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ACLS Flashcards

1
Q

Narrow QRS Complex (SVT) Tachycardia - causes

A

qrs <.12

sinus tach, a fib, a flutter, AV nodal reentry

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2
Q

Wide QRS Complex Tachy - causes

A

qrs>0.12

monomorphic or polymorphic VT

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3
Q

Adult Tachycardia algorithim, first three steps

A

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

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4
Q

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

A

evaluate QRS

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5
Q

Stable Tachycardia, wide qrs; next step….

A

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

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6
Q

Stable Tachycardia, narrow qrs; next step….

A 
IV, 12 lead
vagal manuevers
adenosine if regular
BB or CCB
expert
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7
Q

adenosine dose

A

6 mg

can give second dose - 12 mg

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8
Q

can adenosine be used in pregnancy?

A

yes

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9
Q

adenosine AE

A

bronchospasm (don’t give to pts with asthma)

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10
Q

antiarrythmics for stable wide qrs tachycardia

A

procaineamide
amiodarone
sotalol

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11
Q

unstable tachycardia, step after seeing signs of hypotension,etc

A

synchronized cardioversion!
consider sedation
if regular narrow complex, adenosine

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12
Q

unsychnoized shocks for

A

VF/VT

pulseless

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13
Q

use sychncronized shocks for

A

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

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14
Q

unstable a fib cardioversion dose

A

200 J

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15
Q

unstable monomorphic VT cardioversion dose

A

100 J

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16
Q

other unstable SVT/a flutter cardioversion dose

A

50 to 100 J

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17
Q

polymorphic VT and unstable, cardioversion dose

A

treat as VF, high energy dose

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18
Q

Adult Suspected Stroke First 5 Steps

A

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?

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19
Q

Stroke: CT showing Hemorrhage

A
  • consult neurologist/neurosurgeon/transfer

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

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20
Q

Stroke: CT no hemorrhage next step

A

consider fibrinolytic therapy

  • check for exclusions
  • repeat neuro exam to see if improvement
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21
Q

Stroke: not a candiate for fibrinolytic therapy, next steps

A

administer aspirin

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

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22
Q

Stroke: canidate for fibrinolytic therapy, next steps

A

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

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23
Q

post tpa pathway

A

aggresively monitor BP, neurologic deterioration

admission to stroke/ICU

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24
Q

cincinnati prehospitial stroke scale

A

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

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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

Internal Med (23 decks)

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