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ACLS
Advanced Cardiac Life Support
| Question | Answer |
|---|---|
| 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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