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ACLS 2023 > flash cards > Flashcards

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1
Q

When do you measure capnography? and what is the range

A

to measure someones CO2. The range is 35-45. When looking at the waveform on the monitor, it should rise between 20-40mm HG

  • if there is less than 20 mm HG, it could mean that the ET tube is dislodged
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2
Q

End tidal CO2

A

Put on PT for moderate OSA to measeure concentration CO2

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3
Q

potential or reversable causes of ACS or cardiac arrest (H and T’s)

A
  • hypovolemia
  • hypoxia
  • hydrogen ion (acidosis)
  • hypo/hyperkalemia
  • hypothermia
  • Tension pneumothorax
  • Tamponade Cardiac
  • Toxins
  • Thrombus (pulmonary)
  • Thrombus (coronary)
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4
Q

post-cardiac arrest syndrome

A
  • post- brain injury
  • post MI dysfunction
  • systemic ischemia and reperfusion response
  • persistent acute and chronic pathology that may have precipitated the MI
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5
Q

ETCO2 is an indication for?

A
  • cardiac output
  • and can signal return of spontaneous circulation ROSC
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6
Q

how deep are the chest compressions?

A

5 cm adult

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7
Q

how many compressions/min

A

100-120

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8
Q

if there is a pulse how many rescue breaths?

A

one every 6 seconds and check pulse every 2 min

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9
Q

ROSC is unlikely if ETCO2 is less than?

A

10 mm HG

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10
Q

what is agonal gasps

A
  • appears to be drawing in air, slow and irregular, can be snort, snore or groan
  • this is a sign of cardiac arrest
  • start CPR right away
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11
Q

primary assessment

A

ABCDE
airway
breathing
circulation
disability
exposure

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12
Q

secondary assess (SAMPLE)

A

S- signs and symptoms
A- allergies
M- medications
P- past medical hx
L- last meal consumed
E- events leading up to current illness

H’s and T’s

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13
Q

what are the two most common causes of PEA

A
  • hypovolemia and hypoxia
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14
Q

hypovolemia cardiac symptoms

A
  • sinus tachycardia
  • narrow complexes
  • typically increases diastolic and decreases systolic
  • blood loss
  • hypovolemia causes hypotension = PEA
  • replace volume
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15
Q

what can an US or ECHO discover? and what would be the solution

A
  • cardiac tamponade = pericardialcetesis
  • tension pneumothorax = chest tube
  • ECHO (echocardiographic) US for PE = fibrinolytics
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16
Q

What would a large PE cause

A
  • acute right heart failure bc it obstructs the pulmonary vasculature
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17
Q

what do you do for drug overdoses and toxic exposures?

A
  • CPR
  • renal dialysis
  • replace electrolytes
  • drug antidotes
  • trascut pacing
  • adjunctive agents
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18
Q

Immediate actions for STEMI or NSTEMI

A
  • O2
  • aspirin 160-325mg
  • nitro spray
  • morphine IV
  • consider P2Y12- plavix (clopidogril), ticegralor
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19
Q

Reperfusion goals (times)

A
  • < 12 hrs
  • PCI balloon inflation < 90 min
  • door-to-needle fibrinolysis < 30 min
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20
Q

Both morphine and nitro?

A

Venodilate- can cause hypotension

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21
Q

What is classified ST elevation

A

ST elevation 2mm or more or new LBBB

Leads 2 and 3:
men J point > 2
Women > 1.5
> 1mm or more for all other leads or new LBBB

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22
Q

NSTEMI ischemic ST depression

A
  • 0.5 mm or greater dynamic T-wave inversion with pain or discomfort
  • if trop is elevated
  • transient elevation of 0.5 or greater for less than 20 min
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23
Q

when to treat NSTEMI

A
  • refractory ischemic chest pain
  • recurrent/persistent ST-segment deviation
  • vent tachy
  • hemodynamic unstable
  • signs of HF
  • then start adjunct therapies: nitro, heparin
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24
Q

what is the best treatments for STEMI?

A

-reprofusion therapies
- fibrinolytics 30 min (alteplase)
- PCI’s : balloon/stents 90 min (120 min from 1st medical contact)

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25
Q

when not to give fibrinolytics?

