ACLS
a MAP of ________ mmHg or greater is a reasonable goal for optimizing perfusion post cardiac arrest.
65
What is a stroke?
A stroke is neurologic impairment that occurs following an interruption in the blood flow to a specific area in the brain.
What does AVPU stand for and what aspect of the primary assessment does it involve?
A-Alert V- Voice P- Painful U-Unresponsivness - apart of the disability section
If you are unsure about the presence of a pulse, should you begin compressions and ventilations?
YES... it is less harmful if you give unnecessary compressions than failing to give them when needed.
What happens if a pt is in a non-PCI facility and contraindicated for fibrinolytics?
You should transfer them regardless of transit time but they need to have the pt out and transported w/in 30 mins
If a suspected stroke pt has an O2 stat of 93%- should you admin O2?
YES! If it is under 94%, they are considered hypoxic
You want to limit your interruptions of chest compressions for no longer than _______ secs.
10 - except when there are extreme circumstances.
A suction force of ________ mmHg can be delivered by a wall suction device if the tube is clamped at full suction.
-300 mmHg
A suction force of _____-______ mmHg is generally necessary to provide adequate suctioning from a portable suction device.
-80 to -120 mmHg
What are the 6 roles on a high-performance team?
1. Compressor 2. AED/monitor/Defribrillator 3. Airway 4. Team Leader 5. IV/IO/Medications 6. Timer/recorder
What are the 8 D's of stroke care?
1. Detection 2. Dispatch 3. Delivery 4. Door 5. Data 6. Decision 7. Drug/Device 8. Disposition
What are the 4 D's which cause delays in the in-hospital evaluation?
1. Door to data 2. Data to decision 3. Decision to 4.Drug (PCI)
What are the 3 EKG categories the initial 12-lead EKG is used in all ACS cases?
1. ST-segment elevation- acute injury 2. ST depression - ischemia 3. nondiagnostic/normal
Answer the following based on respiratory rate: 1. What is the normal? 2. What is the rate that requires assisted ventilation? 3. What rate is considered tachypnea? 4. What is the normal tidal vol?
1. What is the normal? - 12-16/min 2. What is the rate that requires assisted ventilation? - < 6/min 3. What rate is considered tachypnea? - > 20/min 4. What is the normal tidal vol? - 8-10 mL/kg
What is the ventilation rate during: 1. cardiac arrest 2. resp arrest
1. cardiac arrest - q 6 secs 2. resp arrest - q 5-6 secs
Why is morphine given in an ACS pt?
1. causes anagelsia = decreased catecholamine release. 2. vasodilator= decreased LV preload and O2 requirements 3. helps redistribute blood volume in PE pts.
What is the systematic BLS assessment in an adult?
1. check scene 2. determine consciousness by taping&shouting "are you OK" 3. shout for help and instruct someone to get AED 4. check breathing and pulse by opening the airway (head tilt-chin and listening for no more than 10 secs) while feeling for a carotid pulse (nearest to you) simultaneously. 5. if no pulse- start CPR with chest compressions. if pulse present- start rescue breaths @ 1 breath q6 secs. recheck pulse q2mins. 6. Once AED arrives follow instructions.
What are the steps associated with insertion of an OPA? (4)
1. clear the mouth and pharynx (pharyngeal suction if needed) 2. select the proper size of OPA (should be the length from the corner of the mouth to the angle of the mandible.) 3. insert the OPA (initially upward towards the hard palette.) 4. As it hits the soft palette, rotate the OPA 180 degrees into anatomical position. You can also insert it at a 90 degree angle then turned down towards the posterior pharynx. (the goal is to not push back the tongue into the pharynx.) - - - you can also insert the OPA directly by using a tongue depressor to help bring the tongue forward.
What are some important guidelines that must be taken if you have elected to use advanced airway management?
1. confirm proper integration of CPR and ventilation 2. confirm proper placement of advanced airway devices by: - PE - quantitative waveform capnography 3. secure device to prevent dislodgement 4. monitor airway placement w/cont. quantitative waveform capnography.
