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AHA Guidelines 2010 > Part 8: Adult Advanced Cardiovascular Life Support > Flashcards

Part 8: Adult Advanced Cardiovascular Life Support Flashcards

1
Q

Why can a normal ventilation-perfusion relationship be

maintained with a minute ventilation that is much lower

than normal during CPR?

A
  • Because both systemic and pulmonary perfusion are substantially reduced during CPR.
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1
Q

When should an advanced airway be placed during CPR?

A
  • There is inadequate evidence to define the optimal timing of advanced airway placement in relation to other interventions during resuscitation from cardiac arrest.
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1
Q

During CPR and after placement of ETT the provider

delivering ventilation should provide 1 breath every _ to _

seconds?

A

6 to 8 seconds (8 to 10 breaths per minute)

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1
Q

What does it mean when a CO2 detector shows a false-negative reading?

A
  • Failure to detect CO2 despite tube placement in the trachea.
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1
Q

Name the T’s that a provider should consider to identify

during management of cardiac arrest.

A
  • Toxins
  • Tamponade(cardiac)
  • Tension pneumothorax
  • Thrombosis, pulmonary
  • Thrombosis, coronary
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1
Q

How can IV sodium bicarbonate during CPR alter the

correlation between PETCO2 and cardiac output?

A
  • The bicarbonate is converted to water and CO2
  • causing a transient increase in delivery of CO2 to the lungs.
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1
Q

What change in PETCO2 can be expected following

administration of IV sodium bicarbonate during CPR? (Increase or decrease)

A
  • Increase
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1
Q

What are the side effects of Amiodarone according to AHA2010?

A
  • Bradycardia
  • Hypotension
  • Phlebitis
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1
Q

What are the side effects of Magnesium according to AHA2010?

A
  • Hypotension
  • CNS toxicity
  • Respiratory depression
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1
Q

Is third degree AV block permanent or transient?

A

Can be either depending on the underlying cause

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1
Q

When should you avoid relying on Atropine in a

bradycardia?

A
  • In type II second degree or
  • third degree AV block or
  • in patients with third-degree AV block with a new wide-QRS complex where the location of block is likely to be in non-nodal tissue (such as in the bundle of His or more distal conduction system)
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1
Q

At what rate does a tachycardia have a clinical

significance and is more attributable to the arrhythmia?

A

>=150b/min

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2
Q

What are the indications for ETT according to AHA2010?

A
  • The inability of the provider to ventilate the unconscious patient adequately with a bag and mask
  • Absence of airway protective reflexes (coma or cardiac arrest)
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3
Q

What are the advantages of IO cannulation?

A
  • Access to a noncollapsible venous plexus
  • Enables drug delivery similar to that achieved by peripheral venous access at comparable doses
  • Can be established efficiently;
  • Is safe and effective for fluid resuscitation drug delivery blood sampling
  • Attainable in all age groups
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4
Q

When should 2 providers change compressor and

ventilator roles to prevent fatigue during CPR?

A
  • Every 2 minutes
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5
Q

Where in the myocardium does the Mobitz type II block

usually occur?

A
  • Usually below the AV node, within the His-Purkinje system
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6
Q

What are the possible reasons for a false-negative reading

during cardiac arrest?

A
  • Low blood flow and delivery of CO2 to the lungs
  • Pulmonary embolus
  • Detector contaminated with gastric contents or acidic drugs (eg endotracheally administered adrenaline)
  • Severe airway obstruction
  • Ppulmonary oedema
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6
Q

Why is Amiodarone the first-line antiarrhythmic agent

given during cardiac arrest?

A

Because it has been clinically demonstrated to improve

the rate of ROSC and hospital admission in adults with

refractory VF/pulseless VT.

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7
Q

When is the bag-mask ventilation particularly helpful

during CPR?

A
  • When placement of an advanced airway is
  • delayed or
  • unsuccessful.
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8
Q

What are the possible complications with insertion of a

nasopharyngeal airway during CPR and what are the

related precautions?

A
  • Airway bleeding
  • NPA should be used with caution in patients with severe craniofacial injury.
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9
Q

What are the advantages of the ETT according to

AHA2010?

A
  • Keeps the airway patent
  • Permits suctioning of airway secretions
  • Enables delivery of a high concentration of oxygen
  • Provides an alternative route for the administration of some drugs
  • Facilitates delivery of a selected tidal volume
  • With use of cuff, may protect the airway from aspiration
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9
Q

Which tachyarrhythmias fall under narrow-QRS-complex (SVT) tachycardias classification?

A
  • Sinus tachycardia
  • Atrial fibrillation
  • Atrial flutter
  • AV nodal reentry
  • Accessory pathway-mediated tachycardia
  • Atrial tachycardia (including automatic and reentry forms)
  • Multifocal atrial tachycardia (MAT)
  • Junctional tachycardia (rare in adults)
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10
Q

What is a synchronized cardioversion?

