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Health Assessment > Exam 1 ACLS > Flashcards

Exam 1 ACLS Flashcards

1
Q

What HR would be considered bradyarrhythmia?

A

Less than 50 bpm

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2
Q

What is the leading cause of bradycardia?

What are other causes of bradycardia?

A

Hypoxia

MI/infarction
Drugs/toxicities (CCB, BB, Dig)
Hyperkalemia

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3
Q

What can persistent bradyarrhythmia cause?

A

Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF

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4
Q

What do you do if someone is bradycardic but clinically stable?

A

Monitor and observe

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5
Q

What is the treatment for bradycardia?

A

1 mg Atropine every 3 to 5 minutes.
Max: 3 mg

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6
Q

What to do if atropine is ineffective for bradycardia?

A

Transcutaneous pacing and/or dopamine infusion or epinephrine infusion.

Dopamine infusion: 5-20 mcg/kg/min TTE
Epinephrine infusion: 2-10 mcg/min TTE

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7
Q

Why do you have to be cautious about when giving atropine for adult bradycardia?

A

A very low dose (0.1 mg) can actually worsen bradycardia. Make sure you give 1 mg.

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8
Q

How do you treat bradycardia secondary to calcium channel blockers?

A

Give Calcium

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9
Q

How do you treat bradycardia secondary to beta blockers?

A

Glucagon and give something for rate support while the glucagon kicks in

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10
Q

How do you treat bradycardia secondary to digoxin?

A

Digibind or Digifab

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11
Q

What is the rate for CPR?

A

100-120 compressions/min

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12
Q

Features of quality CPR?

A

Push hard (2 in) and fast (100-120/min)
Minimize interruptions in compressions
Avoid Excess ventilation
Change Compressors every 2 minutes or fatigued
30:2 compression: ventilation ratio if no airway
ETCO2 > 35-45 mmHg (normal)

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13
Q

ETCO2 of what level indicates perfusion.

A

15 mmHg

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14
Q

Shock Energy for Defibrillation
Biphasic:
Monophasic:

Shockable rhythms:
Non-shockable rhythms:

A

Biphasic: Manufacturer recommendation (120 to 200J)
Monophasic: 360J

Shockable rhythms: V-fib/ pulseless V-tach
Non-shockable rhythms: PEA/Asystole

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15
Q

Drug Therapy for Cardiac Arrest

A

Epinephrine IV/IO: 1mg every 3 to 5 minutes

Amiodarone IV/IO: first dose 300mg bolus, second dose 150mg

Lidocaine IV/IO: First dose 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

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16
Q

Should you stop CPR to place an advanced airway?

A

No, oftentimes a supraglottic airway (LMA) will be placed during the code. Once the patient is stabilized, they will be intubated.

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17
Q

What is used to confirm and monitor ET tube placement?

A

Waveform capnography or capnometry

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18
Q

With an advanced airway, one breath will be delivered every ______ seconds.

A

6 seconds/ 1 breath

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19
Q

What are indications of Return of Spontaneous Circulation (ROSC).

A

Palpable Pulse
Blood Pressure, spontaneous atrial pressure wave
Abrupt sustained increase in ETCO2 (15 mmHg to 40 or 50 mmHg)

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20
Q

What are your reversible causes of cardiac arrest (H’s and T’s )

A

Hypovolemia - give blood, fluids
Hypoxia - oxygen and airway
Hydrogen Ion (acidosis)- bicarb and ventilation
Hypo/Hyperkalemia
Hypothermia- cold hearts are irritable

Tension Pneumothorax - can result in PEA, decompress chest
Tamponade, Cardiac- Pericardiocentesis
Toxins- use antidotes
Thrombosis (PE) -cannulation/ECMO/thrombectomy
Thrombosis (Coronary)-cannulation/ECMO/thrombectomy

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21
Q

How often do you defibrillate a shockable rhythm?

A

every 2 minutes

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22
Q

What HR is considered tachyarrhythmia?

A

HR greater than 150 bpm

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23
Q

What can persistent tachyarrhythmias cause?

A

Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF

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24
Q

Treatment for unstable tachycardia:

A

Synchronized Cardioversion
-consider sedation

25
Q

Difference between wide and narrow complexes in tachycardia.

A

Narrow complexes are supraventricular (consider adenosine)

Wide complexes are ventricular (consider ventricular antiarrhythmics )

26
Q

What is the dose for adenosine for SVT?

A

First dose: 6 mg rapid IV push; follow with NS flush
Second dose: 12 mg

27
Q

IV Amiodarone dosing for stable wide complex tachycardia.

A

Amiodarone: First dose 150 mg over 10 minutes followed up by 1 mg/min infusion for first 6 hours, 0.5 mg/min for the next 18 hours.

28
Q

What is the IV dosing for Procainamide for stable wide tachycardia?

A

20 to 50 mg/min until arrhythmia suppression,
Hypotension ensues, QRS duration >50%, or max dose of 17 mg/kg.

Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.

29
Q

What is the IV dosing for Sotalol for stable wide tachycardia?

A

100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.

30
Q

Treatment for patients with stable narrow tachycardia.

A

Vagal maneuvers
Adenosine
Beta-blockers (esmolol)
Calcium channel blockers
Carotid sinus massage (young person)
Expert consultation

31
Q

What is the first thing to do after ROSC has been obtained?

