ACLS Flashcards Preview

Internal Med > ACLS > Flashcards

Flashcards in ACLS Deck (81):
1

Narrow QRS Complex (SVT) Tachycardia - causes

qrs <.12
sinus tach, a fib, a flutter, AV nodal reentry

2

Wide QRS Complex Tachy - causes

qrs>0.12
monomorphic or polymorphic VT

3

Adult Tachycardia algorithim, first three steps

1) hr > 150
2) id/treat underyling causes (airway, oxygen, check rhythm/bloodpressure/o2 sat)
3) signs of hypotension/ams/shock/ischemic chest discomfort/AHF

4

Adult Tachycardia: if tachyarrythmia is not causing symptoms, next step

evaluate QRS

5

Stable Tachycardia, wide qrs; next step....

IV access, 12 lead
adenosine of regular and monomorphic
antiarrhythmmic infusion
expert consult

6

Stable Tachycardia, narrow qrs; next step....

IV, 12 lead
vagal manuevers
adenosine if regular
BB or CCB
expert

7

adenosine dose

6 mg
can give second dose - 12 mg

8

can adenosine be used in pregnancy?

yes

9

adenosine AE

bronchospasm (don't give to pts with asthma)

10

antiarrythmics for stable wide qrs tachycardia

procaineamide
amiodarone
sotalol

11

unstable tachycardia, step after seeing signs of hypotension,etc

synchronized cardioversion!
consider sedation
if regular narrow complex, adenosine

12

unsychnoized shocks for

VF/VT
pulseless

13

use sychncronized shocks for

unstable SVT
unstable a fib
unstable a flutter
unstable regular monomorphic tachycardia with pulses

14

unstable a fib cardioversion dose

200 J

15

unstable monomorphic VT cardioversion dose

100 J

16

other unstable SVT/a flutter cardioversion dose

50 to 100 J

17

polymorphic VT and unstable, cardioversion dose

treat as VF, high energy dose

18

Adult Suspected Stroke First 5 Steps

1) ID signs, activate emergency response
2) critical EMS assessment
3) general assessment/stabilize in ED
4) neurologic assessment by stroke team
5) CT show hemorrhage?

19

Stroke: CT showing Hemorrhage

- consult neurologist/neurosurgeon/transfer
- begin stroke/hemorrhage pathway and admit to stroke/ICU unit

20

Stroke: CT no hemorrhage next step

consider fibrinolytic therapy
- check for exclusions
- repeat neuro exam to see if improvement

21

Stroke: not a candiate for fibrinolytic therapy, next steps

administer aspirin
- begin stroke/hemorrhage pathway and admit to stroke/ICU unit

22

Stroke: canidate for fibrinolytic therapy, next steps

give tpa (no anticoag for 24 hrs)
-->
post tpa pathway

23

post tpa pathway

aggresively monitor BP, neurologic deterioration
admission to stroke/ICU

24

cincinnati prehospitial stroke scale

facial drop
arm drift
abnormal speech *you can't teach an old dog new tricks)

25

fibrinolytic therapy inclusion criteria

ischemic stroke with measurable deficit
onset or = 18

26

general stroke care

monitor glucose, bp, temp
dysphagia screening
stroke/fibrinolytic complications screening

27

stroke care, bp > 185/110

labetalol
nicardipine

28

Respiratory Arrest Case, pt

have pulse but not breathing
unconscious, unreponsive

29

ventilations during resp arrest

1 vent every 5-6 seconds (both bag mask, advanced airway)

30

ventilations during cardiac arrest

bag mask 2/30 comp
advanced airway 1 vent evey 6-8 seconds

31

Resp Arrest -- Assessing Airway

maintain airway patency - head tilt-chin lift, OPA, NPA
use advanced airway management
monitor airway placement with continuous quantitative waveform capnography

32

Resp Arrest - Breathing

give supplement o2
monitory: watching chest, waveform capno, oxygen sat
avoid excess ventilation

33

Resp Arrest - Circulation

monitor CPR quality
attach monitor/def
iv/io access, fluids, drugs

34

when to insert OPA or NPA

unconscious with no cough or gag reflex

35

soft flexible catheter for suctioning

mouth, nose

36

rigid catheter for suctioning

oropharynx

37

suction attempt - time

no more than 10 seconds

38

trauma patients

jaw thrust without head extension
manual spinal motion restriction better than immobilization

39

is the rhythm shockable?

