ACLS for H and P

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ACLS for H and P
2012-04-23 09:38:24

ACLS questions for H and P final exam
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  1. Door to baloon inflation (PCI) goal time is
    90 mins
  2. Door to needle (fibrinolysis) goal time is
    30 mins
  3. What does mona stand for
    • Morphine
    • Oxygen
    • Nitroglycerine
    • Asprin
  4. Dose of asprin given to a suspected STEMI
  5. What are some ABSOLUTE contraindicatins to fibrinolysis therapy
    • Any prior intracranial hemorrhage
    • Known structural cerebral vascular lesion
    • Known malignant intracranial neoplasm
    • Ischemic stroke within 3 months Except acute ishcemic stroke within 3 hrs
    • Suspected aortic dissection
    • Active bleeding or bleeding diathesis
    • Significant closed head trauma or facial within 3 hrs
  6. What are some relative contraindications to Fibrinolysis therapy
    • History of chronic severe poorly controlled hypertension
    • Severe uncontrolled hypertension on presentation (SBP>180 mmHg or DBP >110 mmHg)
    • History of prior Ischemic stroke >3 months, dementia or known intracranial pathology not covered by the absolute contraindications
    • Traumatic or prolonged CPR (>10mins) or major surgery in the last 3 wks
    • Recent internal bleeding (within 2-4 wks)
    • Noncompressible vascular punctures
    • For streptokinase antistreplase: prior exposure or prior allergic reaction to these agents
    • Pregnancy
    • active peptic ulcer
    • Current use of anitcoagulatns: the higher the INR the higher the risk of bleeding
  7. What are the 3 parts of the Cincinnati prehosptital stroke scale?
    • Facial droop
    • Arm drift
    • Abnormal speech
    • If any of 1 of these 3 signs is abnormal the probability of the pt having a stroke is 72 %
  8. What is the inclusion criteria for pts who can be treated with rtPA within 3 hours of symptom onset
    • Diagnosis of ischemic stroke causing measurable neurologic deficit
    • Onset of symptoms less than 3 hrs before beginning tx
    • Age >18 yrs
  9. What are the exclusion criteria for rtPA administered within 3 hrs of symptoms onset
    • Head trauma or piror stroke in the previous 3 mo
    • Symptoms suggesting subarachnoid hemmorhage
    • Arterial puncture at a noncompressible site in the previous 7 days
    • Hx of previous intracranial hemorrhage
    • Elevated blood pressure ( systolic over 185 and diastolic over 110)
    • Evidence of active bleeding on examination
    • Acute bleeding diathesis including: platelet count under 100,000, heparine recieved within 48 hrs resulting in aPTT greater than normal, Current use of an anticoagulant with INR greater than 1.7 or PT >15 sec
    • Blood glucose concenctration of less than 50mg/dl
    • CT demonstrates multilobar infarction
  10. What are the relative exclusion criteria for tx of a stroke pt with rtPA within 3 hrs of sx onset
    • Recent experince suggest that under some circumstance with careful considert and weighing of risk to benifit the pt may recieve fibrinolytic therapy despite 1 or more relative contraindications:
    • Only mionr or rapidly improving stroke sx
    • Seizure at onset with post ictal residual neurologic impariments
    • Major surgery or serious trauma within 14 days
    • Recent gastrointestinal or urinary tract hemorrhage within previosu 21 days
    • Recent acute myocardial infarction (within the previous 3 months)
  11. What are the Inclusion criteria for treatment of a stroke with rtPA from 3-4.5 hrs
    • Diagnosis of ischemic stroke causing measurable neurologic deficit
    • Onset of symptoms 3-4.5 hrs before beginning treatment
  12. What is the Exclusion criteria for treatment of a stroke with rtPA from 3-4.5 hrs out
    • Age >80
    • Severe stroke
    • Taking oral anticoagulants reguardless of INR
    • History of both diabetes and prior ischemic stroke
    • and all of the exlcusion criteria for treatment before 3 hrs
  13. For a pt who is having an acute ischemic stroke and who is eligible for acute reprofusion therapy, but has a blood pressure higher than 185/110. What pharmacotherapy can you give to brink their HTN down/manage them
    • Labetalol 10-20 mg IV over 1-2 mins may repeat once
    • Nicardipine IV 5mg per hour, titrate up by 2.5 mg per hour every 5-15 mins max is 15 mg per hour, when desired blodo pressure is reached lower to 3 mg per hour
    • Other agents (hydralazine, enalaprilat) may be considered when appropriate
    • If blood pressure cannot be maintained below 185/110 do not administer rtPA
  14. How do you manage HTN after or during rtPA or othe racute reperfusion therapy
    • Monitor blood pressrue every 15 mins for 2 hrs from the start of rtPA therapy then every 30 mins for 6 hrs and then every hour for 16 hrs
    • If systolic blood pressure exceeds 180-230 mm Hg or diastolic is 105-120 then:
    • Lebatalol 10mg IV followed by continuous infusion 2-8 mg per min or
    • Nicardipine IV 5 mg per hous titrate up to desired effect by 2.5 mg per hour every 5-15 mins max 15mg per hour
    • If blood pressure is not controlled or diastolic blood pressure is >140 mmHg consider sodium nitroprusside
  15. Consider lowering blood pressure in a pt with acute ichemic stroke if the systolic blood pressure is > ___ or the diastolid blood pressure is > ___
    • 220mmHg
    • 120mmHg
  16. Consider blood pressure reduction with a pt with acute ishchemic stroke, but follow the protocol for the other concomitant organ system injury if the pts has one of these 3 conditions
    • Acute myocardial infarction
    • Congestive heart fialure
    • Acute aortic dissection
  17. What are the Hs and Ts of reversible causes of Cardiac arrest
    • Hypovolemia
    • Hypoxia
    • Hydrogen ion (acidosis)
    • Hypo/hyperkalemia
    • Hypothermia
    • Tension pneumothorax
    • Tamponade cardiac
    • Toxins
    • Thrombosis pulmonary
    • Thrombosis coronary
  18. What is the initial dose of epinephrine in cardiac arrest
  19. How often can you give epinephrine
    3-5 minutes
  20. Vasopressin in cardiac arrest can replace what drug when? and what is the dose given
    40 units can replace the first or second dose of epinerphine
  21. Monphasic you should deliver a shock of __ j
  22. for a biphasic machine when you shock you should use __ Js
  23. ROSC is defined as a PETCO2 of >___ mmHg or spontaneous arterial pressure waves withintrarterial monitoring
  24. CPR quality needs to be improved if:
    PETCO2 is less than ___ mmHg or the Intra-arterial pressure (diastolic) is less than ___ mmHg
    • PETCO less than 10
    • Intra-arterial less than 20
  25. If there is no advanced airway the chest compression to breath ratio is
  26. Rotate compressor for CPR every __ mins
  27. With ROSC you should maintain O2 sat at __
  28. What 4 IV infusions can be considered for a Pt with ROSC
    • IV bolus: 1-2 L normal saline or lactated ringers if inducing hypothermia may use 4 degree C
    • Epinephrine: 0.1-0.5 mcg/kg per min in a 70 kg adult this is 7-35 mcg
    • Dopamine: 5-10 mcg/kg per min
    • Norepinephrine: 0.1-0.5 mcg/kg per min
  29. A heartrate less than __ beats/min is typically concidered a bradyarrythmia (if symptomatic)
  30. 1st line drug for symptomatic bradycardia
  31. what is the first dose of atropine?
    0.5 mg bolus
  32. how often can you give atropine?