INTRO TO ACLS Flashcards
Required knowledge & skills for CLS
BLS Skills
-ECG Interpretation for core ACLS rhythms
-Knowledge of airway management and adjuncts
-Basic ACLS drugs and pharmacology knowledge
-Effective high-performance team skills
Interpretation of what rhythms
Sinus Rhythm
Atrial Fibrillation
Atrial Flutter
Bradycardia
Tachycardia
Supraventricular Tachycardia
AV Blocks
Asystole
PEA
Ventricular tachycardia (VT)
Ventricular fibrillation (VF)
Chain of Survival
Prevention and preparedness
Responder training, early recognition, rapid response
Activation of the emergency response system
Either outside and inside hospital
High-quality CPR
Early defibrillation of VF and VT
Advanced resuscitation interventions
Medications, advanced airway interventions, CPR
Post-cardiac arrest care
Critical care, targeted temperature management
Recovery
Effective support for physical, cognitive, emotional, and family
needs
In Hospital Cardiac Arrest (IHCA)
IHCA Chain of Survival
In Hospital Cardiac Arrest (IHCA)
IHCA Chain of Survival
Early recognition and prevention
Activation of emergency response (RRT)
High-quality CPR
Defibrillation
Post cardiac arrest care
Recovery
In Hospital Rapid Response Team (RRT)
RRT Alert Activated in following criteria are present
In Hospital Rapid Response Team (RRT)
RRT Alert Activated in following criteria are present
Threatened airway
RR less than 6/min or more than 30/min (know baseline)
HR less than 40/min or greater than 140/min (know baseline)
Systolic BP less than 90mmHg (know baseline)
Symptomatic HTN
Unexpected decreased LOC
Unexplained agitation
Seizure
Significant fall in urine output
Subjective concern of the patient
Respiratory Distress
Tachypnea
Increased respiratory effort
Inadequate respiratory
effort
Abnormal airway sounds
Tachycardia
Pale, cool skin
Changes in LOC
Use of abdominal muscles to
help breathe
Respiratory Failure
Marked tachypnea
Bradypnea, apnea
No respiratory effort
Poor to absent air movement
Tachycardia (early), bradycardia
(late)
Cyanosis
Stupor, coma(late
High Performance Teams
Timing
Quality
Coordination
Administration
Timing
Time to first compression and first shock, chest compression
fraction greater than 80%, minimize preshock pause, early
response time
Quality
Rate, depth, chest recoil, minimizing interruptions,
switching compressions, avoiding excessive ventilation, use
of feedback device
Coordination
Team members working together, proficiency
Administration
Leadership, measurement, CQI, number of code team
members.
High Performance Teams
Team Leader
Team Member
CPR Coach
Role of TEAM LEADER in High Performance Team
Role of Team Leader
-Organize the group
-Monitor individual performance of team members
-Backs up team member
-Models excellent team behavior
-Trains and coaches
- Facilitates understanding
-Focuses on comprehensive patient care
- Temporarily designation another member as leader if advance procedure is required
Role of TEAM MEMBER in High Performance Team
Role of the Team Member
-Proficient in performing skills within scope of practice
-Clear about role assignments
-Prepared to fulfill their role responsibilities
-Well practiced in resuscitation skills
-Knowledge about the algorithm
-Committed to success
Role of CPR COACH in High Performance Team
Role ofCPR Coach
-Coordinate the start of CPR
-Coach to improve the quality of chest compressions
-State the midrange targets
-Coach to the midrange targets
-Help minimize the length of pauses in compressions
Elements of Effective Team Dynamics
-Clear roles and responsibilities
-Knowing your limitations
-Constructive Interventions
-Knowledge Sharing
-Summarizing and Reevaluating
-Effective Communication
Effective Communication
Closed-Loop Communications
Clear Messages
Mutual Respect
Closed-Loop Communication
Closed-Loop Communications
-TL gives a message, order, or assignment to a TM.
-By receiving a clear response and eye contact, the TL confirms
that the TM heard and understood the message.
- The TL listens for confirmation of the task performance from the TM before assigning another task
Clear Messages
Clear Messages
- Concise communication spoken with distinctive speech in a controlled tone of voice
Mutual Respect
Mutual Respect
- Work together in a collegial, supportive manner
Systematic Approach
Initial assessment
BLS Assessment
Primary Assessment
Secondary Assessment
Initial Assessment
Visualization
Verify scene safety
Determine conscious vs unconscious patient
BLS Assessment
Check Responsiveness
Check Responsiveness
Tap and Shout “Are you Ok?”
