ACLS Flashcards
Advanced life support
1
Q
What are agonal gasps an indication of
A
Cardiac arrest
2
Q
What does ACLS stand for
A
Advanced cardiac life support
3
Q
Airway
A
Airway is adequate and protected, insert advanced airway
4
Q
Breathing
A
Give O2, Confirm placement of Endotracheal toube, Monitor waveform capnography, Don’t over ventilate
5
Q
Circulation
A
IV/IO access, treat hr/rythm, monitor CPR quality, defibrillate, vitals
6
Q
Differential diagnosis and disability
A
Determine problem, h and t, mental status, Glasgow coma scale
7
Q
ACE
A
Angiotensin-converting enzyme
8
Q
ACS
A
Acute Coronary syndromes
9
Q
AED
A
Automated external defibrillator
10
Q
AHF
A
Acute heart failure
11
Q
AIVR
A
Accelerated idioventricular rhythm
12
Q
AMI
A
Acute myocardial infarction
13
Q
aPTT
A
Activated partial thromboplastin time
14
Q
AV
A
Atrioventricular
15
Q
CARES
A
Cardiac arrest registry to enhance survival
16
Q
CCF
A
Chest compression fraction
17
Q
CPR
A
Cardiopulmonary resuscitation
18
Q
CPSS
A
Cincinnati prehospital stroke scale
19
Q
CQI
A
Continuous quality improvement
20
Q
CT
A
Computed tomography
21
Q
DNAR
A
Do not attempt resuscitation
22
Q
ECG
A
Electrocardiogram
23
Q
ED
A
Emergency department
24
Q
EMS
A
Emergency medical services
25
ET
Endotracheal
26
FDA
Food and drug administration
27
FIO2
Fraction of inspired oxygen
28
GI
Gastrointestinal
29
ICU
Intensive care unit
30
INR
International normalized ratio
31
IO
Intraosseous
32
IV
Intravenous
33
LV
Left ventricle/ventricular
34
mA
Milliamperes
35
MACE
Major adverse cardiac events
36
MET
Medical emergency team
37
MI
Myocardial infarction
38
mm Hg
Millimeters of Mercury
39
NIH
National institutes of health
40
NIHSS
National institutes of health stroke scale
41
NINDS
National institute of neurological disorders and stroke
42
NPA
Nasopharyngeal airway
43
NSAID
Nonsteroidal anti-inflammatory drug
44
NSTE-ACS
Non-ST-segment elevation acute coronary syndromes
45
NSTEMI
Non-ST-segment elevation myocardial infarction
46
OPA
Oropharyngeal airway
47
Paco2
Partial pressure of carbon dioxide in arterial blood
48
PCI
Percutaneous coronary intervention
49
PE
Pulmonary embolism
50
PEA
Pulses electrical activity
51
PETCO2
Partial pressure of end-tidal carbon dioxide
52
PT
Prothrombin time
53
pVT
Pulseless ventricular tachycardia
54
ROSC
Return of spontaneous circulation
55
RRT
Rapid response team
56
rtPA
Recombinant tissue plasminogen activator
57
RV
Right ventricle/ventricular
58
SBP
Systolic blood pressure
59
STEMI
ST-segment elevation myocardial infarction
60
SVT
Supraventricular tachycardia
61
TCP
Transcutaneous pacing
62
TTM
Targeted temperature management
63
UA
Unstable angina
64
VF
Ventricular fibrillation
65
VT
Ventricular tachycardia
66
How do you optimize ACLS
A team leader effectively integrates high-quality CPR w/minimal interruptions of compressions/advanced life support strategies (defibrillation, meds, advance airway)
67
What should intervals be between compressions and shock delivery for increased predicted shock success
10 seconds or less
68
BLS survey is for people who are
Unconscious
69
ACLS survey is for people who are
Conscious
70
BLS survey
Check responsiveness, call for help, check carotid/ chest rise, assess pulse/breathing 5-10 sec, pulse present but no breath assist ventilation, no pulse no breathing CPR, defibrillate
71
Where do narrow QRS complexes originate
Syria near av node
72
Where do wide complexes originate
Ventricles
73
What is the most common rhythm to occur immediately after cardiac arrest
Ventricular fibrillation
74
What is happening during vfib
Ventricles quiver and cant pump blood
75
What are the 2 types of vfib
Coarse and fine
76
Which type of vfib is more easily corrected with defibrillation
Coarse
77
What type of vfib is seen more in a pt with cardiac arrest
Fine vf
78
What is vtach
Ventricular focus takes over control of heart and fires at tachy rate
79
In vtach what does the QRS complex look like and why
Wide because it originates in the ventricles
80
What is treatment for vfib and pulseless vtach
Defibrillate, Cpr for 2 minutes, check rhythm/pulse, shock again if needed, repeat until rhythm not shockable, meds admin with CPR/defibrillation
