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ACLS > ACLS—Preventing Arrest > Flashcards

ACLS—Preventing Arrest Flashcards

1
Q

Name S/S of an adult pt who is deteriorating

A

-Airway compromise
-RR <6 or >30
-HR <40 or >140
-SBP <90
-Symptomatic Hypertension
-Unexpected decrease in LOC
-Symptomatic Hypertension
-Unexplained Agitation
-Seizure
-Significant decrease in urine output
-Subjective concern about the pt

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2
Q

What 2 ECG categories are outlined int he ACS algorithm?

A

-STEMI
-NSTEMI ACS (NSTE-ACS)

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3
Q

What can be seen on the EKG of the pt w/ NSTEMI?

A

-ST segment depression, T wave inversion, Transient ST Segment Elevation
-Nondiagnostic or normal EKG

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4
Q

What are the primary goals for ACS patients?

A

-Prevention of major adverse cardiovascular events such as Death, Nonfatal MI and the need for urgent Post Infarction Revascularization
-Identification of pts w/ STEMI & triage for early reperfusion therapy
-Relief of ischemic chest discomfort
-Tx of acute, life-threatening complications of ACS, such as VF/pVT, Unstable Bradycardia, Ventricular Wall Rupture, Decompensated Shock & other Unstable Tachycardias

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5
Q

What rhythms should be anticipated for ACS w/ acute ischemia?

A

-Sudden Cardiac Death
-Ventricular Tachycardias
-Hypotensive Bradycardia

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6
Q

What drugs are used to treat ACS?

A

-O2
-Aspirin
-Nitroglycerin
-Opiates (Morphine)
-Fibrinolytic Therapy
-Heparin

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7
Q

When is Nitroglycerin contraindicated?

A

-Inferior Wall MI w/ RV Infarction
-Hypotension, Bradycardia & Tachycardias
-Recent Phosphodiesterace Inhibitor use (drugs for ED)

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8
Q

When is Morphine indicated for STEMI?

A

-When chest discomfort does not respond to Ntg.

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9
Q

What are the benefits of using Morphine to manage ACS?

A

-CNS analgesia
-Reduces O2 demand
-Alleviates Dyspnea
-Produces venodilation which reduces LV preload & O2 requirements
-Decreases SVR which reduces LV after load
-Helps redistribute blood volume in pts w/ acute pulmonary edema

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10
Q

If hypotension develops after Morphine is given, what should be done?

A

IV Fluids

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11
Q

Why is pain relief after Ntg administration not useful in diagnosis the cause of chest pain or discomfort?

A

Because GI & other causes of chest discomfort can also improve after Ntg.

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12
Q

Why are coronary arteries also called epicardial arteries?

A

Because they run along the outer surface of the heart on the epicardium. The main coronary/epicardia arteries and the Left Coronary and the R Coronary arteries.

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13
Q

When STEMI is seen on the EKG there is usually a complete occlusion of what artery/arteries?

A

Left or Right Coronary artery.

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14
Q

What is the most commonly occluded of the coronary arteries and what is a nickname given to ST elevation of this artery?

A

Left Anterior Descending—“Widow Maker”

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15
Q

D’s of in-hospital STEMI therapy?

A

Door
Data
Decision
Drug

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16
Q

What leads are affected w/ ST elevation >2.0 mm for presumed “New LBBB”?

A

III, aVF, V3, V4, I & aVL

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17
Q

EKG findings of an acute posterior wall MI include the following:

ST segment depression (not elevation) in the early precordial leads V1-V4 (anterior & septal leads). This occurs because the EKG leads will see the MI backwards: the leads are placed anteriorly but the myocardial injury is posterior.

A

Posterior wall

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18
Q

Name the 2 different types of strokes and the common percentage each occur:

A

Ischemic—87%
Hemorrhagic—13%

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19
Q

What are the 3 physical findings assessed on the Cincinnati Prehospital Stroke Scale?

A

Facial Droop—smile or show teeth
Arm Drift—close eyes and hold out both arms palms up
Abnormal speech—have pt say “You can’t teach an old dog new tricks.”

20
Q

What is the goal of B/P management in order to give TPA?

A

</= 180/105

21
Q

Name the rhythms for Bradycardia:

A

Sinus Bradycardia
1st degree AV Block
2nd degree AV Block
-Mobitz Type I or Wenkebach
-Mobitz Type II
3rd degree AV Block

22
Q

What drugs are used to treat Bradycardia?