A
  • typically after the first 12 hrs of symptoms
  • Those with ST depression, unless its true posterior MI
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26
Q

when do you use IV nitro

A
  • chest pain that isnt responsive to subling nitro
  • pulmonary edema
  • HTN complicating MI
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27
Q

rules for IV nitro

A
  • titrate
  • keep SBP > 90mm HG
  • limit drop in SBP 30 mm Hg below baseline in HTN PTs
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28
Q

drugs for strokes

A
  • fibrinolytic
  • glucose D10/D50
  • labetolol
  • hydralazine
  • ASA
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29
Q

critical time periods stroke:

A
  • assess 10 min
  • CT/MRI 15 min
  • interpret CT/MRI 45 min
  • fibrinolytic therapy 30 min (door to needle)
  • fibrinolytics need to be started 4.5 hrs from time of onset
    -EVT (endovascular thombolectomy)- up to 6 - 24 hrs
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30
Q

EVT, CTA and CTP

A

EVT- endovascular thombolectomy

CT angio - diagnose vasculature

CT perfusion

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31
Q

to start fibrolytic therapy BP has to be…

A

systolic < 185
diastolic < 110

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32
Q

if BP is > 185 treat with

A

labetolol 10-20 mg IV over 1-2 min

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33
Q

meds for bradycardia

A
  • atropine
  • dopamine (infusion)
  • epi (infusion)
34
Q

signs and symptoms of bradycardia

A
  • hypotension
  • altered LOC
  • signs of shock
  • ischemic chest discomfort
  • acute HF

if bradycardia not causing these (poor perfusion) then just monitor

35
Q

if atropine is ineffective then

A
  • consider transcutaneous pacing or dop/epi inf
36
Q

what to do for bradycardia

A
  • maintain airway
  • O2
  • cardiac monitor
  • IV
  • 12 lead
  • consider hypoxic/toxic causes
37
Q

what is a normal atropine dose and how often can you admin?

A

1st dose: 1 mg

repeat 3-5 min up to 3 mg

38
Q

is the bradycardia causing…

A
  1. hypo
39
Q

If atropine doesn’t work and u use TCP what setting do you use?

A

The lowest possible. Also give sedatives and analgesics.

  • use only as an emergent bridge to TVP (transvenous pacing)
  • you can do TVP with dop or epi infusion
40
Q

No atropine in which PTs

A

Heart transplant

41
Q

What do u need to give bfr TCP

A
  • analgesic
  • benzo (Midaz) for anxiety and muscle contractions
  • use chronotropic drugs (dopamine and epi also vasoconstrictors)
  • need expert consult for TVP
42
Q

When do you want to use dobutamine

A

When you don’t want to vasoconstrict by using dopamine and epi

43
Q

Dopamine low dose and high dose

A

5-20mcg/kg/min
Low- selective affect on inotropy and HR

High- also has vasoconstriction effects

44
Q

Chrinotropic

Inotropic

A

Chrono- rate

Inotropic- force

45
Q

Set up TCP

A
  • place electrodes by picture
  • turn on
  • set demand rate btwn 60-80/min
  • set milliamperes output 2mA above the does at which consistent capture is observed
46
Q

Unstable tachycardia causes

A

(decreases CO )

  • hypotension
  • acutely altered mental status
  • signs of shock (pale, diaphoretic, tachipnea, N/V, enlarged pupils, weak, dizzy, fainting, anxious)
  • ischemic chest discomfort
  • acute heart failure
47
Q

When to cardiovert

A
  • when HR > 150 and symptomatic
  • if the PT is serious I’ll or has cardiac disease, they might be symptomatic at lower rates
48
Q

Never cardiovert when…

A

A person is in sinus rhythm

49
Q

Tachycardia algorithms

A

1) identify underlying cause and do basic: O2, maintain airway, cardiac monitor, IV, 12 lead
- if PT persist and is unstable then

2) synchronized cardio version with sedation and adenosine if narrow QRS

3) - if wide QRS > 0.12 then adenosine if regular and monomorphic (no cardiovert if wide QRS and biphasic)
- vagal maneuvers, BB’s, CCB’s

50
Q

Most wide QRS stem from

A

Ventricles

51
Q

If the PT is pulseless tachycardia treat them as

A

Ventricular fibrillation

52
Q

If the PT has a wide QRS tachy and is unstable treat them as

A

Vent tachy VT

53
Q

If the PT has polymorphic vent tachy treat as:

A

VF with high energy unsynchronized shocks

If you don’t know if the unstable Pt has polymorphic or monomorphic VT, = high energy unsync shocks

54
Q

Why do you synchronize

A

To prevent R on T. When the heart is depolarizing (t-wave) - can cause VF

  • synch uses lower energy level
  • unless polymorphic or pulseless, you can’t synch
55
Q

What med might the dr. Trial as you wait for cardio version?

