BLS and ACLS COPY Flashcards by Frankie Aguinot

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VF cardiac arrest survival rates decrease how much per minute delay in defibrillation WITHOUT CPR

7-10%

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survival rates decrease how much per minute delay in defibrillation WITH CPR

3-4%

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Rescue breathing cycle

1 breath every 5-6 seconds

or 10-12 breaths/min

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CPR Cycles

30 compressions and 2 breaths

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CPR compression rate

100 - 120 per min

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CPR compression depth

2” adult

5cm child

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What two condition do you shock patients?

VF/pVT

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In ACLS what medicine do you give every 3-5 minutes

Ephinephrine

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in ACLS what medicine do you give for VF/pVT

Amiodarone

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In cardiac arrest algorithm, after BLS what are the two main branches?

VF/VT

PEA/Asystole

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In cardiac arrest algorithm, What do you do after determining it is VF/VT?

Shock 360/200 + CPR > SAS

Shock 360/200 + CPR + Epinephrine 1 mg > SAS

Shock 360/200 + CPR + Amiodarone 300mg

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In cardiac arrest algorithm, What do you do after determining it is PEA/Asystole?

CPR + Epinephrine 1mg

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In cardiac arrest algorithm, how much epinephrine is administered?

1mg

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In cardiac arrest algorithm, how much amiodarone is administered?

300mg

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What is the acronym for cardiac arrest algorithm?

SCREAM

Shock
CPR
Rhythm Check
Epinephrine
Amiodarone

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What are the Hs that need ACLS (5)

hypoxia
hypovolemia
hydrogen ion
hyper/hypokalemia
hypothermia

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What are the Ts that need ACLS (5)

tension pneumothorax
tamponade
toxins
thrombosis, pulmo
thrombosis, coronary

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In bradycardia algorithm, what are the two main branches after BLS?

Unstable

Stable

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In bradycardia algorithm, what are the steps for unstable?

atropine So4 0.5mg TIV > trancutaneous pacing > dopamine/epinephrine infusion > transvenous pacing

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In bradycardia algorithm, how much atropine is administered?

0.5mg TIV

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In bradycardia algorithm, what are the steps for stable?

observe and monitor

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In tachycardia algorithm, what are the two main branches?

stable and unstable

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In tachycardia algorithm, how are the two main branches subdivided?

wide (VT)

narrow

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In tachycardia algorithm, what are the steps for untable wide (VT)?

Sedate + Cardiovert 100J

In tachycardia algorithm, what are the steps for unstable narrow?

Regular (SVT) > sedate + cardiovert 50-100J + Adenosine Irregular (AF) > sedate + cardiovert 120-200J

In tachycardia algorithm, what are the steps for stable wide (VT)?

. Adenosine . Amiodarone . Sotalol . Procainamide

In tachycardia algorithm, what are the steps for stable narrow?

. Vagal maneuvers . Adenosine . Bb/ccb . Expert consultation

In tachycardia algorithm, what is the common medicine?

Adenosine

In what two conditions are amiodarone administered in ACLS?

cardiac arrest VF/VT tachycardia stable wide VT

In what two conditions are adenosine administered in ACLS?

tachycardia unstable narrow regular svt tachycardia stable wide VT

Which tachycardia state receives cardiovert 100J?

tachycardia unstable wide vt

which tachycardia state receives cardiovert 50-100J?

tachycardia unstable narrow regular svt

which tachy cardia state receives cardiovert 120-200J?

tachycardia unstable narrow irregula af

In SCA, which is more important? Chest compression Maintain O2 and eliminate CO2

Chest compressions

In SCA, when is maintaining O2 and eliminate CO2 more important than chest compressions?

prolonged VF in SCA and asphyxial arrest

Why is 100% oxygen optimised oxyhemoglobin content important?

hopoxemia leads to anaearobic metabolism which may blunt benefits of chemical and electrical therapy

What underlying conditions could be a cause of hypoxia in the SCA patient?

. Underlying respiratory disease . low cardiac output . intrapulmonary shunting . ventilation-perfusion mismatch

What is the oxygen level in exhaled air for rescue breathing?

16-17%

What is the best practice for bag-valve device in ventilation?

2 operators: 1 to hold mask, 1 to ventilate

a 1-2 L of O2 bag capacity delivers how much O2?

600ml

oral airways are used for what type of patient?

unconscious

nasal airways are used for what type of patient?

with trismus and biting

What is a considering of using advance airways in ACLS?

minimal interruption of cardiac compression

what are the advantages of laryngeal mask airway (LMA) in ACLS?

