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ACLS - 2011 Review
2011 Guideline Review
72
Health Care
Professional
09/25/2011

Additional Health Care Flashcards

 


 

Cards

Term
List the 6 H's in ACLS.
Definition
1. Hypoxia
2. Hypovolemia
3. Hypothermia
4. Hypoglycemia
5. Hypo/HyperKalemia
6. Hydrogen Ion - Acidosis
Term
List the 5 T's in ACLS.
Definition
1. Toxins
2. Tamponade - cardiac tension
3. Tension Pneumothorax
4. Thrombosis
5. Trauma
Term
In a case of a patient in respiratory arrest with a pulse, how many breaths do you give per minute?
Definition
1 breath every 5-6 seconds -- 10-12 breaths per minute
Term
The systematic approach of the BLS survey is….
Definition
Assessment, then action!
Term
When stopping CPR to take a pulse check, what is the maximum amount of time you should take for a pulse check?
Definition
10 seconds.
Term

List the steps of the BLS survey...

 

Definition

1.  Check responsiveness ("Are you alright?" -- check for absent of abnormal breathing"

2.  Activate the emergency response system/getAED

3.  Circulation (check the carotid pulse for 5-10 seconds)

4.  Defibrillation (if no pulse, check for shockable rhythm with AED, follow each shock with CPR starting with compressions)

Term
What are the ventilation rates when using a Bag-Mask during Cardiac Arrest?  Respiratory Arrest?
Definition

Cardiac Arrest:  2 ventilations after every 30 compressions

Respiratory Arrest:  1 ventilation every 5-6 seconds (10-12 breaths per minute)

Term
What are the ABCS's of the ACLS survey?
Definition

A - Airway

B - Breathing

C - Circulation

D - Differential Diagnosis

Term
When delivering assisted ventilation, it is critical to avoid what type of ventilation?  Why?
Definition

Excessive Ventilation.

1.  In can increase intrathoracic pressure.

2.  Decrease venous return to the heart

3.  Decrease Q

Term
Do NOT use the Oropharyngeal Airway (OPA) in patients that are…?
Definition

Conscience.

Always check to see if patient has an intact cough and gag reflex.

Term

Nasopharyngeal Airways devices (NPA) may only be used in unconscious patients.

True or False?

Explain.

Definition

FALSE

The NPA is a soft rubber or plastic uncuffed tube that provides airflow between the nares and the pharynx.  

Term
When would you use a NPA vs. a OPA?
Definition
You may use a NPA on a conscious or semi-conscious patient, a patient with trismus, massive trauma around the mouth, or wiring of the jaws.
Term
A quick way to measure the appropriate sized NPA is?
Definition
The length of the NPA should be the same as the distance from the tip of the patients nose to the earlobe.
Term
You find a patient laying on the ground, unresponsive.  You are alone.  What BLS steps are taken?
Definition

1.  Activate emergency response system and get an AED machine 

2.  Check carotid pulse for 5-10 seconds.

3.  If no pulse, begin chest compressions (30:2)

4.  Hook up AED machine to patient chest.

5.  Rhythm is shockable, give 1 shock and resume CPR immediately for 2 minutes (if rhythm is not shockable, resumeCPR immediatly and check rhythm every two minutes)

Term

A patient in VT has just had a successful defibrillation and has begun normal sinus rhythm.  You can now stop chest compressions.

True or False?

Definition

FALSE

It is important to continue chest compressions immediately after a shock for several minutes until adequate heart function resumes.

Term
Use AEDs only when a patient has what 3 clinical findings?
Definition

1.  No response

2.  No pulse

3.  Abnormal or absent breathing (no breathing or only gasping)

Term
If a patient has collapsed, but is gasping…what steps should be taken to treat?
Definition
Call emergency response team, check pulse, if patient is gasping, that is not normal ventilation.  If no pulse, use AED machine to shock.
Term

As soon as a AED has been delivered, rescuer must resume CPR, starting with checking for a pulse, followed by 30 chest compressions and two breaths.

