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ACLS Flashcards

1
Q

Post-Cardiac Arrest Cara

A

Temperature Management : between 32-36Celcius 89.6-95.2Farenheit for at least 24 hours
Oxygen: should titration of oxygen to lowest level possible to avoid oxygen toxicity. Approximately 94% oxygen or greater
Ventilation: start at 10/min and ventilate for capnography at around 35-45mmHg
Pressure: mean arterial pressure of at least 65mmHg is reasonable

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2
Q

Roles of Arrest

A 
Airway
Compressor
Defibrillator
Team Leader
Medications
Time/Recorder
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3
Q

Team Member

A

Ask for new task or role if unable to perform assigned task because it is beyond level of experience
Suggest an alternative drug dose in a confident manner
Question a colleague who is about to make a mistake

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4
Q

Team Leader

A

Clearly define roles for each person
Ask new intervention be done if it is higher priority
Ask for ideas of diagnoses
Confirm what members do and be clear about instructions

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5
Q

If Unsure about a Pulse

A

Start CPR because it can be more harmful to not do it if it is needed

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6
Q

BLS Assesment

A 
Check Respnsiveness
Shout for Help
Check Breathing and Pulse
Start CPR and Rescue Breathing 
Attach Defibrilator
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7
Q

Coronary Perfusion pressure

A

Aortic relaxation “diastolic”

  • relates with both myocardial blood flow and ROSC
  • one study showed that ROSC did not occur unless a CPP 15mmHg or greater was achieved
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8
Q

Quality Compresion

A

At least 2 inches
Rate of 100-120
Allow full chest recoil

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9
Q

Depth of Compressions

A

More often too shallow but too deep >2.4 inches has shown to decrease survival rate in cardiac arrest due to injuries

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10
Q

High Quality CPR

A 
Compress chest hard and fast
Allow complete chest recoil
Minimize interruptions less than 10 seconds
Avoid excessive ventilations
Switch compressor every two minutes
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11
Q

Capnography

A

If less than 10mmHg then reasses quality of CPR

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12
Q

H’s and T’s

A 
Hypovolemia
Hypoxia
Hydrogen Ion
Hypo/hyperkalemia
Hypothermia
Tension Pneumo
Tamponade
Toxins
Thrombosis (coronary and PE)
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13
Q

Tidal Volume of Adult

A

8-10ml/kg

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14
Q

Respiratory

A

Respiratory Rate below 6/min is considered hypoventilation and requires ventilation assistance

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15
Q

Resp Distress

A

Abnormal Respiratory Rate

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16
Q

Resp Failure

A

Inadequate Oxygenation

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17
Q

Resp Arrest

A

Absent Breathing

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18
Q

Tidal Volume for Patient not breathing

A

6-7ml/kg will suffice enough to rise the chest

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19
Q

BVM

A

If ventilations are being properly delivered and are adequate, providers may differ from an advanced airway

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20
Q

Excessive Ventilation

A

Can increase thoracic pressure, decreases venous return to the heart and diminishes cardiac output

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21
Q

Common Airway Obstruction

A

Loss of tone in the throats muscles. When the tounge falls to the back of the throat

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22
Q

Airway Obstruction

A

If obstructed and resp arrest occurs, start CPR and check mouth after every two minutes when going to give ventilations and remove with fingers if clearly visible

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23
Q

BVM device

A

Delivers approximately 600ml of volume and should see chest rise over 1 second

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24
Q

Suctioning

A

Suction force of 80-120mmHg is nescessary
Soft: used for mouth or nose and et deep suction
Ridged: suction oropharynx and thick secretions

