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Flashcards in ACLS Deck (70):
1

Obtunded

loss of perception and ability to respond to the environment

2

Comatose

Sleeplike state with total absence of awareness of self and the environment

3

GCS score 14-15

good

4

score <8

intubate

5

eye opening GCS scores

4 = opens eyes spontaneously

3 = opens eyes to command

2 = opens eyes to pain

1 = no eye opening

6

verbal response GCS scores

5 = oriented, fluent speech

4 = confused conversation

3 = inappropriate words

2 = incomprehensible words

1= no speech

7

motor response GCS scores

6 = obeys commands

5 = localizes pain

4 = withdraws to pain

3 = decorticate posturing

2 = decerebrate posturing

1 = flaccid

8

decorticate posture

stiff with bent arms, clenched fists, and legs held out straight

9

decerebrate posture

arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward

10

How many breaths are given during CPR if there is an advanced airway?

8-10 breaths per minute

11

How many breaths are given during CPR if there is not an advanced airway?

2 breaths every 30 compressions

12

Biphasic shock strength

120-200J

13

monophasic shock strength

360J

14

What rhythms are shockable?

V tach
V fib

15

DCAP-BTLS

Deformities
Contusions
Abrasions
Penetrating injuries
Burns / Bruises
Tenderness
Lacerations
Swelling

16

What rhythms are non-shockable?

PEA and asystole

17

If p waves don't all match, what should you consider?

wandering pacemaker
or
multifocal atrial tachycardia

18

If there is not a p for every QRS or QRS fro every p waht should you consider

irregular rhythms

escape

premature beats

19

If p wave is not

atrial hypertrophy

20

If there is no p wave what rhythm could it be

Escape rhythms

A-fib

Ventricular rhythms

Sinus arrest

21

U waves indicate

Hypokalemia, low Mg

22

Peaked T waves indicate

hyperkalemia

23

Flat T waves indicate

hypokalemia

24

If every QRS TU does not watch what should you think

PVC

25

What is nrml QRS interval

<0.12s

26

What should you think if QRS interval is >0.12s

BBB

V-fib
or
hyperkalemia

27

What is nrml PR interval

0.12 to 0.2s normal

28

what should you consider if PR interval is abnormal

Blocks

WPW

29

Short QT interval

high Ca

high Mg

30

Long QT interval

low Ca

low Mg

MI

subarachnoid

tricyclics

31

ST depression could indicate

Ischemia

Posterior MI

Digoxin

PE

LBBB

32

ST elevation could indicate

Acute MI !!!

Pericarditis

33

Q waves could indicate

necrosis

34

Atrial Fibrillation

irregularly irregular rhythm

no P waves

undulations in baseline -- fib waves


various ventricular rates

35

Atrial Flutter

Regularly irregular

Regular atrial activity often with rate of 300

P waves have a saw tooth appearance

variable ventricular response

36

Multifocal Atrial Tachycardia

Atrial tachycardia with at least 3 different P wave morphologies

37

Paroxysmal Supraventricular Tachycardia AKA AV nodal re-entry tacycardia

150-240 bpm

Subtle notching seen at the end of QRS

Atrial activity is often not evident

38

Junctional (AV nodal) Rhythms

Various P wave morphologies- inverted and preceding, following QRS, absent

AV nodal escape: Between 40-60 bpm

Accelerated Junctional: Rate up to 60-100 bpm

Junctional tachycardia: Rate exceeds 100

39

Ventricular Tachycardia

Regular rhythm with rate 150-250 bpm

Wide QRS complexes

P waves with complete A-V dissociation or no P waves at
all

Tombstone

40

Ventricular Fibrillation

Irregularly irregular ventricular response, rate 350- 500/min

chaotic QRS morphology

baseline ranges from flat to coarse

41

First Degree AV Block

Regularly irregular

Long P-R interval

P-R > 0.20 with complete conduction of impulses (no dropped QRS complexes)

May be a sign of CAD, rheumatic carditis, digitalis toxicity, electrolyte abnormalities

42

Second Degree AV Block Type I (wenkebach)

Irregularly irregular

Progressive lengthening of P-R interval

Normal or prolonged P-R with occasional failure of impulse to be conducted through AV node

43

Tx for Second Degree AV Block Type I (wenkebach)

Check electrolytes, observe

44

Second Degree, Mobitz Type II

Irregularly irregular

Constant P-R interval with occasional non- conducted atrial beat

Associated with: Anterior septal MI, Chronic fibrotic disease of the conduction system

