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ACLS Flashcards

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1
Q

Obtunded

A

loss of perception and ability to respond to the environment

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2
Q

Comatose

A

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

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3
Q

GCS score 14-15

A

good

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4
Q

score <8

A

intubate

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5
Q

eye opening GCS scores

A

4 = opens eyes spontaneously

3 = opens eyes to command

2 = opens eyes to pain

1 = no eye opening

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6
Q

verbal response GCS scores

A

5 = oriented, fluent speech

4 = confused conversation

3 = inappropriate words

2 = incomprehensible words

1= no speech

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7
Q

motor response GCS scores

A

6 = obeys commands

5 = localizes pain

4 = withdraws to pain

3 = decorticate posturing

2 = decerebrate posturing

1 = flaccid

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8
Q

decorticate posture

A

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

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9
Q

decerebrate posture

A

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

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10
Q

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

A

8-10 breaths per minute

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11
Q

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

A

2 breaths every 30 compressions

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12
Q

Biphasic shock strength

A

120-200J

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13
Q

monophasic shock strength

A

360J

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14
Q

What rhythms are shockable?

A

V tach

V fib

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15
Q

DCAP-BTLS

A 
Deformities
Contusions
Abrasions
Penetrating injuries
Burns / Bruises
Tenderness
Lacerations
Swelling
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16
Q

What rhythms are non-shockable?

A

PEA and asystole

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17
Q

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

A

wandering pacemaker
or
multifocal atrial tachycardia

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18
Q

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

A

irregular rhythms

escape

premature beats

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19
Q

If p wave is not

A

atrial hypertrophy

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20
Q

If there is no p wave what rhythm could it be

A

Escape rhythms

A-fib

Ventricular rhythms

Sinus arrest

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21
Q

U waves indicate

A

Hypokalemia, low Mg

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22
Q

Peaked T waves indicate

A

hyperkalemia

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23
Q

Flat T waves indicate

A

hypokalemia

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24
Q

If every QRS TU does not watch what should you think

A

PVC

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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)

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