ACLS Study Guide Questions and Answers Already Passed

ACLS Study Guide Questions and Answers Already Passed Primary Survey ABCD A-airway B-breathing C-circulation D-defibrilation Secondary Survey IAID I-intabate (if resp. arrest or can't get good venitlaiton) A-access airway I-IV/IO access for Drugs D-differential diagnosis (H's & T's) What do you do with a non responsive patient? 1st survey, then second survey Med Administration -IV access: large bore 18 g -Site: AC -always flush after med admin What do you do if AED determines non-shockable rhythm? continue chest compressions What is PEA? Pulseless electrical activity (ECG shows activity but there is no pulse felt in patient) ACLS Survey ABCD A-airway B-breathing C-circulation D-defibrilation ACLS Airway Survey SUPPLEMENTAL OXYGEN when indicated: -100% for cardiac arrest -titrate others to achieve 94% O2 sats MONITOR VENTILATION EFFECTIVENESS by: -chest rise/fall -cyanosis -O2 sats -waveform capnography AVOID EXCESSIVE VENTILATION How many ventilations do you provide when patient is in cardiac arrest? With an advanced airway? In respiratory arrest only? 2 ventilations every 30 compressions if advanced airway: 1 every 6-8 seconds if respiratory arrest: 1 every 5-6 seconds What do you do with a non-responsive patient? 1. Shout for help/Activate the Emergency Response System (get AED) 2. Check for Pulse 3. Start CPR What do you do for a patient who is stable and has chest pain? Monitor-support ABC Be prepared to give CPR & Defib Admin Aspirin (O2-sats94%, Nitro, Morphine if needed) Get 12 lead ECG Cases NOT to give Nitro hypotension (SBP 90) bradycardia ( 50/min) tachycardia Nitro Administration 1 tablet (or spray dose) every 3-5 min up to total of 3 doses H's Hypovolemia Hypoxia Hypothermia Hyper/Hypokalemia Hydrogen ions (acidosis) ECG Clues for Hypovolemia Narrow complex Rapid rate Clues from History/Physical for Hypovolemia & Effective Intervention Flat neck veins History of condition *internal bleeding & severe dehydration* Intervention: volume infusion ECG Clues for Hypoxia slow rate Clues from History/Physical for Hypoxia & Effective Intervention Cyanosis ABG Airway Problems Intervention: O2, ventilation, advanced airway ECG Clues for Hydrogen Ions (acidosis) Smaller-amplitude QRS Complexes History/Physical Clues for Hydrogen Ions & Effective Intervention History of diabetes Bicarb responsive pre-existing acidosis Renal Failure Intervention: ventilation; sodium bicarb ECG Clues for HyperKalemia or Hypokalemia Hyper: -tall, peaked T waves -P waves get smaller -QRS widens -sine wave PEA Hypo: -flattened T waves -prominent U waves -QRS widens -QT prolongs -Wide complex tachycardia History/Physical Clues for Hyper/HypoKalemia HYPER: -history of renal failure -diabetes -recent dialysis -dialysis fistulas -medications HYPO: -abnormal loss of potassium -diurectic use Effective Interventions for Hyper/HypoKalemia HYPER: -Calcium chloride -Sodium Bicarb -Glucose plus insulin -Possibly albuterol HYPO: add magnesium if cardiac arrest ECG Clues for Hypothermia J or Osborne waves History/Physical Clues for Hypothermia history of cold exposure central body temp T's Tension pneumothorax Tamponade, cardiac Toxins (drug overdoses) Thrombosis (pulmonary) Thrombosis (cardiac-MI) ECG Clues for Tension pneumothorax narrow complex slow rate (Hypoxia) History/Physical Clues for Tension pneumothorax & Effective Intervention history of condition no pulse felt w/CPR neck vein distention tracheal deviation unequal breath sounds difficulty ventilating patient INTERVENTION: needle decompression; tube thoracostomy ECG Clues for Tamponade (cardiac) narrlow complex rapid rate History/Physical Clues for Tamponade & Effective Intervention history of condition no pulse felt w/CPR vein distention INTERVENTION: pericardiocentesis ECG Clues for Toxins various but predominately prolongation of QT interval History/Physical Clues for Toxins & Effective Intervention bradycardia empty bottles at scene pupils neurologic exam INTERVENTION: intubation; specific antidotes ECG Clues for Thrombosis (pulmonary) narrow complex rapid rate History/Physical Clues for Thrombosis (pulmonary) & Effective Intervention history of condition no pulse felt w/CPR distended neck veins prior positive test for DVT or PE INTERVENTION: surgical embolectomy; fibrinolytics ECG Clues for Thrombosis (Cardiac-MI) abnormal 12-lead ECG with -Q waves -ST segment changes -T waves, inversions History/Physical Cues for Thrombosis (Cardiac-MI) & Effective Intervention history of condition cardiac markers good pulse with CPR INTERVENTION: none listed Amiodarone VF/VT Cardiac Arrest (unresponsive to Shock, CPR & Vasopressor-epi) -first dose 300mg -second dose 150mg NON Arrest -150 mg Atropine Bradycardia (with or without ACS) -0.5mg every 3-5 min not to exceed 3 mg Adenosine stable, narrow complex SVT -first dose: 6 mg -second dose: 12mg given 1-2 min after 1st dose Vasopressin Cardiac Arrest: -40 mg 1 time only -can be given instead of 1st or 2nd dose of EPI Dopamine Bradycardia (used after atropine) use for hypotension 70 w/S&S of shock -2 to 20 mcg/kg per min Magnesium Sulfate Cardiac Arrest (due to Hypomagnesemia OR Torsades de Pointes) -1 to 2 g diluted in 10mL of D5W IV/IO Torsades de Pointes w/Pulse or AMI with Hypomagnesemia -1 to 2 g mixed in 50-100mL of D5W over 5-160 min What is the desired PETCO2? 35-40 or = 10 means good compressions 10 means need to evaluate compressions When is synchronized cardioversion indicated? Symptomatic or Unstable SVT VT with pulses What joules dose do you use during cardio version? Atrial flutter and SVT: initial 50 J - 100 J Monomorphic VT with pulse: inital 100 J Unstable atrial fib: -monophasic dose 200 J -biphasic dose 120 J - 200 J Which drugs can be given through ET tube? lidocaine vasopressin epi atropine