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ACLS EHS

QuestionAnswer
name parts of BLS 1ry survey **1st check responsiveness, activate EMS, get AED, then go back to pt and Airway, Breathing, Circulation, Defib
Name steps of ea part of BLS 1ry survey Airway: head tilt-chin lift or jaw thrust w/o head extension if trauma; Breathing: look chest rise/fall, listen/feel air, 2 rescue breaths >1sec; Circulation: pulse check 5-10sec…CPR until AED; Defib: if rhythm shockable->shock immed CPR starting w CC
Name steps of ACLS 2ry survey A: advanced airway needed? Properly placed&secured; Breath: assess oxygenation and vent w O2 sat, capnometry/capnography, give O2; Circ: assess rhythm, vol resusc? BP mgmt? Action: IV access, ECG leads, Rx, IVF; DDx: find underlying causes and treat
in respiratory arrest go through steps thru end of BLS 1ry check pt responsive, activate emergency response, get AED, then BLS 1ry: A=open airway; B=look chest rise, listen/feel air mvmt; 2 breaths ea 1 sec; C=feel carotid 5-10 sec; give 10-12 breaths/min and recheck pulse q2min
when use or when NOT use OPA OPA only for unconscious/no gag, so check for gag
sizing of OPA should reach edge of mandible
how insert OPA insert upside down and twist 180 as put in
NPA when to use can be used in semi-conscious (ie gag reflex), if trauma around mouth but be careful bc cribiform plate fx can go to brain
length and size of NPA dia should be that of smallest finger or small enough so doesn't blanche nares going in; length=nares to earlobe
when/how to Yankauer give O2 before suction and after, suction for <10sec, don't insert further than nose to earlobe distance.
ET suction, before, after, how to give 100% O2 before hand, then 1-2ml NS and positive pressure to disperse NS, don't insert catheter beyond ET and only occlude side opening while wdrawing c rotation
describe CPR when pt intubated or advanced airway give 8-10 breaths/min and don't need to synchronize w CC but ideally give during chest recoil;
describe breaths if pulse and no advanced airway rescue breathing if pulse and no advanced airway 10-12 breaths/min
when assume spine injury if mltpl traumas, head/facial traumas, fallen from hgt, or MVA
why don't use cervical collars may complicate airway mgmt, interfere w airway patency, and incrs ICP
how handle possible spinal injury incl during transport during transport should immobilize, otherwise use manual spinal restriction (Safer) and have someone stbilize during any manipulation of airway
describe BLS 1ry survey if unsure pulse already opened airway, checked breathing and given 2 rescue breaths if nec, if uncertain during 5-10 sec pulse check start CC ((30:2 w ventilations) until AED pads placed
describe proper CC 1.5-2 inches in depth, 100/min, allowing complete recoil
describe using AEDs power on, wipe sweat/water white pad above R chest, red pad at L side, what left to L shoulder (white to right, red to ribs, what's left to L shoulder); make sure NO ONE touching pt and analyze rhythm, if tells you to shock say I'm going to shock on 3,
what happens if AED says rhythm nonshockable it will say CPR immed
describe algorithm for shockable VF/VT 1) CPR until can do Shock
if ever get asystole or PEA during cardiac arrest, what are the steps 5 cycles CPR and when avail epi 1mg q3-5min or vasopressin 40U; consider atropine 1mg for asysteole or slow rate PEA q3-5min, max 3 doses.
what do if hypothermia and cardiac arrest defibx1, if doesn't work wait until greater than 30 C; if just moderate hypothermia just need to space out Rx bc slower metabolism (worried abt toxicity)
what priority for access IV, then IO (venous plexus of the marrow), then ET
what procedure for giving Rx via IV follow ea bolue w 20cc and elevate exremities (will take 1-2 min to reach central circulation)
how give Rx via ET, incl how you adjust dose dose is usu 2-2.5x IV dose, dilute in 5-10cc NS and give directly into trachea
what Rx can you give via ET epi, vaso, atropine, lido [amio and Mg not listed]
when think abt giving Mg if saw QT prolongation in pre-arrest EKG, or ppl w low Mg (ie ETOH, malnutrition)
dose amio given in CPR 300, then 150 after 3-5min
dose lidocaine CPR 1-1.5mg/kg, then repeat 0.5-0.75 over 5-10min
postresuscitation treatment infusion of anti-arrhythmic, amio: bolus 150 over 10min then 1mg/min for 6hrs and 0.5mg/min for next 18hrs (if already got during arrest just start infusion); lidocaine loading 1-1.5mg/kg, then 0.5-0.75 mg/kq q 5-10min; infusion 1-4mg/min
max dose of amio and lido post resuscitation amio: 2.2g/24hr; lido max 3mg/kg
what to watch for w amio hypotension, bradycardia, GI toxicity
when should lido be reduced elderly and liver dz
