ACLS

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Author:
mthompson17
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280487
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ACLS
Updated:
2014-08-11 00:39:39
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ACLS
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ACLS
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  1. ROSC?
    return of spontaneous circulation
  2. First step in assessment of pt?
    first determine if pt is conscious

    • conscious - do ACLS survey
    • unconscious - do BLS survey then ACLS survey
  3. Deliver each rescue breath over ___ second(s).

    Indication breaths are effective?
    1 second

    chest rise
  4. 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.
  5. Compress at _____ compressions per minute at a depth of at least ____ inches.
    100

    2
  6. Interruptions in compression should be ___ seconds or less.
    10
  7. Switch breaths/compressors every ____ minutes.
    2
  8. Rescue breaths should be given every ____ seconds/_____ breaths per minute.  Pulse should be checked every ____ minutes.
    5 - 6 seconds / 10-12 breaths per minute

    2 minutes
  9. ACLS survey steps?
    • 1. airway
    • 2. breathing
    • 3. circulation
    • 4. differential diagnosis
  10. ACLS airway?
    • 1. is airway patent
    • 2. advanced airway indicated?
    • 3. advanced airway secured & placement reconfirmed frequently?
  11. Ways to maintain patent airway?
    • 1. head-tilt-chin lift
    • 2. oropharyngeal airway (OPA)
    • 3. nasopharyngeal airway - NPA
    • 4. advanced airway - ET tube, other
  12. Check and monitor placement of ET tube?
    waveform capnography
  13. ACLS breathing?
    • 1. are ventilation & oxygenation adequate?
    • 2. are quantitative & oxyhemoglobin saturation monitored?
  14. How much O2 should be given?
    cardiac arrest -100% O2

    others- titrate for O2 sat >/= 94%
  15. 3 ways to monitor adequacy of ventilation & oxygenation?
    • 1. chest rise & cyanosis
    • 2. waveform capnography
    • 3. O2 sat
  16. Circulation?
    • 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
  17. 2 indications CPR quality is not good?
    1 waveform capnography PETCO2 is <10mmHg

    2. intra-arterial pressure/diastolic pressure <20mmHg
  18. PETCO2?
    partial pressure of CO2 in exhaled air at the end of exhalation phase
  19. Differential diagnosis phase of ACLS?
    why pt developed s/s or arrest & is there a reversible cause that can be TX
  20. Team leader?
    make sure everything done at right time & monitor performance of team members
  21. 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
  22. METs & RRT's
    MET - medical emergency team

    RRT - rapid response team
  23. 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)
  24. O2 after resusitation?
    titrate to lowest level required to have O2 sat of >/= 94%
  25. Ventilations may be titrated to acheive PETCO of ______ or PaCO2 of _____.
    35-40

    40-45
  26. Goal for BP after cardiac arrest?
    mean arterial pressure >/= 65 mmHg
  27. Intervention that may be done for coronary cause of cardiac arrest?
    PCI - coronary reperfusion
  28. Goal BS for ROSC pt?
    144 - 180
  29. ACS?
    acute coronary syndrome
  30. ED protocols for ACS?
    • 1.activation of cardiac cath lab
    • 2. Admission to coronary ICU
  31. S/S of respiratory arrest?

    Survey used?
    • 1. unconscious, unresponsive
    • 2. respirations absent or inadequate
    • 3. Pulse is presentj

    BLS then ACLS
  32. BLS survey of respiratory arrest pt?
    • 1. pt has a pulse - no compressions or defib
    • 2. no/inadequate respirations
    • 3. unconscious/unresponsive
    • 4. need to assess & reassess for changes - may need to start CPR later
  33. Tx of respiratory arrest?
    • BLS:
    • 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

    • ACLS:
    • 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
  34. Ventilations with an advanced airway?
    1 ventilation q 6-8sec (8-10 breaths/min)
  35. Most reliable method of confirming & monitoring correct placement of an ET tube?
    waveform capnography
  36. What to do if pt in resp arrest & known to be choking?
    open mouth & look for object & remove with fingers if possible
  37. 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
  38. How to insert OPA?
    • 1. get correct size - from corner of mouth to curve of jaw
    • 2. insert
  39. When are NPA's used?
    pt with cough or gag reflex/ conscious or semi-consciuos pt

    pt that cannot have OPA
  40. Inserting NPA?
    • 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
  41. When should NPA not be used?
    facial trauma
  42. Suctioning?
    give 100% O2 before and after and suction <10 sec
  43. Monitoring during suctioning?
    • 1. HR
    • 2. O2 sat
    • 3. clinical appearance


    Stop suctioning if bradycardia occurs, O2 sat drops, or clinical appearance deteriorates
  44. Precautions for possible spinal injury?
    • 1. jaw thrust
    • 2. manual stabilization of cervical spine
    • 3. mobilization devices during transport
  45. 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
  46. Criteria for using AED?
    • 1. no response
    • 2. absent or abnormal breathing
    • 3. no pulse
  47. 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

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