. more secure and reliable than BVM . LMA equavalent ventilation than ET . LMA not require larygonscopy and visualization of vocal cords

Whare are the advantages of ET intubation in ACLS?

. Isolates the airway, keeping it patent . reduce risk of aspiration . provides conduit for suctioning secretions . delivers high concentration of oxygen . provides route for drug administration . ensures delivery of selected tidal lung volume to maintain lung inflation

What are the drugs for ACLS that are administered thru ETT?

``` . Naloxone . Atropine . Vasopressin . Epinephrine . Lidocaine ```

What is the size of the ETT for adult male?

8.0-8.5 mm ID

What is the size of the ETT for adult female?

7.0-7.5 mm ID

What is are parts of postintubation care in ACLS?

. Record the depth of the ET . Secure the ET using tapes . Chest X-Ray for confirm position

What are the 4 arrest rythms?

. VF . VT . Pulseless Electrical Activity . Asystole

Jugular, Subclavian femoral, Supraclavicula a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

a. Centeral IV access

Rapid arrival of drug at site of action a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

a. Centeral IV access

Increase risk of complications : subcutaneous emphysema, pneumothorax a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

a. Centeral IV access

Antecubital or external jugular a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

b. Peripheral IV access

Antecubital or external jugular a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

b. Peripheral IV access

Easier to learn, few complications a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

b. Peripheral IV access

No interruption CPR a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

b. Peripheral IV access

Venous access is not achieved a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

c. Intraoseaous access

Jamshidi needle a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

c. Intraoseaous access

proximal tibia below the tuberosity or at the distal femur a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

c. Intraoseaous access

Pediatric patients a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

c. Intraoseaous access

osteomyelitis a. Centeral IV access b. Peripheral IV access c. Intraoseaous access

c. Intraoseaous access

What are IV fluid expanders? Which are given to pediatric patients?

. Fresh Whole Blood . Crystalloid solutions - pedia . Colloid Solutions - pedia

What type of IV fluid is preferred for CPR?

Plain NSS or LR

What is volume administration recommeded in routine cardiac arrest?

indication of volume depletion

Which has a worse neurologic outcome? What is MOA? Hyperglycemia or hypoglycemia

Hyperglycemia due osmotic diuresis

Sodium overload is rare/common

rare

What is the dose for volume expanders in neonates?

Dose 10 ml / kg

What are the IV fluids given to neonates?

Plain NSS or LR

Lidocaine • Amiodarone a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

a. control heart rhythm and rate

* Adenosine * Beta-Blockers a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

a. control heart rhythm and rate

* Procainamide * Atropine a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

a. control heart rhythm and rate

• Verapamil/ Diltiazem a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

a. control heart rhythm and rate

Epinephrine • Norepinephrine a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

b. improve cardiac output and blood pressure

* Dopamine * Dobutamine a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

b. improve cardiac output and blood pressure

* Sodium Nitroprusside * Nitroglycerine a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

b. improve cardiac output and blood pressure

* Digitalis * Diuretics a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

b. improve cardiac output and blood pressure

* Morphine SO4 * Oxygen a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

c. myocardial infarction

* Nitroglycerine * Aspirin a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

c. myocardial infarction

• Thrombolytic agents : Streptokinase, r- TPA, Heparin a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

c. myocardial infarction

* Glycoprotein IIb/IIIa inhibitors * Beta Blockers a. control heart rhythm and rate b. improve cardiac output and blood pressure c. myocardial infarction

c. myocardial infarction

Steps of post cardiac arrest care

``` Insertion of an NGT > decompress the stomach of air due BVM ventilation • Insertion of foley catheter > measure urine output • Take a 12 lead ECG • Do portable chest radiographs • Therapeutic hypothermia • Antibiotics • Nutrition ```

In post cardiac arrest care what is the purpose of insertion of an NGT?

decompress the stomach of air due BVM ventilation

In post cardiac arrest care what is the purpose of insertion of foley catheter?

measure urine output

question

answer

What are the regions of the abdominal area

right/left hypochondraic region, epigestric region right/left lumbar region, umibilical region right/left iliac region, hypogastric region

Hepatitis right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

right hypochondraic region

cholecystitis right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

right hypochondraic region

peptic ulcer right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

epigestric region

pancreatitis right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

epigestric region

splenic injury right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

left hypochondraic region

renal and uretic pain right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

right lumbar region | left lumbar region

(back) bowel obstruction right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

umibilical region

aortic aneurysm right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

umibilical region

appendicitis right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

right iliac region

pelvic pain right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

hypogastric region

diverticulitis right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

left iliac region

Where does peptic ulcer and pacreatic pain refer to? right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

right lumbar region left lumbar region umibilical region (from epigestric region)

