ACLS Review
Form differential diagnosis
Which action is part of secondary assessment of a conscious patient?
Hypovolemia and hypoxia
Which are the 2 most common underlying and potentially reversible causes of PEA?
Confirmed right ventricular infarction
Which clinical findings represents a contraindication to the administration of nitroglycerin?
Head injury and drowning
Which events usually cause respiratory arrest?
Recent GI bleed
Which is a contraindication to the administration of aspirin for the management of a patient with ACS?
Hypothermia Hypoxia Hyperkalemia/hypokalemia HypovolemiaAcidosis Hypocalcemia Hyperventilation Hypertensive crisis
Which of the following are the "H's" causes of reversible cardiac arrest?
Tension pneumothorax Toxins Cardiac tamponade Pulmonary thrombosis Coronary thrombosis
Which of the following are the "T" causes of reversible cardiac arrest?
Hypovolemia= fluid resuscitation Hypoxia= supplemental oxygen Hydrogen (acidosis)= treat cause/possibly bicarb Hypo/hyperkalemia= fix imbalance Hypoglycemia= check/replace glucose Hypothermia= rewarm Toxins= treat specific agent Tamponade= pericardiocentesis Tension pneumothorax= needle decompression Thrombosis= treat per cause Trauma= surgical intervention
H&Ts
EKG
Obtaining a what is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndrome?
90%
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than?
A comatose patient with ROSC after cardiac arrest should maintain a temperature between 32 C and 36 C
Targeted temperature management
If patient has a confirmed inferior wall stemi or right ventricular infarction Avoid nitro if patient has hypotension, bradycardia, or tachycardia If patient recently has taken sildenafil, vardenafil, or tadalafil in the past 24-48 hrs
What are the contraindications of nitroglycerin?
Pain radiating down left arm
What is a classic symptom of acute ischemic chest discomfort?
Reduce preload
What is a physiological effect of nitroglycerin?
Relief of ischemic chest pain
What is one goal of therapy for patients with ACS?
Stable angina is chest pain during exertion
What is the difference between stable angina and unstable angina?
Activation of emergency response
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival?
Initial impression
What is the first step in the systematic approach to patient assessment?
Oxygen (if needed) Aspirin Nitroglycerin Morphine
What is the initial drug therapy for ACS?
Retrosternal chest pain
What is the most common symptom of myocardial ischemia and infarction?
162-325 mg
What is the recommended dose of aspirin if not contraindicated?
32-36 C
What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest?
20 minutes
What is the time goal for neurologic assessment by the stroke team or designee and non-contrast CT or MRI performed after hospital arrival?
1 mg epi IV
you arrive and CPR is in progress. pt was recovering from PE and suddenly collapsed. two shocks have been delivered and IV has been initiated. what do you administer now
Start high-quality CPR
A patient becomes unresponsive. You are uncertain if a faint pulse is present. The rhythm shown here is seen on the cardiac monitor. An IV is in place. Which action do you take next?
Seek expert consultation
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138. He is asymptomatic with a BP of 110/7-. He has a history of angina. Which of the following actions is recommended?
Give an immediate unsynchronized high-energy shock (defibrillation dose)
A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. Which action is indicated next?
Epinephrine 1 mg
A patient is in cardiac arrest. VFib has been refractory to an initial shock. Of the following, which drug and dose should be administered first by IV/IO route?
Intraosseous
A patient is in cardiac arrest. VFib has been refractory to an initial shock. Two attempts at peripheral IV have been unsuccessful. The next recommended access route of administration for the delivery of drugs during CPR is:
Resume high quality chest compressions
A patient was in refractory ventricular fibrillation. A third shock had just been administered. Your team looks to you for instructions. What is your next action?
Use of phosphodiesterase inhibitor within 12 hours
A patient with a possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication for administration of nitrates?
24 hours
During post-cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?
The primary goals of therapy for a patient with ACS?
1) Reduce the amount of myocardial necrosis 2) Prevent major adverse cardiac events (death, nonfatal MI, need for urgent revascularization) 3) Treat acute, life-threatening complications of ACS
reperfusion therapy
12 lead shows STEMI. pt has resolution of moderate chest pain after 3 doses of sublingual nitroglycerin. BP is 104/70. what intervention is most important in reducing pt's in hospital and 30 day mortality rate
Vagal maneuvers
A 35-year-old woman presents with a chief complain of palpitations. She has no chest discomfort, sob, or light headedness. Her BP is 120/78 mmHg. Which intervention is indicated first?
Cardiovesion
A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm Hg. Which action do you take next?