A
  • Shock delivery that is limited (synchronized) with the QRS complex
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11
Q

Is it true that during CPR performed by providers trained in

its use, the supraglottic airway is a reasonable alternative

to bag-mask ventilation and endotracheal intubation?

A

Yes (Class IIa, LOE B)

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11
Q

What methods can be used in addition to clinical

assessment as the initial method for confirming correct

tube placement in a patient in cardiac arrest when

waveform capnography is not available?

A
  • Colorimetric CO2 detectors and
  • nonwaveform exhaled CO2 detectors.
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11
Q

Is Adenosine administration in Pregnancy safe and

effective?

A

Yes, however adenosine does have several important drug interactions

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12
Q

Should cricoid pressure be applied routinely during CPR?

A

No, routine use of cricoid pressure in cardiac arrest is not recommended.

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13
Q

What is the classification of tachycardias based on?

A
  • Appearance of the QRS complex
  • Heart rate
  • Regularity
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15
Q

What drug is Dopamine?

A

Dopamine hydrochloride is a catecholamine with both

Alpha and Beta adrenergic actions.

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16
Q

What is the definition of tachycardia according to AHA2010?

A
  • Arrhythmia with a rate of >100 b/min
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18
Q

What is the expert opinion on initial energy settings for a

monomorphic VT (regular form and rate) with a pulse?

A
  • 100J for initial shock
  • If there is no response to the first shock, it may be reasonable to increase the dose in a stepwise fashion
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19
Q

What can a dose of

A

It may paradoxically result in further slowing of the heart rate

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21
Q

What are the key principles of arrhythmia (tachycardia)

recognition and management in adult?

A
  • If the tachycardic patient is unstable with severe signs and symptoms related to a suspected arrhythmia,
  • immediate cardioversion should be performed (with prior sedation for conscious patients)
  • If the tachycardic patient is stable, determine if
    • the pt has a narrow-complex or
    • wide-complex tachycardia, whether the rhythm is regular or
    • irregular, and for wide complexes whether the QRS morphology is monomorphic or polymorphic
  • Know when to call for expert consultation regarding complicated rhythm interpretation, drugs, or management decisions
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22
Q

What should the adenosine initial dose be reduced to in

patients taking dipyridamole or carbamazepine, those with

transplanted hearts, or if given by central venous access?

A
  • 3 mg
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23
Q

What does ‘unstable’ refers to, according to AHA2010?

A
  • Refers to a condition in which vital organ function is
  • acutely impaired or
  • cardiac arrest is ongoing or imminent
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24
Q

Which tachyarrhtymias fall under the classification of

wide-QRS-complex tachycardias?

A
  • Ventricular tachycardia (VT)
  • Ventricular fibrillation (VF)
  • SVT with aberrancy
  • Pre-excited tachycardias (Wolf-Parkinson-White [WPW] syndrome)
  • Ventricular paced rhythms
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26
Q

What are the main signs and symptoms of cardiovascular

compromise due to tachycardia?

A
  • Acute altered mental status
  • Ischemic chest discomfort
  • Acute heart failure
  • Hypotension
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27
Q

What does it mean when CO2 detector shows false

positive reading?

A

CO2 is detected but the tube is in the esophagus.

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28
Q

Under what condition can a patient with a regular narrow-

complex SVT be treated with adenosine while preparing

for synchronized cardioversion?

A
  • If not hypotensive
29
Q

Besides affecting protein channels, what other properties

does IV amiodarone have?

A
  • Alpha and
  • Beta-adrenergic blocking properties
30
Q

Is the EDD accurate for the continued monitoring of ETT

placement?

A
  • No, there is no evidence that the EDD is accurate for the continued monitoring of ETT placement.
32
Q

What does an assessment by physical examination

consist of once an advanced airway is inserted?

A
  • Visualising chest expansion bilaterally and
  • listening over the epigastrium.
34
Q

How is a first-degree AV block defined?

(on the basis of ECG interpretation)

A

Prolonged PR interval (>0.20 second)

35
Q

What is the most common mechanism of SVTs?

A
  • Reentry Abnormal rhythm circuit that allows a wave of depolarization to repeatedly travel in a circle in cardiac tissue
36
Q

What is the optimal timing of vasopressor administration

during the 2 minute period of uninterrupted CPR?

A

The optimal timing has not been established

37
Q

What are the side effects of Lidocaine according to AHA2010?

A
  • Slurred speech
  • Altered consciousness
  • Seizures Bradycardia
38
Q

What is the primary goal of giving a vasopressor during CPR?

