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Flashcards in ACLS Deck (169):
1

What are agonal gasps an indication of

Cardiac arrest

2

What does ACLS stand for

Advanced cardiac life support

3

Airway

Airway is adequate and protected, insert advanced airway

4

Breathing

Give O2, Confirm placement of Endotracheal toube, Monitor waveform capnography, Don't over ventilate

5

Circulation

IV/IO access, treat hr/rythm, monitor CPR quality, defibrillate, vitals

6

Differential diagnosis and disability

Determine problem, h and t, mental status, Glasgow coma scale

7

ACE

Angiotensin-converting enzyme

8

ACS

Acute Coronary syndromes

9

AED

Automated external defibrillator

10

AHF

Acute heart failure

11

AIVR

Accelerated idioventricular rhythm

12

AMI

Acute myocardial infarction

13

aPTT

Activated partial thromboplastin time

14

AV

Atrioventricular

15

CARES

Cardiac arrest registry to enhance survival

16

CCF

Chest compression fraction

17

CPR

Cardiopulmonary resuscitation

18

CPSS

Cincinnati prehospital stroke scale

19

CQI

Continuous quality improvement

20

CT

Computed tomography

21

DNAR

Do not attempt resuscitation

22

ECG

Electrocardiogram

23

ED

Emergency department

24

EMS

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