Can lead to syncope or complete AV block

45

Tx for Second Degree, Mobitz Type II

pacemaker

46

Third degree AV block

Regularly irregular

Complete dissociation of atria and ventricles

Constantly changing P-R interval

Underlying junctional or idioventricular rhythm

Ventricular rate will depend on level of escape mechanism

47

Tx for Third degree AV block

pacemaker

48

Tx for adult tachy >150, hypotension, AMS, signs of shock, ischemic chest discomfort and acute heart failure

synchronized cardioversion

consider sedation

If narrow complex consider adenosine

49

Tx for adult tachy >150 with wide QRS >.12 sec

IV access and 12 lead

consider adenosine if reg and monomorphic

consider antiarrhytmial infusion

50

Adenosine IV dose for adult tachy

first dose: 6 mg rapid IV push followed by NS flush

Second dose 12 mg if required

51

Anti-arrhythmic drugs for adult tachy

Procainamide IV

Amiodarone IV

Sotalol IV

52

Procainamide IV dose for adult tachy

20-50 mg until arrhythmia suppressed, hypotension ensues, QRS duration inc >50% or max dose 17 mg/kg is given

Maintenance infusion of 1-4 mg/min

AVOID if prolonged QT or CHF

53

Amiodarone IV dose for adult tachy

First dose: 150 mg over 10 min

Repeat as needed if VT recurs

Follow by maintenance infusion of 1 mg/min for 1st 6 hrs

54

Sotalol IV dose for adult tachy

100 mg (1.5 mg/kg) over 5 min

AVOID if prolonged QT

55

Tx for adult tachy >150

WITHOUT hypotension, AMS, signs of shock, ischemic chest discomfort and acute heart failure or widened QRS

IV access and 12 lead EKG

vagal manuevers

adenosine (if reg)

beta blockers or calcium channel blocker

consider expert consult

56

Tx for adult bradycardia <50 bpm WITH hypotension, AMS, signs of shock, ischemic chest discomfort, acute heart failure

Atropine (transcutaneous pacing)

OR

Dopamine infusion

or Epinephrine infusion

consider expert consult

57

Tx for adult bradycardia <50 bpm WITHOUT hypotension, AMS, signs of shock, ischemic chest discomfort, acute heart failure

monitor and observe

58

Atropine IV dose for adult brady

First dose: 0.5 mg bolus

Repeat q3-5 min

Max 3 mg

59

Dopamine IV infusion dose for adult brady

2-20 mcg/kg per min infusion

Titrate to pt response adn taper slowly

60

Epinephrine IV infusion dose for adult brady

2-10 mcg per min infusion

titrate to pt response

61

Adult cardiac arrest NON-shockable rhythm (asystole/PEA) tx

after starting O2, CPR for 2 min and AED

IV/IO access

Epi q3-5 min

consider adv airway

continue if non-shockable or if ROSC then check pulse and BP

62

Adult cardiac arrest SHOCKABLE rhythm (VF and VT) tx

after starting O2, CPR for 2 min and AED

IV/IO access

Shock

CPR 2 min

Epi q3-5 min

consider adv airway

shock again and cont 2 min CPR

amiodarone and tx of reversible cause

63

Epinephrine IV/IO cardiac arrest dose

1 mg q3-5 min

64

Amiodarone IV/IO dose for cardiac arrest

First dose: 300 mg bolus
Second dose: 150 mg

65

What are reversible causes of cardiac arrest

hypovolemia

hypoxia

hydrogen ion (acidosis)

hypo/hyperkalemia

hypothermia

tension pneumo

tamponace, cardiac

toxins

thrombosis, pulmonary or coronary

66

Return of spontaneous circulation ROSC post-cardiac arrest care

optimize ventillation and O2 >94%, consider aadv airway

treat hypotension- vasopresssor

if can follow commands then adv critical care

67

Dose of NS for post-cardiac arrest care

1-2 L NS or LR

68

Epi IV dose for post-cardiac arrest care

0.1-0.5 mcg/kg per min (in 70 kg adult 7-35 mcg per min)

69

Dopamine IV dose for infusion post-cardiac arrest care

5-10 mcg/kg per min

70

Norepinephrine IV dose for post-cardiac arrest care

0.1-0.5 mcg/kg per min (in 70 kg aduly 7-35 mcg per min)