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28 Cards in this Set

  • Front
  • Back
What are the H's and T's of PEA?
What do these conditions cause?
Hydrogen ions (acidosis)
Hypo- and hyperkalemia
Tablets (TCAs, Dig, BBlockers, CCBs)
Tension Pneumothorax
Thrombosis of the heart (MI)
Thrombosis of the lungs (PE)
What are the BLS primary survey steps?
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
Describe the "A" in the secondary survey of ACLS?
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.
Generally when is an advanced airway indicated during the secondary survey in ACLS?
If the patient's airway is not maintained with non-invasive measures, what is the appropriate next step?
Describe the "B"in the secondary survey of ACLS.
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.
Describe the "C" of secondary survey of ACLS.
Circulation- Obtain IV/IO access and give fluids.
ECG leads and identify arrythmias.
What are the initial steps during any civilian emergency?
1) Check patient responsiveness, 2) call 9-1-1 and 3) get the AED.
What are the two most important interventions for sudden cardiac arrest?
1) CPR with minimal interruptions and 2) Defibrillation in the first minutes of arrest.
How long can chest compressions be paused before resucitation is affected?
10 seconds
Upon determining an ACLS patient is in VF or VT, what is the next appropriate order of events?
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.
What drugs should be used as vasopressors?
Epinephrine 1mg IV q3min or vasopressin 40U IV for 1st or 2nd dose of Epi
What drugs should be used as antiarrhythmics?
Amiodarone 300mg IV x1, consider 150mg IV x1
Lidocaine 1.5mg/kg x1, then 0.75mg/kg x2
Magnesium 1-2g IV for Torsades
Upon determining an ACLS patient is in asystole or PEA, what is the appropriate order of events?
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.
What is the ACLS bradycardia algorithm following identification and initial ABCs?
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
What drugs should be given during symptomatic bradycardia according to ACLS? When are they given?
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
What scenarios require transcutaneous pacing?
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.
What rhythms in the setting of an MI are so unstable as to require standby TCP?
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)
What is the initial assessment step in a tachycardic patient? What is the immediate next step?
Determine if pulses are present. Perform the ACLS ABCs and treat reversible causes to see if symptoms resolve.
What are some signs of an unstable tachycardic patient?
altered mental status, hypotension, respiratory distress, chest pain, decreased urine output.
What should be done immediately if a tachycardic patient is determined to be unstable?
Perform immediate synchronized cardioversion.
If a tachycardic patient is clinically stable, what is the proper sequence of actions?
Get IV access and a ECG and determine if the QRS complex is narrow and regular.
How is a narrow QRS complex defined?
A narrow QRS complex is less than 0.12sec (three blocks)
How should regular narrow complex be treated?
Attempt vagal maneuvers, and then give Adenosine 6mg IV push, then 12mg IV push, and again if necessary.
If patient's narrow complex regular tachycardia converts with appropriate treatment, what is the cause and follow-up action?
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)
If patient's narrow complex regular tachycardia does not convert with appropriate treatment, what is the cause and follow-up action?
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.
What is the single ACLS recommendation for wide complex tachycardia or irregular narrow complex tachycardia?
get expert consultation.
If a patient has stable, regular wide complex tachycardia, what is the appropriate action?
Give Amiodarone 150mg over 10 min and prepare for elective cardioversion.
If a patient has stable, irregular wide compex tachycardia, what is the appropriate action?
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.