True or False?

Definition

FALSE

Do not stop to check pulse after shock has been delivered.  Immediately begin 30 chest compressions followed by 2 breaths.  After two minutes of CPR, the AED machine will prompt you to clear patient to analyze rhythm and shock if needed.

Term
If AED does not promptley analyze the rhythem (5-15 seconds) what should the rescuer do?
Definition

Resume chest compressions and ventilations.

Check all connections between the AED and the patient to make sure they are intact.

Term

Is is ok to use an AED in patient with a implanted defibrillator or pacemaker.

True or False?

Definition
True
Term

List the basic cardiac arrest algorithm

(patient is in VF/VT).

Definition

1.  Start CPR with AED

2.  Shockable - "CLEAR"

3.  CPR (30:2) - Establish IV/IO access

4.  Shockable - "CLEAR"

5.  CPR (30:2) - give EPI (1 mg) OR VASOPRESSIN (40 units) every 3-5 minutes

6.  Shockable - "CLEAR"

7.  CPR (30:2) - give AMIODARONE (300 mg bolus -- second dose 150 mg bolus)

REPEAT STEPS 2 - 7

Term

List basic cardiac arrest algorithm.

(Asystole/PEA)

Definition

1.  CPR - 30 compressions to 2 breaths

2.  NOT shockable

3.  CPR (30:2) - establish IV/IO assess - give EPI (1 mg or 40 unites of VASOPRESSIN) every 3-5 minutes

4.  NOT shockable

5. CPR (30:2)

6.  NOT shockable

7.  If no signs of ROSC, begin cycles again.  If ROSC, go to post cardiac arrest care.

Term
What are the appropriate dosing for a patient in VF/VT?
Definition

EPI - 1 mg, 3-5 minutes

VASOPRESSIN - 40 units

AMIODARONE - 300 mg bolus

(2nd dose, 150 mg bolus)

If Amiodarone is not available...

LIDOCAINE - 1-1.5 mg/kg IV/IO

(2nd dose, .5 -.75 mg/kg max 3 mg/kg)

MAGNESIUM SULFATE (only for torsades) - 1-2 g

Term

A patient is in asystole, TCP is recommended to eliminate cardiac arrest.

 

True or False?

Definition

FALSE

 

The AHA does not recommend the use of TCP for patients with asystolic cardiac arrest.

Term
A patient is in asystole.  At what phase in the cardiac arrest cycle do you determine a differential cause to treat?
Definition
During the second cycle of CPR, if the patient is not responding to EPI dose and CPR, consider 6H's and/or 5 T's.  
Term
What drugs are used to treat patients with ACS?
Definition

Oxygen

Aspirin

Nitroglycerin

Morphine

Fibrinolytic Therapy

Heparin

Term
"Clot-Buster" Drugs are called?  And are used for patients with what problem?
Definition

Fibrinolytics

 

Used in patients with ACS.

Term

PCI stands for…?

 

 

Definition
Percutaneous Coronary Intervention
Term
PCI performed as the initial reperfusion method is called….?
Definition

PRIMARY PERCUTANEOUS CORONARY INTERVENTION

(PPCI)

Term
It is important to remember that for STEMI...
Definition

1.  The ECG is central to the initial risk and treatment stratification process.

 

and

 

2.  Healthcare personnel do not need evidence of elevated cardiac markers to make a decision to administer fibrinolytic therapy in STEMI patients.

Term
For a patient with STEMI, the goals of reperfusion are to give fibrinolytics within how many minutes of arrive to ED? or to perform PCI (balloon etc.) within how many minute?
Definition

Administer fibrinolytics within 30 minutes.

 

Peform PCI's withint 90 minutes.