A

To increase myocardial blood flow and achieving ROSC

40
Q

What are the key principles of arrhythmia (bradycardia)

recognition and management in adult?

A
  • Recognition of signs and symptoms of instability
  • initial treatment is atropine.
  • If bradycardia is unresponsive to atropine, IV infusion of beta-adrenergic agonists with rate-accelerating effects (adrenaline) or
  • transcutanous pacing can be effective
41
Q

When is bag-mask ventilation most effective during CPR?

A

When performed by 2 trained and experienced providers

42
Q

How can you determine/calculate the upper rate of age

related sinus tachycardia?

A

Approximately 220b/min - patient’s age in years

43
Q

When are periodic pauses in CPR permitted?

A
  • To assess rhythm
  • Shock VF/VT
  • Perform a pulse check when organised rhythm is detected
  • To place an advanced airway
45
Q

What are the three classes of AV blocks?

A

First, second, and third degree

47
Q

When can the compressions be interrupted and for how

long during CPR?

A
  • For the time required by the intubating provider to visualise the vocal cords and insert the tube
  • This is ideally less then 10 seconds.
49
Q

What are the signs and symptoms of poor perfusion?

A
  • Hypotension
  • Acutely altered mental status
  • Signs of shock Ischemic chest discomfort
  • Acute heart failure
50
Q

What are the most common forms of wide-complex

tachycardia according to AHA 2010?

A
  • VT or VF SVT with aberrancy
  • Pre-excited tachycardias (associated with or mediated by an accessory pathway)
  • Ventricular paced rhythms
51
Q

What are the precautions or special considerations

according to AHA2010 for Adenosine?

A
  • Contraindicated in patients with asthma
  • May precipitate atrial fibrillation, which may be very rapid in patients with WPW, thus defibrillator should be readily available
  • Reduce dose in post-cardiac transplant patients, those taking dipyridamole or carbamezapine and when administered via central vein
52
Q

What is a common cause of bradycardia?

A
  • Hypoxemia
53
Q

What treatment may be considered for patients with

witnessed, monitored, unstable ventricular tachycardia if a

defibrillator is not immediately ready for use?

A
  • Precordial thump
54
Q

What are the general causes of AV blocks?

A
  • Medications
  • Electrolyte disturbances
  • Structural problems resulting form AMI or
  • other myocardial disease
55
Q

What is the purpose of ventilation during CPR?

A
  • To maintain adequate oxygenation and
  • sufficient elimination of carbon dioxide.
56
Q

What do the AHA guidelines 2010 say about

administration of vasopressor following shock which

results in a perfusion rhythm during the subsequent 2

minute period of CPR? (before rhythm check)?

A

It could theoretically have detrimental effects on

cardiovascular stability.

58
Q

What does ‘symptomatic’ imply according to AHA2010?

A
  • Symptomatic implies that arrthythmia is causing symptoms, such as
    • palpitations,
    • lightheadedness, or
    • dyspnea, but the patient is stable and not in imminent danger.
59
Q

Give three examples of automatic arrhythmias

A
  • Ectopic Atrial tachycardia
  • Multifocal atrial tachycardia (MAT)
  • Junctional tachycardia
61
Q

Why may checking for a pulse in the femoral triangle

indicate venous rather than arterial blood flow?

A
  • There are no valves in the inferior vena cava, therefore
  • retrograde blood flow into the venous system may produce femoral vein pulsations.
62
Q

Why can ‘normalizing’ of heart rate be detrimental in a

patient with poor cardiac function with compensatory

tachycardias?

A
  • The cardiac output can be dependent on a rapid heart rate or
  • compensatory tachycardia, whereby the stroke volume is limited.
63
Q

When can a vasopressor be given during CPR with

persistant VF/pulseless VT?

A
  • When VF/pulseless VT persists after at
  • least 1 shock and a 2 minute CPR period
64
Q

What is the cause of automatic tachycardias?

A

An excited automatic focus

65
Q

What is the benefit of synchronized cardioversion?

A

Synchronization avoids shock delivery during the relative refractory period of the cardiac cycle when a shock could produce VF.

66
Q

What is the recommended initial energy for cardioversion of SVTs for biphasic and monophasic defibrilator?

A
  • Initial energy of 50J to 100J
  • If initial 50J shock fails, the provider should increase the dose in a stepwise fashion
  • Cardioversion with monophasic waveforms should begin at 200J and increase in stepwise fashion if not successful
67
Q

What is the primary treatment of polymorphic VT?

A

Immediate defibrilation

68
Q

What channels does amiodarone affect?

A
  • Sodium,
  • Potassium, and
  • Calcium channels
69
Q

When is synchronized cardioversion recommended

according to AHA2010?

