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Flashcards in ACLS Deck (96):
1

Initial stabilizing/diagnostic measures for suspected MI?

VS, IV, O2, monitor

2

dose of nitroglycerin

400 mcg q3-5min

3

dose of morphine

2-4mg q5min

4

Four diagnostic categories for EKG interpretation in setting of suspected MI:

1. normal
2. STEMI
3. ischemia
4. non-specific T wave changes

5

EKG normal - next step?

trend trops

6

EKG = non-specific T wave changes - next step?

repeat EKG in 20 min

7

EKG = ischemia - next step?

O2, nitroglycerin

8

Unstable angina Dx made, what 2 meds do you give continuously?

heparin drip, nitroglycerin

9

Someone starts to code, what are initial steps?

1. Call 911/Code Blue
2. Start CPR
3. Assign roles
4. AED
5. Bag Valve Mask
6. monitor

10

When should the first drug in every pulse-less arrest be given? What’s the drug, dose and interval?

2nd round or ASAP
-epi 1mg q3min

11

Where do you place AED pads?

sternum and apex

12

How do you manage airway for first 2 min?

Bag valve mask

13

CPR - once pt has a pulse, what do you do?
3 steps:

1. BP check
2.500cc NS bolus
3. IV bicarb
*also do EKG/ABG/labs/CXR

14

Pt recovers, how do you prevent another run of vfib?

amio 150mg

15

Dose and drip rate for amio for pt with pulse:

150mg IV over 8-10 min loading dose
-1mg/min x6 hrs
-0.5mg/min x18hrs
-avoid decrease in BP

16

Refractory vfib: which drug do you give during 2nd cycle of CPR that will facilitate successful defib?

amio 300mg

17

lidocaine:
-bolus dose:
-drip dose:

-100mg IV push
-2-4mg IV drip

18

2nd round CPR
-which 2 additional airway management considered?

-ETT
-larygneal mask airway

19

First step after placing ETT or LMA?

listen to epigastrium for gurgles

20

Gold standard for documenting ETT placement?

End Tidal CO2
*ETCO2

21

ROSC
-why is pt tachy? 2 reasons:

-epi
-acidosis

22

ROSC
-why hypotension? 2 reasons:

-acidosis
-stunned mycocardio = CHF

23

ROSC
-Sinus w/occasional PVCs. What to do?

amio drip

24

ROSC
-What to do about hypotension? 2 things:

-1-2L bolus
-dopamine drip: 10mcg/kg/min for hypotension SBP <90 but > 70.

25

dopamine drip dose:

10mcg/kg/min for hypotension SBP <90 but > 70.

26

ROSC
-2 ways to treat metabolic acidosis:

-bicarb IV
-increase vent rate

27

ROSC
-even if it doesn't show STEMI - do you still take to cath lab?

yes

28

NRM - non rebreather
-how many L?

15L

29

In prep for ETT placement, what 3 things should you do?

1. pre-oxygenate
2. prepare suction
3. BVM assist

30

Causes of ACS: mnemonic:

6Hs and 5Ts

31

Causes of ACS:
-What are 6 H's?

-hypovolemia
-hypoxia
-hydrogen ion = acidosis
-hyper/hypokalemia
-hypothermia
-hypoglycemia

32

Causes of ACS:
-What are the 5T's?

-tablets (drug OD)
-tamponade
-tension ptx
-thrombosis (coronary)
-thrombosis (PE)
-trauma

33

First pressor to start?

levophed

34

No pulse: whats rate have to be to cardiovert?

150+

35

BP: 80/50 not responsive to fluids
-which pressor do you start?
-dose?

between SBP 90 and 70 use dopamine drip
-10mcg/kg/min

*SBP < 70 then levophed

36

PEA due to tamponade:
-resuscitation measures?

-IV x2
-dobutamine
-pericardiocentesis
-ETT/BVM
-epi 1mg q3-5min

37

Pericardiocentesis
-how much fluid to remove?
-how should pt's vitals respond?

-30cc
-BP increase

38

What does POLST stand for?

Physician's Orders for Life-Sustaining Treatment

39

aflutter
-3 characteristics:

-lack of normal P waves
-x:1 = abnormal P waves : QRS
-regular rhythym (vs afib which is irregular)

40

what limits aflutter and afib from transmitting every impulse to the ventricles?

refractory cells of the AV node

41

afib v aflutter
-which one is regular? which irregular?

afib = irregular
aflutter = regular
*regular means equal intervals btwn QRS complexes

42

AV nodal reentrant tachy
-is every impulse sent to ventricles?
-regular or irregular?

yes
-regular

43

Vtach
-wide or narrow?
-p waves present?

-wide
-no p waves

44

Vtach
-regular or irregular?

-regular

45

Vfib
-regular or irregular?

-irregular

46

Vtach vs Vfib
-which has varying amplitudes?

Vfib

47

1st deg AV block
-definition?

PR interval > 200ms

48

Symptomatic bradycardia
-atropine dose?