Where does aortic aneurysm pain refer to? right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

to back

back

Where does diverticulitis pain refer to? right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right iliac region left iliac region hypogastric region

left lumbar region

Where does pelvic pain refer to? right hypochondraic region left hypochondraic region epigestric region right lumbar region left lumbar region umibilical region right region left iliac region hypogastric region

right iliac region | left iliac region

lung bugs stomach foregut midgut hindgut

foregut

upper abdominal pain foregut midgut hindgut

foregut

periumbilical pain foregut midgut hindgut

midgut

mesophrenic duct cloaca foregut midgut hindgut

hindgut

lower abdominal pain foregut midgut hindgut

hindgut

abdominal wall autonomic nerves somatic nerves

somatic nerves (SPW)

parietal peritonium autonomic nerves somatic nerves

somatic nerves (SPW)

abdominal organs autonomic nerves somatic nerves

autonomic nerves (AVO)

visceral peritonium autonomic nerves somatic nerves

autonomic nerves (AVO)

inflammatory causes of acute abdominal pain

``` appendicitis diverticulitis cholecystitis PID pancreatitis pyelonephritis intra-abdominal abcess ```

perforation/rupture causes of acute abdominal pain

peptic ulcer diverticular disease ovarian cyst aortic aneurysm

obstruction causes of acute abdominal pain

intestinal obstruction biliary colic ureteric colic

severe pain triage level 1 level 2 level 3

level 2

abdominal pain with stable vitals triage level 1 level 2 level 3

level 3

history taking abbreviation

SOCRATES ``` site onset character radiation associated symptoms time exacerbating factors severity (subjective pain) ```

What are the steps of abdominal examination?

inspection palpation percussion auscultation

What are you looking for in auscultation of the abdomen?

bowel sounds bruit

Signs for appendititis

rovsing's sign point sign (McBurney's) psoas sign obturator sign

ddx for pain/vomiting ± rigidity

acute pancreatitis diabetic gastric paresis dka incercerated hernia

ddx for pain/vomiting/distention

bowel obstruction | celcal volvulus

ddx pain (±vomiting)

``` acute diverticulitis adnexal torsion mesenteric ischemia myocardial ischemia testicular torsion ```

ddx pain/shock

``` abdominal sepsis aortic dissection hemorrhagic pancreatitis leaking/ruptured abdominal aortis aneurysm mesenteri ischemia (late) MI ruptured ectopic pregnancy ```

abdominal pain which later shifts to right iliac fossa

acute appendicitis

periumbilical or loin bruising

acute pancreatitis

blood in stool

acute diverticulitis

murphy's sign

acute cholecystitis

pain in right hypochondrium radiating to should or scapula

acute cholecystitis

asymmetrical femoral pulses

ruptured aortic aneurysm

lab test for pancreatitis

lipase (amylase if lipase not available)

lab test for mesenteric ischemia

lactate

question

answer

how many newborns require assistance to begin breathing?

it is 10%

What 3 questions used to identify neonate who do not need resuscitation?

Term? Tone? Breathing or crying?

What are the initial steps in stabilizing neonate needing resusciation?

``` warm and maintain normal temp clear secretions (only if copious and/or obstructing the airway dry stimulate position infant in "sniffing" position ```

After the stabilization of neonate requiring resuscitation, what other steps maybe taken?

ventilate and oxygenate initiate chest compressions admnister epinphrine and/volume

What determines if there is need for additional steps for neoatal resuscitation?

``` respirations heart rate (<100/min) ```

What is target heart rate for neonate?

>100/min

What serious morbidities are there with hypothermia in neonates?

IVH, respiratory issues, hypoglacemia, late-onset sepsis

Possible complications of using suction immediately after birth?

deterioriating pulmonary compliance, oxygenation, and cerebral blood flow

What is the most rapid and accurate way to meansure heart rate of neonate?

3 lead ECG

When are chest compressions indicated for neonate?

HR <60/min despite ventilation

How are chest compression performed on neonate?

lower third of sternum | one thirs of the AP diameter of chest

What medication can be used for neonate needing resuscitation?

epinephrine

When is volume expansion indicated for neonate needing resusitation?

blood loss known or suspected | hr non responsive to other methods

What is a possible complication of volume expansion in neonates?

IVH (intraventricular hemorrhage)

What may be used for volume expansion in neonates?

isotonic crystalloid solution | blood

What is guideline for discontinuing resuscitative efforts in neonates?

Apgar score of 0 at 10 minutes (determine if HR is detectable or not)

question

answer

pulmonary etiologies of DOB

