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Advanced Cardiac Life Support

ROSC Return of Spontaneous Circulation
ACS Acute Coronary Syndrome
SCA Sudden Cardiac Arrest
Most Common Cause of SCA Ventricular Fibrillation (VF)
AED Automated External Defibrillator
Chain of Survival 1-Early Access 2-Early CPR 3-Early Defibrillation 4-Early Advanced Care
Early Access Activation of 911/EMS
Early CPR Circulation immediately
Early Defibrillation Within 3 to 5 minutes
Early Advanced Care Trained Healthcare Professionals
Compression Depth 1.5 to 2 inches
Oxygen Devices Wall or Cylinder, Nasal Cannula, Face Mask, Venturi Mask
NC 1L/min 21-24%
NC 2L/min 25-28%
NC 3L/min 29-32%
NC 4L/min 33-36%
NC 5L/min 37-40%
NC 6L/min 41-44%
Face Mask 6-10L/min 35-60%
NRB 6L/min 60%
NRB 7 L/min 70%
NRB 8 L/min 80%
NRB 9 L/min 90%
NRB 10-15 L/min 95-100%
Venturi Mask 4-8 L/min 24-40%
Venturi mask 10-12 L/min 40-50%
NC provides up to ___ O2 44%
FM provides up to ___ O2 60%
NRB provides up to ___ O2 100%
VM O2 % Range 24 to 50%
Mask for COPD & CO2 Retainers Venturi Mask
LMA Laryngeal Mask Airway
ETT Endotracheal Tube
OPA Oropharyngeal Airway
NPA Nasopharyngeal Airway
Adult Chest Compression Rate 100 per minute
Adult Ventilation Rate Every 6 to 8 seconds 8-10 per minute)
Combitube Complications Can be fatal
Combitube Contraindications 1-Under 16 2-Gag reflex 3-Esophageal disease 4-Caustic ingestion
Combitube Inflation 1-Proximal blue 100ml 2-Distal white 15ml
Lubrication of LMA Posterior surface only
PEEP Positive End-Expiratory Pressure
ETT Drug Mnemonic NAVEL
NAVEL Naloxone, Atropine, Vasopressin, Epinephrine, and Lidocaine
ETT Dose to IV/IO Dose Ration 2 to 2.5 times higher
Quantitative End-Tidal CO2 Monitor Capnometer
ECG Rhythms in CA VF, PVT, PEA, Asystole
VF Rate 150 to 500 BPM
VF Rhythm Indeterminate
Fine VF amplitude 2 to <5 mm
Medium or Moderate VF amplitude 5 to <10 mm
Coarse VF amplitude 10 to <15 mm
Very Course VF amplitude >15 mm
Fine VF difficult to differentiate from ___ . asystole
PEA fka EMD (Electromechanical Dissociation)
Fast PEA >100 per minute (noncardiac)
Slow PEA <60 per minute (cardiac)
Narrow PEA QRS <0.10 second (noncardiac)
Wide PEA QRS >0.12 second (cardiac)
Cause of PEA H's & T's
H's Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypoglycemia, Hypothermia
T's Toxins, Tamponade, Tension Pneumothorax, Thrombosis (ACS or PE), Trauma
Asystole Rate <6 complexes per minute
SVT Rate >100 per minute
Non-arrest ECG Rhythms SVT, ST, AFib, AF, AMSVT
Ventricular Tachyarrhythmias Monomorphic VT, Polymorphic VT, Torsades de Pointes
SVT Etiologies Exercise, Fever, Hypovolemia, Adrenergic stimulation, Anxiety, Hyperthyroidism
AFib Rate Various
AF Rate 220 to 350 per minute
AFib & AF Etiologies ACS, CAD, CHF, MVD, TVD, Hypoxia, PE, Drugs, HTN, Hyperthyroidism
AMSVT Rate 150 to 250 per minute
AMSVT Etiologies (Healthy) Caffeine, Hypoxia, Cigarettes, Stress, Anxiety, Sleep Deprivation, Numerous Medications
