Acls 2010 Cases

Front 1

Describe steps in VF Treated with CPR & AED

Back 1

Activate EMS / Get AED
Check Pulse:
---If no pulse - Begin 30comp:2breaths
---If pulse give 1 breath every 5-6 seconds, recheck pulse every 2 minutes
Place AED

Front 2

VF Tx w/CPR&AED - Pulsless: Shockable rhythm

Back 2

Give 1 shock
Resume CPR for 2 minutes

Front 3

VF Tx w/CPR&AED - Pulseless: Rhythm is not shockable

Back 3

Resume CPR for 2 minutes
Check rhythm every 2 minutes
Continue until ALS providers take over

Front 4

VF Tx w/CPR&AED: Intro - Pulse present

Back 4

Activate EMS / Get AED
Check Pulse - present -> Give 1 breath every 5-6 seconds
Give 1 breath every 5-6 seconds
Recheck pulse every 2 minutes

Front 5

VF Tx w/CPR&AED: Protocol if pulseless

Back 5

Activeate EMS / Get AED
Begin 30comp:2breaths
Place AED

Front 6

For every minute that passes between collapse and defibrillation, the chance of survival from a witnessed VF sudden cardiac arrest declines by:
_____ % if no CPR is provided
_____ % if CPR is provided

Back 6

7-10% if no CPR is provided
3-4% if CPR is provided

Front 7

AED's should only be used in the setting of what 3 clinical findings??

Back 7

No response
Absent or Abnormal breathing
No pulse

Front 8

Which of the following scenarios are shockable vs non-shockable:
--VF/Pulseless VT
--Asystole / PEA

Back 8

VF/Pulseless VT - Shockable
Asystole / PEA - Nonshockable

Front 9

What action should be undertaken if PETCO2 < 10mmHg

Back 9

Attempt to improve CPR quality

Front 10

What action should be undertaken if diastolic < 20mmHg

Back 10

Attempt to imporve CPR quality

Front 11

What is the significance of abrupt sustained increase in PETCO2 >= 40mmHg

Back 11

ROSC

Front 12

What is the sequence of VF/VT?

Back 12

Start CPR
Shock
CPR 2 minutes
IV Access
Advanced Airway/Capnography
Assess rhythm - if not Shockable : Asystole/PEA, if Shockable:
---Shock
---CPR 2 minutes
---Capnography
---Epi every 3-5 minutes
Assess rhythm - if not Shockable : Asys/PEA, if Shockable:
---Shock
---CPR x 2 minutes
---Amiodarone

Front 13

What is the sequence for Asystole/PEA?

Back 13

CPR x 2 min
IV Access
Epi 1mg every 3-5 min
Advance airway/capnography
┌─►Assess Rhythm, if Shockable go to VF/VT
│ if not shockable:
└──CPR x 2 min

Front 14

List shock energy for
Biphasic - first and second shock
Monophasic - first and second shock

Back 14

Biphasic - Initial: 120-200J / Subsequent: equivalent or higher
Monophasic - Initial & Subsequent: 360J

Front 15

List reversible causes of arrest: 5H

Back 15

Hypovolemia
Hypoxemia
Hypothermia
Hypo/hyperkalemia
Hydrogen Ion - Acidosis

Front 16

List reversible causes of arrest: 5T

Back 16

Tension ptx
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary

Front 17

What medication/dosing may be used if Amiodarone is not available?

Back 17

Lidocaine 1-1.5 mg/kg IV/IO followed by 0.5-0.75mg/kg every 5-10 min to max dose of 3mg/kg

Front 18

What procedure should follow each IV/IO dose of epi?

Back 18

20ml flush IV fluid
Elevate extremity above the level of the heart for 10-20 seconds

Front 19

What are the two arrest pathways in the Cardiac Arrest Algorithm?

Back 19

Asystole/PEA -and- Vfib/VTach

Front 20

Define PEA

Back 20

Organized rhythm without pulse

Front 21

How much time should be taken for pulse check?

Back 21

5-10 seconds

Front 22

What is the role of routine fibrinolytic treatment in patients with cardiac arrest without known pulmonary embolus?

Back 22

No role - it is of no benefit and not recommended

Front 23

What are the two most common and easily reversible causes of PEA?

Back 23

Hypovolemia and hypoxia

Front 24

What are the first 5 steps of supportive care in bradycardia?

