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ACLS Flashcards

1
Q

BLS Primary Survey What is The First things You Do

A

Scene Safety

Check Response

Check for Breathing

Activate the emergency response system

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2
Q

BLS-Circulation

A

Feel for carotid pulse for 5-10 seconds

Begin CPR if you do not feel a pulse

30 compressions

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3
Q

BLS-Breathing

A

Give Two Breaths

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4
Q

BLS-DEFIBRILLATION

A

if no pulse attach AED/manual defibrillator as soon as it arrives

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5
Q

BLS Primary Survey

A

BLS survey focuses on early CPR and early defibrillation

Remember to assess and perform the appropriate action

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6
Q

BLS-Activation of the Emergency Response System

Adults and Adolescence

A

If you are alone with no mobile phone leave the victim to activate the response system and get the AED before beginning CPR

Otherwise send someone and begin CPR immediately use the AED as soon as it is available

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7
Q

BLS-Activation of the Emergency Response System

Infants and Children where the arrest has been witnessed

A

If you are alone with no mobile phone leave the victim to activate the response system and get the AED before beginning CPR

Otherwise send someone and begin CPR immediately use the AED as soon as it is available

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8
Q

BLS-Activation of the Emergency Response System

Infants and Children where the arrest has not been witnessed

A

Give 2 minutes of CPR, then leave the victim to go activate the emergency response system.

Return to the child or infant and resume CPR use the AED as soon as it is available

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9
Q

BLS Compression to Ventilation Ratio With an Advanced Airway

A

Continuous compression at a ratio of 100-120 beats/min

Give 1 breath every 6 seconds (10 breath/min)

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10
Q

BLS Compression to Ventilation Ratio Without an Advanced Airway

Infants and Children

A

1 Rescuers-30:2

2 Rescuers-15:2

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11
Q

BLS Compression to Ventilation Ratio Without an Advanced Airway

Adults and Aldoscents

A

1 or 2 rescuers

30:2

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12
Q

What should your compression rate be with CPR

A

100-120/ min

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13
Q

Compression depth for adults

A

2 inches

5 cm

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14
Q

Compression depth for Children

A

At least one third AP diameter of chest

About 2 inches (5 cm)

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15
Q

Compression Depth for Infants

A

At least one-third AP of the chest

About 1 1/2 inches (4 cm)

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16
Q

Respiratory Arrest

A

Patient has a pulse but is not breathing

10-12 bpm (1 every 5-6 seconds)

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17
Q

Cardiac Arrest BVM

A

30 compression to 2 breaths

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18
Q

Cardiac Arrest- Advanced Airway

A

100 compression per minute with minimal interruptions (<10 seconds)

8-10 bpm (~1 breath every 6-8 seconds)

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19
Q

Why do we only give breath at a slow rate with an advanced airway

A

We are trying to avoid excessive ventilation so that we can ensure that the patent has enough oxygen well also avoiding vasoconstriction

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20
Q

ACLS Survey-Breathing

A

When indicated give oxygen

Assess the adequacy of oxygenation/ventilation

Waveform capnography

Look for adequate chest rise

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21
Q

ACLS Survey-Airway

A

Maintain airway patency (open airway, OPA, NPA)

Advanced airway when indicated

Airway confirmation

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22
Q

ACLS-Circulation

A

Begin with 30 compression before you begin breaths in order to improve blood flow

Monitor CPR Quality

Obtain IV/IO access

ECG monitoring; rhythm assessment

Give drugs/fluid bolus as indicated

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23
Q

ACLS-Differential Diagnosis

A

Search for and treat reversible causes (Hs and Ts)

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24
Q

Quality of Chest Compression

A

Push hard and fast-If you are pushing hard and fast and getting effective chest compression you should have some CO2 on the capnography

Aim for a rate between 100-120 bpm

The depth you are aiming for is 2 inches (5 cm) but not more than 2.4 inches (6 cm)