81
****Medication sequence for vfib and pulselss vtach
Epi 1mg 1:10,000 IV/IO every 3-5 min, ****(persistent vf) amiodarone 300mg IV/IO 1st dose amiodarone 150mg last dose
82
Asystole
No detectable activity on EKG
83
***Pulseless electrical activity
Heart not beating and no pulse but rhythm still present on EKG
84
Treatment for asystole
CPR, epinephrine 1mg 1:10,000 IV/IO 3-5 min, consider H and T
85
Hypovolemia
Volume depletion: excessive loss of body water/blood
86
Hypoxia
Oxygen depletion
87
Hydrogen ion
Excess of acid in blood/alkali. drop in ph
88
Hypo/hyperkalamia
Low/high potassium
89
Hypoglycemia
Low blood sugar
90
Tamponade, cardiac
Fluid build-up around heart
91
Tension pneumothorax
Air in the pleural space
92
Thrombus, coronary
Clot in coronary artery causing block of blood flow
93
Thrombus, pulmonary
Clot/material in artery of lungs
94
What are the h's and t's to consider for asystole and PEA
Hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypoglycemia, toxins, Tamponade cardiac, tension pneumothorax, thrombosis coronary, thrombosis pulmonary
95
What are the bradycardic rhythms
Sinus Bradycardia, 1st degree AV block, 2nd degree block type 1, 2nd degree block type two, 3rd degree block
96
1st degree AV block
Conduction through AV node slowed ( long PR wave inteval) Less than 5 boxes no treatment needed but may indicate higher degree in future
97
2nd degree block type one
Increase delay AV node conduction until failure of P wave
98
2nd degree block type 2 mobitz
Occurs below AV node. P waves regular but QRS drops. Atrial contractions not followed by ventricular contractions. Pacing recommended
99
3rd degree block
Complete heart block. No communication between SA and AV
100
Treatment for symptomatic blocks
O2, atropine .5mg 3-5min till 3mg***, transcutaneous pacing for high degree, airway maneuvers and ventilation for airway/breathing complications
101
TCP alternative
Dopamine IV infusion 2-20mcg/kg/min, epinephrine IV infusion 2-20 mcg/min
102
Tachycardic rhythms
Sinus tachycardia, supraventricular tach, monomorphic ventricular tach, polymorphic ventricular tach, torsades de pointes
103
How many beats per min would be considered tachycardic
101-150
104
SVT
Indistinguishable P wave due to HR greater than 150. Narrow QRS, P runs into T.
105
SVT rhythms
Atrial tach, junctional tach, atrial flutter, a-fib, and sinus tach
106
Treatment for stable supraventricular tach
Vagal maneuvers, adenosine 6mg rapid IVP, adenosine 12mg IVP 2nd dose, beta blocker or calcium channel blocker
107
Treatment for unstable supraventricular tach
Sedate, cardioversion (6mg adenosine if have IV at beginning of signs if meds are ready)
108
Monomorphic ventricular tach with pulses
ORS complex same size and shape
109
Treatment for stable monomorphic v-tach
Expert consult, adenosine 6mg rapid IVP, adenosine 12mg, amiodarone infusion 150mg over 10 min
110
Treatment for unstable monomorphic v-tach
Sedate, cardioversion
111
Polymorphic v-tach with pulse
QRS complex different size and shapes
112
Treatment for polymorphic v-tach
Defibrillate and CPR
113
Torsades de pointes
Twisting pattern. QRS diff size and shapes, treat with magnesium
114
Types of electrical therapy
Defibrillation, cardioversion, transcutaneous pacing
115
What shouldn't be happening during shock for safety
Oxygen should not be blowing over pt chest
116
Do you have to move a pt when defibrilating if they are on water or snow
No only if water is on chest
117
High quality compressions immediatly before and after shock increase chance of what
Conversion from vf
118
Difference between defibrillation and cardioversion
Defibrillation: random shocks during cardiac cycle Cardioversion: delivery of energy that is synchronized to QRS complex
119
Recommended initial cardio version dosages
Narrow regular: 50 - 100 J biphasic
Narrow irregular: 120 - 200 J biphasic/200 J monophasic Wide regular: 100 J biphasic Wide irregular: defibrillation dose (do not sync)
120
How to perform transcutaneous pacing
Consider sedation, place electrodes on patient, turn on pacer, set the pace rate, slowly increase MA until capture achieved with corresponding pulse.
