ACLS

Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what would you first actions include?

-Administer aspirin -If considering prehospital fibrinolysis, use the fibrinolytic checklist -Provide prehospital notification to the receiving hospital -consider oxygen, nitroglycerin, and morphine if needed -obtain a 12 lead ECG

What is the maximum time from last known normal when endovascular therapy can be performed?

24 hours

When you use a bag-mask device, you should deliver approximately ___________________ mL tidal volume?

500-600

What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?

6 hours

What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?

6 to 8 mL/kg

What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?

60 minutes

What is the door-to device goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?

90 minutes

What action is part of the secondary assessment of a conscious patient?

Formulate a differential diagnosis

What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure?

Hypercapnia

What are the "H" causes of reversible cardiac arrest?

Hypoxia Hypothermia Hypovolemia Hyperkalemia/hypokalemia Acidosis

What are signs of clinical deterioration that would prompt activation of the rapid response system?

-unexplained agitation -seizure -symptomatic hypertension

What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?

180 mg/dL

Identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?

185 mm Hg

What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival?

45 minutes

The initial assessment reveals a conscious patient. The patient's airway is patent, and an advanced airway is not indicated. What action in the primary assessment should you perform next?

Administer oxygen as needed

What is a contraindication to the use of an oropharyngeal airway?

Conscious patient

While performing the BLS assessment, you initiate high-quality CPR and assist ventilation with a bag-mask device. The AED does not recommend a shock. What action in the primary assessment should you perform first?

Determine if the patient's airway is patent

What additional questions help you determine next steps?

Do you take medication? When did the symptoms start? Do you have any allergies?

What is a potential complication of using a nasopharyngeal airway that is too long?

Entering the esophagus

Your patient continues to say he has chest discomfort. What treatment can you repeat as long it is not contraindicated by vital signs?

Nitroglycerin sublingual or translingual every 3 to 5 minutes

Your patient is unresponsive and not breathing but has a strong pulse. What should your initial action include?

Open the patient's airway via head tilt chin lift or jaw thrust Initiate

What class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?

Oral antiplatelet medications

What is a potential complication of inserting an oropharyngeal airway that is too small?

Pushing the base of the tongue back

What are the "T" causes of reversible cardiac arrest?

Tension pneumothorax Cardiac tamponade Coronary thrombosis Pulmonary thrombosis Toxins

What happens when teams rapidly assess and intervene when a patient's vital signs are abnormal?

The number of in-hospital cardiac arrests decreases

What is the maximum length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue?

The tip of the nose to the earlobe

What is the most effective way to deliver bag-mask ventilation?

Using a 2 person technique

When should you occlude the side opening of a suction catheter when performing oropharyngeal suctioning?

While withdrawing the catheter

The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the

earlobe

The BLS assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses

early CPR and defibrilliation

What action is not part of the acute stroke pathway?

seizure prophylaxis

What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?

10 minutes

What is the maximum amount of time you should simultaneously perform pulse and breathing checks?

10 seconds

What is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?

110 mm Hg

What initial actions should be taken?

Assess airway, breathing, and circulation Check for responsiveness Call for additonal help

What is the first step in the use of an oropharyngeal airway?

Clear the mouth and pharynx

What is the highest level of stroke center certification?

Comprehensive stroke center

What clinical finding represents a contraindication to the administration of nitroglycerin?

Confirmed right ventricular infarction

You obtain a 12-lead ECG in a patient with retrosternal chest pain. What electrocardiographic finding is suggestive of high-risk non=ST segment elevation acute coronary syndrome?

Dynamic T-wave inversion

When performing the haw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?

Just under the angle of the lower jaw

What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?

Quantitative waveform capnography

A 75 year old patient with a hx of emphysema is drowsy and is having difficulty breathing with increased respiratory effort. Bilateral wheezing on auscultation, RR 38 bpm, SpO2 is 85% and PETCO2 is 49 mm Hg. How would you categorize this patient's condition?

Respiratory failure

What is the most common symptom of myocardial ischemia and infaction?

Retrosternal chest pain