
Capture
Sense

60
Q

What is failure to capture?

A

Inability of pacemaker (TCP) stimulus to depolarize myocardium

Acute cardiac life support (5 decks)

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