AMSVT Etiologies (Unhealthy) CAD, COPD, CHF
MVT Rate 100 to 250 per minute
Nonsustained VT <30 secs...No intervention
MVT Etiologies Ischemia, PVC's, Drugs
PVT Rate 120 to 250 per minute
PVT Etiologies Ischemis, PVC's, Drugs, Genetics
TDP Characteristics Long QT, R-on-T phenomenon, Spindle-Node Pattern
TDP Rate 150 to 250 complexes/min
SB Rate <60 per minute
SB PR interval <0.20 sec
SB Etiolgies Vasovagal, Vomiting, Valsalva, Rectal Stimuli, Carotid sinus pressure, ACS, Drugs, Inferior MI's
1 AVB Rate Brady or Tachy
1 AVB PR interval Fixed >0.20 sec, P->QRS
1 AVB Etiologies Drugs, Vasovagal, AMI's (RCA)
2 AVB Mbtz I Wenckebach PR interval Progressive Lengthening
2 AVB Mbtz II Atrial Rate 60 to 100 per minute
2 AVB Mbtz I Wenckebach Etiologies BB, CCB, Dig, Vasovagal, ACS (RCA)
2 AVB Mbtz II Ventricular Rate Slower than Atrial Rate
2 AVB Mbtz II PR interval Fixed
2 AVB Mbtz II Etiologies ACS (LCA)
2 AVB Mbtz II Normal QRS High Nodal or Nodal Block
2 AVB Mbtz II Wide QRS Infranodal Block
3 AVB (Complete) Areas AV Node, Bundle of His, Bundle Branches
3 AVB (Complete) Rate At 60-100...V Varies by Escape Beats
3 AVB Rate 20 to 40 per minute
AV Dissociation Rate 40 to 55 per minute
3 AVB (Complete) P waves Typical in Size and Shape
3 AVB (Complete) Etiologies ACS (LCA), especially LAD and Branches
Maximus acceptable shock delay 20 to 30 seconds
Do you see VF or PVT? Immediately deliver shock
Manual biphasic device Joules 150 to 200 J
Monophasic dvice Joules 360 J
White monitor lead placement White to Right (below clavicle)
Red montior lead placement Red to Ribs (L midaxillary line/apex)
Lead left monito lead placement Lead Left to Left Shoulder (lateral L clavicle)
Before each shock Clear yourself and your team
"One, I am clear."
"Two, You are clear."
"Three, Everybody is clear."
AED waveform Mostly Biphasic
___ defibrillation increases patient's chance of ___ Early, survival
Top priorities in CA High-quality CPR and Early Defibrillation
Importance of Drug Therapy in CA is ___ Secondary to Top Priorities
Advanced airway insertion in CA is ___ Secondary to Top Priorities
Absorption of ETT drugs is ___ Unpredictable
Drug administration route priority: IV - IO - ETT
CVP with fibrinolytic therapy is ___ Contraindicated
Interrupt CPR to get IV access? No
Time for IV drugs to reach central circulation: 1 to 2 minutes
After IV drug administration (1) Give 20 mL bolus and (2) Elevate extremity 10 to 20 seconds
Maximus time to get IO access 30 to 60 seconds
Three IO accesses (1) IO needle w stylet, (2) Butterfly, and (3) Hypodermic
Dilute ETT drugs with ___ 5-10 mL H20 or NS
Ideal veins for CA Antecubital
Radial-side veins (3) Superficial radial v., median cephalic v., and cephalic vein
Ulnar-side veins (4) Superficial ulnar vv., median basilic v., bifurctes to median cephalic and median basilic vv.
Basilic vein goes to ___ Brachial v., then axillary v.
Cephalic vein goes ___ Into pectoralis and deltoid mm. to axillary v.
