ACLS Flashcards
Practice Advanced Cardiac Life Support
1
Q
Which four therapies are managed during post-cardiac arrest treatment?
A
- Target Temperature Management: Maintain between 32-36°C for at least 24 hours.
- Oxygen: Aim for SpO2 94% or greater.
- Ventilation: Start VR at 10 breaths/min; ETCO2 35-45mmHg
- Pressure: Keep MAP at 65 mmHg or greater.
2
Q
What are the tasks of the team leader?
A
- Clearly define roles for each person.
- Ask that a new intervention be performed if it is a greater priority.
- Seek input for diagnoses.
- Confirm actions and be provide clear instructions.
3
Q
List the key roles involved in cardiac arrest.
A
- Airway manager
- Chest compressor
- Defibrillator operator
- Team leader
- Medication administrator
- Time/recorder
4
Q
What is the role of a team member.
A
- Ask for a new task or role if unable to perform assigned task.
- Suggest an alternative drug dose in a confident manner.
- Question a colleague who is about to make a mistake.
5
Q
What should you do if you are unsure about detecting a pulse?
A
start CPR
6
Q
What is coronary perfusion pressure?
A
Aortic relaxation
diastolic
7
Q
What is a quality chest compression?
A
Includes:
- at least 2 inches in depeth
- full chest recoil
- 100-120 compressions/min
8
Q
Fill in the blank.
If ETCO2 is <10 mmHg, you should reassess _____ of CPR.
A
quality
9
Q
List the H’s
A
- Hypovolemia
- Hypoxia
- Hydrogen ion
- Hypo-/Hyperkalemia
- Hypothermia
10
Q
What is the normal tidal volume of an adult?
A
8-10 ml/kg
11
Q
Define:
Respiratory Failure
A
Inadequate oxygenation
12
Q
Define:
Respiratory Arrest
A
Absent breathing
13
Q
What is bad about excessive ventilation?
A
- Increases thoracic pressure
- Decreases venous return to the heart
- Decreases cardiac output
14
Q
What is the tidal volume you give for a patient not breathing?
A
6-7 ml/kg
15
Q
What is a common airway obstruction?
A
tongue
16
Q
Treatment
Unresponsive airway obstruction
A
- Begin CPR immediately.
- Every two minutes, check the mouth before giving ventilations.
- Remove visible obstructions with fingers.
- Use direct laryngoscopy with Magill forceps if trained.
17
Q
How much pressure should be applied when squeezing a BVM during ventilations?
A
Until you see the chest rise.
18
Q
What suctioning pressure (mmHg) should be used?
A
80-120 mmHg
19
Q
What are the reperfusion goals?
Hint: duration in minutes
A
- door to balloon: 90 minutes
- door to needle: 30 minutes
20
Q
Fill in the blank.
- A rigid suction should be measured the same as an ____.
- Suctioning should not exceed ____ seconds.
A
- OPA
- 15
21
Q
List the ACS algorithm.
A
- Assess ABCs and obtain a 12-lead ECG.
- Administer O2 if saturation is below 90% and give aspirin.
- Provide nitroglycerin.
- Administer morphine if pain persists despite nitroglycerin.
22
Q
What is the dosage for aspirin?
Acute myocardial infarction
A
160-325 mg
23
Q
What is the dosage for Nitroglycerine
A
400 mcg Q 3-5 minutes
24
Q
What medication should be avoided in patients who have recently used Phosphodiesterase Inhibitors?
A
nitroglycerine
25
Why is **morphine** given for chest discomfort?
It decreases pain which also **decreases myocardial oxygen demand**.
26
What is an **NSTEMI**?
It is characterized by:
* ST depression indicating injury; or
* Dynamic T wave inversion
27
Why is **heparin** given?
It is given as an adjunct to PCI therapy.
28
What type of medication is **streptokinase**?
fibrinolytic
29
# Fill in the blank.
**Fibrinolytic therapy** should be initiated within ____ of hospital arrival time.
30 - 60 minutes
30
List the types of strokes.
* **Ischemic** 87%
* **Hemorrhagic** 23%
31
What are the **signs/symptoms** of **stroke**?
* confusion
* trouble speaking
* sudden weakness
* dizziness
* trouble walking
* severe headache
32
What are the **three** components of the **Cincinnati Stroke Scale?**
* facial droop
* arm drift
* abnormal speech
## Footnote
If one of these signs is identified, there is a 72% chance the patient is having a stroke.
33
When should you provide oxygen to a **stroke** patient?
< 94% SPO2
34
What type of medication is **rTPA**?
| recombinant tissue plasminogen activator
alteplase
## Footnote
A clot buster used for stroke patients.
35
What is the **defibrillation shock dosage**?
200j-300j-360j
36
What is the **rate of decline** in survival chances for patients without CPR?
For every minute without CPR, survival chances **decrease by 7-10%**.
37
# Mechanism of action.
Amiodarone
It blocks **sodium** and **potassium** channels.
38
What is the dosage for **Lidocaine**?
## Footnote
Cardiac arrhythmias
* **1 - 1.5mg/kg** bolus
* **0.5 - 0.75mg/kg**, MAX of **3mg/kg**
39
# Indication:
Magnesium Sulfate
**Torsades** in patients with long QT interval.
40
Termination of CPR
* If ETCO2 \<10 mmHg after 20 minutes
* No bystander during CPR
* No defibrillations
41
What conditions are considered indicative of **symptomatic unstable bradycardia**?
* hypotension
* AMS
* ischemic chest pain
* shock
42
What are the signs/symptoms of **symptomatic bradycardia**?
* dizziness
* weakness
* datigue
* light headed
* syncope
43
# Indication:
Transcutaneous Pacing
* hypotension
* AMS
* shock
* ischemic chest discomfort
44
What **rhythms** are commonly treated with **cardioversion**?
* Atrial fibrillation/flutter with RVR
* V-tachycardia
* SVT
45
# Treatment
Symptomatic/Stable **SVT**
* Vagal maneuvers
* Adenosine
* Amiodarone
## Footnote
*make sure pathological*
46
At what point does the monitor **synchronize a rhythm**?
Highest point of the **R wave**.
47
# Treatment
symptomatic but stable **A-fib with RVR**
* **Vagal** maneuvers
* **Diltiazem** (Cardiazem):
Initial dose: **0.25 mg/kg**
If needed, a subsequent dose: **0.35 mg/kg**
* Maintenance infusion: **5-15 mg/hr**
48
List some key components of **post-cardiac arrest care**.
* Avoid excessive ventilation: **10 breaths/min, maintain PaCO2 at 35-40 mmHg**.
* Keep oxygen saturation **>94%**.
* Consider advanced airway and capnography.
* Treat hypotension **(SBP < 90 mmHg)**:
IV/IO fluid bolus (1-2 liters).
Vasopressor infusion.
* Address reversible causes.
* Perform a **12-lead ECG**.
* Implement temperature management **(32-36°C)**.
49
What is the dosage for **post-arrest vasopressor infusion**?
* Epinephrine: **.1-.5 mcg/kg/min**
* Dopamine: **5-10 mcg/kg/min**
50
What is the dosage for **epinephrine** infusion in **unstable bradycardia**?
2-10 mcg/min
51
What is the dosage for **epinephrine** infusion in **persistent hypotension**?
.1 - .5 mcg/kg/min
52
What are the **T's** of **reversible causes for cardiac arrest**?
* Tension pneumothorax
* Cardiac tamponade
* Toxins
* Thrombosis (coronary and pulmonary embolism)
