ACLS Final Comprehensive
What is the antidote for Acetaminophen overdose?
Acetylcysteine (Mucomyst)
What is the antidote for Cyanide overdose?
Tydroxycobalamin, Sodium thiosulfate
When are chest thrusts used instead of abdominal thrusts to relieve airway obstruciton?
pregnant or obese victims
Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is not breathing normally but a pulse is present. Your next action should be to:
provide rescue breathing (one breath every 5-6 seconds) and recheck for a pulse every 2 minutes; be ready to perform high quality CPR if you do not feel a pulse; if opioid use is suspected, consider administering naloxone
Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is not breathing normally but a pulse is present. Your next action should be to:
provide rescue breathing (one every 3-5 seconds); add compressions if pulse remains <60/min with signs of poor perfusion; activate ERS after 2 min; continue rescue breathing and check pulse about every 2 min (if no pulse begin CPR)
If the chest does not rise when you give a breath, what should you do?
reposition the head and try again
What is the importance of measuring coronary perfusion pressure during CPR?
represents myocardial blood flow during chest compressions and is a key determinant of the success of resuscitation
What is the most common cause of cardiac arrest in children?
respiratory failure or shock
Upon finding an unresponsive infant, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to:
simultaneously look for breathing and feel for a brachial pulse for no more than 10 seconds
Upon finding an unresponsive child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to:
simultaneously look for breathing and feel for a carotid or femoral pulse for no more than 10 seconds
Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. Your next action should be to:
simultaneously look for breathing and feel for a carotid pulse for no more than 10 seconds
What action should you take when the AED is analyzing the heart rhythm?
stand clear of the victim
A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. Several rescuers respond, and you ask them to activate the emergency response and retrieve the AED and emergency equipment. As you check for a pulse and breathing, you notice that the man is gasping for air and making "snorting" sounds. You do not feel a pulse. What is your best next action?
start high-quality CPR, beginning with chest compressions
What are signs and symptoms of mild airway obstruction?
still has good air exchange, can cough forcefully, may wheeze between coughs
What is chest compression fraction?
the proportion of time that chest compressions are performed during a cardiac arrest
What is the purpose of the primary survey?
to detect the presence of life-threatening problems that require rapid interventions
What is the recommended compression depth for infants?
1 1/2 inches
What is the correct hand placement for performing high-quality chest compressions on an infant?
1 rescuer: 2 fingers in the center of the chest, just below the nipple line 2 or more rescuers: 2 thumb-encircling hands in the center of the chest, just below the nipple line
How does one properly perform 2 finger compression technique on an infant?
1. Place the infant on a firm, flat surface. 2. Place 2 fingers in the center of the infant's chest, just below the nipple line, on the lower half of the breastbone. 3. Give compressions at a rate of 100-120/min. 4. Compress at least one third the AP diameter of the infant's chest (about 1 1/2 in). 5. Allow for complete chest recoil. Minimize interruptions to less than 10 seconds. 6. After every 30 compressions, open the airway using head tilt-chin lift method and deliver two breaths. 7. After about 5 cycles (2 min) of CPR, if you are alone and the ERS has not been activated, leave the infant (or carry the infant with you) and activate the ERS and retrieve the AED. 8. Continue compressions and breaths at 30:2 ratio and use the AED as soon as it arrives. Continue until advanced providers take over or the infant begins breathing or moving.
How does one properly performing choking relief in a responsive infant?
1. Kneel or sit with the infant in your lap. 2. If it is easy to do so, remove clothing from the infant's chest. 3. Hold the infant face-down with the head slightly lower than the chest, resting on your forearm. Support the infant's head and jaw with your hand. Take care to avoid compressing the soft tissues of the infant's throat. Rest your forearm on your lap or thigh to support the infant. 4. Deliver up to 5 back slaps forcefully between the infant's shoulder blades, using the heel of your hand. 5. After delivering up to 5 back slaps, place your free hand on the infant's back, supporting the back of the infant's head with the palm of your hand. The infant will be adequately cradled between your 2 forearms, with the palm of one hand supporting the face and jaw while the palm of the other hand supports the back of the infant's head. 6. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant faceup, with your forearm resting on your thigh. Keep the infant's head lower than the trunk. 7. Provide up to 5 quick downward chest thrusts in the middle of the chest, over the lower half of the breastbone. Deliver chest thrusts at a rate of about 1 per second. 8. Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the object is removed or the infant becomes unresponsive.
