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28 Cards in this Set
- Front
- Back
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What are the H's and T's of PEA?
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What do these conditions cause?
Hypovolemia Hypoxia Hydrogen ions (acidosis) Hypo- and hyperkalemia Hypothermia Tablets (TCAs, Dig, BBlockers, CCBs) Tamponade Tension Pneumothorax Thrombosis of the heart (MI) Thrombosis of the lungs (PE) Trauma |
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What are the BLS primary survey steps?
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Airway- Look for rise and fall of chest. Open the airway
Breathing- check breathing for 5 seconds. Give 2 rescue breaths, looking for chest rise Circulation- Check carotid pulse. Perform CPR (30:2 compressions:ventilations) Defibrillation- Defibrillate ASAP |
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Describe the "A" in the secondary survey of ACLS?
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Airway- open the airway using jawthrust, then look/listen/feel for breath.
If no breath is present, administer non-invasive or invasive airway as necessary. |
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Generally when is an advanced airway indicated during the secondary survey in ACLS?
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If the patient's airway is not maintained with non-invasive measures, what is the appropriate next step?
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Describe the "B"in the secondary survey of ACLS.
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Breathing- administer bag-valve-mask ventilations every 5-6 seconds (10-12 breaths per minute).
In addition to administering breaths, confirm placement of the advanced airway if indicated. |
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Describe the "C" of secondary survey of ACLS.
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Circulation- Obtain IV/IO access and give fluids.
ECG leads and identify arrythmias. |
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What are the initial steps during any civilian emergency?
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1) Check patient responsiveness, 2) call 9-1-1 and 3) get the AED.
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What are the two most important interventions for sudden cardiac arrest?
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1) CPR with minimal interruptions and 2) Defibrillation in the first minutes of arrest.
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How long can chest compressions be paused before resucitation is affected?
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10 seconds
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Upon determining an ACLS patient is in VF or VT, what is the next appropriate order of events?
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1) Shock then CPR (5 cycles/2 min)
2) Recheck - Shock then CPR with vasopressor 3) Recheck - Shock then CPR with anti-arrythmic 4) Recheck and return to top. |
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What drugs should be used as vasopressors?
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Epinephrine 1mg IV q3min or vasopressin 40U IV for 1st or 2nd dose of Epi
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What drugs should be used as antiarrhythmics?
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Amiodarone 300mg IV x1, consider 150mg IV x1
Lidocaine 1.5mg/kg x1, then 0.75mg/kg x2 Magnesium 1-2g IV for Torsades |
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Upon determining an ACLS patient is in asystole or PEA, what is the appropriate order of events?
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1) no shock- CPR immediately (5 cycles)
2) Give vasopressor and consider Atropine 1mg for asystole. 3) Recheck- no shock- no pulse/electrical activity- CPR with vasopressors and atropine. |
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What is the ACLS bradycardia algorithm following identification and initial ABCs?
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1) Assess perfusion 2) if poor perfusion, prepare transcutaneous pacing for high degree block, giving atropine and then epinephrine or dopamine while waiting 3) Prepare transvenous pacing and consult cardiology
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What drugs should be given during symptomatic bradycardia according to ACLS? When are they given?
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Atropine .5mg IV (total 3mg) before pacing if patient is mildly unstable, and epinephrine (2-10 ug/min) and dopamine (2-10 ug/kg/min) if pacing is not available or not working
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What scenarios require transcutaneous pacing?
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Symptomatic bradycardia that is refractory to atropine or if the patient is unstable, or if they have 2nd degree Mobitz Type II or Third degree heart block.
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What rhythms in the setting of an MI are so unstable as to require standby TCP?
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symptomatic sinus node dysfunction with symptomatic bradycardia; asymptomatic type 2 second degree or third degree heart block; a new bundle branch block (left, right, alternating or bifascicular)
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What is the initial assessment step in a tachycardic patient? What is the immediate next step?
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Determine if pulses are present. Perform the ACLS ABCs and treat reversible causes to see if symptoms resolve.
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What are some signs of an unstable tachycardic patient?
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altered mental status, hypotension, respiratory distress, chest pain, decreased urine output.
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What should be done immediately if a tachycardic patient is determined to be unstable?
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Perform immediate synchronized cardioversion.
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If a tachycardic patient is clinically stable, what is the proper sequence of actions?
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Get IV access and a ECG and determine if the QRS complex is narrow and regular.
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How is a narrow QRS complex defined?
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A narrow QRS complex is less than 0.12sec (three blocks)
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How should regular narrow complex be treated?
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Attempt vagal maneuvers, and then give Adenosine 6mg IV push, then 12mg IV push, and again if necessary.
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If patient's narrow complex regular tachycardia converts with appropriate treatment, what is the cause and follow-up action?
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The cause is likely a reentry SVT and the patient should be monitored for recurrence. Recurrences should be treated with adenosine or long acting AV blocking agents (dilt or BB)
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If patient's narrow complex regular tachycardia does not convert with appropriate treatment, what is the cause and follow-up action?
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The cause may be A. flutter, ectopic atrial tachy or Junctional Tachycardia. The patient's rate should be controlled with dilt or BB, and the underlying cause should be treated.
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What is the single ACLS recommendation for wide complex tachycardia or irregular narrow complex tachycardia?
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get expert consultation.
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If a patient has stable, regular wide complex tachycardia, what is the appropriate action?
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Give Amiodarone 150mg over 10 min and prepare for elective cardioversion.
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If a patient has stable, irregular wide compex tachycardia, what is the appropriate action?
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Get expert consultation. If Torsades, give magnesium, if pre-excitation A. fib (AF+WPW) avoid AV node blocking agents (Adenosine, digoxin, diltiazem or verapamil) and give Amiodarone.
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