Do not give aspirin for at least 24 hours if tPA is administered
A 62 year-old man suddenly began to experience difficulty speaking and left-sided weakness. He is brought to the ER. He meets initial criteria for fibrinolytic therapy and a CT scan of the brain is ordered. Guidelines for antiplatelet and antothrombotic therapy are:
Give epinephrine 1 mg IV/IO
After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm is present on the next check. A second shock is given, and chest compression are resumed. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?
establish IV/IO access
CPR in progress. AED has advised no shock indicated. rhythm check finds you in asystole. after resuming compressions what action do you take next
Epinephrine 1 mg
You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check you see the Rhythm shown here team members tell you that the patient was well but reported chest discomfort and then collapse. She has no pulse or respirations. Bag mask ventilation are producing visible chest rise and IO access has been established. Which intervention would be your next action?
Lidocaine, epinephrine, vasopressin
Your patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route of administration?
Atropine 1 mg IV
Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale and diaphoretic. Her BP 80/60. The cardiac monitor shows sinus bradycardia. She is receiving O2 @4L/min via nasal cannula. An IV has been established. What do you administer next?
1 mg epi
a patient is in refractory v fib. high quality CPR is in progress. one dose epi given after the second shock. an antiarrythmic drug then given after third shock. now which med do you push
allows maximum blood to return to heart
how does complete chest recoil contribute to effective CPR
every 2 mins
how often should you switch compressors to avoid fatigue
hypotension
in which situation does bradycardia require tx
adenosine 12 mg IV
pt has history of palpitations and develops light headedness and palpitations. received adenosine 6 mg IV for v tach. BP is 128/70. what is next appropriate intervention
seeking expert consultation
pt has irregular wide complex tachycardia. ventricular rate is 138/min, with BP 110/70. hx of angina. what is recommended next
adenosine 6 mg
pt has palpitations, light headedness and stable tachycardia. monitor shows regular narrow QRS at rate of 180/min. vagal maneuvers have not been effective. IV established. what drug should be administered
epi 2 - 10 mcg/min
pt has sinus brady with HR of 36/min. Atropine has been given of a total dose of 3 mg. transcutaneous pacemaker has failed to capture. pt is confused and BP 88/56. what therapy is indicated next
epi 1 mg IV/IO
pt in cardiac arrest. compressions are being given. pt is intubated and IV started. rhythm in asystole. what is the first drug to be administered
IV/IO access
pt in cardiac arrest. v fib has been refractory to initial shock. if no pathway for med administration what method is preferred
amiodarone 300 mg
pt in pulseless v tach. two shocks and 1 dose epi have been given. which drug should be next
150 mg IV push
pt in refractory v fib and has received multiple defib shocks, epi 1 mg IV twice, and initial dose of amiodarone 300 mg IV. pt is intubated. what is the recommended second dose of amiodarone.
epi 1 mg IV/IO
pt is in cardiac arrest. v fib has been refractory to a second shock. what drug should be administered first
start rescue breathing
pt is not responsive and not breathing. you can palpate a carotid pulse. which action do you take next
1 mg Atropine IV
pt is pale and diaphoretic. BP is 80/60, and in sinus bradycardia. On O2 at 4 L/min by NC and IV is established. what do you adminster
hold aspirin for at least 24 hours if rtPA is administerted
pt suddenly experience difficulty speaking and left sided weakness. meets criteria for fibrinolytic therapy. CT scan ordered. what guidelines for antiplatelet and fibrinolytic therapy
resume high quality compressions
pt was in refractory v fib. third shock has been administrated. what is the next action
give aspirin 160 - 325 mg to chew
pt with STEMI has ongoing chest discomfort. Hep 4000 units IV bolus and hep infusion 1000 units/hour are given. pt doesn't take aspirin due to hx of gastritis, which was treated 5 yrs ago. what is next action
aspirin
pt with hx of large intracerebral hemorrhage 2 months ago. under evaluation for another acute stroke. CT is neg. pt on O2 via NC at 2 L/min. IV established. BP 180/100. what drug do you anticipate for pt
perform electrical cardioversion
pt with palpitations, chest discomfort and tachycardia. monitor shows regular wide QRS at rate 180/min. Now pt is diaphoretic and BP is 80/60. what action do you take next
use of phosphodiesterase inhibitor within previous 24r hours
pt with possible STEMI has ongoing chest discomfort. what is a contraindication to nitrate administration
ventilating until you see chest rise
what action minimizes the risk of air entering the victim's stomach during bag mask ventilation
resume chest compressions
what action should you take immediately after providing an AED shock
epi
what intervention is most appropriate for tx of asystole
100 - 120 compressions per min
what is recommended compression rate for high quality CPR
pulseless v tach associated with torsades de pointes
what is the indication for the use of magnesium in cardiac arrest
10 secs
what is the maximum interval for pausing chest compressions
at least 2 inches
what is the recommended depth of chest compressions for an adult victim
ventilating too quickly
which action is likely to cause air to enter the victims stomach during bag mask ventilation
every 5 - 6 seconds
you are providing bag mask ventilations to a patient in respiratory arrest. how often should you provide ventilation