How does one properly perform chest compressions on an adult during resuscitation efforts?
1. Make sure the victim is lying face-up on a firm surface. 2. Put the heel of one hand in the center of the victim's chest, on the lower half of the sternum. 3. Put the heel of your hand on top of the first hand. 4. Straighten your arms and position your shoulders directly over your hands. 5. Rate of 100-120/min. 6. Press down at least 2 in with each compression. 7. Allow for complete chest recoil. 8. Minimize interruptions in chest compressions.
How does one properly use an AED?
1. Open the carrying case and power on the AED. 2. Attach AED pads to the victim's bare chest. 3. When the AED prompts you, clear the victim and allow the AED to analyze the rhythm. 4. Resume chest compressions while the AED is charging. 5. Clear the victim when delivering a shock; resume compressions after the shock has been delivered. 6. If no shock is needed, immediately resume CPR starting with chest compressions.
How does one properly palpate a femoral pulse on a child?
1. Place 2 fingers in the inner thigh, midway between the hipbone and the pubic bone and just below the crease where the leg meets the torso. 2. Feel for a pulse for at least 5 but no more than 10 seconds.
How does one properly palpate a brachial pulse on an infant?
1. Place 2-3 fingers on the inside of the upper arm, midway between the elbow and the shoulder. 2. Then press the fingers to attempt to feel the pulse for at least 5 seconds but no more than 10 seconds.
How does one properly perform the jaw thrust maneuver?
1. Place one hand on each side of the victim's head. You may rest your elbows on the surface on which the victim is lying. 2. Place your fingers under the angles of the victim's lower jaw and lift with both hands, displacing the jaw forward. 3. If the lips close, push the lower lip with your thumb to open the lips.
How does one properly perform the head tilt-chin lift technique?
1. Place one hand on the victim's forehead and push with your palm to tilt the head back. 2. Place the fingers of the other hand under the bony part of the lower jaw near the chin. 3. Lift the jaw to bring the chin forward.
How does one properly perform 2 thumb-encircling hands technique on an infant?
1. Place the infant on a firm, flat surface. 2. Place both thumbs side by side in the center of the infant's chest, on the lower half of the breastbone. Thumbs may overlap in small infants. 3. With your hands encircling the chest, use both thumbs to depress the breastbone at a rate of 100-120/min. 4. Compress at least one third the AP diameter of the infant's chest (about 1 1/2 in). 5. After each compression, completely release the pressure on the breastbone and allow the chest to recoil completely. 6. After every 15 compressions, pause briefly for the second rescuer to open the airway with a head tilt-chin lift and give 2 breaths, each over 1 sec. 7. Continue compressions and breaths in a ratio of 15:2 (2 rescuer). The rescuer providing chest compressions should switch roles with another provider about every 5 cycles (2 min). Continue CPR until the AED arrives, advanced providers take over, or the infant begins to breath/move.
How does one properly use a pocket mask to deliver breaths using the head tilt-chin lift technique?
1. Position yourself at the victim's side. 2. Place the pocket mask on the victim's face, using the bridge of the nose as a guide for correct position. 3. Seal the pocket mask against the face. Using the hand that is closer to the top of the victim's head, place the index finger and thumb along the edge of the mask. Place the thumb of your other hand along the edge of the mask. 4. Place the remaining fingers of your second hand along the bony margin of the jaw and lift the jaw. Perform a head tilt-chin lift to open the airway. 5. While you lift the jaw, press firmly and completely around the outside edge of the mask to seal the pocket mask against the face. 6. Deliver each breath over 1 second, enough to make the victim's chest rise.