``` COPD asthma restrictive lung disorder hereditary lung disorder pneumonia pneumo-thorax ```

cardiac etiologies of DOB

``` CHF Coronary artery disease (CAD) MI cardiomyopathy valvular dysfunction left ventricular hypertrophy pericarditis arrythmias ```

mixed cardiac/pulmonary etiology of DOB

chronic pulmonary emboli pleural effusion deconditioning COPD with HTN and/or cor pulmonale

noncardiac or nonpulmonary etiology of DOB

``` metabolic disorders pain trauma neuromuscular disorders functional cheminal exposure ```

< 20 yo asthma COPD

asthma

worse during night or early morning asthma COPD

asthma

lung function normal between symptoms asthma COPD

asthma

variable airflow limitation asthma COPD

asthma

CXR normal asthma COPD

asthma

> 40 yo asthma COPD

COPD

daily symptoms and exertional dyspnea asthma COPD

COPD

persistent airflow limitation asthma COPD

COPD

lung function abnormal between symptoms asthma COPD

COPD

CXR shows severe hyperinflation asthma COPD

COPD

possible clinical features of severe asthma

``` tachypnea tachycardia silent chest cyanosis accesssory muscle use altered consciouness ```

Why use PEF for asthma dx

more convinient and cheaper than FEV1

What SpO2 level do you seek to maintain withoxygen therapy

92% O2

When is ABG necessary for DOB?

patients with SpO2 <92% or features of life threatening asthma

Management of asthma accronym

ASTHMA ``` Adrenergics (beta 2 agonists - Albuterol) Streoids Theophylline Hydration (IV) Mask O2 Anticholinergics ```

digital clubbing + DOB

COPD

pursing of lips + DOB

COPD

COPD airflow obstruction level

FEV1/FVC ratio <0.7 post-bronchodilator

What is performed to diagnose COPD

spirometry, post-bronchodilator

COPD spirometry is performed (pre/post) bronchodilator

post bronchodilator

COPD exacerbations mangement

``` O2 bronchodilators (SABA with or without short-acting anticholinergics) systemic corticosteroids (40 mg prednisone per day for 5 days) ```

Type 1 pneumonias (2)

lobar and bronchopneumonia

Type 2 pneumonia (2)

CAP and HAP

patch consolidation usually in bases of both lungs what type of pneumonia?

bronchopneumonia

What is the point criteria for treatment of penumonia? Acryonym and scoring

CURB 65 ``` Confusion Uremia Respiratory Rate >30 Blood pressure low 65 yo or greater ```

Uses structure for classification ACCF/AHA stages of HF NYHA functional

ACCF/AHA stages of HF

Cardiogenic shock. Hypotension, peripheral vasoconstriction Kilip classification Stage I Stage II Stage III Stage IV

Stage IV

Severe HF. Frank pulmonary edema with rales Kilip classification Stage I Stage II Stage III Stage IV

Stage III

HF. Rales, S3 gallop and pulmonary venous hypertention Kilip classification Stage I Stage II Stage III Stage IV

Stage II

Acute HF management

SpO2 95-98% patent airway and FiO2 can be increased diuretics (secondary to fluid retension)

MC cause of dyspnea in AHF

pulmonary edema

In AHF, morphine induced the following

venodilation mild aterial dilation redude HR

In AHF, what is a potential adverse effect?

increasing need for inasive ventilation

reduce LV-preload and after-load wo imparing tissue perfusion nitrates sodium nitroprusside nesiritide inotropes

nitrates

hypertensive HF or MR, severe HR with predominantly increased after-load nitrates sodium nitroprusside nesiritide inotropes

sodium nitroprusside

reduce preload and after-load, increase CO wo direct inotropic effects nitrates sodium nitroprusside nesiritide inotropes

nesiritide

Pts with severely reduced cardic output compromised vital organ perfusion nitrates sodium nitroprusside nesiritide inotropes

inotropes

When are vasopressors indicated?

combination inotropic agent and fluid challenge fails to restore adequate arterial pressure and organ perfusion

HVS causes (increase/decrease) pCO2 which leads to (metabolic/respiratory) (alkalosis/acidosis)

HVS causes DECREASE pCO2 which leads to RESPIRATORY alkalosis

common ddx for HVS

acute coronary syndrome pulmonary embolism CO2 poisoning

HVS has (abnormal/normal) pH with (high/low) PaCO2 and a (high/low) bicarbonate level

HVS has NORMAL pH with LOW PaCO2 and a LOW bicarbonate level

Pharmaco therapies for HVS

benzodiazepines lorazepam (ativan) diazepam (valium) paroxetine (paxil)

BLS and ACLS COPY Flashcards

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