What are the 3 physical findings of the Cincinnati prehospital stroke scale? the probability of a stroke is ____% if any 1 of the 3 signs are present. if all 3 findings are present, then it is ____ % probable that the pt is having a stroke.
1. facial droop (try to have pt smile or show teeth) 2. arm drift (have pt close eyes and hold both arms out 3. abnormal speech - have the pt say "you cant teach an old dog new tricks" - 72% - 85%
Answer the following questions, based on a pt who is suspected to have had a stroke: 1. within 10 mins of arrival, what should've happened? 2. After 25 mins, what should've happened? 3. After 45 mins, what should be happening? 4. Initiation of the fibrinolytic therapy should occur when? 5. How long after ED arrival, should the pt be admitted to a monitored bed?
1. general assessment and order for a noncontrast CT 2. the pt should have the CT preformed and neurologic assessment . 3. interpretation of the CT scan 4. 1 hr of ED arrival and 3 hours from sx onset 5. 3 hours
What are the conditions where you would NOT advise NTG to be given as tx for ACS?
1. inferior wall MI and RV infarction - (if this is the case you want to avoid all meds that decrease preload= diuretics and morphine) 2. hypotension, bradycardia, or tachycardia - SBP <90 or no lower than 30 mmHg below baseline and the HR is 50-100/min 3. recent PDE inhibitors - viagra (sildenafil) or vardenafil w/in 24 hrs - tadafil w/in 48 hrs
What are the steps for preforming oropharyngeal suctioning? (2)
1. measure the length of the cathater (same as NPA) and gently insert it into the oropharynx beyond the tongue. 2. apply suction by occluding the side opening of the catheter while withdrawing with a rotating motion. (if using a rigid device- place the tip gently into the oral cavity, advance by pushing the tongue down to reach the pharynx if necessary.
When would you use IV NTG if the pt had a STEMI?
1. recurrent or unresponsive chest pain to SL or paste 2. PE complicating STEMI (limit to drop of 10%SBP) 3. HTN complicating STEMI (limit to drop of 10%SBP)
What are the steps associated with insertion of an NPA? (3)
1. select the proper size by choosing the a NPA that has a slightly smaller diameter to the nare, then take NPA and place it on the top of the nose and it shouldn't be longer than the angle of the mandible/earlobe. 2. lubricate the airway w/a water-soluble jelly or anesthetic jelly. 3. insert the airway through the nostril. - RIGHT NASAL PASSAGE- place bevel to the septum - LEFT NASAL PASSAGE- invert the NPA w/bevel up and rotate to allow it to become like the anatomical passageway.
What is the ventilation rate that a healthcare worker may start at?
10/min or titrate to the normal carbon dioxide partial pressure in arterial blood (35-45mmHg)
reperfusion therapy is the mainstay treatment for STEMI pts as long as it is w/in < ________ hours of the onset of s/s.
12 hours
What is the door to PCI timeframe for a pt traveling from a non-PCI capable hospital?
120 mins. NORMALLY it is 90 mins
Compress the chest at least ______ inches in an adult at a rate of _______/min while allowing for complete chest recoil.
2 inches 100 compressions/min
When preforming chest compressions, you should switch providers every ________ __________ or earlier if fatigued.
2 minutes
generally w/in ____ hours of the onset of s/s from an ischemic stroke fibrinolytic therapy should be initiated. Endovascular therapy should be given w/in _____ hours of onset of symptoms.
3 hours. - can be 4.5 hours in certain pts. 6 hours
a comatose pt w/ ROSC after cardiac arrest is advised to maintain what temperature range?
32-36 Celsius for at least 24 hours
V-fib is most likely to develop in the first ______ hours after the onset of symptoms.
4
What are the H's which are the most common potentially reversible causes of cardiac arrest?
5 H's H- Hypovolemia H- Hypoxia H- Hydrogen ions (acidosis) H- Hypo/hyper-kalemia H- Hypothermia
What are the T's which are the most common potentially reversible causes of cardiac arrest?
5 T's T- Tension pneumonthorax T- Tamponade (cardiac) T- Toxins T- Thrombosis (pulmonary) T- Thrombosis (coronary)
Fibrin-specific agents are effective in acheiving normal flow in about ____ % of pt given these drugs.
