Acls Algorithm Flascards

Front 1

In pulseless arrest, What two rythms are immediately shockable?

Back 1

Ventricular fibrillation (coarse), ventricular tachycardia

Front 2

In pulseless Arrest, what two rythms are not immediately shockable?

Back 2

PEA, Asystole

Front 3

Once you have determined it is a shockable rythm, Do you shock, or perform CPR first?

Back 3

Shock first. Manual biphasic: device specific- usually 120-200J; AED- device specific; Monophasic- 360J CHECK FOR A PULSE

Front 4

Your first shock has not affected the heart rythm. What is your next step?

Back 4

Give 5 cycles of CPR*. Check the rythm.

* after advanced airway is placed, give continuous chest compressions without pauses for breaths. Give 8-10 breaths per minute.

Front 5

After your first shock, the pt still has a shockable rythm. Your partner is is establishing IV access. What is your next step?

Back 5

Continue CPR while defibrillator is charging. GIVE 1 SHOCK.
Manual Biphasic- same as first shock or higher dose.
AED-device specific.
Monophasic-360J
Resume CPR immediately after shock.

Front 6

IV access has been established. Pt has been down less than 10 minutes. What medicine(s) would you give first and second?

Back 6

Epinephrine (1mg IV/IO) every 3-5min.
OR
Vasopressin (40u IV/IO)

*Order doesn't matter, but you must give both*

Front 7

How often is Vasopressin given during a pulseless arrest?

Back 7

1 time dose. It must be given either first, or second in place of a dose of epi.

Front 8

Two shocks have been given, you have pushed a round of epi, and vasopressin. your pt still has a shockable rythm. What's next?

Back 8

Continue CPR while defibrillator is charging.
Deliver 1 shock.
Manual Biphasic- same as first shock or higher dose.
AED-device specific.
Monophasic-360J
Resume CPR immediately after shock

Front 9

what antiarrhythmics would you consider during pulseless arrest?

Back 9

Amiodarone- 300mg IV/IO once, then consider additional 150 once; or
Lidocaine-1-1.5mg/kg first dose, then 0.5-0.75mg/kg IV/IO max 3 doses, or 3mg/kg

Front 10

What medicine would you consider for Torsades de pointes?

Back 10

Magnesium Sulfate-1-2g IV/IO

Front 11

You arrive on scene and pt is in asystole for less than 10 minutes. Your partner is establishing an IV. Do you shock, or give CPR?

Back 11

CPR immediately.

Front 12

An IV has just been established on your asystolic pt. What medicines do you consider?

Back 12

Epinephrine- 1mg IV/IO every 3-5 min.
OR
Vasopressin 40u IV/IO to replace first or second dose of epi.

Consider atropine 1mg IV/IO for asystole, or slow PEA rate every 3-5 min up to 3 doses.

Front 13

You have administered your first round of medication to your pt with no shockable rhythm. Do you shock immediately, or give CPR?

Back 13

Give cycles of CPR unless advanced airway has been placed. After advanced airway placement, give continuous chest compressions without pauses for breaths.

Front 14

How often per ACLS algorithm do you check the rythm, and rotate compressors?

Back 14

Every 2 minutes for both.

Front 15

You arrive on scene and pt is in asystole for less than 10 minutes. Your partner is establishing an IV. Do you shock, or give CPR?

Back 15

CPR immediately.

Front 16

An IV has just been established on your asystolic pt. What medicines do you consider?

Back 16

Epinephrine- 1mg IV/IO every 3-5 min.
OR
Vasopressin 40u IV/IO to replace first or second dose of epi.

Consider atropine 1mg IV/IO for asystole, or slow PEA rate every 3-5 min up to 3 doses.

Front 17

You have administered your first round of medication. Do you shock immediately, or give CPR?

Back 17

Give cycles of CPR unless advanced airway has been placed. After advanced airway placement, give continuous chest compressions without pauses for breaths.

Front 18

How often per ACLS algorithm do you check the rythm, and rotate compressors?

Back 18

Every 2 minutes for both.

Front 19

Your preciously asystolic patient has converted to a rhythm with a pulse. What is your next step?

Back 19

Begin postresuscitation care.

Front 20

What are the 6H's and 6t's that can cause pulseless electrical activity?

