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Flashcards in ACLS notes Deck (64):
1

What are the two indications that CPR is ineffective?

PETCO2 is less than 10 mmHg
DBP is less than 20 mmHg

2

What are the components of the ACLS survey?

Airway (need to establish one?)
Breathing (oxygenation and ventilation adequate)
Circulation (CPR effective)
Differential (Search for a cause)

3

What are the things that should be assessed for in ensuring adequate circulation? (3)

-IV access
-Cardiac rhythm/need for defibrillation
-Meds/fluids needed?

4

What are the two major reasons for understanding team member roles?

Knowledge of how to communicate and work as a member of a team

5

What are the components of the BLS survey? (4)

-Check responsiveness
-Activate EMS/ AED
-Breathing and circulation (CPR)
-Defibrillator

6

How long should interruptions in CPR be?

No more than 10 seconds

7

How often should providers be switched while performing CPR?

2 minutes

8

What are the three ways of monitoring oxygenation during CPR?

Clinical criteria (cyanosis, chest rise)
Quantitative waveform capnography
Oxygen sat

9

What is the main role of the team leader?

Ensuring comprehensive patient care

10

Who "closes the loop" in closed loop communication?

The team member performing the action

11

What is the oxygen saturation that should be achieved post arrest?

94%

12

Why is it necessary to avoid over ventilating a patient? (2)

-Decreased cerebral blood flow with PaCO2 decreases
-Increase risk of aspiration if air in stomach

13

What is the rate of ventilation post cardiac arrest?

10-12 / min

14

What is the goal PETCO2 post cardiac arrest?

35-40 mmHg

15

Can PCI be done in patients that are cooled?

Yes

16

What is the goal BG levels post arrest?

144-180 mg/dL

17

What is the frequency and duration of the pulse checks in respiratory arrest?

Recheck every 2 minutes
5-10 secs for checks

18

What are the components of the ACLS survey for respiratory arrest?

1. Check responsiveness
2. Activate EMS/AED
3. Circulation
4. Defibrillation PRN

19

What is the rate of breaths given during CPR wwo an advanced airway for cardiac arrest? For respiratory arrest?

CPR w/o = 30:2
CPR w/ = 1 vent / 6-8 secs
Respiratory arrest = 1 / 5-6 seconds

20

The benefit of an advanced airway is always weight against what?

Stopping compressions

21

What is the general order of the ACLS survey for respiratory arrest?

ABCD

22

What is the appropriate tidal volume delivery for bag masks (in mLs)?

600 mL

23

How do you select the proper OPA?

tip of OPA should reach the angle of the mandible

24

How is an OPA inserted?

Curve upwards, then turn down

25

Which can be used in conscious patients: NPAs or OPAs?

NPAs

26

How is the appropriate diameter of the NPA selected?

Should not blanch the nostril (pinky rule)

27

How is the appropriate length of an NPA selected?

Tip of nose to earlobe

28

What should always be assessed for immediately after placement of an OPA or NPA?

Spontaneous return of breathing

29

What are the indications for soft vs hard suction tubing respectively?

Soft - Intratracheal or through an airway

Hard - Thick particulate matter

30

How far should a suction catheter be inserted?

No further than the distance from the tip of the nose to the earlobe

31

How is suction applied appropriately?

With withdrawal

32

How long (in seconds) should suction attempts be made with ET tubes? Do the tubes have to be sterile?

No more than 10 seconds
Need sterile tubing

33

What should always be monitored for with suctioning an ET tube?

Heart rate and breathing

34

True or false: you must still pause for ventilations while during CPR when an advanced airway is in place

False

35

Should the pulse be assessed for prior to, or after calling for an AED?

After

36

Why is CPR started immediately after a shock?

Heart needs time to resume

37

What are the three indications for an AED?

1. No response
2. Absent or abnormal breathing
3. No pulse

38

Are agonal gasps adequate breathing?

No

39

Do you turn on the AED before or after hooking it up to the patient?

Before

40

Should AEDs be used in patients with defibrillators?

Yes, but ensure that you're not placing the AED pad over the defibrillator, and allow time for it to shock

41

What is the equation for coronary perfusion pressure?

Aortic DBP - Right atrial DBP

42

Why is Epi used in the treatment of VF/VT or asystole/PEA?

Alpha adrenergic causes vasoconstriction, which increases cerebral and coronary perfusion

43

What is the MOA of vasopressin?

Causes vasoconstriction

44

What are the doses of Epi/Vasopressin?

1 mg of epi
40 units of vasopressin

45

What is the role of antiarrhythmics given during cardiac arrest? What is the drug of choice?

Not been shown to help
Amiodarone

46

What is the dosing of amiodarone?

300 mg IV bolus

47

What is the drug of choice if amiodarone is not available? Dose?

Lidocaine--1 - 1.5 mg/kg

48

When is MgSO4 given? Dosage?

TdP
1-2 g loading dose in 10 mL

49

How far should the chest recoil with compressions?

2 inches (5 cm)

50

What are the 5 H's of reversible causes of cardiac arrest?

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia

51

What are the five Ts of reversible causes of cardiac arrest?

Tension pneumothorax
Tamponade
Toxins
Thrombosis, pulmonary
Thrombosis, cardiac

52

Values of PETCO2 of less than what in intubated patients indicates that ROSC is unlikely?

10 mmHg

53

How often should epi be administered during a cardiac arrest?

1 mg q 3-5 minutes

54

What should be done following administration of epi?

Give a 20 mL flush of IVF and elevate the extremity above the level of the heart for 10-20 seconds

55

What is the role of MgSO4 in the treatment of TdP?

Prevents recurrence--still needs shock

56

Flat neck veins in a cardiac arrest pt = ?

Dehydration--give IVF

57

What are the EKG findings of a dehydration pt?

Narrow complexes and rapid rate

58

What are the EKG findings of hypoxia?

Slow rate

59

What are the EKG findings of acidosis?

Smaller amplitude QRS complexes

60

What are the EKG findings of Hypokalemia?

-U waves
-Flattened T waves

61

What are the EKG findings hyperkalemia?

Peaked T waves

62

What are the EKG findings of tension pneumothorax?

Narrow complexes and slow rate

63

What are the EKG findings of tamponade?

Narrow complexes
Rapid rate

64

Is volume infusion appropriate for treating cardiac tamponade?

Yes--should be given