50 %
What is the tidal volume needed in an adult who is in resp arrest?
500-600 mL (6-7mL/kg) - this amt is sufficient to cause the chest to rise.
if a high risk pt in a non-PCI facility receives fibrinolytics w/in 12 hrs of S/S but needs rescue PCI, what is the time frame that the pt needs to get to a PCI facility?
6 hours
What are the basic components of the primary assessment?
Airway Breathing Circulation Disability Exposure
What is the guideline for management of resp arrest?
BLS and ACLS interventions: - give supp O2 - opening the airway - provide basic ventilation - using basic airway adjuncts (OPA/NPA) - suctioning
If the pt appears unconscious- what is the correct systemic approach from the following options: Primary and secondary assessments BLS assessment What if the pt appears conscious?
BLS assessment first, then after completing all of the appropriate steps of BLS assessment, you use the primary and secondary assessments for more advanced evaluation & tx. use the Primary and secondary assessments initially
What is the most reliable method , via AHA, to assess the correctness of placement for an ET tube?
Cont. waveform capnography
During your primary assessment you quickly asses for responsiveness, LOC, and pupil dilation to asses for ____________
Disability
What EKG abnormality and BP effect is most often seen with hypovolemia?
EKG- rapid, narrow-complex tachycardia. (sinus tach) BP- increase diastolic but decreased systolic - Eventually, as the blood continues to be loss, the BP falls but the sinus tachy continues bcs the body is trying to pump as hard as it can to distribute the blood to the body.
EMS uses __________ scale to assess stroke pts. ED PAs use __________ scale to assess stroke pts.
EMS= Cincinnati prehospital stroke scale ED PAs= NIH Stroke Scale or Canadian neurologic scale
Which advanced airway has two tubes that are fused that can be used if inserted into either the trachea or esophagus?
Esophageal-tracheal tube
True or false: Healthcare workers need evidence of increased biomarkers in order to order PCI in a STEMI pt
FALSE
True or false: Morphine has an association with increased mortality in STEMI pts.
FALSE - It has an association with increased mortality in NSTEMI pts. USE CAUTION
True or false: post-cardiac arrest glycemic control is very important to strictly monitor and intervention is indicated if glucose levels range from 80-110mg/dL
FALSE - healthcare workers SHOULD NOT attempt to alter glucose conc. w/in a lower range (80-110) bcs of the increased risk of hypoglycemia.
True or false: with a single healthcare provider present- they should always provide 2 mins of CPR before activating the emergency response system.
FALSE - it depends on the likely cause of the cardiac arrest. i.e. if a healthcare worker sees an adolescent suddenly collapse, it is reasonable to assume that the pt has suffered a sudden cardiac arrest and that it is advised to get help and AED before returning to the pt to do CPR. - whereas if the cardiac arrest is caused by hypoxia, then you should do CPR for 2 mins before getting help.
True or false: IV NTG is a common form preferred to be used for STEMI tx
FALSE - really only used for ischemic conditions- not a STEMI
True or false: In an ACS pt w/o a known PE antifibrinolytics has been shown effective in resolving the occlusion.
FALSE - there is no benefit shown and is not recommended.
True or false: you may use an OPA in a conscious pt.
FALSE -this may induce gagging and vomiting. If the pt has an intact gag reflex- then DO NOT USE THIS
True or False: BLS assessment includes drug interventions and advanced airway techniques
FALSE BLS is an approach that stresses early CPR and defibrillation.
true or false: a STEMI indicates partial occlusion of an epicardial a.
FALSE it is indicative of fully occluded epicardial a.
True or false: It is important for a healthcare worker to decide if the best course of action is to induce hypothermia or to schedule a PCI because they can't be given concomitantly.
FALSE PCI and hypothermia are feasible and safe and have good outcomes.
True or false: Streptokinase is fibrin specific
FALSE- not fibrin specific rTPA, reteplase, and tenecteplase are fibrin specific
After determining that the scene is safe, ACLS providers determine the pt's ________ _______ ____________.
LOC
What do you need to be sure to monitor while suctioning?