Allow for full recoil

Switch providers every 2 minutes

Avoid interruptions

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25
Is An Advanced Airway Indicated?
An advanced airway should only be used when indicated not as an automatic response ## Footnote An advanced airway is considered any type of artificial airway (LMA, ETT) Do not interrupt chest compression to establish an advanced airway Confirmation of airway-Waveform capnography Securing
26
PetCO2 and CPR
If PetCO2 is \<10 mmHG you need to improve your CPR
27
Airway for Unconscious Patient
OPA NPA Head Tilt Chin Lift Jaw Thurst
28
Breathing for cardiac arrest
100% O2 This may change in the future Titrate O2 for SpO2 ≥ 94
29
Avoid Excessive Ventilation
Will push air into the stomach May result in vasoconstriction which will reduce blood flow
30
Breathing With Advanced Airway
When an advanced airway is in place you can give breath one every 6-8 seconds
31
H with Differential Diagnosis
* Hypovolemia * Hypoxia * Hydrogen Ion (acidosis) * Hyper/Hypokalemia * Hypoglycemia * Hypothermia
32
T with Differential Diagnosis
Toxins Tampnade (cardiac) Tension pneumothorax Thrombosis-Coronary and pulmonary Trauma
33
What are the Different Routes of Administration for Medication
In order of how they should use 1. IV 2. IO 3. ETT
34
IV Route of Administration
Peripheral Most preferred route of access Give by bolus injection unless otherwise specified Follow with 20 cc bolus NS; raise extremity
35
IO Route of Administration
Sternal (FAST)/ Tibial Preferred over ETT route Any drug that can be given IV can be given IO When you go through the sternum IO route it will make it hard to do chest compression
36
ETT Route of Access
NAVEL drugs Optimal dosage not known Typical dose: 2 to 2.5 times the IV dose
37
Navel Drugs
Naloxon Atropine Valium Epinephrine Lidocaine
38
Epinephrine
This is a vasopressor Will improve initial ROSC but does not affect overall survival and discharge rates
39
Amiodarone vs. Lidocaine
Amiodarone will increase short term survival when compared to a placebo or lidocaine Amiodarone can cause amiodarone lung which is a restrictive lung disease and will also cause smurf syndrome
40
Atropine Vs. Pacing
Atropine is the first line drug used for acute symptomatic bradycardia Failure to respond is an indication for TCP, even though the use of epi and dopamine may be successful and can be used to temporarily until pacing is started
41
When should you not use Atropine
Do NOT rely on Atropine in Mobitz Type II or 3° heart blocks
42
Transcutaneous Pacing should be started immediately when
There is no response to atropine Atropine is unlikely to be effective or IV access is not quickly available The patient is severely symptomatic
43
TCP-How to Adjust
Place the pads on the patient If able you should sedate the pt Set the rate Set the current
44
When may you not be able to sedate the pt
When they are already very hypotensive
45
TCP-Setting the Rate
60/min to start and can be adjusted once pacing has been established Most patients will improve with rates of 60-70 ppm
46
Setting the Current (mA) for TCP
* Incrementally increase until capture has been noted and then increase by 2 mA further for a safety margin * Assess for mechanical capture has been notes * Check via the femoral pulse * We check through the femoral pulse because if we check with the carotid pulse we pay just be feeling the large muscle contracting with the electricity * Assess response to the treatment/clinical status * If BP is still low try to increase set rate
47
Mechanical Capture
When you have mechanical capture you will have a pulse with every single beat
48
Stable Vs. Unstable Pt
When a patient is stable we will tend to not do anything and instead consult will cardiology When a patient is unstable (symptomatic) we will begin treatment
49
What is the first thing you should do when a patient is pulseless
CPR
50
Which rhythms are shockable
VF pVT
51
What Should You Do after you give the shock
Do CPR for 2 min Give epinephrine every 3-5 min Consider advanced airway Check capnogrphy
52
You Have given the shock a second time
do CPR for 2 min amiodarone- You first give a vasopressor (epi) and then you give an antiarrhythmic (amiodarone)
53
The rhythm is not shockable
Continue CPR for 2 min before you do another rhythm check Give epinephrine Consider advance airway Think and reversible causes
54
CPR and Intra arterial pressure
If diastolic pressure is \<20 mmHg then you should improve CPR quality
55
Shock Energy for Defibrillation BiPhasic
Manufacturer recommendation Initial dose 120-200 J If unknown use max available
56