A
  • Unstable SVT
  • Unstable atrial fibrillation
  • Unstable atrial flutter
  • Unstable monomorphic (regular)VT
70
Q

In which patients is magnesium sulphate no likely to be

effective in terminating irregular/polymorphic VT? (looking at ECG)

A
  • In patients with normal QT interval
71
Q

How does Epinephrine produce beneficial effects (alpha and beta-adrenergic stimulation) in

patients during cardiac arrest?

A
  • Primarily because of its alpha-adrenergic receptor-stimulating (ie, vasoconstrictor) properties.
  • The alpha-adrenergic effects of epinephrine can increase CPP and cerebral perfusion pressure during CPR.
  • The value and safety of the Beta-adrenergic effects of epinephrine are controversial because they may increase myocardial work and reduce subendocardial perfusion
72
Q

When is Atropine most likely to be ineffective and why?

A

In patients who have undergone cardiac transplantation

because transplanted heart lacks vagal innervation

73
Q

What are the common side effects of adenosine according

to AHA2010?

A
  • Flushing,
  • Dyspnea, and
  • Chest discomfort
74
Q

What should the initial evaluation of any patient with

tachycardia focus on?

A
  • Signs of increased work of breathing
  • Tachypnea
  • Intercostal retractions
  • Suprasternal retractions
  • Paradoxical abdominal breathing
  • Oxyhemoglobin saturation (pulse oximetry)
75
Q

Where can a third degree AV block occur?

A
  • AV node
  • Bundle of His bundle branches
75
Q

What is the most likely arrhythmia with irregular narow-

complex or wide-complex tachycardia

A
  • Atrial fibrillation with an uncontrolled ventricular response
77
Q

Where in the heart can reentry circuits occur, resulting in SVT?

A
  • Atrial myocardium
  • Whole or in part in the AV node itself
78
Q

When using BVMR during CPR what tidal volume should

the provider deliver?

A
  • Approximately 600ml of TV
  • sufficient to produce chest rise
  • over 1 second.
79
Q

What is the value of monitoring of PETCO2 trends during

CPR?

A
  • Optimisation of compression depth and rate
  • Detect fatigue in the provider performing compressions
  • Abrupt sustained increase in PETCO2 during CPR is an indicator of ROSC.
80
Q

What are patients with atrial fibrillation and duration >48

hours at risk for ?

A

They are at increased risk for cardioembolic events

81
Q

When is a rhythm considered to be supraventricular?

A

If the QRS complex is narrow (

82
Q

What is the role of precardial thump according to AHA 2010?

A
  • The precordial thump may be considered for
    • termination of witnessed monitored unstable ventricular tachyarrhythmias
    • when defibrillator is not immediately ready for use, but
  • should not delay CPR and shock delivery.
83
Q

What is bradycardia defined as?

A

Any rhythm disorder with a heart rate < 60b/min

84
Q

What is the primary drug commonly used to treat torsades de pointes VT?

A

Magnesium Sulphate

86
Q

What do the guidelines AHA 2010 say about intentionally

delaying defibrillation to perform CPR?

A

The value of intentionally delaying defibrillation to perform

CPR is less clear.

87
Q

What should the initial evaluation of any patient with

bradycardia focus on?

A
  • Signs of increased work of breathing
  • Tachypnea
  • Intercostal retractions
  • Suprasternal retractions
  • Paradoxical abdominal breathing
  • Oxyhemoglobin saturation as determined by pulse oximetry
88
Q

When may the EDD yield misleading results?

A
  • In patients with:
    • Morbid obesity
    • Late pregnancy
    • Status asthmaticus copious endotracheal secretions
89
Q

What is the most common cause of polymorphic VT in the

absence of a prolonged QT interval?

A

Myocardial ischemia

91
Q

Name the H’s that a provider should consider to identify

during management of cardiac arrest.

A
  • Hypoxia
  • Hypovolemia
  • Hydrogen ion(acidosis)
  • Hypo-/hyperkalemia
  • Hypothermia
92
Q

When should a pulse check be performed during CPR?

A

If an organised rhythm is observed

93
Q

When can immediate pacing be considered?

A
  • In unstable patients with high-degree AV block when IV access is not available
95
Q

What should be monitored continuously in a patient with

perfusing rhythm who requires intubation?

A
  • Pulse oximetry
  • Electrocardiographic (ECG) status
96
Q

What complications can be produced when using bag-mask ventilation?

A
  • Gastric inflation with complications including:
    • regurgitation
    • aspiration pneumonia
    • elevation of diaphragm, which can restrict lung movement and
    • decrease respiratory system compliance
97
Q

What other most reliable method of confirming and

monitoring correct placement of ETT is recommended?

A

Continuous waveform capnography

AHA Guidelines 2010 (5 decks)

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