Back 20

Hypovolemia, Hypoxia, Hydrogen ion(acidosis), Hypo-/ hyperkalemia, hypothermia

Toxins, tamponade(cardiac), tension pneumothorax, thrombosis(coronary, or pulmonary) trauma, tablets

Front 21

It is important that you minimize _________ in chest compressions, and ensure full chest ______ during CPR.

Back 21

interruptions, recoil

Front 22

During your initial assessment of a new patient, he says he just woke up and his pulse was racing. Your EMT pratner verifies that his pulse is 170 bpm. Per the tachycardia algorithm, what are the top 4 basic things you are to do?

Back 22

-Assess and support ABCs as needed.
-Give OXYGEN
-Monitor ECG (identifyu rhythm), blood pressure, oximetry
-identify and treat reversible causes.

Hint 22

this is straight out of box 2 on the flow chart

Front 23

Before you can implement a treatment for a tachycardic patient, what must you do regarding the rate?

Back 23

Discern if this stable or unstable tachycardia.

Front 24

What sort of things do you expec to to see in a pt with unstable tachycardia of <150bpm?

Back 24

Altered mental status, ongoing chest pain, hypotension, or other signs of shock.

Front 25

Are rate related symptoms common if the heart rate is below 150bpm?

Back 25

No.

Front 26

You have discerned that your pt is experiencing unstable tachycardia. Provided he is on oxygen, maintaining his airway, and the ECG, BP, and Sp02 has been put on him, What is your next immediate action?

Back 26

Perform immediate synchronized cardioversion:

-establish IV access and give sedation if pt is still conscious, do not delay cardioversion.
-consider expert consultation
-if pulseless arrest develops, got to pulseless arrest algorithm.

Hint 26

His heart is not beating efficiently, you need to take it over for him.

Front 27

You discern that your pt is in a stable tachycardia. What are your next steps, and what do you need to discern before continuing treatment?

Back 27

-Establish IV access
-Obtain 12-lead ECG (when avainable) or rhythm strip.
-discern if the QRS is wide or narrow.

Front 28

What is considered a wide QRS complex?

Back 28

Greater than or equal to .12 sec (120 milisec)

Front 29

You discern that your pt has a wide complex tachycardia. what is your next question, and what is advised?

Back 29

You need to know is the rhythm regular, or irregular.

Expert consultation is advised.

Front 30

Your pt who is in a wide complex tachycardia has now become unstable. What is your next move?

Back 30

Immediate synchronized cardioversion

Hint 30

I hope you have that IV established! But don't delay treatment getting one right now.

Front 31

Your pt is in a regular rhythm wide complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?

Back 31

If V-tach, or uncertain rhythm:
Amiodarone- 150mg over 10 min. Repeat as needed to max dose of 2.2g/24hrs.
-prepare for elective synchronized cardioversion
-or-
If SVT with aberrancy:
Adenosine 6mg RIVP

Front 32

Your pt is in an irregular rhythm wide complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?

Back 32

If a-fib with aberrancy:
probable a-fib, or possible a flutter or MAT.
-consider expert consultation
- Control rate ( diltiazem, beta blockers *use beta blockers with caution in pulmonary disease or CHF*)

If afib with WPW:
-expert consultation advised
AVOID AV nodal blocking agents (adenosine, digoxin, diltiazem, verapamil)
-consider antiarrhythmics (amiodarone 150mg IV over 10 min.)

If recurrent polymorphic VT, seek expert consultation.

If torsades de pointes, give mag sulfate (load 1-2g over 5-60 minutes, then infuse)

Front 33

During your initial assessment, your pt says he just woke up and his pulse was racing. Your EMT partner verifies that his pulse is 174 bpm. Per the tachycardia algorithm, what are the top 4 basic things you are to do?

Back 33

-Assess and support ABCs as needed.
-Give OXYGEN
-Monitor ECG (identify rhythm), blood pressure, oximetry
-identify and treat reversible causes.

Front 34

You discern that your pt is in a stable tachycardia. What are your next steps, and what do you need to discern before continuing treatment?

Back 34

-Establish IV access
-Obtain 12-lead ECG (when available) or rhythm strip.
-discern if the QRS is wide or narrow.

