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30 Cards in this Set
- Front
- Back
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How do ventilation and pulse checks work in a patient in respiratory arrest with a pulse? |
10-12 breaths per minute
recheck pulse every 2 min (don't take longer than 5-10 sec for a pulse check) - this is with use of OPA/NPA and bag mask |
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how do you confirm placement of ET Tube
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continuous quatitative waveforme capnography
- it displays the partial pressure of CO2 |
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ACLS secondary survery
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A- Airway (maintain patency, use advanced airway if needed)
B- Breathing- bag mask ventilation C- Circulation. IV/IO access, ECG, monitor for arrythmias, fluids if needed D- Differential Diagnosis |
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management of respiratory arrest steps
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Give O2
open the airway provide basic ventilation use basic airway adjuncts (OPA/NPA) Suctioning provide ventilation with advanced airway |
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why must you avoid hyperventilation and what are the effects?
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giving too many breaths or too large a volume can be harmful because it increases intrathoracic pressure, decreased venous return to the heart and diminishes cardiac output
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Oxygen devices and flow rates:
percentage oxygen delivered: nasal cannula |
1-6 L/min
21-44% O2 delivered |
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Oxygen devices and flow rates:
percentage oxygen delivered: venturi mask |
4-12 L/min
24-50% O2 delivered |
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Oxygen devices and flow rates:
percentage oxygen delivered: partial rebreather mask |
6-10 L/min
35-60% O2 delivered |
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Oxygen devices and flow rates:
percentage oxygen delivered: nonrebreather O2 mask |
6-15 L/min
60-100% O2 delivered |
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Oxygen devices and flow rates:
percentage oxygen delivered: bag mask with nonrebreather tail |
15 L/min
95-100% O2 delivered |
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when is the OPA used?
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in UNCONSCIOUS patients who are at risk for airway obstruction from the tongue or from relaxed upper airway muscles. DO NOT use in a conscious/ semiconscious patient
also used to keep airway opening during suctioning, and patients with ET tube in place |
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how do you know NOT to use OPA?
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if unconscious patient has an intact gag or cough reflex
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when do you use NPA?
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in conscious/semiconscious patients. It is used when insertion of an OPA is difficult (mouth trauma, stong gag reflex
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what cautions need to be considered with the NPA?
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- gentle insertion otherwise you could lacerate nasal mucosa with bleeding and possible aspiration
- improperly sized NPA can go into the esophagus - NPA can cause laryngeal spasm and vomiting - caution in pts with facial trauma lest you put it into the cranial cavity |
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what are the 2 shockable rhythms?
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pulsless VT
VF (this deteriorates to asystole if not treated) |
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where do you place electrode pads of the AED?
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upper right side oft he bare chest and left of the nipple below the armpit
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TRUE or FALSE?
the presence of an implantable defribrillator is a contraindication to using an AED |
FALSE- you can use it, just don't place the pads right over the device
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drugs for VF/VT
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epinephrine
vasopressin lidocaine amiodarone magnesium (if torsades present) |
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VF/VT algorithm
(after BLS primary survey and initial ABCs and O2) |
Give 1 shock
- bipahsic 120J-200J - monophasic 360J Resume CPR- 5 cycles (2 min) Check rhythm give another shock (if needed) Resume CPR immediately give epinephrine 1mg IV/IO - repeat every 3-5 min - can use vasopressin 40U to replace 1st or second dose of epi Resume CPR- 5 cycles Check rhythm give 1 shock Resume CPR cosider antiarrythmics - amiodarone 300mg once (then 150mg additional) OR - lidocaine 1-1.5 mg 1st dose then 0.5-0.75; max 3 doses |
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asystole/ pulseless arrest algorithm- not shockable rhythm
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CPR- 5 cycles
Give epi 1mg every 3-5 min or vasopressin 40U CPR- 5 cycles Check rhythm rinse and repeat if rhythm remains unshockable no antiarrhythmics needed since PEA is not an arrhythmia |
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what does 1 cycle of CPR consist of?
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30 compressions and 2 breaths
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when should you administer the vasopressor? (epi or vasopressin?)
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either BEFORE or AFTER the shock
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when should you conduct a rhythm check?
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after every 5 cycles of CPR
1 cycle = 30 compressions, 2 ventilations |
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when and how do you give magnesium?
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Magnesium is for torsades de pointes
loading dose 1-2g IV/IO diluted in 10ml D5W |
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how does the VF/VT algorithm differ in a patient with hypothermia?
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a single defibrillation attempt is appropriate
- hypothermic heart may be unresponsive to drug therapy so defer admin of drugs until core temperature rises above 86 |
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what are the 3 routes of access for drugs?
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IV
IO thru ET tube |
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what's important to remember about administering drugs via the ET route?
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you have to give 2 to 2.5 times the IV dose
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which drugs can be administered via the ET route?
how do you give it? |
epinephrine
vasopressin atropine lidocaine naloxone dilute the dose in 5-10ml of water or NS |
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with the bag-valve device, what is the preferred tidal volume that needs to be given with ventilating a patient?
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10-15 ml/kg
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what's the potential complication of the bag-valve mask device
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pneumothorax if you infalte too hard
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