ACLS

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Author:
ebelgirl
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107319
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ACLS
Updated:
2011-10-09 12:14:09
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ACLS
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ACLS Review
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  1. What are the ABCD assessments of the BLS Primary Survey?
    Airway, Breathing, Circulation, Defibrillation.
  2. What are the ABCD assessments of the ACLS secondary survey?
    Airway, Breathing, Circulation, Differential diagnosis
  3. How often should a patient be ventilated if they are experiencing respiratory distress?
    Once every 5-6 seconds or 10-12 breaths a minute.
  4. What are 3 risks associated with Hyperventilation?
    • 1. Decreased venus return
    • 2. Diminished cariac output
    • 3. Inceased intrathoracic pressure
  5. How often should a patient be ventilated with an airway in place?
    One breath every 6-8 seconds or 8-10 breaths a minute.
  6. Compress the center of the chest ______ & _____ with at least _______________ at a depth of at least _____ inches.
    • Hard & Fast
    • 100 compressions/min
    • 2
  7. Normal Value of PETCO2
    30-40 mmHg
  8. Biphasic shock initial dose
    120-200 joules
  9. Monophasic shock energy
    360 joules
  10. Epinephrine dose & frequency
    • Vasopressor
    • 1mg every 3-5 minutes
  11. Vaspressin dose & frequency
    • 40 Units
    • may replace 1st or 2nd dose of Epi
  12. Amiodarone
    • Anti-Arrhythmic
    • 300mg 1st dose
    • 150mg 2nd dose after 3-5minutes
  13. Lidocaine
    • Anti-Arrhythmic
    • 1-1.5mg/kg 1st dose
    • 0.5-0.75 mg/kg 2nd dose
    • repeat over 5-10 min intervals up to max of 3mg/kg

    ETT dose 2-4mg/kg
  14. Magnesium Sulfate
    • Anti-Arrhythmic
    • Used for Toursades de pointes
    • 1-2g in 10ml D5W given over 5-20 mins
  15. The 5 H's
    • Hypovolemia - Fluids
    • Hypoxia - Oxygen
    • Hydrogen ion (acidosis) - Ventilation, Bicarb
    • Hypo/Hyper Kalemia - (hyper)Calcium, sodium, glucose, insulin (hypo) magnesium
    • Hypothermia - warm
  16. The 5 T's
    • Tension Pneumothorax - needle decompression, thoracostomy
    • Tamponade, cardiac - Pericardiocentesis
    • Toxins - Intubation
    • Thrombosis, Pulmonary - Fibrolytics, surgical embolectomy
    • Thrombosis, Coronary
  17. Hypotension
    • SBP <90mmHg
    • IV bolus 1-2L NS or lactated ringers
    • Epinephrine 0.1-0.5mcg/kg/min IV
    • Dopamine 5-10mcg/kg/min IV
    • Norepinephrine 0.1-0.5mcg/kg/min IV
  18. What are the 2 most common easily reversible causes of PEA?
    • Hypovolemia
    • Hypoxia
  19. Algorythm for Asystole/PEA
    • CPR
    • Epi 1mg IV or Vasopressin 40 units IV
    • CPR 3-5 mins
    • Epi
    • CPR 3-5 mins
    • EPI
  20. Acute Cornary Syndrome
    Drugs
    • Immediate:
    • Oxygen keep Sats >94
    • Aspirin 160-325mg
    • Nitroglycerin 1 tab every 3-5mins if SBP >90mmHg
    • Morphine (only with STEMI)

    • 2nd
    • Fibrolytic therapy
    • Heparin
  21. Pathophysiology of Acute Cornary System
    • A. Unstable plaque
    • B. Plaque rupture
    • C. Unstable angina
    • D. Microemboli
    • E. Occusive thrombus
  22. ST elevation MI & Treatment
    • STEMI
    • Give Fibrinolytics within 30mins
  23. Non-ST elevation MI (depression)
    UA/NSTEMI
  24. What is the mainstay of treatment for STEMI?
    Early reperfusion therapy achieved with Fibrinolytics or primary PCI
  25. 4 Rhythms for Bradycardia
    • 1. Sinus Bradycardia
    • 2. 1st degree AV Block
    • 3. 2nd degree AV Block
    • 4. 3rd degree AV Block
  26. 2nd degree AV Block Type 1
    Wenckebach / Mobitz I
  27. 2nd degree AV Block Type 2
    Mobitz II
  28. Drugs for Bradycardia
    • 1st - Atropine 0.5mg blous
    • every 3-5min. Max 3mg