HR, O2 stat, clinical appearence. If bradycardia develops, stop and admin O2
If a pt on morphine develops hypotension, what is your first line tx?
IV fluids
When is it reasonable to administer an antifibrinolytic to a pt w/PEA?
If a pt has evidence of a massive PE or saddle PE. these PE's can cause occlusion of the pulmonary vasculature, which can lead to acute right heart failure.
What is rescue PCI?
If fibrinolytics dont work and you need to do a PCI.
If the PETCO2 is < 10mmHg what should you do? If the diastolic pressure is < 20 mmHg, what should you do?
In both cases- you should Improve the quality of the CPR
Why is it important to push hard and fast in the center of the chest? Why is it important to ensure complete chest recoil? Why do you want to minimize chest compression interruptions? Why do you want to avoid excessive ventilation?
It's the most important part of CPR- this action ensures that you pump blood to the brain and heart. Chest recoil allows blood to flow into the heart and is necessary for chest compression to create blood flow. Any break in pumping means you are not getting blood to your body. Excessive ventilation during is likely to increase intrathoracic pressure, decrease venous return to the heart, and diminish CO. It can also cause gastric inflation, which can cause regurgitation and aspiration.
Which advanced airway provides comparable ventilation to ET intubation and has an inflatable mask in the front of the tube that blocks the airflow into the esophagus?
Laryngeal mask airway
Which advanced airway has advantages similar to an esophageal-tracheal tube, but is more compact and less complicated to insert?
Laryngeal tube
What is the immediate tx of a pt w/suspected ACS?
M- morphine 2 mg q 15 mins prn (if nitro doesnt help) O- oxygen, if O2 <90% N- Nitro, 0.4 mg q 5 min x 3 A- ASA 160-325mg
These teams are responsible for preforming a rapid patient assessment and initiating appropriate treatment to reverse physiologic deterioration and prevent a poor outcome.
Medical emergency teams (METs) Rapid response teams (RRTs)
Can you use the bag-mask ventilation with one person CPR?
NO
Is the use of cricoid pressure recommended in cardiac arrest?
NO the routine use of cricoid pressure and cardiac arrest is not recommended
If the chest pain responds to the NTG administration, does this mean that the source is exclusively ACS?
NO- NTG admin can also relieve esophageal spasm and other GI causes of chest pain
What is the alternate airway adjunct that may be used in a conscious pt that provides a conduit for airflow between the nares and the pharynx?
NPA (nasopharyngeal airway)
What analgesic medication is contraindicated in pts who have had an MI?
NSAIDs - they increase risk of mortality, reinfarction, HTN, CHF, myocardial rupture
What is the J-shaped device that is used when pts are unconscious, previous techniques have failed to maintain airway patency, and who are at risk for developing airway obstruction from the tongue or from relaxed upper throat muscles
OPA
In pt's who are unconscious with no cough or gag reflex, insert a ____________ or __________ to maintain airway patency.
OPA or NPA
What are the roles of the team leader?
Organizes the group Monitors individual performance of team members backs up team members Trains and coaches Facilitates understanding Focuses on comprehensive patient care
______________ ______________ is the cessation of breathing.
Resp arrest
the memory aid SAMPLE is useful for what? What does SAMPLE stand for?
SAMPLE is useful in taking a focused hx of the pt. S- Signs and Symptoms A- Allergies M- Medications (including the last dose taken) P- PMHx (esp r/t current illness) L- Last meal consumed E- Events
What are the holding parameters for NTG?
SBP <90 or no lower than 30 mmHg below baseline and the HR is 50-100/min
What suspicions on an ECG would lead you to believe that it is a NSTEMI? What would be the treatment plan if this was the case?
ST depressions, >0.5 mm, or T wave inversions, >2mm. ** transient ST elevations >0.5mm for <20 mins are in this category. It depends on the levels of cardiac biomarkers and ACS risk- if they are elevated or have a high risk then you could consider the invasive strategy (PCI) and start adjunctive therapies.
What suspicions on an ECG would lead you to believe that it is a STEMI? If this is the case, what would be your tx plan?