Back 24

Maintain airway
O2
Cardiac monitor
IV Access
12 lead EKG (if available)

Front 25

In the setting of bradycardia, what symptoms indicate instability and need to treat?

Back 25

Hypotension
Altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure

Front 26

What is the first line treatment for bradycardia?

Back 26

Atropine

Front 27

If atropine is ineffective in the treatment of bradycardia, what other pharmacological options are available?

Back 27

Dopamine IV infusion (2-10mcg/kg/min)
Epinephrine IV infusion (2-10mcg/minute)

Front 28

In what two types of AV block is atropine contraindicated?

Back 28

Second degree - Mobitz type II
Third degree

Front 29

What is the atropine dosage used in AVB?

Back 29

Start 0.5mg bolus
Repeat every 3-5 minutes
Maximum total dose 3mg

Front 30

What is the role of transvenous pacing in symptomatic bradycardia?

Back 30

Second-line treatment

Front 31

At what current setting should transcutaneous pacing be set?

Back 31

2mA aobve the dose at which consistent capture is observed

Front 32

In the setting of infarction, which rhythms are indications for the placement of TCP electrodes in anticipation of clinical deterioration?

Back 32

1) Sinus node dysfunction with severe bradycardia
2) Second Degree AV Block - Mobitz Type II
3) Third degree AV block
4) Newly acquired left, right or alternating BBB or bifascicular block

Front 33

In what type of tachyarrhythmia is adenosine indicated?

Back 33

REGULAR and monomprophic
REGULAR Narrow complex tachycardia

Front 34

List types of tachyarrhythmias (Narrow/wide versus Regular/Irregular) and initial recommended cardioversion doses - specify synchronized versus unsynchronized

Back 34

Narrow Regular: SYNC 50-100 J
Narrow Irregular; SYNC 120-200J Biphasic / 200J monophasic
Wide regular: SYNC 100J
Wide Irregular: UNSYNC Defib dosing

Front 35

What is the QRS width beyond which QRS is considered wide complex?

Back 35

>= 0.12 second

Front 36

In what rhythyms are synchronized shocks recommended:

Back 36

Unstable SVT or VT with pulses
Unstable Afib, Aflutter
Unstable regular monomorphic tachycardia with pulses

Front 37

In what rythyms are unsynchronized shokcs indicated?

Back 37

1) Pulseless patient
2) Uncertain whether monomorphic or polymorphic VT is present in the setting of an unstable patient
3) Clinical deterioration in prearrest

Front 38

What are energy dosages for cardioversion of unstable Afib:
Monophasic?
Biphasic?

Back 38

Monophasic: Initial 200J sync
Biphasic: Intiial 120-200J sync

Front 39

What are energy dosages used for cardioversion of Aflutter and SVT:
Initial?
Subsequent?

Back 39

Biphasic: Initial 50-100J
Increase dose in stepwise fashion

Front 40

What is the dose used for cardioversion of monomorphic VT:
Initial?
Subsequent?

Back 40

Initial dose: 100J
Subsequent dose: increase stepwise fashion

Front 41

List monophasic synchronized initial doses for:
Unstable AFib
Unstable monomorphic VT
Unstable SVT A flutter
Unstable Polymorphic VT

Back 41

Unstable Afib, Aflutter, SVT: 200J monophasic sync
Unstable Monomorphic VT: 100J monophasic sync
Polymprophic VT - Treat as VF defib doses

Front 42

In IV Adenosine - what is
1st dose
Second dose

Back 42

1st dose: 6mg rapid IV push - followed with NS Flush
2nd dose: 12mg if required

Front 43

In what setting is Adenosine contraindicated in tachycardia?

Back 43

Irregular whide-complex tachyarrhythmias

Front 44

What medical condition can be worsened by adenosine?

Back 44

Asthma - adenosine can induce bronchospasm

Front 45

In wide complex tachycardia, what characteristics indicate it is safe to use adenosine?

Back 45

regular and monomorphic

Front 46

In the setting of unstable tachycardia, under what 3 scenarios is unsynchronized shock indicated?

Back 46

1) Pulseless patient
2) Prearrest - clinical deterioration
3) Uncertain whether monomorphic or polymorphic VT is present

Front 47

In unstable tachycardia, if an unsynchronized shock causes VF, what is the next treatment step?

Back 47

Attempt immediate defibrillation