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127 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Chest compression rate and depth? |
2 inches, 100-120/min Minute (30:2) |
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How often should compressors switch? |
Every 2 minutes |
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How long should you scan the chest for breathing? |
5-10 seconds; preform pulse check simultaneously. |
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Maximum time between compressions |
No longer than 10 seconds |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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What comprises that Primary accessment |
Airway- ? Is an advanced airway needed? Breathing- cardiac arrest - need 100% 02, otherwise, aim for 95-98% Circulation: Monitor effectiveness of chest compressions (< 10 inadequate): What’s the rhythm? Start an IV Disability: Responsiveness: AVPU: alert, Voice, Painful, Unresponsiveness Exposure: look for signs of trauma or medical alert bracelets.
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ABCD |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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What comprises that Primary accessment |
Airway- ? Is an advanced airway needed? Breathing- cardiac arrest - need 100% 02, otherwise, aim for 95-98% Circulation: Monitor effectiveness of chest compressions (< 10 inadequate): What’s the rhythm? Start an IV Disability: Responsiveness: AVPU: alert, Voice, Painful, Unresponsiveness Exposure: look for signs of trauma or medical alert bracelets.
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ABCD |
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What comprises that secondary assessment? |
Sign and symptoms: breathing, pulse rate, fever, headache, abdominal pain, bleeding Allergies: Medications - ask about last dose and time of recent medications. Look for medications on person. PMHX Last meal- time consumed, what was it Events: particulars leading up to currents illness |
SAMPLE |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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What comprises that Primary accessment |
Airway- ? Is an advanced airway needed? Breathing- cardiac arrest - need 100% 02, otherwise, aim for 95-98% Circulation: Monitor effectiveness of chest compressions (< 10 inadequate): What’s the rhythm? Start an IV Disability: Responsiveness: AVPU: alert, Voice, Painful, Unresponsiveness Exposure: look for signs of trauma or medical alert bracelets.
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ABCD |
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What comprises that secondary assessment? |
Sign and symptoms: breathing, pulse rate, fever, headache, abdominal pain, bleeding Allergies: Medications - ask about last dose and time of recent medications. Look for medications on person. PMHX Last meal- time consumed, what was it Events: particulars leading up to currents illness |
SAMPLE |
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5H & 5T’s |
Hs: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia. T’s: toxins, tamponade, tension pneumonia, thrombosis x 2 (cardiac and pulmonary) |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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What comprises that Primary accessment |
Airway- ? Is an advanced airway needed? Breathing- cardiac arrest - need 100% 02, otherwise, aim for 95-98% Circulation: Monitor effectiveness of chest compressions (< 10 inadequate): What’s the rhythm? Start an IV Disability: Responsiveness: AVPU: alert, Voice, Painful, Unresponsiveness Exposure: look for signs of trauma or medical alert bracelets.
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ABCD |
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What comprises that secondary assessment? |
Sign and symptoms: breathing, pulse rate, fever, headache, abdominal pain, bleeding Allergies: Medications - ask about last dose and time of recent medications. Look for medications on person. PMHX Last meal- time consumed, what was it Events: particulars leading up to currents illness |
SAMPLE |
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5H & 5T’s |
Hs: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia. T’s: toxins, tamponade, tension pneumonia, thrombosis x 2 (cardiac and pulmonary) |
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Most common reversible causes of PEA? |
Hypovolemia and hypoxemia |
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Maximum time between compressions |
No longer than 10 seconds |
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Minimum coronary perfusion pressure for ROSC to return |
One study should a value of 15 |
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What comprises that Primary accessment |
Airway- ? Is an advanced airway needed? Breathing- cardiac arrest - need 100% 02, otherwise, aim for 95-98% Circulation: Monitor effectiveness of chest compressions (< 10 inadequate): What’s the rhythm? Start an IV Disability: Responsiveness: AVPU: alert, Voice, Painful, Unresponsiveness Exposure: look for signs of trauma or medical alert bracelets.
