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Oral Surgery - ABGD - Oral Boards > ACLS > Flashcards

ACLS Flashcards

1
Q

If a patient doesn’t have a pulse, what is the first order of actions?

A

Chest Compressions

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2
Q

If a patient is not breathing, what should you do?

A

Rescue Breaths

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3
Q

If the heart is fibrillating, what should you do?

A

Defibrillate it!

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4
Q

What ratio of breaths is good to prevent hyperventilation?

A

1 breath every 6 seconds with a bag valve mask

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5
Q

How long are CPR cycles?

A
  • CPR is performed in cycles of 2 minutes
  • Do not interrupt chest compressions except every 2 minutes to reassess your patient!
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6
Q

What is the ratio of compression to breaths for CPR?

A
  • 30:2
  • Push hard and fast
  • At least 100-120 compression/min!
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7
Q

What’s a good idea if your patient is having chest pain?

A

12 - Lead ECG within 10 minutes

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8
Q

How do you monitor CPR quality?

A
  • Use quanitative waveform capnography (PETCO2) to monitor CPR quality
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9
Q

How to you verify ET tube placement?

A

Quanitative Waveform CApnography (PETCO2)

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10
Q

What does PETCO2 have to be at to ensure compressions are adequate?

A

> 10

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11
Q

Is Synchronized Cardiovesion for patient with a pulse or without a pulse?

How man Joules?

A
  • With a pulse!
  • 50-100 joules and increased if needed
  • Press the sync button on the monitor
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12
Q

Is Defibrillation for patients with or without pulses?

How many Joules?

A
  • Without pulses!
  • Start at 200 Joules (Biphasic) or
  • 360 J (Monophasic) and increase as needed
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13
Q

What are the 2 only shockable rhythms?

A

V-Fib and V-Tach

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14
Q

What rhythms do you NEVER defibrillate?

A
  • Any rhythm with QRS complexes of flat line!
  • Unless you do not want them to achieve ROSC
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15
Q

What is this?

A

V-Fib

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16
Q

What is this?

A

V-Tach

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17
Q

What do you do after defibrillation?

A
  • 2 minute cycle starts
  • Within 2 minutes, begin vasopressor therapy with Epi
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18
Q

What is the dosing regimen for Epinephrine?

A

1 mg every 3 - 5 minutes with no max

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19
Q

When would you consider Amiodarone?

A

After around 4 minutes, you may consider Amiordarone 300 mg for refractory V-Fib/Pulseless V-Tach

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20
Q

What is this?

A

PEA/Asystole

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21
Q

What is PEA?

A
  • Elecgrical system is working
  • Mechanical system is malfunctioning
  • Any organized rhythm with QRS complexes but no pulse if PEA
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22
Q

What is Asystole?

A

No electrical activity period!

Is there anything here to defbrillate?

NO!

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23
Q

What is the next course of action when PEA/Asystole is recognized?

A
  • CPR and EPI
  • 2 minutes CPR cylces with PBM checks every 2 minutes
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24
Q

What are 5 H’s?

A
  • Hypoxia
  • Hydrogen Ion
  • Hypovolemia
  • Hypothermia
  • Hypo/Hyper Kalemia
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25
Q

What are 5 T’s?

A
  • Tension Penumothorax
  • Trauma
  • Thrombosis
  • Tamponade
  • Toxicity
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26
Q

What is this?

A

SVT

  • These patient have pulses, so they just need their heart rate decreased
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27
Q

What is this?

A

V-Tach

  • These patient have pulses, so they just need their heart rate decreased
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28
Q

How do you recognize SVT?

A
  • Look at the QRS, is it wide or narrow?
  • If narrow…
  • Then look at the rate…
  • if it’s > 150, you have SVT
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29
Q

How do you recognize V-Tach?

A
  • Look at the QRS, is it wide or narrow?
  • Wide?
  • Don’t worry about the rate, you have V-Tach!
30
Q

What is something you can offer both types of tachcardia’s if systolic is < 90?

A
  • Unstalbe patients (< 90) need synchronized cardioversion with both types of tachycardia
31
Q

If a BP is table with Tachycardia…what can you offer?

A

Stable patient can receive drugs first

32
Q

What drug would you give for stable SVT?

A
  • Adenosine for stable SVT
  • Dose if 6 mg rapid IVP
  • Then additional doses of 12 mg if needed X 2
33
Q

What drug would you give for stable V-Tach?

A
  • Amiordarone 150 mg IVPB for stable V-Tach
34
Q

What is going on here?

A

Bradycardia

35
Q

What kind of Bradycardia do you treat?

A

Symptomatic!

36
Q

What drug can you give for Bradycardia?

A
  • Atropine 0.5 - 1.0 mg every 3-5 minutes IVP X doses
37
Q

How can you treat Bradycarida is Atropine is unsuccessful?

A
  • Initiatie Chronotropic drug therapy by IVPB
  • Dopamine at 2-20 mcg/kg/min works quite well for this
38
Q

Who gets Epinephrine?

A

All Dead People

39
Q

How does Epinephrine work?