ST elevations in >2 leads or the presence of a new LBBB - * J point elevation >2mm in precordial leads or 1mm in other leads. give adjunctive therapy (heparin, ADP inhibitor, GPIIb/GP IIIa inhibitors). If the hospital has a cath lab- set pt up for cath w/in 90 mins, if not or no hospital is close by, then set them up for fibrinolytic therapy w/in 30 mins.
True or false DONT give ASA, UFH, rtPA until the CT has ruled out a hemorrhagic stroke
TRUE
True or false an NPA may induce vomiting even in a semiconscious pt.
TRUE
True or false an improperly sized NPA may enter the esophagus.
TRUE
True or false: ET intubation can provide an alternate medication delivery when IV access is not possible.
TRUE
True or false: You should use caution in pt w/ facial trauma bcs of the risk of misplacement into the cranial cavity through a fractures cribiform plate.
TRUE
True or false: There are cases of resp failure that can be without an increase in resp effort.
TRUE - this can happen in the case of abnormal CNS control of breathing or muscle weakness.
True or false avoid excessive ventilation in a pt who is post-cardiac arrest.
TRUE - you want to avoid excessive ventilation for several reasons: 1. hemodynamic effects when intrathorasic pressures are increased. 2. decreases in intracranial blood flow r/t decreases in arterial CO2.
True or false Agonal gasps are not normal and is a sign of cardiac arrest that can happen mins after cardiac arrest
TRUE!!!
Name the appropriate tx to the condtion: Tension pneumonthorax Tamponade (cardiac) Thrombosis (pulmonary) (PE)
Tension pneumonthorax- needle aspiration & chest tube Tamponade (cardiac) - IV fluids & pericardiocentesis Thrombosis (pulmonary) (PE) - antifibrinolytics
Which type of assessment should you use to make the decision to place an advanced airway?
This should be made in the primary assessment
What rhythms are considered cardiac arrest?
V-fib pulseless V-tach asystole PEA
What is the rhythm present in most pts who die of ACS before reaching the hospital?
V-fib or pulseless ventricular tachycardia
What are some acute life threatening complications of ACS?
VF pulseless VT symptomatic bradycardia unstable tachycardias
What are the drugs to relieve ischemic discomfort? What are the drugs to dissolve clots? What are the drugs to inhibit thrombin and platelets?
What are the drugs to relieve ischemic discomfort? - MONA What are the drugs to dissolve clots? - fibrinolytics (TPA, ect) What are the drugs to inhibit thrombin and platelets? - UFH, LMWH,
What are the contraindications for ASA?
allergy to ASA or GI bleed
What are the other life-threatening diagnosis which should be on your ddx for chest pain?
aoritc dissection tension pneumothorax PE pulm effusion w/cardiac tamponade
How many hours should you wait to give neurological prognostication if the pt underwent hypothermia? How many hours should you wait to give neurological prognostication if the pt DID NOT undergo hypothermia?
at least 72 hours after return to normal temp. at least 72 hours AFTER cardiac arrest
What are some late signs of resp failure?
bradycardia cyanosis stupor, coma apnea
What is generally recommended during the first 24 hrs of evaluation in pts w/ acute ischemic stroke to detect a fib and potentially life-threatening arrhythmias?
cardiac monitoring
Why do you advise the use of chewable ASA instead of ASA tabs?
chewable has better absorption - you can use rectal ASA for pts w/ N/V, active peptic ulcer diz, or other upper GI problems.
Which aspect of the primary assessment involves obtaining IV access and administration of meds or fluids if indicated?
circulation - the drugs and fluids help to maintain BP and heart rhythm.
the CT shows a hemorrhagic stoke- what do you do?
consult neurologist and begin stroke hemorrhagic pathway. admit to stroke unit or ICU
What is a major adverse cardiac event (MACE)?
death nonfatal MI urgent postinfarction revascularizatoin
What are the steps for preforming ET tube suctioning? (3)
done w/a soft tip catheter. 1. use sterile technique 2. insert the catheter into the ET tube. Be sure the side opening is NOT occluded during insertion and DO NOT go past the end of the tube (may injure mucosa and cause coughing) 3. apply suction by occluding the side opening of the catheter while withdrawing with a rotating motion. Suction attempts should NOT exceed 10 secs to avoid hypoxia. admin 100% O2 in between suctioning attempts.