A

Adenosine first dose 6mg fast with fast NS flush and immediate elevate arm

Second dose 12 mg if needed

May cause: asystole, flushing, chest pain, moment bradycardia, bronchospasm

56
Q

When can you use adenosine: if the QRS is…

A

Narrow, regular and monomorphic

Can use on wide QRS only if regular and monomorphic

Then use antiarrhythmic infusion: procainamide or adenosine

57
Q

If the tachycardia is polymorphic with a wide QRS then

A

Cardiovert unsynch shock

58
Q

For wide complex tachy’s consult professional bc

A
  • treatment has potential for harm
59
Q

What do you do first for tachy with narrow QRS with regular rhythm - symptomatic but stable

A
  • vagal maneuvers
  • adenosine
  • BB CCB
60
Q

You have a pulse with no breathing.

A
  • get an airway and give one breath every 6 seconds checking pulse every 2 min
61
Q

Post-cardiac care what do you want o2 to be at

A

92-98%

62
Q

What % O2 do you want for ACS?
Stroke?
Post cardiac arrest

A

ACS 90%

Stroke 95-98%

Post cardiac 92-98%

63
Q

CCF

A

Chest compression fraction
Time during cardiac arrest resuscitation during chest compressions

CCF= actual chest compression time / total code time

64
Q

Drugs for VF/pVT

A
  • Epi 1mg Q3-5min
  • amiodarone 300mg, then 150mg or
  • lidocaine 1-1.5mg/kg, second dose 0.5-0.75mg/kg
  • magnesium sulfate: hypomag or torsades de pointes 1-2g (2-4ml of 50% solution in 10mls NS or D5W)
  • dopamine: for Brady and hypotension
  • O2
  • others….
65
Q

When you have an advanced airway how often are breaths

A

Every 6 seconds

66
Q

when does brain damage start and when is it irreversible?

A

6-10

after 10

67
Q

when do you check for a pulse?

A

only if you see an organized rhythm

68
Q

if you have a rhythm with a pulse?

A

proceed to post-cardiac arrest care

-O2 >or = to 92-98%
-advanced airway
-treat hypotension SBP <90 1-2L
: Epi/dopamine/levo inf
-12 lead
-TTM

69
Q

if the rhythm is non-shockable and there is no pulse?

A

follow asystole/PEA

CPR/IV EPI, shockable? CPR treat causes

70
Q

if the rhythm is shockable?

A

continue to VF/VT pathway

give one shock and resume CPR

71
Q

when do you give Epi?

A

after the second shock repeat Q4 min

72
Q

what does EPi do?

A
  • vasoconstricts and increases blood flow to the brain/coronary
  • improves aortic diastolic pressure
73
Q

when should antiarrhythmics be given?

what should you give?

A
  • before or after a shock.
  • use when VF/VT unresponsive to shocks

amiodarone or lidocaine.
(these are better used if it was witnessed)

74
Q

amiodarone

A

for VF/VT

1) 300 mg
2) 150mg

blocks Na channels, lengthens cardiac action potential

75
Q

lidocaine

A

1) 1-1.5 mg/kg
2) 0.5-0.75 mg/kg max dose 3 mg/kg

76
Q

magnesium sulfate

A
  • for torsades de pointes associated with long QT interval

1) 1-2 grams over 20 min

Na/K+ pump agonist
surpresses cardiac calcium channels

77
Q

how do you give each IV drug

A
  • bolus and flush with 20ml NS
  • elevate arm to get into central circulation (for 10-20 seconds) ya right
78
Q

targeted temp managment

A

esophageal, rectal, bladder

32-36 degrees for 24 hrs

79
Q

what else should you do/monitor in post-cardiac arrest care

A
  • EEGs
  • TTM
  • brain CT
  • lung protective ventilation
  • elevate HOB 30 degree to prevent cerebral edema/aspiration and vent acquired pneumonia
  • O2 92-98%
  • start ventilation at 10 breaths/min and adjust to PaCO2 35-45
  • SBP >90 or MAP 65
  • ECGs for ST elevation or new LBBB- treat coronary angiography
80
Q

signs of ROSC

A
  • breathing
  • movement
  • palpable pulse
  • measurable blood pressure

ACLS 2023 (1 decks)

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