Card Set Information
return of spontaneous circulation
First step in assessment of pt?
first determine if pt is conscious
conscious - do ACLS survey
unconscious - do BLS survey then ACLS survey
Deliver each rescue breath over ___ second(s).
Indication breaths are effective?
Steps of BLS survey?
Make sure scene is safe
1. "Are you OK?" & look for breathing
2. Activate emergency response system/get AED or send someone
3. Circulation - check carotid pulse for <10 seconds & start CPR if no pulse. If there is a pulse start rescue breaths.
4. Defibrillation - If no pulse, check for shockable rhythm as soon as defibrillater arrives. Provide shocks as indicated then resume CPR.
Compress at _____ compressions per minute at a depth of at least ____ inches.
Interruptions in compression should be ___ seconds or less.
Switch breaths/compressors every ____ minutes.
Rescue breaths should be given every ____ seconds/_____ breaths per minute. Pulse should be checked every ____ minutes.
5 - 6 seconds / 10-12 breaths per minute
ACLS survey steps?
4. differential diagnosis
1. is airway patent
2. advanced airway indicated?
3. advanced airway secured & placement reconfirmed frequently?
Ways to maintain patent airway?
1. head-tilt-chin lift
2. oropharyngeal airway (OPA)
3. nasopharyngeal airway - NPA
4. advanced airway - ET tube, other
Check and monitor placement of ET tube?
1. are ventilation & oxygenation adequate?
2. are quantitative & oxyhemoglobin saturation monitored?
How much O2 should be given?
cardiac arrest -100% O2
others- titrate for O2 sat >/= 94%
3 ways to monitor adequacy of ventilation & oxygenation?
1. chest rise & cyanosis
2. waveform capnography
3. O2 sat
1. effective compressions? - monitor
2. cardiac rhythm? - attach defib
3. defib/cardioversion indicated? - use prn
4. IV/IO access - establish access
5. ROSC? -
6. pulse but unstable?
7. meds needed for BP or rhythm? - give prn
8. need volume replacement? - give prn
2 indications CPR quality is not good?
1 waveform capnography PETCO2 is <10mmHg
2. intra-arterial pressure/diastolic pressure <20mmHg
partial pressure of CO2 in exhaled air at the end of exhalation phase
Differential diagnosis phase of ACLS?
why pt developed s/s or arrest & is there a reversible cause that can be TX
make sure everything done at right time & monitor performance of team members
Closed loop communications?
1. give msg or order
2. confirm msg received by clear response & eye contact
3. don't give new tasks until receive confirmation of first task given
METs & RRT's
MET - medical emergency team
RRT - rapid response team
When is therapeutic hypothermia indicated and how is it done?
1. comatose adult pt with ROSC after out of hospital VF cardiac arrest
2. consider for comatose adult pt with
ROSC after in-hospital cardiac arrest of any initial rhythm of out of hospital with intitial rhythm of PEA or asystole
cool pt to 32 to 34 degrees C (89.6 - 93.2 F)
O2 after resusitation?
titrate to lowest level required to have O2 sat of >/= 94%
Ventilations may be titrated to acheive PETCO of ______ or PaCO2 of _____.
Goal for BP after cardiac arrest?
mean arterial pressure >/= 65 mmHg
Intervention that may be done for coronary cause of cardiac arrest?
PCI - coronary reperfusion
Goal BS for ROSC pt?
144 - 180
acute coronary syndrome
ED protocols for ACS?
1.activation of cardiac cath lab
2. Admission to coronary ICU
S/S of respiratory arrest?
1. unconscious, unresponsive
2. respirations absent or inadequate
3. Pulse is presentj
BLS then ACLS
BLS survey of respiratory arrest pt?
1. pt has a pulse - no compressions or defib
2. no/inadequate respirations
4. need to assess & reassess for changes - may need to start CPR later
Tx of respiratory arrest?
1. give rescue breaths 1 q 5-6 seconds / 10-12 per minute
2. Recheck pulse about q2min - tk at least 5 sec but less than 10
1. consider advanced airway
2. admin O2 for 94% O2 sat or up
3. Monitor for chest rise and fall, waveform capnography, & O2 sat
4. other ACLS survey actions
5. may require OPA & NPA or suctioning
Ventilations with an advanced airway?
1 ventilation q 6-8sec (8-10 breaths/min)
Most reliable method of confirming & monitoring correct placement of an ET tube?
What to do if pt in resp arrest & known to be choking?
open mouth & look for object & remove with fingers if possible
When are OPA's used?
never used in conscious pt - must be pt without a gag reflex
1. during respirations
2. during suctioning
3. pt with ET tube
How to insert OPA?
1. get correct size - from corner of mouth to curve of jaw
When are NPA's used?
pt with cough or gag reflex/ conscious or semi-consciuos pt
pt that cannot have OPA
1. size: look at circumference of nostrils - from tip of nose to earlobe
2. Lubricate with water-soluble lubricant or anesthetic
3. Insert through nostril - resistance: rotate and/or attempt other nostril
When should NPA not be used?
give 100% O2 before and after and suction <10 sec
Monitoring during suctioning?
2. O2 sat
3. clinical appearance
Stop suctioning if bradycardia occurs, O2 sat drops, or clinical appearance deteriorates
Precautions for possible spinal injury?
1. jaw thrust
2. manual stabilization of cervical spine
3. mobilization devices during transport
Lone rescuer BLS with AED for Vfib & pulseless Vtach?
1. Check responsiveness & breathing
2. Activate emergency response
3. Check for pulse for 5-10 seconds
- no pulse -> start compressions
- pulse -> rescue breath q5-6 seconds
4. Defib as soon as AED available
- shock or not then resume CPR & recheck rhythm q2min
Criteria for using AED?
1. no response
2. absent or abnormal breathing
3. no pulse
Steps of operating AED?
1. Power on
2. Attach electrodes - wipe off sweat/liquids,
- 1 pad on upper-right side of chest below clavicle & other to left of nipple with top margin of pad below left armpit
3. Analyze rhythm & shock prn