More ACLS Flashcards
What is the flow rate for a NC?
1-6 L/min
What is the minimum flow rate for the simple face mask? What will happen if this is too low?
6 L/min
Re-breathe CO2
What type of mask can deliver up to 100% oxygen?
Face mask with reservoir
What type of patients need a face mask with a reservoir?
Those who need an ET tube, but still maintain their airway reflexes, or will need one soon
True or false: you should use cricoid pressure when inserting an LMA
False–increase incidence of misplacement
What should always be inserted into the mouth with an LMA?
Bite block or OPA
What sizes of LMA fit most men and women respectively?
5 for men
4 for women
What is a laryngeal tube?
tube with a cuff that is inserted into the esophagus. The cuff inflates to seal off esophagus, leaving only the larynx open for air
Who should not receive a laryngeal tube? (4)
- Under 16 year or under 4 feet tall.
- Absent gag reflex
- Suspected esophageal injury
How does the dose of medications change when going from the standard IV route to the ET tube?
2x higher
How are drugs prepared to be placed in the ET tube?
Mix the dose in 5-10 mL of sterile water (preferable) or saline. Ventilate and hold compressions briefly to allow for uptake
What size ET tube is used for adult males and females respectively?
Males = 8 Females = 7
What are drugs that can cause 1st degree AV blocks?
beta blockers, CCBs, and digoxin
What type of MI can present with AV block (anterior, lateral, posterior etc).
Inferior AMI
What is the site of pathology for a second degree AV block type I and II respectively?
Type I = AV node
Type II = infrahisian
What is the etiologies for second degree AV blocks type I? (3)
- RCA infarct
- Drugs
- Parasympathetic
What is the etiology of type II second degree AV block?
left coronary infarct
What is the etiology of third degree AV blocks?
Ischemia of the left coronary, (LAD)
What is the amount of joules needed for a-fib? Stable VT? SVT?
a-fib = 120-200 J
Stable VT = 100J
SVT = 50-100 J
True or false: you can use the AED safely and effectively if the patient is covered in water
False-need dry chest
True or false: you can use the AED safely and effectively if the patient is in the snow or laying in a puddle of water, so long as the pads and chest are not wet
True
What is the defibrillation dose of monophasic electrodes?
360 J
Where should the arm with an IV be relative to the patient if giving fluids or drugs?
At level of the heart
Where is the IO insertion site for the tibial plateau?
two finger breadths inferior, then medial of the tibial tuberosity
What should be done immediately after inserting an IO to ensure that it did not go through the bone?
Infuse with IVFs and ensure that no swelling occurs posteriorly
What should be done to IV tubing with an IO needle to ensure that it does not tear out the needle?
tape tube to skin
What is the cause of a slow heart rate with low BP?
RV infarct
What are the two components of the breathing part of the ABCs?
Ventilation and oxygenation
What is the dose of Naloxone IM and intranasally? How often can this be repeated?
IM = 0.4 mg
IN = 2 mg
q4 minutes
True or false: you should perform CPR on an opioid overdose patient if they’re not breathing (regardless of pulse)
True
What is the goal oxygen saturation for cardiac arrest patients?
94%–only give enough oxygen to get to here.
How long after induced hypothermia should you wait to assess for returned neurologic function?
72 hours
What are the 6 roles for cardiac arrest?
- Leader
- Compressor
- AED
- Airway
- IV/IO meds
- Timer
What qualifies for low blood pressure in the normotensive and hypertensive individual?
Normal = less than 90 mmHg Hyper = more than 30 mmHg drop
How long must you wait to give nitrates in a patient who has taken nitrates?
- 24 hours for sildenafil or vardenafil
- 48 hours for tadalafil
Why is morphine in particular good for MIs?
Venodilator and CNS depressant
Are other NSAIDs besides ASA safe for use in MIs?
No
What are the goals for PCI in hospital and transfers?
90 minutes door to balloon in hospital, 120 minutes if transfer
What is the goal for door to fibrinolytics?
30 minutes
What is the goal for door to transfer?