121
What are airway adjuncts
Nasopharyngeal airway, oropharyngeal airway
122
When can you use a nasopharyngeal airway
Semi conscious patient
123
When is a nasopharyngeal airway contraindicated
In head injuries
124
When is an oropharyngeal airway used
In unconscious patients with no gag reflex
125
What are the advanced airways
Endotracheal tube, Laryngeal mask Airway
126
Which airway is the most ideal
Endotracheal
127
Things to watch out for using an Endotracheal tube
Suction during with draw 10 seconds or less, No tube ties obstructing veins in neck, Monitor capnography to confirm ET tube placement
128
Why is a laryngeal mask airway used
Used by providers not familiar with ET tube intubation
129
After advanced airway is placed what happens
A 100 compressions per minute Do not stop for breaths, ventilate Once every 6 seconds
130
If oxygen is delivered through a BVM what should O2 be set at
10 - 15LPM
131
Where should oxygen be kept post cardiac arrest
Between 94 and 99%
132
What can be caused by excess ventillation
Increased chest pressure and decrease cardiac output
133
What does Capnography measure
Partial pressure of end-tidal CO2
134
Where does normal capnography range
35 - 40MMHG
135
What allows for monitoring of CPR quality
Quantitative capnography
136
What will indicate that chest compressions may not be effective
PETCO2 readings of less than 10MMHG
137
What are signs and symptoms of a stroke
Loss/difficulty speaking, loss of vision, sudden severe headache, difficulty standing/walking, Weakness/numbness of face extremities or one side of body
138
How to treat stroke
Support ABC's, eval using Cincinnati pre-hospital stroke scale, check blood sugar, establish stoke time, transport to stroke center, CT scan Priority
139
What is the Cincinnati pre hospital stroke scale
Facial droop, arm drift, slurred speech
140
What will a CT scan possibly show in a stroke victim
Intracranial hemorrhaging
141
After a CT If there are no signs of hemorrhaging what do you do
Begin fibrinolytic therapy ASAP
142
What are the 3 groups of ACS
Unstable angina, ST segment elevation MI cama non-ST-segment elevation MI
143
What are signs and symptoms of ACS
Chest pain to jaw/left arm
144
Signs of ACS are typically more subtler in who
Women and diabetic patients
145
What should you do if you are unsure a patient is having ACS
Perform 12 lead ECG
146
Treatment for ACS stable
ABC's, 12 lead, O2, aspirin, nitroglycerin, morphine, labs, chest X-ray
147
Treatment of ACS unconscious and not breathing
CPR and defibrillate
148
After how long in a systole should you stop CPR and medication
25 minutes or more
149
How quickly should CPR be performed on victims they have no pulse and no normal breathing
Within 10 seconds
150
What is a common mistake in cardiac arrest management
Prolonged interruptions in chest compressions
151
It's there is no suspected neck injury what is the best way to open the airway
Head tilt chin lift
152
When an infant's pulse rate reaches less than ___ beats per minute you should start CPR
60
153
What is hand placement for adult CPR
2 hands on the lower half of the breastbone
154
What is hand placement for infant CPR
One rescuer - 2 fingers on center of chest, Two rescuer - encircleing thumbs technique
155
How many breaths a minute Should you give someone with a pulse but poor breathing
Adults - 1 every 5-6 seconds, children- 1 every 3-5 seconds
156
Best place to check infants pulse
Brachial artery
157
How many compressions do you deliver per minute
100 - 120
158
How often should you switch compressors
Every 2 minutes or 5 cycles of CPR
159
Compression depth for adults
At least 2"
160
Compression depth for children and infants
At least 1/3 the depth of the chest
161
Compression and breath rates after advanced airway placed
Compressions - 100 per minute continuous, breaths - 1 every 6 seconds
162
What is the best way to relieve severe choking in responsive infants
5 back slaps followed by 5 Chest thrusts
163
What is the highest priority for patients in respiratory failure with rapidly dropping heart beats
Assist with ventillation and simple airway maneuvers
164
Airway for those who have achieved ROSC
Optimize ventillation and oxygenation
165
Breathing for those who have achieved ROSC
A PETCO2 range of 35-40MMHG
166
Circulation for those who have achieved ROSC
For hypotensive A122L Bullis of IV fluid, Systolic BP of 90MMHG, Epinephrine drip .1 - .5 mcg/kg/min, Differential diagnosis
167
At what temperature would be considered therapeutic hypothermia
32 to 36ﾟC
168
When is their pubic hypothermia not indicated
When the patient is responding to verbal command
169
What might be beneficial to a patient Who are comatose
Therapeutic hypothermia for at least 24 hours