Term
What 4 agents are primary used for patients with ischemic type chest discomfort?
Definition

1.  Oxygen

2. Aspirin

3. Nitroglycerin

4.  Morphine

Term
What are the major contraindications of treating a patient with aspirin?
Definition

GI bleeding 

(current or recent)

Term
What are the major contraindications for treating a patient with nitroglycerin and morphine?
Definition
Patient has hypotension or shows RV infarction.
Term
What are the 4 major points of in-hospital therapy commonly referred to as the "4 D's"?
Definition

1.  Door

2.  Data

3.  Decision

4.  Drug

Term
STEMI is characterized how on an ECG?
Definition

1.  ST-elevation in 2 or more contiguous leads 

2.  New development of LBBB

3.  J-point elevation is GREATER than 2 mm (men), 1.5 mm in women in leads V2 and V3 (>2.5mm in men <40)

Term
High risk UA/NSTEMI is characterized on an ecg how?
Definition

1.  ST depressions of </= .5 mm or dynamic T-wave inversion

 

Term
Peaked T waves may indicate?
Definition
Hyperkalemia
Term
The use of fibrinolytic therapy is used in patients with a J-point ST segment elevation great than?
Definition
2 mm in leads V2 and V3, 1 mm in all other leads, or by a new LBBB.
Term
What is the most common agent used for acute STEMI reperfusion therapy?
Definition
Streptokinase
Term

It is appropriate and expected to use fibrinolytic therapy on any patient that shows signs of ischemia.

 

True or False?

Definition

FALSE

 

There are contraindications for using fibrinolytic therapy 

Term

What is rescue PCI?

 

Definition
Rescue PCI is used early after fibrinolytic therapy has been used and has not worked for the patient. 
Term
Rescue PCI is referred to now as?
Definition
Pharmacoinvasive strategy.
Term
According to the AHA, which is the treatment of choice for the management of STEMI?  PCI or Fibrinolytic Therapy?  
Definition
PCI -- however, only if it is performed effectivly with a door to balloon time of <90 minutes by a skilled PCI facility.
Term
Define symptomatic bradycardia.
Definition
Signs and sympotms due to the slow heart rate.
Term
Bradycardia refers to…?
Definition
Any rhythm disorder with a heart rate less than 60bpm.
Term
Symptomatic bradycardia exists clinically when what 3 criteria are present?
Definition

1.  HR is slow

2.  Patient is showing s/s

3.  Symptoms are due to the slow HR.

Term
What are the symptoms of possible symptomatic bradycardia?
Definition

Chest Discomfort or Pain

Shortness of Breath

Decreased level of Consciousness

Weakness

Fatigue

Litght Headedness

Dizziness

Presyncope/Syncope

Term
An adult is found with a pulse but has bradycardia. Describe the Bradycardia Algorithm.
Definition

1.  Assess that patient has Bradycardia (<50bpms)

2.  Identify and treat underlying cause -- ACLS survey...Maintain airway, offer oxygen if hypoxemic, monitor blood pressure and oximetry, establish IV access, 12 lead ecg if available.

3.  Determine Persistent bradyarrhythmia causing:

i.e. hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure?  YES

4.  Give .5 mg bolus of ATROPINE

5.  If ATROPINE is ineffective, offer TCP OR EPINEPHRINE (2-10 mcg/min) OR DOPAMINE (2-10 mcg/kg/min).

6.  Consider expert consulation/TVP

Term
What is the key critical question you must answer when determining a patient with bradycardia?
Definition
Determine whether the bradycardia is causing the symptoms OR if another illness is.
Term
In the absence of an immediate reversible cause, what medication is the first line of defense for a patient with bradycardia?  dosing?
Definition

Atropine 

.5 mg IV/IO MAX 3 mg IV/IO

Term
A patient has second degree heart block (type II) or third degree heart block in bradycardia.  How should you proceed?
Definition
Do not rely on Atropine working.  TCP may be useful for treating the patient.  
Term
What are the contraindications for TCP?
Definition
Severe hypothermia and asystole.
Term

It is important to assess the carotid pule during TCP to confirm capture.

