ACLS Study Guide Questions and Answers Already Passed

ACLS Study Guide Questions and Answers Already Passed Primary Survey ✔✔ABCD A-airway B-breathing C-circulation D-defibrilation Secondary Survey ✔✔IAID I-intabate (if resp. arrest or can't get good venitlaiton) A ...

ACLS Study Guide Questions and Answers Already Passed Primary Survey ✔✔ABCD A-airway B-breathing C-circulation D-defibrilation Secondary Survey ✔✔IAID I-intabate (if resp. arrest or can't get good venitlaiton) A-access airway I-IV/IO access for Drugs D-differential diagnosis (H's & T's) What do you do with a non responsive patient? ✔✔1st survey, then second survey Med Administration ✔✔-IV access: large bore 18 g -Site: AC -always flush after med admin What do you do if AED determines non-shockable rhythm? ✔✔continue chest compressions What is PEA? ✔✔Pulseless electrical activity (ECG shows activity but there is no pulse felt in patient) ACLS Survey ✔✔ABCD A-airway B-breathing C-circulation D-defibrilation ACLS Airway Survey ✔✔SUPPLEMENTAL OXYGEN when indicated: -100% for cardiac arrest -titrate others to achieve >94% O2 sats MONITOR VENTILATION EFFECTIVENESS by: -chest rise/fall -cyanosis -O2 sats -waveform capnography AVOID EXCESSIVE VENTILATION How many ventilations do you provide when patient is in cardiac arrest? With an advanced airway? In respiratory arrest only? ✔✔2 ventilations every 30 compressions if advanced airway: 1 every 6-8 seconds if respiratory arrest: 1 every 5-6 seconds What do you do with a non-responsive patient? ✔✔1. Shout for help/Activate the Emergency Response System (get AED) 2. Check for Pulse 3. Start CPR What do you do for a patient who is stable and has chest pain? ✔✔Monitor-support ABC Be prepared to give CPR & Defib Admin Aspirin (O2-sats<94%, Nitro, Morphine if needed) Get 12 lead ECG Cases NOT to give Nitro ✔✔hypotension (SBP < 90) bradycardia (< 50/min) tachycardia Nitro Administration ✔✔1 tablet (or spray dose) every 3-5 min up to total of 3 doses H's ✔✔Hypovolemia Hypoxia Hypothermia Hyper/Hypokalemia Hydrogen ions (acidosis) ECG Clues for Hypovolemia ✔✔Narrow complex Rapid rate Clues from History/Physical for Hypovolemia & Effective Intervention ✔✔Flat neck veins History of condition *internal bleeding & severe dehydration* Intervention: volume infusion ECG Clues for Hypoxia ✔✔slow rate Clues from History/Physical for Hypoxia & Effective Intervention ✔✔Cyanosis ABG Airway Problems Intervention: O2, ventilation, advanced airway ECG Clues for Hydrogen Ions (acidosis) ✔✔Smaller-amplitude QRS Complexes History/Physical Clues for Hydrogen Ions & Effective Intervention ✔✔History of diabetes Bicarb responsive pre-existing acidosis Renal Failure Intervention: ventilation; sodium bicarb ECG Clues for HyperKalemia or Hypokalemia ✔✔Hyper: -tall, peaked T waves -P waves get smaller -QRS widens -sine wave PEA Hypo: -flattened T waves -prominent U waves -QRS widens -QT prolongs -Wide complex tachycardia History/Physical Clues for Hyper/HypoKalemia ✔✔HYPER: -history of renal failure -diabetes -recent dialysis -dialysis fistulas -medications HYPO: -abnormal loss of potassium -diurectic use Effective Interventions for Hyper/HypoKalemia ✔✔HYPER: -Calcium chloride -Sodium Bicarb -Glucose plus insulin -Possibly albuterol HYPO: add magnesium if cardiac arrest ECG Clues for Hypothermia ✔✔J or Osborne waves History/Physical Clues for Hypothermia ✔✔history of cold exposure central body temp T's ✔✔Tension pneumothorax Tamponade, cardiac Toxins (drug overdoses) Thrombosis (pulmonary) Thrombosis (cardiac-MI) ECG Clues for Tension pneumothorax ✔✔narrow complex slow rate (Hypoxia) History/Physical Clues for Tension pneumothorax & Effective Intervention ✔✔history of condition no pulse felt w/CPR neck vein distention tracheal deviation unequal breath sounds difficulty ventilating patient INTERVENTION: needle decompression; tube thoracostomy ECG Clues for Tamponade (cardiac) ✔✔narrlow complex rapid rate History/Physical Clues for Tamponade & Effective Intervention ✔✔history of condition no pulse felt w/CPR vein distention INTERVENTION: pericardiocentesis ECG Clues for Toxins ✔✔various but predominately prolongation of QT interval History/Physical Clues for Toxins & Effective Intervention ✔✔bradycardia empty bottles at scene pupils neurologic exam INTERVENTION: intubation; specific antidotes ECG Clues for Thrombosis (pulmonary) ✔✔narrow complex rapid rate History/Physical Clues for Thrombosis (pulmonary) & Effective Intervention ✔✔history of condition no pulse felt w/CPR distended neck veins prior positive test for DVT or PE INTERVENTION: surgical embolectomy; fibrinolytics ECG Clues for Thrombosis (Cardiac-MI) ✔✔abnormal 12-lead ECG with -Q waves -ST segment changes -T waves, inversions History/Physical Cues for Thrombosis (Cardiac-MI) & Effective Intervention ✔✔history of condition cardiac markers good pulse with CPR INTERVENTION: none listed Amiodarone ✔✔VF/VT Cardiac Arrest (unresponsive to Shock, CPR & Vasopressor-epi) -first dose 300mg -second dose 150mg NON Arrest -150 mg Atropine ✔✔Bradycardia (with or without ACS) -0.5mg every 3-5 min not to exceed 3 mg Adenosine ✔✔stable, narrow complex SVT -first dose: 6 mg -second dose: 12mg given 1-2 min after 1st dose Vasopressin ✔✔Cardiac Arrest: -40 mg 1 time only -can be given instead of 1st or 2nd dose of EPI Dopamine ✔✔Bradycardia (used after atropine) use for hypotension <70 w/S&S of shock -2 to 20 mcg/kg per min Magnesium Sulfate ✔✔Cardiac Arrest (due to Hypomagnesemia OR Torsades de Pointes) -1 to 2 g diluted in 10mL of D5W IV/IO Torsades de Pointes w/Pulse or AMI with Hypomagnesemia -1 to 2 g mixed in 50-100mL of D5W over 5-160 min What is the desired PETCO2? ✔✔35-40 > or = 10 means good compressions <10 means need to evaluate compressions When is synchronized cardioversion indicated? ✔✔Symptomatic or Unstable SVT VT with pulses What joules dose do you use during cardio version? ✔✔Atrial flutter and SVT: initial 50 J - 100 J Monomorphic VT with pulse: inital 100 J Unstable atrial fib: -monophasic dose 200 J -biphasic dose 120 J - 200 J Which drugs can be given through ET tube? ✔✔lidocaine vasopressin epi atropine