Cephalic vein is ___ for CVP unsuitable
IV access after CA stabilization Replace IV with aseptic technique
KVO rate >= to 10 mL/h
Local complications of IV access (1) hematoma, (2) cellulities, (3) thrombosis, (4) phlebitis
Systemic complications of IV access (1) sepsis, (2) pulmonary thromboembolism, (3) air embolism, (4) catheter fragment embolism
IO access is suitable for ___ all agegroups
IO site for young children: Proximal Tibia (below the growth plate)
IO site for older children and adults: (1) sternum, (2) distal tibia above the medial malleolus, (3) lateral malleolus, (4) medial malleolus, (5) distal radius, (6) distal ulna, (7) distal femur, and (8) ASIS
Flush after IO drugs with ___ 5-10 mL NS
Always use ___ ___ Universal Precautions
Hand placement in IO access Never behind the needle direction
___, don't ___, the IO needle Twist, don't Push
Replace IO with ___ IV access ASAP
Time of IO access: <24 h
RVI presents with Excess parasympathetic tone
RVI Right Ventricular Infarction
RVI signs: Bradycardia and Hypotension
RVI usually due to: Hypovolemia
RVI primary treatment Careful 250-500 mL NS bolus
RVI secondary treatment 1-2 L NS
IMI Inferior Myocardial Infarction
IMI presents with (3) (1) symptomatic 2 or 3 AV block with JR 40-60 BPM, (2) Excess vagal tone, and (3) AV node ischemia
IMI treatment (symptomatic): Bradycardic alogorithm (A.E.D.) and Prepare for TCP
IMI treatment (asymptomatic): Monitor
IMI usually involves which artery? RCA
Fibrinolytic Checklist, Step 1a Chest pain >15 m and <12 h?
Fibrinolytic Checklist, Step 1b ECG STEMI or new LBBB?
Contraindications to Fibrinolytics (1) SBP > 180 (Tufts)
Contraindications to Fibrinolytics (2) DBP > 110 (Tits)
Contraindications to Fibrinolytics (3) RABP vs LABP > 15 mm Hg difference (Toll)
Contraindications to Fibrinolytics (4) Hx of CNS disease (Brain in car)
Contraindications to Fibrinolytics (5) Closed head or facial trauma <3 mos (3 hands to head)
Contraindications to Fibrinolytics (6) Major Trauma, Surgery, GI/GU bleed < 6 mos (Gun shooting by 6 monks)
Contraindications to Fibrinolytics (7) Bleeding or Clotting problems or Blood Thinners (Dice falling out of nose)
Contraindications to Fibrinolytics (8) CPR > 10 min (CPR with Skate Toes)
Contraindications to Fibrinolytics (9) Pregnant Female (Swollen Cat)
Contraindications to Fibrinolytics (10) Serious Systemic disease
Fibrinolytic Checklist, Step 2 Any Contraindications?
Fibrinolytic Checklist, Step 3 (1) HR >= 100 AND SBP < 100?
Fibrinolytic Checklist, Step 3 (2) Pulmonary Edama (rales)?
Fibrinolytic Checklist, Step 3 (3) Signs of Shock (cool, clammy)?