Shout/Seek for Nearby Help
Shout for nearby help
Activate emergency response system
Get AED (if available) or send someone to get
AED and activate emergency response system
Check Breathing and Pulse
Scan chest for 5-10 seconds for movement for absent or abnormal
breathing
Check pulse simultaneously (5-10 seconds)
No pulse within 10 seconds – start chest compression
If pulse – rescue breathing (1 breath every 5 – 6 seconds)
Check pulse every 2 mins
Defibrillation
If no pulse, check for shockable rhythm
Provide shock as indicated
Follow each shock immediately with CPR, beginning with
compressions
BLS Assessment
Check Breathing and Pulse
Check Breathing and Pulse
Scan chest for 5-10 seconds for movement for absent or abnormal
breathing
Check pulse simultaneously (5-10 seconds)
No pulse within 10 seconds – start chest compression
If pulse – rescue breathing (1 breath every 5 – 6 seconds)
Check pulse every 2 mins
BLS Assessment
Defibrillation
Defibrillation
If no pulse, check for shockable rhythm
Provide shock as indicated
Follow each shock immediately with CPR, beginning with
compressions
BLS Assessment
3 Steps
Check Responsiveness
Shout/Seek for Nearby Help
Check breathing and pulse
Defibrillate
CPR Adult
Compress chest at least 2 inches (5 cm)
Compress chest at a rate of 100-120/min
Allow complete chest recoil after each compression
Compress hard and fast
Minimize interruption in compressions (10 seconds of
less)
Avoid excessive ventilation (30:2)
Switch compressor every 2 mins (or earlier if
fatigued)
Primary Assessment
ABCDE
Airway
Breathing
Circulation
Disability
Exposure
Airway
Airway
Maintain patency in unconscious patients
Use advanced airway management if needed
Confirm proper CPR-Ventilation coordination
Secure device to prevent dislodgment
Monitor airway placement with capnography waveform
Breathing
Breathing
Given supplemental O2 if indicated
Monitor adequacy of Ventilation and Oxygenation
Avoid excessive ventilation
Circulation
Circulation
Monitor CPR quality
Attach monitor/defibrillator for arrhythmias or cardiac
arrest rhythms
Provide defibrillation/cardioversion
Obtain IV/IO access
Give appropriate Drugs
Give IV/IO fluid if needed
Check glucose and temperature
Check perfusion issues
Disability
Disability
Check for neurologic function
Quickly assess for responsiveness, LOC, Pupil dilation
AVPU: Alert, Voice, Painful, Unresponsiveness
Exposure
Exposure
Remove clothing to perform physical examination
Looking for obvious signs of trauma, bleeding, burns,
unusual markings, or medical alert bracelets
Secondary Assessment
SAMPLE
S – Signs and symptoms
Breathing difficulty, tachypnea, tachycardia, fever, headache,
abdominal pain, bleeding
A – Allergies
Medications, foods, latex, etc. and associated reactions
M – Medications (including the last dose taken)
Patient medications, including OTC, vitamins, inhalers, herbal
supplements, last dose and time, home meds
P – Past Medical History
Health history, family history, significant underlying health problems,
past surgeries, immunization status
L – Last meal consumed
Time and nature of last intake of liquid or food
E – Events
Events leading to current illness, hazards at scene, treatment course,
estimated time of onset
Secondary Assessment
H’s & T’s
The most common causes of cardiac arrest
Hs –
Hypvolemia
Hypoxia
Hydrogen ions (acidosis)
Hypo-hyper kalemia
Hypothermia
Secondary assessment
H’s & T’s
The most common cause of cardiac threats.
Ts –
Tension ptx
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary or coronary)
Indications for Advanced Airway
Indications for Advanced Airway
Inability to oxygenate patient
(SpO2 < 90%, PaO2 < 55)
Inability to ventilate patient
(rising PaCO2, respiratory acidosis, mental status
change or other symptoms)
Patient unable to protect the airway
Airway management
Providing basic ventilation
Providing Basic Ventilation
Head tilt-chin lift
Jaw thrust without head extension
Suspected cervical spine trauma
Mouth to mouth ventilation
Mouth to nose ventilation
Mouth to barrier device ventilation
Bag-mask ventilation
Flow inflating vs Self inflating
Airway adjuncts
Airway Adjuncts
Nasopharyngeal Airway (NPA)
Oropharyngeal Airway (OPA)
Laryngeal Mask Airway (LMA)
Combitube
Endotracheal Tube (ETT)
LMA
LMA
Plugs esophagus
Air holes take air to trachea
AMBU Bag patient
Listen for breath sounds
Look at chest
Add End Tidal CO2 detector
Check BS over stomach
Make sure air is Not going to stomach
Esophagus is blocked by large cuffed end of tube
Trachea is open for air to enter
Air from holes in tube goes to trachea