0.5 mg IV q3-5min

49

Diltiazem (AV nodal blocking drug)
-1st dose:
-2nd dose:

-20mg IVP
-30mg ivp

50

Adenosine (AV nodal blocking drug)
-1st dose:
-2nd dose:

-6mg IVP
-12mg IVP

51

AV nodal blocking drugs
-name 3

diltiazem, adenosine, metoprolol

52

Metoprolol (AV nodal blocking drug)
-doses:

5mg IVP
-up to 3 doses

53

O2
-how many liters NC for ACS?

4-6L

54

Morphine
-dose
-rate

2mg IVP q3-5min for chest pain unrelieved by NTGx3 and SBP > 100.

55

Following STEMI Dx:
-Clopidogrel dose:

600mg PO

56

Following STEMI Dx:
-Heparin dose:

1) 60 units/kg IV bolus for acute ischemia
-max 4000 units
2) then 12 units/kg/hr
-max 1000units/hr

57

Procainamide
-dose:
-drip:

-17mg/kg IV load over 40 min
-drip: 1-4mg/min

58

Lidocaine
-dose:
-drip:

-100mg IVP in cardiac arrest or symptomatic vtach
-drip: 2-4mg IV

59

Dopamine
-drip:

10mcg/kg/min for hypotension SBP btwn 70 and 90

60

Norepi
-drip:

2-20mcg/kg/min for hypotension SBP < 70

61

Epi
-drip:

2-10mcg/min

62

Sodium bicarb
-when to administer?
-dose?

-50 meq IVP after ROSC

63

IV Fluids in cardiac arrest
-how much?

1 liter wide open to start cardiac arrest resuscitation, 500cc IV bolus for hypotension.

64

Cardioversion
-when to use?
-sequence of voltages?

-when you have perfusing rhythm with a pulse
-100J biphasic => 150J => 200J if no cardioversion.

65

Mnemonic for organs first damaged by hypotension:

SLK BH
-SLK in Beverly Hills
-Skin, Lungs, Kidneys, Brain, Heart.

66

Symptomatic bradycardia
-whats your goal HR when first treating?
-what device do you grab next?

60 bpm
-transcutaneous pacer

67

Transcutaneous pacer
-rate/energy/mode:

60-70
20-200J
demand mode

68

Which benzos to use before trans-cutaneous pacer (which hurts).

valium or versed

69

How to determine if transcutaneous pacer is successful?

mechanical capture
-pulse/BP
-vital organ perfusion

70

Electrical capture - look for what?
Mechanical capture - look for what?

-QRS
-pulse

71

contraindications to adenosine use:
-which 2 drugs?
-what could happen if you used?

tegretol (carbamazepine)
dipyramidole
-asystole

72

What do you expect to see on monitor after giving adenosine?

asystole

73

What is considered a "wide" QRS?

120ms

74

Narrow QRS complexes always have origin from where?

supraventricular
-you know bc you know its going through proper conduction pathway from atria down through AV node.

75

Before cardioversion, what drugs should you give pt?
-be cautious about what?

valium/versed, fentanyl
-watch for decreasing BP.

76

Two common causes of Vtach:

ischemia, electrolyte probs

77

Evaluation method for stroke:

Cincinnati stroke scale

78

3 components of Cincinnati stroke scale

face, arms, speech

79

Time frame for thrombolytic therapy?

4.5 hrs

80

Contraindications to tPa therapy?

1. trauma
2. hx of hemorrhagic stroke
3. ischemic stroke last 3 mo.
4. aneurysm
5. avm
6. INR >1.7
7. active bleeding
8. metastatic tumor
9. melena

81

Acute stroke: if you decide not to give tPa, which med should you give?

ASA

82

Rate of symptomatic intracranial hemorrhage with tPA is used for stroke?

6.4% in literature

83

What % improvement in neuro outcomes if tPa given?

30%

84

BP necessary to give tPa?
-how to reach if over? which drugs?

< 185/110
-metop or nicardipine

85

Where is transvenous pacer placed?

apex of R ventricle

86

do "unstable" pts have a pulse?

yes but w/poor circulation.

87

Is there ever a pulse w/vfib?

no

88

is FB(+) contra to tPa?

no but melena is.

89

rhythm strips:
Inverted P wave w/rate of ~50
Normal QRS

junctional rhythm

90

If you see QRS w/o preceding P wave, what should you think?

ectopic rhythm

91

sinus brady w/unifocal pvc vs. ventricular bigeminy

Ventricular bigeminy there is a PVC following every sinus beat.

92

rhythm strips:
A sinus beat is shortly followed by a PVC, a pause, another normal beat, and then another PVC.

Ventricular bigeminy,

93

rhythm strips:
Rate of 30 - whats first thing to think of?

3rd degree block
-ventricular escape rhythm is 30 bpm.

94

valium dosage

5mg

95

versed dosage

2mg

96

Cardioversion
-sequence of doses:

100J biphasic => 150J => 200J