Intern Year: Acls

Front 1

patient is hooked up to a monitor. You see V-fib. What should you do

Back 1

Immediate shock

Biphasic: 200
Monophasic: 360

Front 2

How often can epinephrine be given?

what is the proper dose?

what can replace this?

Back 2

Every 3-5 minutes

dose: 1mg

40 units of Vasopressin can replace the first or second dose of epi

Front 3

you have shouted for help and have started the emergency response. What are the first three things you should do when a patient goes down

Back 3

Start CPR
Give O2
Attach monitor/defib

Front 4

To ensure proper CPR quality, how deep should you push?

At what rate?

Back 4

>2 inches [5cm]

>100/min

allow complete chest recoil

Front 5

How often should you rotate the compressor?

Back 5

every 2 minutes

Front 6

If no advanced airway is available, what should your compression-ventilation ratio be?

Back 6

30:2

Front 7

a patient is receiving CPR. An advanced airway is placed and quantitative waveform capnography is in place. What PETCO2 suggests that CPR quality is INADEQUATE

Back 7

<10mmHg

Front 8

a patient is receiving CPR. An advanced airway is placed and and intra-arterial pressure is available. If relation phase (diastolic) pressure is <__mmHg, you should attempt to improve CPR quality

Back 8

<20mmHg

Front 9

At what PETCO2 can you see ROSC?

Back 9

>40mmHg

also look for return of pulse and BP

Front 10

What is the proper initial dose of Amiodarone?

Second dose?

Back 10

initial: 300mg bolus

Second: 150

Front 11

if an advanced airway is in place, how many breaths/min should be given with continuous chest compression?

Back 11

8-10

Front 12

List the 5 H's that can be reversible causes of irregular rhythm

Back 12

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia

Front 13

List the 5 T's that can be reversible causes of irregular rhythm

Back 13

Tension pneumonthorax
Tamponade
Toxins
Thrombosis, pulmonary
Thrombosis, coronary

Front 14

What drug is recommended for the initial treatment of stable monomorphic wide-complex tachycardia?

Back 14

Adenosine

Front 15

What drug SHOULD NOT be used for IRREGULAR wide-complex tachy?

Why?

Back 15

Adenosine

may cause degeneration of the rhythm to VF

Front 16

After obtaining ROSC, what oxyhemoglobin saturation do you want?

Back 16

>94%

the fraction of inspired oxygen (FIO2)
should be adjusted to the minimum concentration needed
to achieve arterial oxyhemoglobin saturation ≥94%, with the
goal of avoiding hyperoxia while ensuring adequate oxygen
delivery.

Front 17

With renewed focus on improving functional outcome, neurologic evaluation is a key component in the routine assessment of survivors. Early recognition of potentially treatable neurologic disorders, such as ________, is important. The diagnosis of these
may be challenging, especially in the setting of hypothermia and neuromuscular blockade, and electroencephalographic monitoring has become an important diagnostic tool in this patient population.
Prognostic assessment in the setting of hypothermia is changing, and experts qualified in neurologic assessment

Back 17

Seizures

Front 18

in general, what should be performed after cardiac arrest

Back 18

PCI

even if not clearly a STEMI

Front 19

When should morphine be given in a STEMI situation

Back 19

if a pt has chest pain unresponsive to nitrates

Front 20

in unstable angina/NSTEMI, _______ should be avoided because it was associated with increased mortality

Back 20

Morphine

Front 21

Patient presents in VT/VF. what is the first thing you do?

Back 21

Shock 200J (biphasic)

Front 22

Pt has VT/VF, you have given the first shock. What do you next?

Back 22

CPR for 2 minutes/5 Cycles

Obtain IV/IO access

recheck rhythm

Front 23

Pt has VT/VF, you have given the first shock. 5 cycles of CPR are done and IV access is obtained. VT/VF remains. What do you do?

Back 23

Shock

Followed by 2 min/5 cycles of CPR

Epi 1 mg given every 3-5 minutes

consider advanced airway/capnography

Front 24

Pt has VT/VF, you have given the first shock. 5 cycles of CPR are done and IV access is obtained. VT/VF remains. You shock again and begin CPR. What is the next step?

Back 24

1 mg Epinephrine every 3-5 minutes

check the rhythm

Front 25

Pt has VT/VF, you have given the first shock. 5 cycles of CPR are done and IV access is obtained. VT/VF remains. You shock again and begin CPR. 1 mg of Epi is given. Rhythm is still shockable. What are the next 2 steps?