Shock Energy for Defibrillation Monophasic
360 J
57
Epinephrine IV/IO Dose
1 mg every 3-5 min
58
Amiodarone IV/IO dose
First dose is 300 mg Second dose is 150 mg
59
Return of Spontaneous Circulation (ROSC)
Pulse and blood pressure Abrupt sustained increase in PET (typically \>40 mmHg) Spontaneous arterial pressure waves with intra-arterial monitoring
60
Adult Tachycardia with Pulse Algorithm Is the Persistent Tachycardia Causing
Hypotension Altered mental status Signs of shock Ischemic chest discomfort Acute heart failure
61
Adult Tachycardia with Pulse Algorithm 1st Steps
**Identify and Treat Underlying Cause** ## Footnote Maintain airway and assist breathing if needed Oxygen is needed Cardiac monitor, BP, and oximetry
62
Adult Tachycardia with Pulse Algorithm Treatment for Symptomatic Tachycardia
**Synchronized Cardioversion** ## Footnote Consider sedation If regular and narrow complex consider adenosine
63
Adult Tachycardia with Pulse Algorithm Not Symptomatic and Has a narrow QRS
QRS is \<0.12 IV Access and ECG Vagal manuver Adenosine-if regular and monomorphic beta blockers and calcium blockers expert consultation
64
Adult Tachycardia with Pulse Algorithm Not Sympomatic and Has a Wide QRS
QRS is \>0.12 IV Access and ECG Adenosine0if regular and monomorphic Antiarrhythmic infusion expert consultation
65
Synchronized Cardioversion Doses Wide Irregular
Defibrillation dose (not synchrnized)
66
Synchronized Cardioversion Doses Wide Regular
100 J
67
Synchronized Cardioversion Doses Narrow Irregular
120-200 J Biphasic 200 J Monophasic
68
Synchronized Cardioversion Doses Narrow Regular
50-100J
69
Adenosine IV Dose
The first dose is 6 mg rapid infusion Follow with NS flush Second dose is 12 mg if required
70
What are your option for an antiarrhythmic infusion for stable wide QRS Tachycardia
Procainamide Amiodarone
71
Procainamide Dose
20-50 mg/min
72
When to stop Procainamide
arrhythmia has been supressed hypotension QRS increase \>50% Max dose of 17 mg/kg has been reached
73
Maintanence infusion of Procainamide
1-4 mg/min
74
When to Avoid Procainamide
Prolonged QT or CHF
75
Amiodarone IV
First dose is 150 mg over 10 min Repeat as needed Maintanence infusion or 1 mg/min for first 6 hour
76
Cardioversion for Unstable Monomorphic VT
Biphasic 120-200J
77
Cardioversion for Polymorphic Vt
Defibrillation Dose
78
Cardioversion for Unstable SVT Atrial Flutter
Biphasic 120-200J
79
Cardioversion for Unstable Atrial Fibrillation
Biphasic 120-200J
80
Bradycardia with a pulse algorithm What to do when symptomatic and atropine is ineffective
Dopamine Epinephrine Expert consultation Tranvenous pacing
81
Bradycardia with a pulse algorithm What to do when symptomatic
**Atropine**
82
Bradycardia with a pulse algorithm What to do when not symptomatic
Monitor and observe
83
Dopamine IV Dose
infusion rate of 2-20 mcg/kg per min Titrate to response Taper slow
84
Atropine IV Dose
First dose is 0.5 mg bolus Repeat every 3-5 min max 3 mg
85
Epinephrine IV Infusion
2-10 mcg per min titrate to response
86
Early Defibrillation
Will not restart the heart Will temporarily stun the heart and terminate all electrical activity including VF and VT If the heart is still viable the normal pacemakers may resume electrical activity
87
Why is Early Defib so important?
The interval from collapse to defib is one of the most important determinants of survival from cardiac arrest! The shock is more likely to work than the vasopressor so it is a higher prority
88
Cardioversion vs. Defibrillation
With synchronized cardioversion we are delivering the shock before the down slope of the T wave On the upslope is the refractory phase and on the down slope if another action potential came the heart muscle could depolarize but it would not be optimal
89
Post-cardiac Arrest Algorithm
**Optimize Ventilation and Oxygenation** Maintain SpO2 of 94% Consider advanced airway and waveform capnography Do not hyperventilate
90
Post Cardiac Arrest Algorithm Hypotension
Want to treat hypotension (SBP \<90mmHg) give IV/IO bolus Vasopressor infusion Consider treatable causes
91
Post Cardiac Arrest Algorithm Was a STEMI or AMI suspected
Consider coronary reprefusion
92
Post Cardiac Arrest Algorithm Do they follow commands
**Yes-**Continue to advanced critical care **No-**Initiate targeted temperature management
93
Acute Coronary Syndrome Immediate ED General Treatment
If SpO2 is \<90% start oxygen at L/min and titrate Aspirin 160-325 mg Nitroglycerin sublingual or spray Morphine IV is pt is in discomfort that is not relieved through nitroglycerin

Interventions 3 (34 decks)

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