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acls final exam
American Heart Association
| Question | Answer |
|---|---|
| what to do when defibrilating | announce clearing. Ensure O2 isn't blowing over the patient. Ensure that no one is touching the patient. |
| Whats a common and fatal mistake in cardiac arrest management? | prolonged interruptions in chest compressions. |
| What to do if someone goes unconscious and your unsure about whether they have a pulse or not? | Begin compressions and ventilation. Its less harmful to do unnecessary compressions than to withhold necessary compressions. |
| Paddles vs. Pads | No existing data suggests ones better than the other. However, pads reduce risk of arching, allow monitoring of the patient's rhythm and permit the rapid delivery of a shock if necessary |
| Ventilations during cardiac arrest | bag-mask (ambu): 2 per 30 compressions. Advanced airway: 1 ventilation per 6-8s (8-10 breaths per minute) |
| Ventilations during respiratory arrest | 1 ventilation every 5-6 seconds. (10-12 per minute) |
| Esophageal tracheal tube | an advanced airway device acceptably used as an alternative to the ET tube for airway management in cardiac arrest. |
| preparing and ET (endotracheal tube) intubation. | an advanced airway. assemble the equipment. intubate. inflate cuff or cuffs on the tube. Attach ventilation bag. Auscultate for placement. Attach capnography (to check and confirm placement). Secure tube in place. Monitor for displacement. |
| breaths for an advanced airway | If patient has a pulse and compressions aren't needed, give one breath Q5-6s (10-12 per minute). If compressions are needed, give asynchronized ventilations Q6-8x (8-10 per minute) |
| Endotracheal suctioning cautions | monitor heart rate, pulse, saO2. If bradycardia develops interrupt suction and give o2 till heart rate returns to normal. |
| resuming CPR while manual defibrillator is charging | to reduce the interruptions in the compressions while using a manual defibrillator it is recommended to continue compressions while the defibrillator is charging. |
| Reasons to stop resuscitative efforts | Rigor mortis (muscle stiffening), Indicators of DNAR, threat to safety of providers. |
| What is a sign of effective CPR | PETCO2 greater than or equal to 10. This value steadily will increase as blood flow circulate due to compressions. |
| purpose of the rapid response team/Medical emergency team | to improve patient outcomes by ID and treating early clinical deterioration. |
| Hypotension treatment | IV bolus: 1-2L of NS or LR. If therapeutic hypothermia is indicated you may use 4 degree celcius fluids.. Epinephrine or norepinephrine .1-.5mcg/kg per minute. or dopamine 5-10mcg/kg per minute IV infusion. All titrated until SBP of >90 or MAP >65 |
| whats the usual post cardiac arrest range for PETCO2 when ventilating someone who achieves ROSC (return of spontaneous circulation)? | 35-40mm Hg. The main determinant of PETCO2 during CPR is blood delivery to the lungs. If PETCO2 abruptly increases to a normal value of 35-40mm Hg its reasonable to consider this an indicator of ROSC. |
| What to do if PETCO2 is <10mm Hg during cpr | improve compressions and vasopressor therapy |
| what to do if AED doesn't promptly detect the rhythm | resume high-quality chest compressions and ventilations. Never delay compressions to troubleshoot AED |
| High quality CPR | Compress chest hard and fast. Allow complete chest recoil after each compression. Minimize interruptions in compressions (10s or less). switch providers Q 2 minutes, avoid excessive ventilation |
| Routes of drug administration in order of priority... pg 78 ACLS provider manual | IV route, IO route, endotracheal route |
| endotracheal route of drug administration | this route is poor and optimal drug dosing is not known. |
| IV route of drug administration | preffered unless central line is already present. Establishing a peripheral line doesn't interrupt CPR. Giving drugs through peripheral line takes 1-2 minutes to reach central circulation |
| tips for drug administration through IV route during CPR | give drug by bolus unless otherwise specified. Follow with 20 ml bolus of IV fluids. Elevate extremitiy for about 10-20s to facilitate delivery of the drug to the central circulation. usually may take several cycles of CPR to get drug in system |
| Things to avoid during ventilation | avoid excessive ventilation. When securing and advanced airway avoid using ties that pass circumstantially around the patients neck, because it can obstruct venous return from the brain |
| What types of rhythms require synchronized cardioversion | unstable supraventricular tachycardia, atrial flutter. |
| what is the most reliable method of confirming and monitoring correct placement of an endotracheal tube | continuous waveform capnography |
| therapeutic hypothermia | 32-34 degrees celcius, 89.6-93.2 degrees fahrenheit |
| step after defibrilation | cpr starting with chest compressions. |
| recommended compression rate for CPR | at least 100 per minute |
| recommended epinephrine dose for hypotension | .5-1 mcg/kg/minute infusion. |
| acceptable method for selecting the size of an OPA (oral pharangyl airway) | measure from corner of mouth to angle of mandible |
| What is the immediate danger of excessive ventilation during the post-cardiac arrest period of a patient who achieves ROSC | Decreased cerebral blood flow. Excessive ventilation can cause adverse hemodynamic effects due to increased intrathoracic pressures and decrease in cerebral blood flow. |
| tachycardia or tachyarrhythmia | heart rate greater than 100/min |
| symptomatic tachyarrhythmia | signs and symptoms due to rapid heart rate |
| unstable tachycardi | exists when the heart rate is too fast for the patients condition and the heart rate causes symptoms or an unstable condition because: heart is beating so fast CO is reduced, causing pulmonary edema, coronary ischemia or reduced blood flow to vital organ |
| unstable tachy signs and symptoms | hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure. |
| What is the recommended duration of therapeutic hypothermia after reaching the target temperature | 12-24 hours. |
| recommened energy dose for biphasic synchronized cardioversion of atrial fibrillation | 120-200J |
| drugs for VF/VT | epinephrine or vasopressin, and amiodarone |
| drugs for bradycardia | atropine, epinephrine infusion and dopamine infusion |
| drugs for tachycardia | adenosine, vagal maneuvor or carotid massage. |
| What is acute coronary syndrome | severe cardiac ischemia |
Created by:
Nana0904