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What are the ABCD assessments of the BLS Primary Survey?
Airway, Breathing, Circulation, Defibrillation.
What are the ABCD assessments of the ACLS secondary survey?
Airway, Breathing, Circulation, Differential diagnosis
How often should a patient be ventilated if they are experiencing respiratory distress?
Once every 5-6 seconds or 10-12 breaths a minute.
What are 3 risks associated with Hyperventilation?
- 1. Decreased venus return
- 2. Diminished cariac output
- 3. Inceased intrathoracic pressure
How often should a patient be ventilated with an airway in place?
One breath every 6-8 seconds or 8-10 breaths a minute.
Compress the center of the chest ______ & _____ with at least _______________ at a depth of at least _____ inches.
- Hard & Fast
- 100 compressions/min
Normal Value of PETCO2
Biphasic shock initial dose
Monophasic shock energy
Epinephrine dose & frequency
- 1mg every 3-5 minutes
Vaspressin dose & frequency
- 40 Units
- may replace 1st or 2nd dose of Epi
- 300mg 1st dose
- 150mg 2nd dose after 3-5minutes
- 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
- Used for Toursades de pointes
- 1-2g in 10ml D5W given over 5-20 mins
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
The 5 T's
- Tension Pneumothorax - needle decompression, thoracostomy
- Tamponade, cardiac - Pericardiocentesis
- Toxins - Intubation
- Thrombosis, Pulmonary - Fibrolytics, surgical embolectomy
- Thrombosis, Coronary
- 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
What are the 2 most common easily reversible causes of PEA?
Algorythm for Asystole/PEA
- Epi 1mg IV or Vasopressin 40 units IV
- CPR 3-5 mins
- CPR 3-5 mins
Acute Cornary Syndrome
- Oxygen keep Sats >94
- Aspirin 160-325mg
- Nitroglycerin 1 tab every 3-5mins if SBP >90mmHg
- Morphine (only with STEMI)
- Fibrolytic therapy
Pathophysiology of Acute Cornary System
- A. Unstable plaque
- B. Plaque rupture
- C. Unstable angina
- D. Microemboli
- E. Occusive thrombus
ST elevation MI & Treatment
- Give Fibrinolytics within 30mins
Non-ST elevation MI (depression)
What is the mainstay of treatment for STEMI?
Early reperfusion therapy achieved with Fibrinolytics or primary PCI
4 Rhythms for Bradycardia
- 1. Sinus Bradycardia
- 2. 1st degree AV Block
- 3. 2nd degree AV Block
- 4. 3rd degree AV Block
2nd degree AV Block Type 1
Wenckebach / Mobitz I
2nd degree AV Block Type 2
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
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.
Rate of Tachycardia
Treatment for unstable tachycardia
Immediate synchronized cardioversion
Adenosine IV dose
1st dose 6mg rapid IV push followed by normal saline flush
2nd dose 12mg if required after 1-2 mins
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)
Amiodarone IV dose
- 1st dose 150mg over 10 mins
- - repeat as needed if VT recurs
- - followed by maintenance infusion 1-4 mg/min
When to use Synchronized shocks
- 1. unstable SVT
- 2. unstable atrial fibrillation
- 3. unstable atrial flutter
- 4. unstable regular Monomorphic tachycardia with pulses
Cardioversion dose for Atrial Flutter & SVT
50-100 Joules with biphasic
if initial dose fails increase
Unstable Atrial Fibrillation cardioversion dose
Monophasic 200 J
Biphasic 120-200 J
Unstable monomorphic VT cardioversion dose
Polymorphic VT (irregular form & rate) and unstable
Treat as VF with high-energy shock (defib doses)
4 Narrow QRS complexes
- 1. Sinus tach
- 2. Artrial fibrillation
- 3. Atrial Flutter
- 4. AV nodal reentry
2 wide QRS complex tachycardias
- 1. Monomorphic VT
- 2. Polymorphic VT
In sinus tach the main goal is to identify & treat underlying systemic causes what are they
cardioversion is contraindicated!
- external influences:
- heart, fever, anemia, hypotension, blood loss, exercise.
may try vagal maneuvers
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
The goal of the stroke team is to access the patient within _____________ of arrival in the ED
"Time is Brain"
Goal of stroke teams neurological assessment is _____________ of arrival to the ED and read within __________.
When to give Fibinolytic therapy for stoke patient
CT negative for hemorrhage.
Do not administer anticoagulants or antiplatelet treatment for ______ after administration of ____, until a follow up CT scan at ____ shows no intercranial hemorrhage.
What is a standard treatment procedure for a patient with STEMI?
What is an adverse sign of bradycardia?
An ischemic stroke accounts for ____% of all strokes and is usually caused by ___________.
- Occlusion of an artery to a region of the brain.
3 physical findings the CPSS uses to identify strokes
- 1. Facial drops
- 2. Arm drift
- 3. Abnormal speech
4 warning signs of a stroke
- 1. trouble speaking
- 2. dizziness
- 3. sudden severe headache
- 4. sudden confusion
Magnesium is indicated for VF/pulseless VT associated with _______
Torsades de pointes
A patient in pulseless VT has been given 1 shock and 1 dose of EPI what is the next drug/dose to administer
A patinet with sinus bradycardia rate at 42, diaphoresis and BP 80/60. What is initial atropine dose
Bradycardia requires treatment when
Chest pain of SOB is present
Which drugs can be given via ETT
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.
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.