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ACLS 2015 guidelines

acls, mnemonics H's T's, AEIOU-TIPS, meds

How to Remember the Causes of Arrhythmias (including asystole (the H’s and T’s) 6 H‘s: think about what blood does:VOGPAT Volume (hypovolemia) Oxygen (hypoxemia) Glucose (hypoglycemia) Potassium (hypo- or hyperkalemia) Acid-base balance (H+ or acidosis) Temperature regulation (hypothermia)
How to Remember the Causes of Arrhythmias (including asystole (the H’s and T’s) 5 T's imagine a (toxic) lead bullet piercing a chest. What can it cause? Trauma Toxins Tamponade Tension pneumothorax Thrombosis (PE or MI)
look for causes of Altered mental status. AEIOU-TIPS A — Alcohol/Acidosis E — Endocrine, Epilepsy, Electrolytes, Encephalopathy I — Infection O — Opiates, Overdose U — Uremia/Underdose T — Trauma I — Insulin P — Poisoning/Psychosis S — Stroke/Seizure/syncope
what is ABCD Airway, breathing, circulation, differential diagnosis
instead of ABC it is what? CAB (circulation, airway, breathing)
Compression depth Between 5 cm and 6 cm (2 inches and 2.4 inches) in adults
Compression frequency No less than 100, no more than 120
Chest recoil Allow the chest to fully recoil between compressions do not lean on the chest between compressions; allow the heart to fully fill with blood
Vasopressin use? No. Vasopressin plus epinephrine provides no advantage as a substitute for epinephrine
admin Epinephrine for what type of cardiac arrest rhythm and when? Administer epinephrine ASAP for non‑shockable cardiac arrest rhythm
In a Witnessed cardiac arrest with shockable rhythm, EMS may or may not delay ventilation? EMS may delay ventilation for up to 3 cycles of 200 continuous chest compressions
Advanced airway during CPR -how many breaths per how many seconds? which = how many per minute? Deliver 1 breath every 6 seconds (10 per minute) when using an advanced airway during CPR
Post-cardiac arrest: use lidocaine and/or beta-blocker? there Inadequate evidence to support the routine use of lidocaine and/or beta-blocker
Post-cardiac arrest re: temp for comatose pts with ROSC? Comatose patients with ROSC should be cooled to between 32°C and 36°C for >24 hrs
Post-cardiac arrest what to do re: systolic BP <90 or MAP <65? Consider avoiding/correcting hypotension systolic BP <90 or mean arterial pressure <65
Administer a vasopressor every ____ minutes. Use what if no IV access? Administer a vasopressor every 3 to 5 minutes; use an endotracheal (ET) tube, if available, until IV access is established
when do you-do IV insertions, delivery of medications, and insertion of advanced airways; wait until preparation for defibrillation and do treatments during that lull in CPR
The optimal endotracheal dose 2 to 2½ times the recommended IV dose.
Dilute the dose in __ to __ mL of_______ (or _____ _____) and inject the drug as a rapid _____ directly into the endotracheal tube. 5 to 10 mL, sterile water or normal saline, spray
During CPR with an advanced airway in place, a _____ rate of rescue breathing reduces risk of ____________. lower, hyperventilation
Advanced airway placement in cardiac arrest should ___ _____initial CPR and defibrillation for what type/or rhythm of cardiac arrest not delay, VF
Use an adult (__to __L) bag and deliver approximately ____mL of tidal volume sufficient to produce chest rise over 1 second. 1-2L, 600
before placement of an advanced airway (supraglottic airway or tracheal tube), EMS providers perform CPR with cycles of 30 compressions and __breaths. 2
oropharyngeal airway (OPA) is also known as an _____airway oral
nasopharyngeal airway (NPA) is also called a _____airway, NPAT (nasopharyngeal airway tube), or nasal _______ nasal, trumpet
oropharynx is the primary site of upper airway obstruction in what type of pt? unconscious or anesthetized patients
Nasopharyngeal airways are also used to keep the airway open and can be used with patients who are what? conscious or semi-conscious
If an advanced airway is used, the _________ airway can be used for adults with out of hospital cardiac arrest in settings with low tracheal intubation success rate or minimal training opportunities for endotracheal tube placement. the supraglottic airway
If an advanced airway is used, either the supraglottic airway orET can be used for adults with out-of-hospital cardiac arrest in settings with high what? or high tracheal intubation success rates or optimal training opportunities for endotracheal tube placement.
Clinical assessment to confirm endotracheal intubation consists of_______ __________ ________bilaterally and listening over the ? visualizing chest expansion bilaterally and listening over the e
what is recommended in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube Continuous waveform capnography
If continuous waveform capnometry is not available,what other options are there to confirm ET placement? a nonwaveform carbon dioxide (CO2) detector, esophageal detector device, or ultrasound used by an experienced operator is a reasonable alternative.