What are the 3 inclusion criteria for the use of fibrinolytic therapy in a suspected nonhemorrhagic stroke?
dx of ischemic stroke causing measurable neurologic damage onset of symptoms < 3 hrs before beginning tx age > 18 yo
Which of the advanced airway devices CAN NOT be applied while chest compressions are occurring?
endotracheal tube. All others can be placed while chest compressions cont.
What are some methods for providing reperfusion in an ACS case?
fibrinolytics PCI (if used as initial reperfusion for STEMI= primary PCI)
ACLS indicates O2 supplementation when indicated: - for cardiac/resp arrest pts, what % of O2 should be admin? - for others (i.e cardiac s/s and resp distress), what % of O2 should be admin?
for pt's in cardiac arrest, the O2 % should be 100% for others you should titrate the O2 admin to achieve 94% or greater arterial saturation via pulse ox.
in which type of cases can you titrate ventilation rates to a higher PaCO2 target?
for special cases where perhaps the pt has acute lung injury or high airway pressures.
What are the basic airway skills used to ventilate a pt?
head tilt- chin lift jaw thrust w/o head extension mouth-mouth mouth-nose mouth-barrier device (pocket mask) bag-mask ventilation
What are some different ways to maintain the airway patency in an unconscious pt?
head-tilt-chin lift oropharyngeal airway nasopharyngeal airway
What is the greatest risk for heparin use?
hemorrhages- intracranial
Which type of stroke are fibrinolytics or any other anticoagulant contraindicated?
hemorrhagic stroke
When a pt's temp is below normal, the lab value reported for PaCO2 might be _____________ (higher or lower) than the actual values.
higher
(Hypo or hyper)-ventilation may cause cerebral vasoconstriction, reducing blood flow to the brain.
hyperventilation
What are the 2 most common causes of pulseless cardiac electivity (PEA)?
hypovolemia hypoxia
What needs to be included in the ED's initial assessment of a pt w/ suspected ACS?
if a pt has suspected ACS, within 10 mins, they need their VS, O2 levels evaluated, IV access, EKG, focused HP, obtain initial cardiac biomarkers, electrolytes, and coag studies. chest X-ray needs to happen < 30 mins.
What are the two major types of stroke?
ischemic stroke- 87% of all strokes- arterial occlusion. hemorrhagic stroke- 13% of all strokes- BV in brain ruptures - intracerebral bleed= 10% - subarachnoid bleed= 3%
How is the OPA useful in the placement of am ET?
it prevents them from biding and occluding the ET tube
What type of maneuver do you use to open the airway in a pt who has a suspected neck injury?
jaw thrust - but if that doesn't work- it is more important to keep the airway open, so you need to use the head tilt- chin lift
What are some examples of advanced airway management?
laryngeal mask laryngeal tube esophageal-tracheal tube endotracheal tube
Occlusion of the ______ ________ coronary a. or _________________ _______________ ____________ _________________ coronary a can present with cardiogenic shock which can progress rapidly into PEA.
left main coronary a. proximal left anterior descending coronary a.
What is the most common cause for upper airway obstruction in the unconscious pt?
loss of muscle tone in the throat which can cause the tongue to fall back and occlude the airway
Which method would you prefer to use to help stabilize the spine in the case of a spinal injury? - manual spinal motion restriction or - immobilization devices
manual spinal motion restriction
Would you rx a fibrinolytic agent to a pt present > 12hrs after S/S of ACS?
not generally, but they can be if ST elevation and chest pain persists... but DONT GIVE THEM if the pt presents >24 hours after s/s unless a posterior MI is suspected.