 

True or False?

Definition

FALSE

 

TCP may cause muscular jerking that may mimic a carotid pulse.

Term
What are the steps for applying TCP?
Definition

1.  Place electrodes on chest

2.  Turn on TCP

3.  Set the demand rate to approx. 60 bpm

4.  Set the current milliamperes output 2 mA about the dose at which consistent capture is observed (safety margin)

Term

When beginning TCP with a patient with ACS, turn the pacing level to the highest heart rate that allows for stability.

 

True or False?

Definition

FALSE

 

Place pacing at the LOWEST level that allows for clinical stability.  Higher heart rates can worsen ischemia which can lead to arrhythmias.

Term
What is unstable tachycardia?
Definition
When the HR is too fast for the patient's clinical condition and the excessive hear rate causes symptoms or unstable conditions due to the heart beating too fast or beating ineffectively.
Term
What are the signs and symptoms of unstable tachycardia?
Definition

Hypotension

Acutely altered mental Status

Signs of Shock

Ischemic Chest Discomfort

Acute Heart Failure

Term
When should you not consider cardioversion in patients showing signs of tachycardia?
Definition

If the patient has sinus tachycardia due to a physiologic factor such as fever, hypotension etc. (you must first treat these problems)

 

If a patient has stable tachycardia.

 

Atrial Flutter -- patients are often stable and a cardioversion is not necessary.

Term
A patient has pulseless tachycardia.  Which algorithm should you use?
Definition
Cardiac Arrest Algorithm
Term
A patient has tachycardia with a pulse.  Which algorithm should you use?
Definition
Tachycardia with a Pulse Algorithm
Term
To implement the appropriate response to a patient, it is important to determine if a patient has a _____ with tachycardia.
Definition

Pulse

 

If patient has a pulse, determine if the are stable or unstable.  Unstable, continue with Tachycardia Algorithm.

Term
Polymorphic QRS refers to?
Definition
QRS complex changes in all leads.
Term
Monomorphic QRS refers to?
Definition
QRS is similar in all leads.
Term
What 5 questions are important to ask yourself when assessing a patient with tachycardia?
Definition

1.  Are symptoms present or absent?

2.  Is patient stable or unstable?

3.  Is the QRS wide or narrow?

4.  Is the rhythm regular or irregular?

5.  Is the QRS monomorphic or polymorphic?

Term
What are the steps of the Tachycardia with a Pulse Algorithm?
Definition

1.  Assess that patient has tachycardia with pulse (>150bpm) and are unstable (showing s/s)

2.  Identify and treat underlying cause (ACLS and BLS survey - ABCD's etc….airway open, offer oxygen if hypoxic etc.)

3.  Underlying cause? (i.e. hypotension, signs of shock, ischemic chest discomfort, acute heart failure) YES?

4.  CARDIOVERSION

IF NO?

5.  Determine wide QRS complex (<.12seconds)

YES?

6.  Establish IV access, administer adenosine (6 mg push) only if regular and monophasic

IF NO?

7.  IV ACESS, VAGAL MANEUVERS, adensone (6 mg push) only if regular, calcium channel blockers, b-blockers

Term
What is the difference between an unsynchronized shock and a synchronized shock?
Definition

A unsynchronized shock is delivered as soon as the operature pushed the shock button, falling randomly anywhere within the cardiac cycle.  These are HIGH energy levels.

 

A synchronized cardioversion uses a sensor that delivers the shock at the peak of a QRS complex. These are LOW energy levels.

Term
When should you use a synchronized shock?
Definition

In patients with:

Unstable SVT

Unstable atrial fib

Unstable atrial flutter

Unstable regular monomorphic

tachycardia with pulse

Term
When should you use a unsynchronized shock?
Definition

In patients with:

No pulse

Clinical deterioration, may result in cardiac arrest

If you are unsure if a patient has monomorphic or polymorphic VT.

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