causes of PEA (5H's, 5T's) Hypovol, hypoxia, H ion, hyper/hypoK, hypogly, hypothermia; toxins, tamponade, tension PTX, thrombosis (heart, lung), trauma
EKG of the 6 Hs hypovol: narrow tachycard; hypoxia: slow rate; H: small QRS h/o DM, CRF; hyperK: pkd T, wide QRS; hypoK flat T, U waves, wide QRS long QT; hypothermia J or Osborne waves
EKG of 5 Ts toxins: various, tamponade: tachyvardia w JVD; t PTX: narrow complex w slow rate (hypoxia); AMI; PE: tachycardia
when can d/c resuscitation no ROSC at anytime >20min BLS/ACLS
tx ACS O2 for 6hrs, ASA chewed, NG, morphine
indications O2 for ACS O2 for 6hrs (and then only continue if CP, hemo instability, Sat<90, pul congestion)
specifics of NG in ACS up to 3 tablets 3-5min apart, only is SBP>90, HR 50-100
what don't do in RV infarct not NG or morphine (preload dependent)
when don't give NG RV infarct or recent PDE use incl sildanefil 24hr, vardenafil 48h
goal tx of ACS fibrinolytics <30min, PCI<90min
how STEMI defined 1mm in 2 contig leads (precordial or limb) or new LBBB
ST depression or T wave inversion is what in ACS high risk unstable angina or NSTEMI
when can fibrinolytics be used after symptoms 12hrs (not effective >24hrs)
name 4 fibrinolytics tPA, reteplase, tenectaplase, steptokinase (but that's not fibrin specific)
how does PCI compare to fibrinolytics superior
when can PCI be used symptoms 3-12 hrs
when IV NG used if CP unresponsive to SL NG, pul edema +STEMI, HTN + STEMI. Only use if SBP>90 and limit drop 30
when should bradycardia be treated if symptoms due to bradycardia, ie inadequate perfusion as in CP, SOB, lightheaded, decrs LOC, wknss, dizzy, syncope, hypotension
tx brady cardia prepare for TCP, atropine 0.5mg IV while awaitng pacer q 3-5 min, max 3mg (if atropine ineffective TCP), consider epi or dopa 2-10ug/min
when TCP used immed if unstable, Mobitz II or 3rd degree, also if atropine ineffective
how set TCP sedate pt first if time; initial rate 60, set to 2mA >capture (if ACS want lowest rate possible to not incrs ischemia)
how sedate pt before TCP benzo, narcotic
tx unstable tachycardia immed cardiovert
how define unstable tachycardia, how high is HR usu AMS, CP, hypotension, presyncope (usu HR >150)
if stable tachy what do you do get ECG and IV access
tx narrow, regular tachy vagal, then adenomsine 6mg, then 12mg
if narrow, regular tachy converted w adenosine what was it reentry SVT
how tx pt after conversion of narrow, reg tachy adenosine for future occurrences or longer acting AV node blcokers, ie dilt and b blocker
if narrow, regular tachy didn't convert w adenosine what could it be, what should you do A flutter, jxnl tachy, ectopic atrial tachy--just control rate w dilt or b blocker
when be careful w b blocker pul dz and CHF
narrow irreg QRS could be, how treat? A fib, or MAT; want to rate control
regular wide QRS is ; tx VT (monomorphic or polymorph); tx amio 150 over 10min and repeat as nec max 2.2g/24hr
how does SVT w aberrancy look? Tx? regular wide QRS, tx w adenosine
if wide complex and unstable think VT
how tx VT monomorphic if unstable w pulse then 100J synch, then step wise 200, 300, 360; polymorphic high energy unsynch
if unsure monomorph v polymorph VT how tx unsynch shock
when use unsynch shock? pulseless VT, deteriorating (polymorph) VT, if unsure monomorph v polymorph
when use syn shock VT w pulse, unstable tachy w pulse (incl A fib or flutter)
shock dose for A fib 100-200 if monophasic, 100-120 if biphasic and escalate
Dose shock A flutter; mono VT 50-100; 100
goals for acute stroke CT within 25min and interpret within 45 and fibrinolytics within 1hr (<3hr symptoms)
tx of stroke after CT done and other than fibrinolytics O2 if Sat <92, tx hypo and hypergly, 12 lead EKG (to see if embolic), IVF 75-100ml/hr, tx fever, CT if change in MS, BP control
after fibrinolytics when can you give tpa or anticoag >24 until f/u CT shows no hemorrhage
BP control before fibrinolytics for >185/110 give labetalol 10-20mg, can repeat 1x or nitropaste
during/after fibrinolytics BP control labetalol 10mg q 10min, max 300 or infusion 2-8mg/min OR nicardipine 5mg/hr can incrs q5min to 15mg/hr
BP control for pp not on fibrinolytics tx if >220/120-140 w labetalol or nicardipine w goal 10-15% reduction BP (same doses as above), if diastolic >140 use nitroprusside 0.5ug/kg/min
when start tx BP for those on fibrinolytics >180/105
other than intracranial bldg, what are risks of fibrinolytics angioedema or transient hypotension
how freq check BP stroke q15min 2hrs, q30min 6hrs, q1hr 16hrs
if not candidate for fibrinolytics what Rx give ASA
Created by: ehstephns on 2012-04-21



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