A
  • A potent alpha/beta adrenergic receptor agonist
  • It will increase HR
  • Increase contractility
  • Increase BP
  • Dilates cerebral & coronary arteries
  • Dilates bronchioles in the lungs
  • All of this is good if you don’t have a pulse
40
Q

What is the dose of Epi when adminstering?

A

1 mg (the whole prefilled syringe) every 3-5 minutes IVP with no max

41
Q

How does Atropine work?

A
  • An anticholinergic that indirectly increases HR
  • Basically, atropine blocks the effects of the vagus nerve allowing the sympathetic nervous system to run wild!
  • This is good if you have a slow heart beat
42
Q

What is the dose of Atropine when administering?

A
  • 0.5 mg (half the prefilled syringe)
  • Every 3-5 minutes IVP with 3 “empty boxes on the floor” max (or 0.04 mg/kg if you want to know the actual textbook max)
43
Q

When would you administer Lidocaine?

A

Fast Ventricular Arrhythmias

44
Q

How does Lidocaine work?

A
  • A sodium channel blocker that can help eliminate ventricular cells with irritiability and fast pacing properties (such as v-fib/v-tach)
45
Q

What is the dose of Lidocaine when administering?

A
  • 100 mg (whole prefilled syringe) every 3 - 5 minutes IVP with a 3 dose max
46
Q

When would you give Amiodarone?

A

Fast Ventricular Arrhythmias

47
Q

How does Amiodarone work?

A
  • A sodium, Calcium, Potassium channel blocker, and an alpha nd beta receptor blocker that has the same effects on ventricular cells as Lidocaine does
48
Q

What is the dose for Amiodarone?

A
  • 300 mg IVP for pulseless arrest with subsequent doses of 150 mg IVP up to 2.2 gram max
49
Q

What drug would you give for V-tach with a pulse?

A
  • Amiodarone
  • 150 mg/100 ml’s IVPB over 10 minutes
50
Q

What are indications for Amiodarone?

A
  • Ventricular and Atrial Tachycardias
  • Pulseless arrest victims of V-Fib/V-Tach
51
Q

When do you administer Adenosine?

A

SVT

52
Q

How does Adenosine work?

A
  • An SA and AV nodal blocker with a very, very, very, very, very short half-life
  • Administer rapid IVP in a large vein, with a saline bolus following
  • This drug COMPLETELY blocks the electrical conduction through the AV node
  • For a split second, allowing the heart’s natural pacemakers to hopefully take back over at a normal rate
53
Q

How much adenosine would you administer to a patient having SVT?

A

6 mg then 12 mg (if needed) and another 12 mg (if needed)

54
Q

When do we utilize Cardioversion?

A

Synchronized cardioversion is performed on patients (with pulses) with symptomatic tachycardias

55
Q

How does Cardioversion work?

A
  • This mode of electrical therapy “sync’s” with the QRS complex and delivers a low energy “shock” at a precise moment during the cardiac depolarization phase
  • This electically stops the heart for a split second in hopes that the natural pacemakers will take back over pacing of the heart
56
Q

What are High Joule settings for Cardioversion?

A

200-300 for A-Fib tachycardia’s

57
Q

What patients get Defifbrillated?

A

Patient that have no pulse!

58
Q

What are the only 2 rhythms that require defibrillation?

A

F-Fib, and pulseless V-Tach

59
Q

What is TCP?

A

Transcutaneous Pacing

60
Q

What are you doing when you use TCP?

A

You are artificially pacing the heart with your monitor

61
Q

What kind of patients should you use TCP?

A

Good for patients with heart blocks (electrical system is malfunctioning so we need to do its job for it)

62
Q

How do you TCP someone?

A
  • Put the big pads that you defibrillate/cardiovert with on the patient
  • Push the “pacer” button
  • Set you mA and rate to 20/80 respectfully
  • Increase mA’s and rate to achieve a good peripheral pulse (mechanical capture)
63
Q

What would be wise prior to using TCP?

A

Sedate your patient!

Versed or Propofol works quite well…

64
Q

If you suspect your patient is experiencing acute coronary syndrome, what should you do?

A

ONAM

65
Q

If you suspect a MI, what would be wise to get?

A

12-lead ECG within 10 minutes of patient contact and have a qualified clinician read it

66
Q

What should be done after MI/ECG?

A

Patient should be sent to cath lab for PCI procedures within 90 minutes (percutaneous coronary intervention)

67
Q

If you suspect a CVA, how can y ou perform a quick exam?

A

F.A.S.T. on any patient you suspect is experiencing stroke symptoms

Then get q quick bedside glucose to make sure it’s not hypoglycemia

68
Q

How soon does a patient need to be delivered to a stroke center if CVA is suspected?

A
  • 3-4 hours of onset of symptoms!
  • This is the window where the physician can and might administer tPa if the CT confirms no cerebral hemorrhage is present
69
Q
A
70
Q

What do you never adminster for hemorrhagic strokes for for a simple TIA?

A

tPa

71
Q

What is a must for CVA patients?

A

Oxygen, IV’s and Cardiac Monitoring

Oral Surgery - ABGD - Oral Boards (7 decks)

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