ACLS Flashcards by Alice Richards

what 2 things are proven to improve survival rate/keep neuro intact

chest compressions

early defib

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epi dosing

1 mg q 3-5 min

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chest compressions should be given at a rate of __

at a depth of at least __

100-120/min

2 in

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what is CCF

chest compression fraction = time compressing / overall time

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minimum CCF for good quality compressions

80%

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primary survey consists of

Airway

Breathing

Circulation

Disability (neuro)

Exposure/Environmental

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circulation in the primary survey includes (2)

IV/IO

12 lead EKG

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secondary survey includes

s/sx

allergies

meds

pmh

last PO

events surrounding

h’s

t’s

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what are the h’s

hypovolemia

hypoxia

H+ (acidosis)

hyper/hypokalemia

hypothermia

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what are the t’s

tension pneumo

tamponade

thrombosis → PE/ACS

toxins

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goal for O2 if hypoxia w. no cardiac/neuro involvement

94-99%

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goal for O2 if there is cardiac/neuro involvement

90-99%

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loss of vascular tone w. cardiac arrest

hypovolemia

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tx for hypovolemia

fluid

pressors → epi

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tx for hypothermia (3)

cover pt

give warm IVF

turn up thermostat

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fastest way to assess for hypo/hyperkalemia

EKG:

hyper → peaked T waves

hypo → depressed/inverted T waves

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nl range for pH

7.35-7.45

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most important aspect of treating slightly acidodic pt (ex pH 7.2)

ventilation

bicarb ok but will lead to acidosis if not properly venitlated

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tx for toxins

epi

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pneumothorax that causes decreased cardiac output

tension pneumo

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2 signs of tension pneumo

absent lung sounds

decreased BP

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becks triad makes you think of

tamponade

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what is beck’s triad

jvd

decreased pulse pressure

muffled heart sounds

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electrical alternans on EKG makes you think of

tamponade

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tx for tamponade (2)

pericardiocentesis lots of fluids

describe pain w. PE

pleuritic CP sharp/pinpoint does not radiate

describe MI pain

crushing generalized radiates

decreased perfusion that does not respond to ventilation makes you think of

tx for PE

anticoag → heparin thrombolytics → TPA tons of O2 fluid PEEP

tx for MI

O2 → goal 90-00% non enteric coated ASA (4 baby ASA) nitro

med proven to help MI outcomes

non enteric coated ASA

3 ASA contraindications

true allergy recent hemorrhagic stroke active GIB

3 nitro contraindications

PDE-5 → viagra r inferior MI hypotn

when should nitro be given

after IV access is established

drugs for ACS

**m**orphine (fentanyl is better) **o**2 **n**itro **a**sa

door to balloon time

90 min

door to needle time

30 min

2 places FDA approved for IO

proximal/distal tibia humeral head

benefit of humoral head IO

can get 6L/hr vs 1L/hr w. tibia

2 indications for IO

cardiac arrest shock (hypovolemia)

4 contraindications for IO

active infxn broken bone any titanium IO in that area in the last 72 hr

what does FAST stand for

**f**acial droop **a**rm drift **s**peech **t**ime last seen normal

optimal time for stoke outcome

\< 3 hr

what does PEA stand for

pulseless electrical activity

tx for pea

**p**ush hard and fast **e**pi **a**ll h & t

2 mc h's

hypoxia hypovolemia

can atropine treat high grade heart blocks

no!

3 causes of high grade heart blocks

meds SSS heart transplant

how do you know when trans pacing is working

all pacer spikes will be followed by QRS

can adenosine treat aflutter/afib/wpw

no!

what should you do post trans pacing

check for pulse

5 sx that indicate unstable pt

cp hypotn ams sob s/s shock

tx for unstable brady

atropine pace epi/dopamine *consider h's and t's*

tachy w. pulse → adult: child: infant:

adult: \>150 child: \>180 infant: \> 220

tx for stable wide tachy

expert opinion

tx for unstable wide tachy

synchronized cardiovert

tx for stable narrow tachy

vagal adenosine expert opinion

when should rescue breathes be given

1 breath q 6 sec

3 steps if you find unconscious pt

check responsiveness activate ERS/get defibrillator check breathing/pulse

if unresponsive pt does not have a pulse you should

give 1 breath q 6 seconds

what should you do if an unresponsive pt has no pulse

start CPR check rhythm/shock if indicated

how often should rhythm be checked/shock administered

q 2 min

4 steps for acute stroke management

obtain vitals/ABC intervention interview witnesses exam and prehospital stroke screen obtain POC glucos

6 initial steps for brady arrhythmias (\<50)

maintain airway/assist w. breathing O2 if hypoxemic cardiac monitor: rhythm, bp, oximetry IV access 12 lead EKG consider h's and t's

first line drug for brady arrhythmias

atropine

second line drugs for brady arrhythmias

dopamine epi

causes of brady arrhythmias

MI toxins hypoxia hyperkalemia

3 meds that can cause brady arrhythmias

CCB BB dig

5 steps in management of tachy arrhythmias

maintain airway/breathing assist O2 if hypoxemic cardiac monitor → rhythm, bp, oximetry IV access 12 lead EKG

tx for narrow tachy arrhythmias

vagal maneuvers adenosine bb/ccb expert opinion

tx for wide tachy arrhythmias

adenosine antiarrhythmics expert opinion

tx if ventricular rate \>150/min w. s/sx

immediate cardioversion

what are the 2 shockable rhythms

VF pVT

tx for shockable rhythms (VF/pVT)

cpr x 2 min/O2/monitor shock cpr x 2 min/IV or IO access epi q 3-5 min shock cpr x 2 min/epi amiodarone vs lidocaine

2 unshockable arrhythmias

asystole PEA

tx for PEA/asystole

epi asap cpr x 2 min IV/IO access +/- airway w. capnography

tx if asystole/PEA persist and there is no sign of return of spontaneous circulation (ROSC)

continue CPR /epi

tx when ROSC occurs → post-cardiac arrest care

monitor bp and O2/pulse advanced airway → endotracheal tube manage respiratory parameters manage hemodynamic parameters 12 lead EKG

hemodynamic parameter goals

sbp \> 90 MAP \> 65

respiratory parameters

SpO2 92-98% PaCO2 34-45 mmHg