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25
Suction Measure
Ridged is the same as an OPA and the Soft is measured from nose, around ear to xiphoid process Should not exceed more than 15 seconds
26
ACS Algorithm
Symptoms of ischemia=> abc's 12 lead => titration oxygen if less than 90%, give 160-325 aspirin, nitoglycerine, morphine if pain not relieved by nitro
27
Reperfusion Goals
Door to Ballon 90minutes | Door to Needle (fibronolysis) 30 minutes
28
Chest Discomfort of Ischemia
- Uncomfortable Pressure, fullness, squeezing, pain in center of chest lasting several minutes - Chest discomfort spreading to shoulders, neck, one or both arms or jaw - Chest discomfort spreading to back or between shoulder blades - Unexplained SOB with or without chest discomfort
29
Aspirin
Dose: 160-325mg causes near immediate and total inhibition of thromboxone IF Pt has not taken aspirin, has allergies, or recent GI bleed
30
Nitroglycerine
Reduces ischemic chest discomfort Cause reduction in LV and RV preload through peripheral arterial and venous dilation 1 spray, or dose, 400mcg every 3-5 minutes for ongoing symptoms Total of three doses BP > 90mmHg Systolic and HR IS 50-100/min
31
Inferior Wall MI
RV infarction may complicate an inferior wall MI because RV infarction rely heavily on RV filling pressures to maintain cardiac output -Should not be given nitroglycerine or other Volume depleting drugs such as morphine or diuretics
32
Recent Phosphodiesterase Inhibitor Use
Avoid using nitroglycerine is suspected or known that patient has taken ED medications with 24-48 hours because may cause severe hypotension
33
Morphine
Opiate given for chest discomfort unresponsive to sublingual or nitro spray with medical control
34
PreHsopital notification of Stemi
Decreases time to treatment by 10-60 minutes
35
NonStemi
ST depression indicating injury or dynamic t wave inversion
36
Heparin
Given as adjunct to PCI therapy
37
Streptokinase
Fribronolytic drug used in MI in hospital
38
Stroke
87% ischemic 10% intracerebral 3% subarachnoid
39
Fibronolytic Therapy
Within 1 hour of hospital arrival time
40
Stroke Symtpoms
``` Confusion Trouble Speaking Sudden Weakness Dizziness Trouble Walking Severe Headache ```
41
Cincinnati
Facial Droop Arm Drift Abnormal Speech If identified one of three signs then 72% chance is having a stroke
42
Establish Information
Last known normal time or seen Bring a witness Check BGL
43
Provide Oxygen to Stroke
If oxygen saturation is less than 94%
44
rTPA
Alteplase is a clot buster for stroke patients Inclusion: onset within 4.5 hours and neurological deficit Exclusion: age>80years old, taking anticoagulant, severe stroke, Hx of diabetes and stroke
45
Cardiac Arrest Algorithm
``` Start CPR Rhythm Shockable ? No, CPR 2 min, IO, Epi Yes, Shock, CPR 2 min, IO Rhythm? Shock, CPR 2 mins, Epi Rhythm? Shock, CPR 2 mins, ami Rhythm? Shock, CPR 2 mins, Epi ```
46
Shock Dosage
200j for defibrillator dose
47
Drug Therapy
Epinephrine 1mg Q 3-5mins | Amiodarone 300mg bolus and 150mg bolus
48
Shocking a Heart
Does not restart Heart. It temporarily stuns the heart and briefly terminates all electrical activity and if the heart is still viable, the heart will resume with its normal pacemaker
49
Rate Of Decline
For every minute of no CPR to cardiac arrest survival chances decrease by 7-10% -with bystander CPR chances decline slower at 3-4%/minute
50
End Tidal Co2
Measure of blood delivered to lungs and readings less than 10mmHg mean ROSC is unlikely
51
Amiodarone
Vf/Vt | Blocks sodium and potassium channels
52
Lidocaine
No proven short term or long term benefits | - 1-1.5mg/kg bolus then consider .5-.75mg/kg to max of 3mg/kg
53
Mag Sulfate
Terminate torsades in patients with long QT interval | Loading dose of 1-2 G /5 minutes
54
Cardiac Arrest PEA
Consider H's and T's and focus on epi and compressions
55
Terminate CPR
If etco2 less than 10 after 20 minutes | Down time
56
Bradycardia
Bradycardia and heart blocks | Rhythm less than 60/min
57
Symptomatic Bradycardia Unstable
Hypotension?
58
Symptomatic Bradycardia Symptoms
Dizziness, weakness, fatigues, light headed, syncope
59
Bradycardia Algorithm
Oxygen, 12 lead, vitals, history - hypotension? AMA? Shock? Ischemic chest discomfort? Acute heart failure? Yes: Atropine Dopamine infusion Epinephrine infusion No effect consider pacing at 70bpm until mechanical and electrical capture on patient and monitor Atropine .5mg Q3-5minutes max of 3mg Dopamine 2-20mcg/kg/min titration Epinephrine 2-10mcg/min
60
Transcutaneous Pacing
Indications: hypotension, ams, Shock, ischemic chest discomfort, acute heart failure (hemodynamically unstable) Heart blocks, ventricular escape rhythms, new BBB Contraindicated: severe hypothermia or asystole -Conscious use analgesics for pain -assess radial pulses and NOT carotid for mechanical capture -once electrical captured set 2ma higher -set rate 60-70bpm -alternative is a chronotropic drug infusion (dopamine, epinephrine)
61
Tachycardia
Heart beating so fast cardiac output is reduced
62
Indications for Cardioversion
Sinus Tachycardia Atrial Flutter Atrial Fin RVR V tach
63
Unstable
Have to use synchronized cardioversion - hypotension - ams - Shock - ischemic chest discomfort - acute heart failure - IF unstable do not waste time obtaining 12 lead to verify rhythm
64
Wide QRS stable
Without unstable then consider adenosine if regular and monomorphic, antiarrhythmic infusion 150mg/10min Peds: 5mg/kg/20-30minutea
65
Polymorphic V Tach
Monitor will not allow synchronization of rhythm due to polymorphic and have to defibrillate at 200j dose
66
Synchronized
Synchronized to the highest point of the R wave to inhibit shocking the patient during an absolute refractory period causing possible asystole or other deadly rhythms
67
Doses
Narrow Regular 50-100j Narrow Irregular 120-200j Wide Regular 100j Adenosine 6mg 12mg 12mg Amiodarone 150mg/10mins with maintanence infusion of 1mg/min Procainamide 20-50mg/min with maintanence infusion of 1-4mg/min
68
Wide Regular Tachycardiac
Vtach with pulse, if stable, medications, unstable, cardiovert
69
Synchronized with Monitor
Make sure to reset "synchronized mode" after shock. Some monitors reset to unsynchronized in case lethal rhythm is produced from shock
70
SvT
Stable : make sure pathological, vagal maneuvers, adenosine, amiodarone, Shock if unstable
71
Adenosine
Contraindications: | A fib or flutter may accelerate rhythm
72
A fib RVR
Stable: vagal, .25 mg/kg bolus Cardiazem then .35mg/kg bolus and maintenance infusion of 5-15mg/HR
73
Post Cardiac Arrest Care
* Avoid Excessive ventilation start at 10 breaths a minute and titration 35-40 mmHg - Maintain oxygen saturation above 94%* - Consider Advanced Airway and Capnograhy * Treat hypotension <90mmHg* - IV IO bolus 1-2L fluid - Vasopressor Infusion - Consider treatable causes * 12 Lead* * Temperature Management* - 32-36degrees Celsius (no contraindications for temperature management) - ice packs in junctional spaces
74
Post Arrest Vasopressor infusion
Epi: .1-.5mcg/kg/min Dopamine: 5-10mcg/kg/min
75
Epi Bradycardia
2-10mcg/min
76
Epi Hypotension
.1-.5 mcg/kg/min

Paramedic 02 (27 decks)

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