Fibrinolytic Checklist, Step 3 (4) Contraindications to Fibrinolytic Therapy
If "Yes" to any of Fibrinolytic Checklist, Step 3, then ___ Transfer to PCI
PCI PCI facility (*)
STEMI ST Elevation Myocardial Infarction
Stroke FT Inclusion Criteria (1) > 18 years of age
Stroke FT Inclusion Criteria (2) Clinical stroke with measurable neurological deficit
Stroke FT Inclusion Criteria (3) Symptoms <180 min
Stroke FT Exclusion Criteria (1) Intracranial Hemorrage on pretreatment NC CT
Stroke FT Exclusion Criteria (2) Clinical Subarachnoid Hemorrage
Stroke FT Exclusion Criteria (3) CT Multilobar Infarction
Stroke FT Exclusion Criteria (4) Hx CVA
Stroke FT Exclusion Criteria (5) Uncontrolled HTN (SBP > 185 or DBP > 110)
Stroke FT Exclusion Criteria (6) AVM, Neoplasm, or Aneurysm
Stroke FT Exclusion Criteria (7) Witnessed Seizure at Stroke Event
Stroke FT Exclusion Criteria (8) Active Internal Bleeding or Fracture
Stroke FT Exclusion Criteria (9) Platelets < 100,000
Stroke FT Exclusion Criteria (10) Heparin <48 hrs (PTT high)
Stroke FT Exclusion Criteria (11) INR >1.7 or PT >15 secs
Stroke FT Exclusion Criteria (12) Intracranial or Intraspinal Surgery, Serious Head Traums, or Stroke < 3 mos
Stroke FT Exclusion Criteria (13) Arterial Puncture (non-compressible) <7 days
Stroke FT Relative Contraindications (1) Minor improving stroke symptoms
Stroke FT Relative Contraindications (2) Major Surgery or Serious Trauma <14 days
Stroke FT Relative Contraindications (3) GI/GU bleed < 21 days
Stroke FT Relative Contraindications (4) AMI <3 mos
Stroke FT Relative Contraindications (5) Post MI Pericarditis
Stroke FT Relative Contraindications (6) BS <50 or >400
Survival Rate of IHCA 17%
Rhythm in >75% of IHCA Non VF/VT Rhythms
Mortality Rate after IHCA >80%
Best way to improve survival after IHCA Prevention
MET Medical Emergency Team
RRT Rapid Response Team
RAT Rapid Assessment Team
Criteria for calling MET (1) Threatened Airway
Criteria for calling MET (2) RR <6 or >30
Criteria for calling MET (3) HR <40 or >140
Criteria for calling MET (4) SBP <90
Criteria for calling MET (5) Symptomatic Hypertension
Criteria for calling MET (6) Sudden Decrease in LOC
Criteria for calling MET (7) Unexplained Agitation
Criteria for calling MET (8) Seizure
Criteria for calling MET (9) Significant fall in Urine Output
Criteria for calling MET (10) Nurse or Provider Concern
Criteria for calling MET (11) Subjective Criteria
Drop in CA after MET intervention 17 to 65%
ROSC in OHCA 50%
Survival Rate of Prehospital CPR 25%
To reduces stress about "failed" CPR: Talk about it
___ can perform CPR without ___ Anyone, fear of legal action
A person is a Good Samaritan if (3) (1) genuinely trying to help, (2) help is reasonable, and (3) rescue effort is voluntary (not a job requirement)
Key determinants of medical futility: Length and Quality of Life
CPR is ___ when survival is ___ Inappropriate, not expected
Discontinue CPR for newborns after ___ 10 minutes with no signs of life
Don't start CPR when ___ (3) (1) Valid DNAR order, (2) Signs of Irreversible Death, and (3) No physiologic benefit
Don't start newborn CPR when (5) (1) Gestation <23 wks, (2) Birth Weight <400 g, (3) Anencephaly, (4) Trisomy 13, or (5) Congenital anomalies incompatible with life
ACEI Angiotensin-Converting Enzyme Inhibitor
Administer ACEI (1) Within 24 h of AMI symptoms and (2) Long-term
ACEI: ED or After Admission After Admission
Transient Side Effects of Adenosine CP or Tightness, Flushing, Asystole, Bradycardia, Ventricular Ectopy
Increase Dose of Adenosine with ___ Caffeine or Theophylline
Reduce dose of Adenosine with ___ Dipyridamole or Carbamazepine
Given Amiodarone, patients must be ___ hospitalized
Symptoms of CP Pressure, Heaviness, Heavy Weight, Squeezing, Crushing
Organophosphate Nerve Agent
Atropine dose <0.5 mg causes ___ paroxysmal slowing of HR
Length of Non-Sustained V-Tach <30 seconds
Treatment of Non-Sust V-Tach No intervention necessary
Created by: tcrouch2000
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