30 minutes
What is the timeframe to ship and drip patients?
12 hours from symptom onset, and 6 hours from start of fibrinolysis
Within how many hours of symptom onset can fibrinolytic be given?
12 hours of symptom onset
What are the three indications for IV nitro in STEMI patients?
- Recurrent chest pain unresponsive to oral
- pulmonary edema
- HTN
True or false: if a stroke patient presents with an arrhythmia and are stable, is it appropriate to watch it
True
What are the goals for the following with a stroke:
- See a physician
- CT scan/neuro assessment
- interpret CT
- Initiate fibrinolytics
- 10 minutes to see physician
- 25 minutes to CT/neruo
- Interpret CT in 45 mins
- Fibrinolytics within 3 hours of symptoms onset
How long after tPA should anticoagulants be avoided?
24 hours
what are the three components of the Cincinnati stroke scale?
Facial droop
Arm drift
Abnormal speech
What is the BP cutoff for tPA?
185/110
An arterial puncture within what timeframe is a contraindication to tPA?
7 days
True or false: a h/o intracranial hemorrhage is a contraindication to tPA
True
platelet count less than how many is a contraindication to tPA?
100000
Heparin received within what timeframe is a contraindication to tPA?
48 hours
What is the INR and PT cutoff for tPA?
INR = 1.7
PT over 15 seconds
BG less than what is a contraindication to tPA?
50 mg/dL
What are the four exclusion criteria for extended time for tPA (4.5 hour mark)?
- Age over 80
- Severe Stroke
- Anticoagulant use
- h/o both DM and prior ischemic stroke
Below what rate is tachycardia usually not the cause of s/sx?
150
What is the dose and rate for dopamine infusion for bradycardia?
2-20 mcg/kg/min
What is the dose and rate for epi infusion for bradycardia?
2-10 mcg/min
What is the treatment for narrow complex tachycardia in the stable patient?
Vagal maneuvers
Adenosine
Beta blockers or CCBs
What is the treatment for unstable tachycardias? (wide or narrow)
Synchronized cardioversion
What is the treatment for wide complex tachycardias in the stable patient?
Consider adenosine or anti-arrhythmic
When is adenosine indicated for the treatment of wide complex tachycardias?
only if regular and monomorphic
What is the dose and rate of infusion of sotalol?
100 mg (1.5 mg/kg over 5 mins)
What is the IV rate of procainamide infusion? What is the max dose?
20-50 mg/min
17 mg/kg
What are the side effects of procainamide (2)
- Hypotension
- QRS duration increases over 50%
What are the four major indications for synchronized cardioversion? (4)
Unstable:
- A-fib
- A-flutter
- SVT
- Regular monomorphic tach with pulses
If you are unsure if an unstable patient has monomorphic or polymorphic VT, what should you do?
Unsynchronized cardioversion
What is the correct dose of monophasic and biphasic electricity for unstable a-fib?
Mono = 200 J Bi = 120-200 J
What is the dose of monophasic electricity for unstable VT with a pulse?
100 J
What happens if you shock sinus tachycardia?
Increases the rate
What are the two main pathophysiologic mechanisms of unstable tachycardia?
- Decreased CO d/t fast
- Beating is ineffective
When you are pacing a patient transcutaneously, where should you never assess for a pulse, and why?
Carotids, due to muscle contraction in that area
True or false: Transcutaneous pacing is indicated even if the patient is hypothermic
False
What is the effect of atropine doses of less than 0.5 mg?
Paradoxical decrease in HR
Why must you be careful in using atropine in cases of an MI?
Increases myocardial oxygen demand
What rhythms should atropine be avoided in, and skipped directly for pacing?
Mobitz type II or 3rd degree heart block
How are bradycardias caused by mobitz type II and 3rd degree heart block treated?
TCP or beta adrenergic support
What is the dose of monophasic electricity for unstable:
- A-fib?
- Monomorphic VT
- SVT/atrial flutter
-a-fib = 200 J
-Mono VT = 100 J
SVT/a-flutter = 50-100 J