What are some common causes of nontraumatic hypovolemia?
occult hemorrhage and severe dehydration
If the pt is in resp arrest, but still has a pulse- what should be your ventilation rate?
once every 5-6 secs and each should take 1 sec and cause the chest to rise.
in the general assessment of a suspected stroke pt, what are some of necessary actions?
order emergent CT or MRI IV access O2 if needed check glucose neurologic screening assessment activate stroke team 12 lead EKG
If the pt shows signs of ROSC, _________-___________ arrest care should be initiated.
post-cardiac
the CT shows no hemorrhage, but the pt has sx of stroke, what do you do?
probably a nonhemorrhagic stroke so you should consider fibrinolytic therapy. repeat the neuro exam if they are a candidate- review risks and benifits and give rtPA. (DONT GIVE ANTICOAG w/in 24 hrs) be sure to monitor BP and neurologic deterioration. if they aren't then give ASA and admit to stroke unit
What are some tx for drug overdose/toxin exposure that can buy you time?
prolonged CPR ECPR (pass blood through machine to make it oxygenated) renal dialysis IV lipid emulsions antidotes correcting electrolyte disturbances
What is involved in checking for "exposure" as part of the primary assessment?
removing the clothing to preform a PE, looking for obvious signs or trauma, burns, unusual markings, or medical alert bracelets.
A clinical state of inadequate oxygenation, ventilation, or both is known as:
resp failure
What is the most common symptom reported with ACS?
retrosternal chest discomfort- more like a pressure
What types of catheter tips are available for suctioning?
rigid and soft
Which type of catheter tip is better for thick secretions and particulate matter in the oropharnyx? Which type of catheter tip is better for thin secretions in the oropharnyx? Which type of catheter tip is better for intratracheal suctioning? Which type of catheter tip is better for suctioning in a pt who has clenched teeth through an in-airway device (NPA)?
rigid catheter tip Soft catheter tip Soft catheter tip Soft catheter tip
resp failure can occur with a ___________ in arterial CO2 or a ______________ in blood oxygenation?
rise drop
the DDx is in which assessment?
secondary
What are some exclusion criteria for the use of fibrinolytic therapy in a suspected nonhemorrhagic stroke?
significant head trauma or prior stroke in previous 3 months symptoms suggest subarachnoid hemorrhage hx of previous intracranial hemorrhage elevated BP blood glucose < 50mg/dL
What is the leading cause of death in the USA?
stroke
NINDS is the association associated with what?
stroke and neurological disorders
What are some S/S of a stroke?
sudden weakness or numbness of hte face, arm, or leg- esp on one side of the body sudden confusion trouble speaking or understanding sudden trouble seeing in one eye or both sudden trouble walking dizziness or loss of balance or coordination sudden severe HA w/no known cause
What are some s/s of resp distress?
tachypnea increased resp effort (nasal flaring, retractions) inadequate resp effort (hypoventilation/bradypnea) abnormal airway sounds (stridor, wheezing, grunting) tachycardia pale, cool skin changes in LOC use of abdominal m. to breath.
what is the most important test for the dx of a stroke?
the noncontrast CT
What is the PETCO2?
the partial pressure of CO2 in exhaled air at teh end of the exhalation phase.
If a pt comes in complaining of chest pain who has a normal EKG or non-dx EKG changes, what would be your treatment?
think about admiting to a chest pain unit for observation and serial enzymes.
What are some physiologic criteria that could be part of an early warning system to prevent IHCA?
threatened airway RR <6 or >30 HR <40 or >140 systolic BP <90 symptomatic hypertension seizure unexpected decreased in LOC sig fall in UO unexplained agitation
During the post-cardiac arrest phase, what % of oxygen should the pt be titrated to?
titrate O2 % to get arterial levels up to 94% or >. - avoid using 100% O2 to prevent any complications ] associated with O2 toxicity.
What happens if you insert an OPA that is too small or too large?
too small- may push the base of the tongue posteriorly and obstruct the airway. too large- may obstruct the larynx or cause trauma.
rtPA glucose labetalol nicardipine enalaprilat ASA nitroprusside These medications are used in the setting of what condition?
treatment for a stroke
If your pt comes in via EMS who had narrow-complex tachycardia on his EKG during the ride over, but has since gone into PEA - what tx should you consider?
volume restoration
What is your TOC for hypovolemia to prevent PEA?
volume restoration
What is "fixation error"
when you become trapped in a specific tx or dx approach.