A

Atropine
Dopamine (infusion)
Epinephrine (infusion)

23
Q

Describe the second degree AV block.

A

There is a block of some, but not all, atrial impulses before they reach the ventricles.

24
Q

Describe the 2nd degree Mobitz type one or Wenkebach rhythm

A

Block typically occurs at the AV w/ successive prolongation of the PR interval until an atrial impulse is not conducted to the ventricles (there will not be a QRS following the last P wave). The cycle of progressive lengthening of the PRI until failure of conduction of the atrial impulse often repeats.

25
Q

Describe the 2nd Degree Mobitz Type II block.

A

Block occurs below the level of the AV node and is characterized by intermittent nonconducting of P Waves (atrial impulses) to the ventricles w/ constant PR interval or conducted beats. There can be a consistent ration of atrial to ventricular depolarizations

26
Q

Describe the 3rd Degree AV Block:

A

Atria and ventricles beat independently of each other. No atrial beats are conducted to the ventricles.

27
Q

What AV Block is the most clinically significant?

A

3rd Degree or Complete Heart Block because it is the most likely to cause cardiovascular collapse and require immediate pacing.

28
Q

Describe 3rd degree or Complete Heart Block:

A

Altria and ventricles beat independently of each other. No atrial beats are conducted to the ventricles.

29
Q

When would Atropine be given for an AV Block?

A

If the pt has S/S of poor perfusion caused by the Bradycardia

30
Q

If Atropine is ineffective for the symptomatic pt w/ an AV Block what other actions can be taken?

A

-Dopamine infusion
-Epinephrine infusion
-Transcutaneous pacing

31
Q

Bradycardia can be a S/O life-threatening Hypoxia.

A

Give O2!!

32
Q

***Bradycardia associated w/ Hypertension can be a S/O life-threatening increase in ICP, especially in the setting of stroke or brain injury.

A
33
Q

***When assessing the pt w/ Bradycardia, the key clinical question is whether the bradycardia is causing the pt’s symptoms or some other illness is causing the bradycardia.

A
34
Q

What are some symptoms of Bradycardia?

A

-Altered mental status
-Shock
-Ischemic chest discomfort

35
Q

What are some symptoms of bradycardia?

A

-Hypotension
-Acuter heart failure

36
Q

What is the the first drug given to the pt w/ poor perfusion secondary to bradycardia?

A

Atropine (but not for pt w/ heart transplant)

37
Q

If Atropine is ineffective for symptomatic bradycardia what treatment should be considered next?

A

Transcutaneous pacing and/or Dopamine @ 5-20mcg/kg/min infusion (Chronotropic or HR dose) or epinephrine @ 2-10 mcg/min infusion

38
Q

How often can Atropine be given?

A

1 mg Q3-5 minutes to max of 3 mg total

Atropine < 0.5 mg IV may further slow the HR.

39
Q

How does Atropine work?

A

Atropine works by reversing cholinergic-mediated decreases in HR.

40
Q

What medication is used to treat Beta-Blocker induces bradycardias or hypotension?

A

Glucagon

41
Q

What type of drug is Atropine and how does it work?

A

-Atropine is an antimuscarinic
-Atropine increases parasympathetic inhibition & allow for pre-existing sympathetic stimulation to predominate, creating increased cardiac output

42
Q

What heart blocks will not likely respond to Atropine?

A

-2nd degree Mobitz Type II
-3rd degree AV Block
-3rd degree AV Block w/ new wide QRS

43
Q

What beta adrenergic drugs can be used as an alternative treatment for bradycardias not responsive to Atropine?

A

-Dopamine
-Epinephrine

44
Q

What can happen if Atropine is given to a heart transplant pt?

A

-Increased likelihood of VF
-Instead treat these pts w/ pacing and/or dopamine or epinephrine.

45
Q

What is the dose of epinephrine for bradycardia?

A

2-10 mcg/min & titrate to pt response

46
Q

What is the dose of dopamine for bradycardia?

A

-5-20 mcg/kg/min & titrate to pt response.
-At lower doses, dopamine has a more selective effect on inotropy & HR; at doses >10 mcg/kg/min dopamine also has vasoconstrictive effects.

47
Q

Patients w/ ACS should be paced at the lowest HR that allows clinical stability—Why?

A

Higher HR can worsen ischemia because HR is a major determinant of myocardial O2 demand & ischemia can precipitate arrhythmias.

ACLS (9 decks)

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