ACLS Questions with Complete Solutions Rated A+

Targeted temperature management - adults. - 32 - 36 C (89.6 - 95.2F). Titrate inspired O2 to... - the lowest level required to achieve arterial O2 sat 94% + to avoid complications associated with O2 toxicity. Mean arterial pressure goal - 65 mm Hg or greater A team leader should be able to explain why it is essential to... - push hard and fast in center of chest. ensure complete chest recoil. minimize interruptions in compressions. avoid excessive ventilation. A team member should be... - clear about role assignments. prepared to fill their responsibilities. well practiced in resuscitation. knowledgeable about algorithms. committed to success. Resuscitation triangle (3) - Compressor: assessed pt, 5 cycles chest compressions, alternates with AED person every 5 cycles or 2 min. AED/Defibrillator Monitor: brings and operates AED, places monitor where it can be seen by team leader, alternates with compressor every 5 cycles or 2 min. Airway: Opens airway, provides bag-mask ventilation, inserts airway adjuncts as appropriate. Leadership roles (3) - Team leader: every team needs one. assigns roles to team members, makes treatment decisions, provides feedback, assumes responsibility for roles not assigned. Meds: Initiates IV/IO access, administers meds. Time recorder: records time of interventions & medications and announces when next are due, records frequency and duration of interruptions in compressions, communicates to the team leader. Should you start CPR when you are unsure about a pulse? - Yes, unnecessary compressions are less harmful than failing to provide compressions when needed. Agonal gasps - A sign of cardiac arrest! May be present in first minutes. Looks like pt is drawing in air quickly. Occur at a slow rate. May be forceful or weak. Time passes between gasps. Snort, snore, groan. BLS assessment - Check responsiveness. Shout for help. Get AED/send someone. Look for breathing - chest 5-10 sec. Check pulse at same time. 5-10 sec. No pulse in 10 sec, start chest compressions. If pulse, rescue breathing 1 breath q 5-6 sec. Check pulse q 2 minutes. Defibrillation: check for shockable rhythm, shock, follow with compressions. Minimize interruptions - No longer than 10 sec! Avoid... prolonged rhythm analysis. frequent/inappropriate pulse checks. taking too long to give breaths. unnecessary moving the pt. Coronary Perfusion Pressure (CPP) - Aortic relaxation (diastolic) - right atrial relaxation (diastolic) pressure. Correlates with both myocardial blood flow and return of spontaneous circulation. ROSC does not occur unless it is 15 mm Hg or + If 20 improve chest compressions and vasopressor therapy. Quality compressions - compress 2 in (5 cm). Rate 100-120 BPM. Allow complete recoil. single rescuer CPR - Cardiac arrest: Call for help, get AED, return to pt, start CPR. Hypoxia (drowning): give 2 mins CPR before activating emergency response system. Primary Assessment - Assess before action!!! Airway, Breathing, Circulation, Disability (Alert, Voice, Painful, Unresponsive), Exposure (remove clothing to examine). Secondary Assessment - Focused medical history and physical exam. SAMPLE Signs and sx. Allergies. Medications (including last dose taken). Past medical hx. Last meal consumed. Events. H&Ts - Common reversible causes of cardiac arrest. Hypovolemia, hypoxia, hydrogen ion (acidosis), Hypo/hyperkalemia, hypothermia. Tension pneumo, tamponade (cardiac), toxins, thrombosis (coronary or pulmonary). 2 most common causes of PEA - Hypoxia and hypovolemia. PEA hypovolemia - rapid, narrow-complex tachycardia (sinus tachy). Increased diastolic, decreased systolic pressure. BP drops. Narrow QRS. Common causes: occult internal hemorrhage, severe dehydration. Consider volume infusion. acute coronary syndrome - sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction Tx for PE - Fibrinolytics. Tx for cardiac tamponade - pericardiocentesis. tx for Tension pneumo - needle aspiration and chest tube placement. Drug overdose/toxic exposure - may lead to peripheral vascular dilation and/or myocardial dysfunction with hypotension. Tx: prolonged basic CPR, etracorporeal CPR, intra-aortic balloon pumping, renal dialysis, IV lipid emulsion, digoxin, glucagon, bicarbonate, transcutaneous pacing, correction of electrolyte imbalances. Normal respiratory rate. Normal tidal volume. - 12-16/min. 8-10 ml/kg. ***6 = assisted ventilation with BVM or advanced airway with 100% O2. Respiratory Distress - abnormal respiratory rate or effort. Sx: nasal flaring, retractions, use of accessory muscles, hypoventilation, bradypnea, stridor, wheezing, grunting, tachycardia, cyanosis, changes in LOC, agitation, use of abdominal muscles. Mild respiratory distress sx - mild tachypnea and mild increase in respiratory effort with changes in airway sounds. Severe respiratory distress sx - tachypnea, increased respiratory effort, deterioration in skin color, changes in mental status. Can be indicitive of respiratory failure. Respiratory Failure - inadequate oxygenation, ventilation or both. Often the end stage of respiratory distress. Confirm dx with objective measures (pulseOx, ABGs). Sx of respiratory failure - marked tachypnea, bradypnea, apnea (late), increased/decreased/no effort, poor/absent distal air movement, tachycardia (early), bradycardia (late), cyanosis, stupor, coma (late). Causes of respiratory failure - upper or lower airway obstruction. Lung tissue disease. Disordered control of breathing. Rise in arterial CO2 (hypercapnia). Drop in blood O2. Respiratory arrest - the cessation of breathing. Caused by drowning or head injury. Tx: tidal volume 500-600ml (visable chest rise). ***Pts with airway obstruction or poor lung compliance may require higher pressures. Complications of excessive ventilation - gastric inflation. regurgitation. aspiration. Intrathoracic pressure increase -- decreased venous return to heart -- low cardiac output. cerebral vasoconstriction -- decreased blood to brain. The most common cause of upper airway obstruction in an unconscious pt - loss of tone in the throat muscles -- tongue occluding airway.