How does one properly use a bag mask device to deliver breaths?
1. Position yourself directly above the victim's head. 2. Place the mask on the victim's face, using the bridge of the nose as a guide for correct position. 3. Use the E-C clamp technique to hold the mask in place while you lift the jaw to hold the airway open. 4. Squeeze the bag to give breaths (1 second each) while watching for chest rise.
If you are performing the Heimlich maneuver on an adult or child or infant and they become unresponsive, what steps should be taken next?
1. Shout for help and send someone for an AED. 2. Lower the patient to the ground/flat surface. 3. Begin CPR, starting with compressions. Do not check for a pulse. 4. Each time you open the airway to give breaths, open the victim's mouth wide. Look for the object. If you see an object that can be easily removed, remove it with your fingers. If you do not see an object, continue CPR. 5. After about 5 cycles (2 min) of CPR, activate the ERS if not already done.
Single rescuers should use the compression-to-ventilation ratio of ____ compressions to ____ breaths when giving CPR to victims of any age.
30:2
How does one properly perform the Heimlich maneuver?
1. Stand or kneel behind the victim and wrap your arms around the victim's waist. 2. Make a fist with one hand. 3. Place the thumb side of your fist against the victim's abdomen, in the midline, slightly above the navel and well below the breastbone. 4. Grasp your fist with your other hand and press your fist into the victim's abdomen with a quick, forceful upward thrust. 5. Repeat thrusts until the object is expelled from the airway or the victim becomes unresponsive. 6. Give each new thrust with a separate, distinct movement to relieve the obstruction.
List the eight components of high quality CPR.
1. Start compressions within 10 seconds of recognition of cardiac arrest. 2. Compress at a rate of 100-120/min with a depth of at least 2 inches in adults/children and 1 1/2 inches in infants. 3. Allow complete chest recoil after each compression. 4. Minimize interruptions in compressions (limit to <10 seconds). 5. Give effective breaths that make the chest visibly rise. 6. Switch compressors about every 2 minutes or earlier if fatigued. 7. Continue delivering chest compressions while the AED is charging. 8. Avoid prolonged rhythm analysis, frequent or inappropriate pulse checks, taking too long to give breaths to the patient, excessive ventilation, or unnecessarily moving the patient.
What is the correct compression-to-ventilation ratio for a single rescuer of a 3-year-old child?
30:2
What is the appropriate tidal volume for adult cardiac arrest patients?
500-600 mL (half a squeeze of an adult ventilation bag; enough to see visible chest rise)
What is the target goal of chest compression fraction during CPR?
60-80%
Adult pads should be used on what age victim?
8 years and older; may use them on infants if you do not have child pads
Interruptions in chest compressions should be limited to how many seconds?
<10
What is an adequate waveform capnogrpahy (PETCO2) range?
10-20 mm Hg
At what rate should compressions occur?
100-120/min
What is an adequate coronary perfusion pressure (CPP)?
15 mm Hg
What is the correct compression ratio for children and infants when two rescuers are present?
15:2
What is the correct compression-to-ventilation ratio for a 7-year-old child when 2 rescuers or more are present?
15:2
What is the correct hand placement for performing high-quality chest compressions on a child?
2 hands or 1 hand (optional for small child) on the lower half of the sternum
What is the recommended compression depth for adults and children?
2 inches
What is the therapeutic dose of Naloxone in the treatment of suspected opioid overdose?
2 mg intranasal or 0.4 mg intramuscular
What is heart attack?
A blockage of blood flow to the heart muscle.
What memory aid may be used when evaluating a patient's level of consciousness?
AVPU Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive
What is the antidote for Cholinergic overdose?
Atropine, Pralidoxine (2-PAM)
What is the antidote for Calcium channel blocker overdose?
Calcium, Glucagon, Insulin
What are some potential signs and symptoms of an opioid overdose?
