Acls

Front 1

End Total CO2 Goal

(PETCO2)

Back 1

30-40 mm Hg

Front 2

94% or >

Back 2

O2 in post-cardiac care phase

Front 3

O2 during initial resuscitation

Back 3

100%

Front 4

Temp x 24 hr s/post Cardiac Arrest

in a comatose pt with ROSC

Back 4

32-36° C, or 89.6-95.2° F

Front 5

MAP Goal for titration meds s/post Cardiac Arrest

Back 5

65 mm/Hg or >

Front 6

Quality Compression depth

Back 6

2 ", and no > 2.4"

Front 7

Compression Rate

Back 7

100-120/Minute

Front 8

Rescue Breathing rate

Back 8

1 breath every 5-6 seconds

Hint 8

(Ensuring they still have a pulse every 2 minutes)

Front 9

List he most common causes of Cardiac Arrest

Back 9

H's:

1. Hypovolemia,2. Hypoxia, 3.Hydrogen Ion (Acidosis), 4. Hypo/Hyperkalemia, 5. Hypothermia

T's:

1. Tension Pneumothorax, 2. Tamponade, 3. Toxins, 4. Thrombosis (pulmonary), 5. Thrombosis (coronary)

Hint 9

5 H'S & 5 T's

Front 10

2 Common causes of PEA

Back 10

Hypovolemia & Hypoxemia

Front 11

Excessive Ventilation may cause what?

Back 11

Cerebral Vasoconstriction (reducing blood flow to the brain)

Front 12

How strong should ventilations be?

Back 12

1. *strong enough to produce visible chest rise (500-600 ml OR 6-7 mm/kg)

*pts with airway obstruction or poor lung compliance may require > pressures, neccisating bypassing the pressure relief valve on some bags mask devices).

Front 13

Nitroglycerin contra-indications

Back 13

1.RV Infarction/Inferior wall MI (RV infarction may complicate an inferior wall MI). NOTE: if R.sided pre-cordial leads confirm RV infarction, MOSO4 & other vasodilators or volume depleting drugs are contraindicated as well (the right ventricalfilling pressures have to maintain cardiac output).

2. Hypotension, bradycardia/ Tachycardia

3. Phosphodiesterase use: sildenafil/Vardenafil <24 hr OR Tadalafil <48 hr. (cause severe hypotension with vasopressors)

Hint 13

3 Major considerations/contraindications

Front 14

Physiological effects of nitrates

Back 14

Reduction in both right & left ventricular pre-load through peripheral arterial & venous dilation

(Pt must be hemodynamically stable with SBP >90 or no lower than 30 mm Hg below baseline, and ♡rate 50-100 bpm.

Front 15

MOSO4; Opiate indications for ACS use for STEMI (NOT FOR NSTEMI--> increased mortality!)

Back 15

1. Analgesia: < neuro hormonal activation, catecholamines, ~<O2 demand.

2. >venodilation (~ < LV pre-load & O2 demand)

3. < systemic vascular resistance, ~< LV after load.

4. Helps redistribute blood volume in acute pulmonary edema pt's.

Hint 15

somewhat of a series of 4 cascade events

Front 16

IF a 12 lead ECG indicates a STEMI, what checklist should be done?

Back 16

Fibronolytic checklist

Front 17

Timing of fibronolytics

Back 17

given within 30 min of arrival OR PCI within 90 min of arrival

Front 18

3 Classifications of ST Segment deviation

Back 18

1. STEMI

2. NSTE-ACS (ST depression or dynamic T-wave inversion)

3. Low/Intermediate-risk ACS (Normal, or non-dx'stc ECGL

Front 19

Delays of therapy for STEMI

(out of hospital delays are only 5%; most delays occur in hospital->25-33%).

Back 19

1. Door:data (ECG)

2. Data:decision

3. Decision:Drug ( or PCI)

Hint 19

"4 D's", really 3 D's

Front 20

IV Nitro treatment goals

Back 20

1. Relief of chest discomfort (titration to effect while maintaining SBP >90 mm hg; Limit drop of SBP to 30 mm Hg below pt baseline in hypertensive pt's).

2. Improvement in pulmonary edema and hypertension (titrate to effect, limit drop to 10% of baseline in normotensive pt's, limit drop in SBP to 30 mm Hg below baseline in hypertensive patients).

Front 21

IV Nitro Indications

Back 21

1. Recurrent or continuing chest discomfort unresponsive to s.l. or spray Nitro

2. Pulmonary edema complicating STEMI

3. HTN complicating STEMI

Front 22

ECG vs CT-->>which takes priority in Arrhythmia with Stroke?

Back 22

CT!! No Arrhythmia is specific for stroke, and many pt's with Stroke may show Arrhythmia, but if the pt is hemodynamically stable, most Arrhythmia will not require treatment

Front 23

National Institute of Neurological Disorders and Stroke (NINDS) time line , 1st general assessment due:

Back 23

10 minutes

Front 24

National Institute of Neurological Disorders and Stroke (NINDS) time line , Immediate NEUROLOGICAL assessment due:

Back 24

25 minutes

Front 25

National Institute of Neurological Disorders and Stroke (NINDS) time line , Acquisition of CT scan:

Back 25

25 min

Hint 25

same time alottment as the NEUROLOGICAL assessment

Front 26

National Institute of Neurological Disorders and Stroke (NINDS) time line , Interpretation of CT scan due:

Back 26

45 min.

Front 27

National Institute of Neurological Disorders and Stroke (NINDS) time line , Administration of fibronolytics (timed FROM ER arrival):

Back 27

60 min!!!

Front 28

National Institute of Neurological Disorders and Stroke (NINDS) time line , Administration of fibronolytics from ONSET of sx's:

Back 28

3 hr, or 4.5 hr in selected pt's

Front 29

National Institute of Neurological Disorders and Stroke (NINDS) time line , Administration of endovascular therapy (timed from ONSET of sx's)

Back 29

6 hr in selected pt's

Front 30

National Institute of Neurological Disorders and Stroke (NINDS) time line , admission to a monitored bed:

Back 30

3 hr

Front 31

3 Inclusion Criteria for rTPA

Back 31

1. It's happenned within 3 hr before beginning treatment

2. >18 yr old

3. Dx of ISCHEMIC stroke causing measurable neuro defect

Front 32

Shockable Rhythm (2)

Back 32

V-fib, & Pulseless V-tach

Front 33

NONSHOCKABLE rhythms (2)

Back 33

PEA, Asystole