how many joules to shock for biphasic? how many for monophasic? 120-200 Joules on a biphasic defibrillator or 360 Joules using a monophasic defibrillator
which are the following are shockable? Vfib? Vtach? Asystole? PEA? VFib and Vtach
for Vfib and Vtach as well as Asystole and PEA what drug do you give and how often? epi, every 3-5 minutes
in Vfib or Vtach after how many shocks can you give amiodarone? 3 shocks
what is the 2nd drug you give after epi in Vfib/Vtach? and what is the dose? amiodarone. 1st dose 300mg, 2nd dose 150mg.
if asystole or PEA what do you do? give epi
in cardiac arrest (VFib, Vtach, Asystole, PEA) what is your primary goal? return to ROSC, find underlying causes.
in cardiac arrest underlying causes-look at __'s and __'s. H's & T's
bradycardia if asymptomatic do what? maintain airway, 02, apply cardiac monitor, monitor BP & pulse ox, IV access, get a 12 lead
bradycardia- what are symptoms? (can be a rate higher than ___ if it's symptomatic) hypotensive, AMS, signs of shock, ischemic chest discomfort, acute heart failure
what meds/doses and when are used for bradycardia? atropine 0.5mg every 3-5min. max of 3mg.
in bradycardia if atropine is ineffective what is the next step? Transcutaneous pacing (TCP)
in bradycardia what can be used as an alternative to TCP? Dopamine or epi infusion
in bradycardia if using dopamine or epi infusion what is the dose/rate? dopamine 2-20mcg/kg/min epi 2-10mcg/min
what other type of pacing may be used in bradycardia if all else is ineffective? transvenous pacing
Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA (short of air), altered mental status, weakness, fatigue, and syncope
The most common causes of tachycardia that should be treated outside of the ACLS tachycardia algorithm are: dehydration, hypoxia, fever, and sepsis.
if unstable tachycardia what do you do synchronized cardioversion
if tachycardia is asymptomatic do what? check QRS
in asymptomatic tachycardia if QRS is wide give antiarrhythmic infusion or if narrow and if monomorphic may give adenosine.
in asymptomatic tachycardia if QRS is NOT wide then do what? vagal maneuvers, adenosine if rate is regular, beta blocker or calcium channel blocker.
what antiarrhythmics may be used in asymptomatic tachycardia if QRS is wide? amiodarone, procainamide, sotalol
what is the adenosine dose for tachycardia? 1st dose 6mg, 2nd dose 12 mg
what % of strokes are ischemic and if caught early could potentially be treated with _______ therapy. 87%, fibrinolytic
Cincinnati Prehospital Stroke Scale shows which 3 physical findings that determine stroke? facial droop, arm drift, abnormal speech
is that early notification to the receiving hospital of a potential______ victim improves the speed with which they are treated after arrival at the emergency department. stroke
pre-hospital interventions for stroke are (think EMS) 1. CPSS 2. blood sugar, 3. establish time 0 4. alert the hospital of incoming stroke victim.
once stroke victim is identified and arrives in ED within 10 minutes they should have what interventions? NIH neuro screen, HCT, assess/tx ABC's, activate Stroke team, blood sugar
stroke timelines: HCT done within ____ read within __ 25, 45 minutes
stroke if bleed then what? move to increased level of care
stroke if no bleed then ______ therapy if within ___minutes. If past that then what? ibrinolytic (tpa) therapy, 60 minutes, aspirin
for stroke pt to ICU or stroke unit by ___hours 3 hours.
ACS pre hospital steps-mona, monitor abc's, readiness for cpr, 12 lead aspirin, 02, nitro, morphine if pain not controlled by nitro
ACS if stemi then start what? if symptoms longer than 12 hrs, do what next? start heparin, NTG, beta blockers, if >12 hrs do stent
ACS if Nstemi then what meds? nitro, heparin, consider beta blockers, clopidogrel, glycoprotein
which ACLS drug is an anticholinergic? it "dries the licker and speeds the ticker" so it's used for what? Atropine, bradycardia
If R is far from P then you have a ___ _____ 1st degree
PRI is variable. longer, longer, drop, then you have a ______ Wenkebach (2 degree, Mobitz I
PRI is constant. If some P's don't get through, then you have a __________ Mobitz II (2 degree)
PRI is N/A. If P's and Q's don't agree, then you have a _______ third degree
In 2nd degree and 3rd degree, there are more __'s than ___'s. and the __-__ is regular. P's than Q's. P-P is regular
Vtach/Vfib. 2 meds. -dose? time? Epidrone Epi 1mg, every 3-5 min. Amiodarone 1st dose 300, 2nd dose 150.
asystole/PEA med? epi
brady- meds: 1-IVP, 2-infusions. names/doses atropine-IVP, infusions- dopamine, epi
unstable tachycardia treat immed. with? synchronized cardioversion
Stable (narrow QRS complex) → vagal maneuvers → then.... adenosine (if regular) → beta-blocker/calcium channel blocker → get an expert
Stable (wide/regular/monomorphic) → ?? → adenosine → consider antiarrhythmic infusion → get an expert
atropine, adenosine, amiodarone
Created by: kerinska



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