Coma, Pinpoint pupils, Respiratory depression, Hypotension, Hypothermia, Hyporeflexia
What is the antidote for beta blocker overdose?
Glucagon
What is the antidote for Digoxin overdose?
Digoxin immune Fab (Digibind or Digifab)
What is the antidote for Ethylene glycol overdose?
Fomepizole, Ethanol
What is the antidote for Anticholinergics overdose?
Physostigmine
What is the antidote for alcohol withdrawal?
Librium
What are the two correct methods for placement of AED pads?
Method 1. AKA Anterolateral Placement. Place one AED pad directly below the right collarbone. Place the other pad to the right side of the left nipple, with the top edge of the pad a few inches below the arm pit. Method 2. AKA Anteroposterior Placement. Place one AED pad on the left side of the chest, between the victim's left side of the breastbone and left nipple. Place the other pad on the left side of the victim's back, next to the spine.
If you encounter an unresponsive victim and suspect opioid overdose, what medication should be given in addition to providing BLS care/assessment?
Naloxone (Narcan)
What is the antidote for Carbon monoxide poisoning?
Oxygen
What is the antidote for Heparin overdose?
Protamine sulfate
What is the antidote for Benzodiazepine overdose?
Romazicon (Flumazenil)
What is the antidote for aspirin overdose?
Sodium bicarbonate
When ROSC occurs, what happens to waveform capnography?
There will be a significant increase in the ETCO2. (35-45 mmHg) This increase represents a drastic improvement in blood flow (more CO2 being dumped in the lungs by the circulation) which indicates circulation.
What two cardiac arrest rhythms are shockable?
VF and pVT
What is the antidote for Coumadin overdose?
Vitamin K
What is the antidote for Anticoagulant overdose?
Vitamin K, FFP (fresh frozen plasma)
Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is breathing normally and a pulse is present. Your next action should be to:
activate ERS, return to victim and monitor until emergency responders arrive
Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. The arrest was sudden and witnessed. Your next action should be to:
activate the emergency response system and retrieve the AED; begin chest compressions 30:2 (1 rescuer), 15:2 (2 rescuer)
What is the importance of measuring waveform capnography (PETCO2) during CPR?
allows for evaluation of CPR quality, optimize chest compressions, detection of ROSC during chest compressions or when a rhythm check reveals an organized rhythm, ET tube placement
If a patient presents with signs of severe airway obstruction, what should the actions of the rescuer be?
ask them if they are choking (adult or child), if the victim nods "yes" and cannot talk severe airway obstruction is present, take steps to immediately relieve the obstruction, if it continues and the victim becomes unresponsive start CPR, send someone for an AED and activate the ERS, if you are alone provide 2 min of CPR before leaving the patient to activate the ERS
What two cardiac arrest rhythms are not shockable?
asystole and PEA
During the primary survey, for what length of time should you assess for the presence of a pulse?
at least 5 seconds but no more than 10 seconds
When placing AED pads on a patient with an implanted defibrillator or pacemaker, what precautions should be taken?
avoid placing AED pad directly over the implanted device
You encounter an unresponsive 56-year-old man who has been taking hydrocodone after a surgical procedure. He is not breathing and has no pulse. You notice that his medication bottle is empty. You suspect an opioid-associated life-threatening emergency. A colleague activates the emergency response system and is retrieving the AED and naloxone. What is the most appropriate action for you to take next?
begin CPR, starting with chest compressions
Your 27-year-old roommate uses opioids. You find him unresponsive with no breathing, but a strong pulse. You suspect an opioid-associated life-threatening emergency. A friend is phoning 9-1-1 and is looking for the naloxone autoinjector. What action should you take?
