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Flashcards in Cardio/ cerebral Deck (26):
1

As you walk into the resuscitation bay, what initial steps should be taken to evaluate and manage this cardiac arrest victim?

1- BLS primary survey
2- Obtain finger stick blood sugar
3- ACLS secondary survey

2

Dentures and airway

-Dentures may be left while bagging--> better seal/ prevent airway occlusion
-should be removed prior to intubation.

3

Check carotid pulse for ________ time

at least 5 seconds, but not longer than 10 seconds.

4

Intubation vs circulation

Endotracheal intubation should not delay delivery of defibrillation in patients with a shockable rhythm.

5

A ________ does not ensure endotracheal intubation.

chest x-ray

6

endotracheal (ET) tube NAVEL dosing

The optimal dosing has not been established
~2-2 1/2 times the IV route is generally accepted.

7

NAVEL: ACLS Drugs Safe for Endotrachael Administration

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine

8

More than 1/2 of arrests in the US are ________ in origin

cardiac

EKG can offer evidence of cardiac ischemia, various toxin exposure, or hyperkalemia.

9

Almost all episodes of sudden cardiac death initiate from a ___________

ventricular tachydysrhythmia

Successful resuscitation is dependent on rapid defibrillation.

10

Improved survival with ventricular tachydysrhythmia is related to ___________ within 10 minutes of onset.

bystander CPR
initial shockable rhythm--> rapid defibrillation
initiation of ACLS

*within 10 minutes of onset*

11

Once pulseless VT or VF is identified, the patient should be immediately defibrillated using ___________ (strength of shock)

200J on a biphasic defibrillator
360J on a monophasic defibrillator

12

ACLS recommends chest compressions should be interrupted only for

ventilation
rhythm checks
shock delivery

13

After 2 minutes of CPR, _________ should be rechecked
*interruption in CPR less than 10 seconds.

the rhythm should be rechecked

*interruption in CPR less than 10 seconds.

14

__________ may be given for torsades de pointes.

Magnesium

15

With PEA, give epin 1mg every 3-5 minutes, but __________ can be substituted for the 1 or 2 dose

Vasopressin 40 U can be substituted for the first or second dose of epinephrine.

16

___________ should be considered for asystole or slow PEA .

Atropine 1mg IV/IO

may be repeated every 3- 5 min f
max of 3 doses

17

Studies have shown that resuscitation efforts are unlikely to be successful after ___________ of combined BLS and ACLS

20 minutes

18

Of pts with return of spontaneous circulation after cardiac arrest, _________ will survive until hospital discharge.

less than one-half will survive until hospital discharge.

19

ACLS recommends unconscious pts with return of spontaneous circulation should be cooled to ___________ when VF was the initial rhythm.

32-34 C for 12-24 hours

*mild hypothermia has shown ↓ 6 month mortality rate with improved recovery at discharge

20

Inclusion Criteria for Therapeutic Hypothermia

-Patients resuscitated after out-of-hospital witnessed arrest with VT/VF as initial rhythm
-Resuscitation initiated by EMS within 5-15
-No more than 60 min from collapse to return of spontaneous circulation
-Persistent coma after ROSC
-Adult age
- intubation and mechanical ventilation

21

Contraindications to Therapeutic Hypothermia

-Severe cardiogenic shock (SBP<90 mmHg) despite fluids and inotropes
-coma not cardiac arrest (overdose, CVA)
-Known coagulopathy
-Life-threatening arrhythmias
-Initial temperature <30 C
-Pediatric/ Pregnancy

22

costochondritis

inflammatory process of costochondral / sternal joints
--> localized pain and tenderness

23

Hyperkalemia cardiac Rx

-unstable cardiac rhythm--> Calcium (gluconate/ chloride)
-no ECG abnormalities--> potassium binding resins (Kayexalate)

24

Absolute contraindications to TPA include

• Previous hemorrhagic stroke
• Known intracranial neoplasm
• Active internal bleeding (excluding menses)
• Suspected aortic dissection or pericarditis

25

Troponin level vs time

-rise 3-6 hours of CP onset
-peak 12-24 hours,
-remain elevated for 7-10 days

26

pericarditis classic s/s


-chest pain, a pericardial friction rub, and diffuse
ST-segment elevation

-pain relieved by sitting forward and worsened by lying down or swallowing