Back 25

CPR 2 minutes/5 cycles

Amiodarone 300mg

Front 26

VT->Shock->CPR->VF->Shock->CPR->1mg epi->VF->Shock->Amiodarone 300mg-->VT->Shock->CPR-->1mg epi-->VT-->Shock-->??

Back 26

Amiodarone 150mg

Front 27

VT->Shock->CPR->VF->Shock->CPR->1mg epi->VF->Shock->??

Back 27

Amiodarone 300mg

Front 28

VT->Shock->CPR->VF->Shock->CPR->?

Back 28

1mg Epi

Front 29

VT->Shock->CPR->VF->Shock->CPR->1mg epi->VF->Shock->Amiodarone 300mg-->VT->Shock->CPR-->??

Back 29

1mg epi

Front 30

Pt arrives in PEA/Asystole. What do you do first?

Back 30

CPR 2 minutes/ 5 Cycles

Obtain IV/IO access

Epi 1 mg every 3-5 minutes

Consider advanced Airway

Front 31

PEA-> CPR->Epi 1 mg-> VT ->?

Back 31

Shock

Front 32

PEA-> CPR->Epi 1 mg-> VT ->Shock->?

Back 32

CPR

Front 33

PEA-> CPR->Epi 1 mg-> VT ->Shock->CPR->

Back 33

Epi 1 mg

Front 34

VT->CPR->PEA->?

Back 34

CPR

Front 35

VT->CPR->VT->CPR->Epi->ROSC->?

Back 35

CPR 2 minutes/5 cycles

Front 36

Patient presents with bradycardia (typically <50 if bradyarrhythmia) with a pulse. You have lookded for underlying cause (maintain airway, O2, monitor, BP, IV access).

The brady persists causing any of the following: Hypotension, AMS, Shock, Ischemia, heart failure.

What is the first step?

Back 36

Atropine 0.5mg bolus

repeat every 3-5 min

max dose is 3mg

Front 37

Patient presents with bradycardia (typically <50 if bradyarrhythmia) with a pulse. You have lookded for underlying cause (maintain airway, O2, monitor, BP, IV access).

The brady persists causing any of the following: Hypotension, AMS, Shock, Ischemia, heart failure.

You give Atropine (what dose again?). How long do you wait and what is the next step?

Back 37

initial dose 0.5mg bolus

wait 3-5 min

give 0.5mg again

max dose 3mg

Front 38

when considering bradycardia with a pulse what is the max amount of atropine you can give?

Back 38

3mg

it is given in 0.5mg doses

so 6 doses

Front 39

Instead of atropine, what can be given for bradycardia? Consider doses

Back 39

Dopamine IV infusion (2-10mcg/kg/min)

Epinephrine IV infusion (2-10mcg/min)

Front 40

Patient presents with bradycardia (typically <50 if bradyarrhythmia) with a pulse. You have lookded for underlying cause (maintain airway, O2, monitor, BP, IV access).

The brady persists causing any of the following: Hypotension, AMS, Shock, Ischemia, heart failure.

You have now given 3mg of Atropine

pt is still unstable.

Next step?

Back 40

Transvenous pacing

Front 41

Pt has persistent tachy arrhythmia (HR usually>150) causing any of the following: Hypotension, AMS, Shock, Ischemic chest discomfort, acute heart failure.

What are your two options?

Back 41

Synchronized cardioversion

Adenosine (6mg rapid IV push, follow NS, 2nd dose 12 if needed)

Front 42

Give the doses of synchronized cardioversion considering the following rhythms:

Narrow regular:

Narrow irregular:

Wide regular:

Wide irregular:

Back 42

Narrow regular: 50-100J

Narrow irregular: 120-200J biphasic or 200J mono

Wide regular: 100J

Wide irregular: DEFIBRILLATION (not synchronized)

Front 43

Pt has wide complex (QRS >0.12) stable tachycardia >150. What should be considered as tx?

Back 43

IV access and 12 lead

Consider Adenosine only if regular and monomorphic

Consider antiarrhythmic infusion (procainamide, amiodarone, sotalol)

Front 44

Pt has narrow complex (QRS <0.12) stable tachycardia >150. What should be considered as tx?

Back 44

IV access and 12 lead

Vagal maneuvers

Adenosine (if regular)

B-blocker or CCB

Front 45

when can vagal maneuvers be tried to stabilize a pt?

Back 45

Stable narrow complex tachycardia

Front 46

Back 46

Front 47

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Front 48

Back 48

Front 49

Back 49

Front 50

Back 50

Front 51

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Front 52

Back 52

Front 53

Back 53

Front 54

Adenosine Dose?

Back 54