begin CPR, starting with chest compressions
Upon finding an unresponsive infant or child, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. The arrest was not sudden and not witnessed. Your next action should be to:
begin chest compressions 30:2 (1 rescuer), 15:2 (2 rescuer); if 2 rescuers are present, one rescuer begins CPR and the other activates the ERS; use the AED as soon as it arrives; after about 2 min of CPR, if you are still alone, activate the ERS and get the AED if not already done
Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient has no pulse and is not breathing normally. Your next action should be to:
begin chest compressions; remove clothing; use AED as soon as it arrives
You are performing abdominal thrusts on a 9-year-old child when he suddenly becomes unresponsive. After you shout for nearby help, what is the most appropriate action to take next?
begin high-quality CPR, starting with chest compressions
What pulse location should be palpated when assessing an unresponsive infant?
brachial
Which pulse is palpated when performing a BLS assessment on an adult?
carotid
A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. The man doesn't respond when you touch his shoulder and shout, "Are you OK?" What is your best next action?
check for breathing and carotid pulse; shout for nearby help
What is the antidote for heavy metal poisoning (iron, mercury, arsenic, and lead) poisoning?
chelation therapy
When communicating with a team member, the team leader communicates by taking these steps: 1. The team leader gives a message, order, or assignment to a team member. 2. By receiving a clear response and eye contact, the team leader confirms that the team member heard and understood the message. 3. The team leader listens for confirmation of task performance from the team member before assigning another task. What type of communication do these steps represent?
closed-loop communication
What are signs and symptoms of severe airway obstruction?
clutching throat with thumb and fingers, unable to speak/cry, poor or no air exchange, weak/ineffective cough or no cough at all, high-pitched noise while inhaling or no noise at all, increased respiratory difficulty, possible cyanosis
Upon finding an unresponsive adult patient, you verified that the scene is safe, called for help and asked that someone get an AED or defibrillator. You check for breathing and a carotid pulse simultaneously. The patient is breathing normally and a pulse is present. Your next action should be to:
continue to monitor until additional help arrives.
What are some signs of poor perfusion?
cool extremities, altered mental status, weak pulses, pale skin, mottling, cyanosis
If a patient presents with signs of mild airway obstruction, what should the actions of the rescuer be?
encourage the victim to continue coughing, do not interfere with the victim's own attempts to relieve the obstruction, stay with the victim and continue to monitor, if it continues or progresses to severe airway obstruction activate the ERS
Rescuers should switch compressors how often?
every 5 cycles (2 min) or sooner if fatigued
What pulse location should be palpated when assessing an unresponsive child?
femoral or carotid
What are two ways to open the victim's airway?
head tilt-chin lift and jaw thrust
What can result if a patient is ventilated too quickly?
hyperventilation -> excessive intrathoracic pressure and gastric inflation -> decreased venous return -> decreased coronary and cerebral perfusion pressures -> diminished cardiac output -> decreased rates of survival
Why is it important to ensure that the infant's head is kept in the neutral position?
if you tilt (extend) an infant's head beyond the neutral (sniffling) position, the infant's airway may become blocked; you should ensure the infant's neck is in a neutral position so that the external ear canal is level with the top of the infant's shoulder
What method should be utilized when opening the airway of a patient who is suspected of having a head or neck injury?
jaw thrust
How does one palpate a carotid pulse?
locate the trachea; slide 2-3 fingers into the groove between the trachea and the muscles at the side of the neck; feel for at least 5 seconds but no more than 10 seconds
When should the victim be moved during chest compressions?
never unless the victim is in a dangerous environment (such as a burning building) or if you believe you cannot perform CPR effectively in the victim's present position or location
When should a blind finger sweep be performed? Why?
never; may push the foreign body back into the airway, causing further obstruction or injury
What do agonal gasps represent?
not normal breathing; is a sign of cardiac arrest
What is cardiac arrest?
occurs when the heart develops an abnormal rhythm and stops beating or beats too ineffectively to circulate blood to the brain and other vital organs
What is the most appropriate first step to take as soon as the AED arrives at the victim's side?
power on the AED
A 53-year-old man suddenly collapses and becomes unresponsive. You witness him collapse and are the first rescuer to arrive at the scene. You find him lying motionless on the floor. What is the first action you should take in this situation?
verify that the scene is safe for you and the victim