A

Manage the airway, with the early placement of an endotracheal tube.

Manage respiration: 10 breaths/min, SpO2 >92%, PaCO2: 35-45 mmHg

Manage hemodynamic parameters: > 90/65, MAP>65

Obtain 12 Lead

32
Q

When to consider emergency cardiac intervention post ROSC?

A

STEMI present
Unstable cardiogenic shock
Mechanical circulatory support required (ECMO, balloon pump)

33
Q

Interventions if the patient is unable to follow commands post ROSC?

A

Targeted temperature management
Head CT
EEG monitoring

34
Q

What is the antidote for Magnesium overdose?

A

Calcium chloride or gluconate

This can happen in a pregnant patient receiving Magnesium for PIH

35
Q

Why do you want IV access to the upper extremities for pregnant patients undergoing cardiac arrest?

A

The patient has uteroplacental displacement. Medication to IVs on the lower extremity might not reach the heart.

36
Q

If no ROSC within _________ minutes, consider immediate perimortem c-section.

A

5 minutes

37
Q

What are the potential etiology of maternal cardiac arrest?

A

Anesthetic complication - spinal
Bleeding - C-section, maternal hemorrhage-DIC
Cardiovascular - underlying issue
Drugs - meth
Embolic -amniotic fluid embolism
Fever
General (H’s and T’s)
Hypertension - Mag overdose for PIH

38
Q

What meds do you give to treat amniotic fluid embolism?

A

Atropine
Ondansetron
Ketolorac (Tordal)

AOK

39
Q

What are the biggest causes of asystole and PEA in pediatrics?

A
  1. Hypoxia
  2. Hypotension
40
Q

How far do you compress during CPR for pediatrics?

A

one-third of the anteroposterior diameter of the chest.

41
Q

Drug therapy during pediatric cardiac arrest.

A

Epinephrine: 0.01 mg/kg every 3 minutes up to a max of 1 mg.

Amiodarone: 5mg/kg bolus up to 3 doses for v-fib/pVT

Lidocaine: 1mg/kg loading dose

42
Q

For pediatric patients when do you start CPR?

A

Start CPR if the patient is symptomatic and HR is less than 60 bpm despite oxygenation and ventilation

43
Q

Meds for pediatric bradycardia.

A

Start with Epinephrine 0.01 mg/kg every 3-5 mins

Atropine 0.02 mg/kg, repeat once.
Minimal Atropine dose 0.1 mg
Max atropine Single dose 0.5 mg

44
Q

Other interventions for pediatric bradycardia?

A

Transthoracic/ Transvenous pacing
ID causes (hypothermia, hypoxia, meds)

45
Q

What is the most common cause of pediatric tachycardia?

A

Pre-existing cardiac disease rather than ischemic events.

46
Q

What HR is considered tachyarrhythmia for a child and infant?

A

Child >180 bpm
Infant >220 bpm

47
Q

What is the intervention for an unstable tachycardiac pediatric patient?

A

Synchronized Cardioversion
Begin with 0.5 - 1.0 J/kg; if not effective increase to 2 J/kg.
Sedate if needed, but don’t delay cardioversion

48
Q

What is the medication of choice for pediatric SVT?

A

Adenosine
First dose 0.1 mg/kg rapid bolus (max of 6 mg)
Second dose 0.2 mg/kg rapid bolus (max of 12 mg)

49
Q

When do you give adenosine for ventricular tachycardia?

A

If the rhythm is regular and monomorphic

50
Q

What are ways to treat stable SVT in children?

A

Vagal maneuvers (blow up a ballon)

51
Q

What is the scoring system for neonates?

A

APGAR score (0-2 points per category)
Score greater than 7, baby is in good health.

Activity
Pulse
Grimace
Appearance
Respiration

52
Q

What to do with neonates if they are not a term gestation, do not provide good tone, and not breathing/crying immediately after birth?

A

Within the first minute:
Warm and maintain a normal temperature
Position Airway
Clear Secretion
Dry
Stimulate

53
Q

What happens if the neonate is showing apnea or gasping after initial intervention?

A

Positive Pressure Ventilation
SpO2 monitor
EKG monitor

54
Q

What happens if the neonate is labored breathing or presents persistent cyanosis after initial intervention?

A

Position and clear airway
SpO2 monitor
Supplementary O2 as needed
Consider CPAP

55
Q

What happens if the neonate is bradycardic (<100 bpm) after initial intervention?

A

Check chest movements
Check for adequate ventilation
ETT or laryngeal mask (know where pediatric equipment is located)

56
Q

What happens if neonate’s HR drops below 60 bpm?

Medications?

A

Intubate if not already done
CPR
Coordinate with PPV
100% O2
EKG Monitor
Consider emergency UVC (In reality, just cannulated the umbilical vein like an IV externally)

IV epinephrine (0.01 mg/kg) every 3-5 minutes

57
Q

Considerations for neonate bradycardia after epinephrine and other interventions?

A

Consider hypovolemia
Consider pneumothorax
Check blood sugar (hypoglycemia)
Narcan

58
Q

What treatment is most important to convert v-fib?

A

Defibrillation

59
Q

What is the initial dose of lidocaine to treat v-fib?

A

1 to 1.5 mg/kg

Health Assessment (30 decks)

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