Front 35

You discern that your pt has a narrow complex tachycardia. what is your next question, and what is advised?

Back 35

You need to know is the rhythm regular, or irregular.

Front 36

Your pt who is in a narrow complex tachycardia has now become unstable. What is your next move?

Back 36

Perform immediate synchronized cardioversion

Front 37

our pt is in a regular rhythm narrow complex tachycardia. Per the tachycardia algorithm,how do you treat?

Back 37

-Attempt vagal maneuvers
- give Adenosine 6mg rapid IV push. If no conversion, give 12 mg rapid IV push; may repeat 12 mg dose once

Hint 37

You will probably need another set of hands for this. And oh yeah, if you can please tell the pt what you are about do!

Front 38

You have given the recommended dose of Adenosine to your pt with a regular narrow tachycardia rhythm. What will decide your next course of action?

Back 38

Whether or not the rhythm converts.

Hint 38

Note: consider expert consultation. This is an easy question. Box 8

Front 39

Your pt with a regular narrow tachycardia rhythm has tolerated your treatment well and the rhythm has converted with Adenosine. What is the probable rhythm, and what is your next step?

Back 39

Probable reentry SVT:
_ Observe for recurrence with Adenosine or longer acting AV nodal blocking agents (eg, diltiazem, beta-blockers)

Hint 39

Remember, you dance with the partner you came with. If the treatment works, MAINTAIN the effects

Front 40

Your pt with a regular narrow tachycardia rhythm has tolerated your treatment well but the rhythm has not converted after giving the maximum doses of Adenosine. What is the probable rhythm, and what is your next step?

Back 40

Possible atrial flutter, ectopic atrial tachycardia, or junctional tachycardia:
- Control rate (eg, diltiazem, beta-blockers- use beta-blockers with caution in pulmonary disease or CHF)
- Treat underlying cause
- Consider expert consultation

Front 41

Your pt is in an irregular rhythm narrow complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?

Back 41

Probable atrial fibrillation or possible atrial flutter or MAT (multifocal atrial tachycardia)
- Consider expert consultation
- Control rate (eg, diltiazem, beta-blockers- use beta blockers with caution in pulmonary disease or CHF)

Front 42

You have been dispatched to a 54 yo female complaining of "not feeling well, and very tired." You arrive to find your female patient looking pale and diaphoretic. Pulse is 56bpm. What are your initial treatment steps per the bradycardia algorithm?

Back 42

-Maintain patent airway; assist breathing as needed.
- Give oxygen
- monitor ECG(identify rhythm), blood pressure, oximetry
- Establish IV access

Front 43

What are signs and symptoms of poor perfusion caused by bradycardia?

Back 43

Acute altered mental status, ongoing chest pain, hypotension or other signs of shock.

Front 44

You have just applied O2, started an IV and attached the monitor to your bradycardic patient. She is adequately perfusing, and her rhythm is showing sinus bradycardia. What is your treatment plan per the ACLS bradycardia algorithm?

Back 44

Observe and monitor

Front 45

You have just applied O2, started an IV and attached the monitor to your bradycardic patient. She is not adequately perfusing, and her ECG is showing second degree AV block type II. What is your treatment plan per the ACLS bradycardia algorithm?

Back 45

Prepare for transcutaneous pacing; use without delay for high-degree block (second degree type II or third degree)
- Consider atropine 0.5mg IV while awaiting pacer. May repeat to a total dose of 3mg. If ineffective, begin pacing
- Consider epinephrine (2-10 mcg/min) or dopamine (2-10 mcg/kg/min) infusion while awaiting pacer or if pacing is ineffective.

Front 46

You are pacing your bradycardic patient. What else should you prepare for and do?

Back 46

-Prepare for transvenous pacing
-Treat contributing causes
-Consider expert consultation

Front 47

QUICK!!!!!
What are the 6Hs and 6Ts?

Back 47

-Hypovolemia
-Hypoxia
-Hydrogen ion (acidosis)
-Hypo-/hyperlkalemia
-Hypoglycemia
-Hypothermia
-Toxins
-Tamponade, cardiac
-Tension pneumothorax
-Thrombosis (coronary or pulmonary)
-Tablets

Hint 47

:)

You may only have 5, but i was given 6Ts