VF or pulseless VT

40

how to check circulation

cartoid pulse for 5-10 seconds

41

Adult BLS flow chart:

1) unresponsive, no breathing or no normal breathing
2) activate emergency/get AED
3) check pulse

42

Adult BLS flow chart, if patient has pulse

give 1 breath every 5-6 seconds
recheck pulse every 2 minutes

43

Adult BLS flow chart, patient has no pulse

30 compressions, 2 breaths
AED arrives
check rhythm

44

adult bls flow chart, shockable rhythm

1 shock
resume cpr for 2 minutes

45

adult bls flow chart, not shockable

resume cpr for 2 minutes
recheck rhythm every 2 minutes

46

VT goes into

VF, which goes into asystole

47

Adult Cardiac Arrest flow chart

start CPR (can also give o2, attach monitor)
check rhythm

48

VF/VT rhythm, flow chart

1) shock
2) CPR 2 minutes, IV/IO access
3) recheck rhythm

49

VF/VT rhythm, first shock

CPR

50

VF/VT rhythm, second shcok

CPR + epinephrine every 3-5 minutes

51

VF/VT rhythm, third shock

CPR + amiodarone

52

return of spontaneous circulation

pulse and blood pressure!

53

2 minutes = how many cycles of cpr

5

54

if amiodarone is not available

can use lidocaine

55

PETco2

<10 mmHg suggest ROSC unlikely
normal value 35-40

56

central venous oxygen sat

normal 60-80
<30 improve chest compression and vasopressors

57

after epinephrine give

20 mg flush of IV fluid
elevated extremity abov eheart for 10-20 sec

58

Post Care Cardiac Arrest

1) ROSC
2) optimize vent and o2 (>94%)
3) treat hypotnsion
4) follow commands

59

post care cardiac arrest - treating hypotension

IV/IO bolus
vasopressor infusion
treatble causes
12 lead

60

post care cardiac arrest - patient follows commands

STEMI or high suscision AMI --> coronary repursion

61

post care cardiac arrest - patient does NOT follow commands

consider induced hypothermia --> STEMI/AMI --> coronary reperfussion

62

IV bolus

1-2 L normal saline or lactate ringers

63

vasopressors

epineprhine
dopamine
norepinephrine

64

induced hypothermia

at least 12 hours

65

Adult Cardiac Arrest, CPR, rhythm shows PEA

cpr 2 mins, IV/IO access, epinephrine ever 3-5 min
recheck rhythm to see if it's shockable

66

PEA, not shockable rhythms

CPR for 2 minutes, keep checking rhythm

67

5 H's

hypovolemia
hypoxia
hydrogen ion (acidosis)
hyper/hypokalemia
hypothermia

68

5 T's

tension pneumothorax
tamponade
toxins
thrombosis - pulmonary, coronary

69

common causes of reversible pea

hypovolemia and hypoxia

70

aspirin, give

160-325 to chew
300 mg rectal

71

when not to give nitroglycerin

inferior wall or RV MI
hypotension/bradycardia/tachycardia
recent PPEI use

72

fibrinolytic therapy goal

30 minutes

73

PCI goal

90 minutes

74

rhythms for bradycardia

sinus
1/2/3 degree AV block

75

bradycardia def

rhythm disorder with <50

76

Adult Bradycardia Algorithm

1) hr <50
2) cause: airway, oxygen, cardiac monitor, IV, ecg
3) signs of bradyarrhythmia

77

signs of bradyarrythmia

hypotension
ams
shock
ischemic chest discomfort
acute heart failure

78

no signs of bradyarryhtmia

monitor observe

79

signs of bradyarrhytmia

atropine
if ineffective, TCP, dopamine or epinephrine

80

sedation before pacing

benzo
narcotic
chronotropic infusion

81

TCP contradicated in

severe hypothermia, asystole