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ABCD |
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What comprises that secondary assessment? |
Sign and symptoms: breathing, pulse rate, fever, headache, abdominal pain, bleeding Allergies: Medications - ask about last dose and time of recent medications. Look for medications on person. PMHX Last meal- time consumed, what was it Events: particulars leading up to currents illness |
SAMPLE |
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5H & 5T’s |
Hs: hypoxia, hypovolemia, hydrogen ion, hypo/hyperkalemia, hypothermia. T’s: toxins, tamponade, tension pneumonia, thrombosis x 2 (cardiac and pulmonary) |
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Most common reversible causes of PEA? |
Hypovolemia and hypoxemia |
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EGK initially for hypovolemia |
Narrow complex tachcardia. As blood loss continues may go to PEA. |
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When should PCI and fibrolytics be given upon arrival to the ED |
PCI: 90 minutes Fibrolytics: 30 minutes |
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When should PCI and fibrolytics be given upon arrival to the ED |
PCI: 90 minutes Fibrolytics: 30 minutes |
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Definition of ST Elevation MI? |
ST Segment elevation in 2 or more continuous leads or new LBBB |
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Threshold values for ST segment elevation consistent with a STEMI? |
J point elevation greater than 2 mm in leads v2 or v3 in men younger than 40 or 1.5 mm in women, or 1 mm or more in all other leads or by new LBBB |
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Threshold values for ST segment elevation consistent with a STEMI? |
J point elevation greater than 2 mm in leads v2 or v3 in men younger than 40 or 1.5 mm in women, or 1 mm or more in all other leads or by new LBBB |
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Time limit for fibrolytics therapy |
< 12 hours |
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Fibrolytics time frame for stroke |
With 3 hrs from onset of symptoms |
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Contraindication to Alteplase for stroke |
Time > (4 hours, some expections) Ischemic stroke in last 3 month Head trauma (severe) last 3 month Spine/intercranial surgery GI - bleed or malignancy within 21 days Platelets < 100,000 |
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Contraindication to Alteplase for stroke |
Time > (4 hours, some expections) Ischemic stroke in last 3 month Head trauma (severe) last 3 month Spine/intercranial surgery GI - bleed or malignancy within 21 days Platelets < 100,000 |
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Symptomatic bradycardia definition for management |
< 50 |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Most important step in bradycardia algorithm ? |
Are signs and symptoms of hypoperfusion Present ? If yes, atropine ( First dose 1 mg) |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Most important step in bradycardia algorithm ? |
Are signs and symptoms of hypoperfusion If yes, atropine ( First dose 1 mg) |
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Atropine dose for bradycardia? |
1 mg first dose, repeat 3-5 minutes Max 3 mg |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Most important step in bradycardia algorithm ? |
Are signs and symptoms of hypoperfusion If yes, atropine ( First dose 1 mg) |
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Atropine dose for bradycardia? |
1 mg first dose, repeat 3-5 minutes Max 3 mg |
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Dopamine dose (bradycardia) |
5-20 mcg/kg |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Most important step in bradycardia algorithm ? |
Are signs and symptoms of hypoperfusion If yes, atropine ( First dose 1 mg) |
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Atropine dose for bradycardia? |
1 mg first dose, repeat 3-5 minutes Max 3 mg |
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Dopamine dose (bradycardia) |
5-20 mcg/kg |
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Epi dose (bradycardia) |
2-10 mcg |
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Symptoms & symptoms of Bradycardia? |
Hypotension, AMS, Signs of shock, Chest pain, Heart failure |
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Most important step in bradycardia algorithm ? |
Are signs and symptoms of hypoperfusion If yes, atropine ( First dose 1 mg) |
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Atropine dose for bradycardia? |
1 mg first dose, repeat 3-5 minutes Max 3 mg |
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Dopamine dose (bradycardia) |
5-20 mcg/kg |
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Epi dose (bradycardia) |
2-10 mcg |
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Hypertension + Bradycardia |
Possible sign of intercranial pressure |
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Don’t give atropine in these types of blocks (use TCP or epi) |
Mobitiz II or 3rd degree block Careful in MI. |
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Tachycardia likely from an arrhythmia? |
> 150/min |
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Tachycardia likely from an arrhythmia? |
> 150/min |
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Tachycardia clinical consequences? |
Pulmonary edema, coronary ischemia, hypotension, reduced cardiac output.. |
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Adenosine dose for unstable tachycardia (narrow complex) |
6 mg first dose 12 mg second dose |
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Wide complex tachycardia- management |
Monophonic VT - synchronized cardioversion |
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How do you approach polymorphic VT, e.g., torsades? |
Treat as VF - unsychronized shocks |
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Synchronized shocks are recommended with these tachyarhythmias? |
Pt has a pulse and unstable: SVT AFib AFlutter Regular monomorphic VT |
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Synchronized shocks are recommended with these tachyarhythmias? |
Pt has a pulse and unstable: SVT AFib AFlutter Regular monomorphic VT |
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Unsynchronized shocks are recommended with these rhythms? |
No pulse (VT/pVT) Polymorphic VT Unstable pt, not sure if mono or polymorphic VT |
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Some rhythms that may not respond to synchronized cardioversion? |
Junctions rhythms Multi focal tachycardia |
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How is sinus tachycardia different than SVT?T |
Sinus tachycardia is not generally > 120-130. Has gradual onset and gradual termination. SVT has an abrupt onset and abrupt termination. |
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Key questions for tachycardia evaluation |
Symptomatic an are these 2/2 tachycardia Stable or unstable? QRS narrow or wide Rhythm monomorphic or polymorphic? Is this sinus tachycardia? |
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Drugs to avoid in irregular wide-complex tachycardia? |