    • If ineffective:
    • Transcutaneous pacing or
    • Dopamine 2-10mcg/kg/min
    • Epinephrine 2-10mcg/min
  29. 4 steps of performing TCP
    • 1. place electrodes
    • 2. turn pacer on
    • 3. Set demand rate at 60/min. (can be adjusted based on clinical response)
    • 4. Set milliamperes output 2 mA above dose at which consistent capture is observed.
  30. Rate of Tachycardia
    > 100/min
  31. Treatment for unstable tachycardia
    Immediate synchronized cardioversion
  32. Adenosine IV dose
    1st dose 6mg rapid IV push followed by normal saline flush

    2nd dose 12mg if required after 1-2 mins
  33. Synchronized Cardioversion for bradycardia doses
    • Narrow regular 50-100 joules
    • Narrow irregular 120-200 joules biphasic or 200 joules monophasic

    • Wide regular 100 J
    • Wide irregular defib dose (not synchronized)
  34. Amiodarone IV dose
    • 1st dose 150mg over 10 mins
    • - repeat as needed if VT recurs
    • - followed by maintenance infusion 1-4 mg/min
  35. When to use Synchronized shocks
    • 1. unstable SVT
    • 2. unstable atrial fibrillation
    • 3. unstable atrial flutter
    • 4. unstable regular Monomorphic tachycardia with pulses
  36. Cardioversion dose for Atrial Flutter & SVT
    50-100 Joules with biphasic

    if initial dose fails increase
  37. Unstable Atrial Fibrillation cardioversion dose
    Monophasic 200 J

    Biphasic 120-200 J
  38. Unstable monomorphic VT cardioversion dose
    100 J
  39. Polymorphic VT (irregular form & rate) and unstable
    Treat as VF with high-energy shock (defib doses)
  40. 4 Narrow QRS complexes
    • 1. Sinus tach
    • 2. Artrial fibrillation
    • 3. Atrial Flutter
    • 4. AV nodal reentry
  41. 2 wide QRS complex tachycardias
    • 1. Monomorphic VT
    • 2. Polymorphic VT
  42. In sinus tach the main goal is to identify & treat underlying systemic causes what are they
    • external influences:
    • heart, fever, anemia, hypotension, blood loss, exercise.

    cardioversion is contraindicated! may try vagal maneuvers
  43. Drug given for SVT
    Adenosine 6mg rapid IV push over 1 second followed by 20ml saline flush.

    12mg for 2nd dose after 1-2 mins
  44. The goal of the stroke team is to access the patient within _____________ of arrival in the ED
    10 mins

    "Time is Brain"
  45. Goal of stroke teams neurological assessment is _____________ of arrival to the ED and read within __________.
    • 25 mins
    • 45 mins
  46. When to give Fibinolytic therapy for stoke patient
    CT negative for hemorrhage.
  47. Do not administer anticoagulants or antiplatelet treatment for ______ after administration of ____, until a follow up CT scan at ____ shows no intercranial hemorrhage.
    • 24
    • rtPA
    • 24
  48. What is a standard treatment procedure for a patient with STEMI?
    Reprofusion therapy.
  49. What is an adverse sign of bradycardia?
    CHF
  50. An ischemic stroke accounts for ____% of all strokes and is usually caused by ___________.
    • 85%
    • Occlusion of an artery to a region of the brain.
  51. 3 physical findings the CPSS uses to identify strokes
    • 1. Facial drops
    • 2. Arm drift
    • 3. Abnormal speech
  52. 4 warning signs of a stroke
    • 1. trouble speaking
    • 2. dizziness
    • 3. sudden severe headache
    • 4. sudden confusion
  53. Magnesium is indicated for VF/pulseless VT associated with _______
    Torsades de pointes
  54. A patient in pulseless VT has been given 1 shock and 1 dose of EPI what is the next drug/dose to administer
    Amiodarone 300mg
  55. A patinet with sinus bradycardia rate at 42, diaphoresis and BP 80/60. What is initial atropine dose
    0.5mg
  56. Bradycardia requires treatment when
    Chest pain of SOB is present
  57. Which drugs can be given via ETT
    • Lidocaine
    • Epi
    • Vasopressin
  58. Stroke viscitm brought to ED meets criteria for fibrolytic therapy and CT is ordered what is the guidelines for fibrolytic thearpy?
    Do not give aspirin for at least 24hrs if rtPA has been administered.
  59. Pt with possible ST segment elevation MI has chest discomfort which would be a contraindication for administration of nitrates?
    Use of a phosphodiesterase inhibitor within 12 hours.

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