AV nodal blocking drugs: adenosine, CCB, digoxin, Beta blockers (preexitation Afib). These cause paradoxically increase the heart rate. |
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Drugs to avoid in irregular wide-complex tachycardia? |
AV nodal blocking drugs: adenosine, CCB, digoxin, Beta blockers (preexitation Afib). These cause paradoxically increase the heart rate. |
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Should beta blockers be given for AFLutter? |
No |
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Ways to increase chest compression |
Precharge the defibrillator Compressor hovers over the chest Have the next compressor hover over the chest Have the next compressor take over immediatleu |
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Ways to increase chest compression |
Precharge the defibrillator Compressor hovers over the chest Have the next compressor hover over the chest Have the next compressor take over immediatleu |
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What is the role of the CPR coach? |
Monitors the compression quality (rate, depth, recoil, too many pauses. |
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Tidal volume for respiratory arrest? |
500-600 ml |
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Why is excessive ventilation harmful? |
Increases thoracic pressure Decreases venous return to the heart Diminished cardiac output and survival Cerebral vasoconstriction |
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Why is excessive ventilation harmful? |
Increases thoracic pressure Decreases venous return to the heart Diminished cardiac output and survival Cerebral vasoconstriction |
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How often to delivery ventilations and check pulse in respiratory arrest? |
1 breath every 6 seconds, 10 breaths/min Check pulse every 2 minutes. |
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What are contraindications to an oral pharyngeal airway? |
cough or gag reflex. |
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02 saturation’s appropriate for ACS, stroke, post cardiac arrest? |
ACS: 90% Stroke:95-95% Post cardiac arrest: 92-98% Cardiac arrest: 100% |
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02 saturation’s appropriate for ACS, stroke, post cardiac arrest? |
ACS: 90% Stroke:95-95% Post cardiac arrest: 92-98% Cardiac arrest: 100% |
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Ventilation rate for use in advanced airway for respiratory or cardiac arrest? |
Once every 6 seconds. |
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Defib dose: biphasic: |
120-200 mg |
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Defib dose: biphasic: |
120-200 mg |
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Defib dose: Monophasic: |
360 J |
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Epi dose ASCL |
1 mg every 3-5 min |
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Amiodarone |
300 mg first dose, second dose 150 mg |
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Lidocaine dose ACLS |
Firs dose 1-1.5 mg/kg, second dose 0.5-075 mg/kg. |
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A PETCO2 consistent with ROSC |
>40 |
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How is the chest compression fraction calculated (CCF?) |
Actual chest compression Tim / total code time. |
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When does ROSC typical happen? |
>35-40, 50 is a substantial increase |
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Preferred route for ASCL drug administration |
IV>IO>Endotracheal (requires 2-3 times drug amount) |
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Differential dx in PEA? |
Not enough preload- left ventricle empty Poor LFT ventricular contractibility (may improve with chest compressions) |
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When should CPR stop? |
ETCO2 less than 10 mcg Hg after 20minutes of CPR and reversible causes have been addressed. |
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For non-shockable rhythms, when should epi be given? |
ASAP. |
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Epi dose ASCL |
1 mg every 3-5 min |
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POST cardiac arrest care optimal bp |
>90 mmHg systolic |
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Amiodarone |
300 mg first dose, second dose 150 mg |
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Lidocaine dose ACLS |
Firs dose 1-1.5 mg/kg, second dose 0.5-075 mg/kg. |
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A PETCO2 consistent with ROSC |
>40 |
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How is the chest compression fraction calculated (CCF?) |
Actual chest compression Tim / total code time. |
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When does ROSC typical happen? |
>35-40, 50 is a substantial increase |
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Preferred route for ASCL drug administration |
IV>IO>Endotracheal (requires 2-3 times drug amount) |
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Differential dx in PEA? |
Not enough preload- left ventricle empty Poor LFT ventricular contractibility (may improve with chest compressions) |
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When should CPR stop? |
ETCO2 less than 10 mcg Hg after 40 minutes of CPR and reversible causes have been addressed. |
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For non-shockable rhythms, when should epi be given? |
ASAP. |
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Epi dose ASCL |
1 mg every 3-5 min |
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POST cardiac arrest care optimal bp |
>90 mmHg systolic |
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Temperate for TTM |
32-36 for 24 hours |
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Amiodarone |
300 mg first dose, second dose 150 mg |
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Lidocaine dose ACLS |
Firs dose 1-1.5 mg/kg, second dose 0.5-075 mg/kg. |
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A PETCO2 consistent with ROSC |
>40 |
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How is the chest compression fraction calculated (CCF?) |
Actual chest compression Tim / total code time. |
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When does ROSC typical happen? |
>35-40, 50 is a substantial increase |
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Preferred route for ASCL drug administration |
IV>IO>Endotracheal (requires 2-3 times drug amount) |
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Differential dx in PEA? |
Not enough preload- left ventricle empty Poor LFT ventricular contractibility (may improve with chest compressions) |
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When should CPR stop? |
ETCO2 less than 10 mcg Hg after 40 minutes of CPR and reversible causes have been addressed. |
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For non-shockable rhythms, when should epi be given? |
ASAP. |
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Number of breaths per min after ROSC |
10 breaths/min |
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O2 sat goals POST ROSC |
92-98% |
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