The sequence for BLS for an Adult or Child who is unresponsive and pulseless.
answer
C-A-B (Chest compressions, Airway, Breathing)
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A pulse check during the BLS survey should be performed for this length of time.
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5 to 10 seconds
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A likely indicator of a cardiac arrest in the unresponsive patient.
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Agonal gasps
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After discovering an unresponsive patient, what is the next step in the assessment and management of this patient?
answer
Check the patient's breathing and pulse
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Compressions rate in an arrest.
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100/min to 120/min
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The ratio of compressions to breaths for the Adult, Child and 1 rescuer infant arrest.
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30 compressions to 2 breaths
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The ratio of compressions to breaths for Infant 2-rescuer arrest.
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15 compressions to 1 breath
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What you should do if the patient is unconscious and apneic and you are uncertain rather or not a patient has a pulse
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Begin compressions
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To properly ventilate a patient with a perfusing rhythm, what is the rate to squeeze the bag (BVM)
answer
Once every 5 to 6 seconds
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The potential complication of excessive ventilations.
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Decreased cardiac output
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Where to measure to appropriately size an oropharyngeal airway.
answer
Measure from the corner of the mouth to the angle of the mandible
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When an advanced airway is in place, how should compressions be delivered?
answer
Continuous chest compressions without pauses
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In the intubated patient, the technique to assess the quality of CPR.
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Monitor the patient's PETCO2
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Your next action if after 2 minutes of CPR an organized, nonshockable rhythm is identified.
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Check a carotid pulse
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The recommendation for chest compression depth for an Adult and CHILD.
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At least 2 inches (5 cm) but not more than 2.4 inches
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Components of High-Quality CPR
answer
• Compress the chest hard and fast
• Allow complete recoil after each compression
• Chest compressions should be interrupted 10 seconds or less
• Switching providers every 2 minutes or every 5 compression (if unable to determine exact time) cycles improves the quality of chest compressions
• Continue CPR while the defibrillator charges
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The AHA position on routine use of cricoid pressure in cardiac arrest.
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The guidelines do not recommend routine use of cricoid pressure in cardiac arrest.
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The definitive treatment for ventricular fibrillation
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Prompt defibrillation
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The recommended next step after a defibrillation attempt
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Resume CPR, starting with chest compressions
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One measure to minimize interruptions in chest compressions
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Continue CPR while charging the defibrillator
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Action to take if during the use of an AED you are not directed to check the rhythm
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Continue CPR (starting with chest compressions) then check the equipment.
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Measures to provide electrical safety during cardioversion or defibrillation.
answer
• Being sure oxygen is not blowing over the patient's chest during the shock
• Verbally and visually "clear" the field
• Charge defibrillator when paddles are in place on the chest
• Consider hands free pads
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An advantage of hands-free pads verses defibrillator paddles
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Hands-free pads allows for more rapid defibrillation
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Physiology of how CPR is a survival advantage
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Supplying a small amount of blood flow to the heart and reducing ischemia
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Problem and management of using of an AED with a hairy chest
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If skin contact is not made AED pads the machine will not be able to analyze; remove the hair.
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Problem and management of using of an AED when the patient is partially submerged in water
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Remove the patient from the water and dry off
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Problem and management of using of an AED when patient is lying on snow or ice
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Use the AED
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If a patient has an implantable device such as a pacemaker/AICD that is not functioning the location you should place the universal pads
answer
Place the AED pads on either side not directly on top of an implantable device
question
Special consideration where to locate AED pads if a patient has a medication patch who requires defibrillation
answer
Do not place AED directly over a medication patch
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The recommended initial biphasic energy dose for cardioversion of atrial fibrillation
answer
120 to 200 Joules
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The recommended initial monophasic energy dose for cardioversion of atrial fibrillation
answer
200 Joules
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Initial energy recommendation for an adult in unstable monomorphic ventricular tachycardia or SVT
answer
Synchronized cardioversion initial energy of 100 Joules (or biphasic equivalent)
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If rhythm is unresponsive to the initial cardioversion attempt, the energy recommendation for next attempt for an adult in unstable monomorphic ventricular tachycardia or SVT
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Increase the dose in a stepwise fashion for monophasic 200 joules, 300 joules, then 360 joules (or biphasic equivalent)
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Management for a patient who is rapidly deteriorating in SVT or monomorphic V-Tach with a pulse (even if profoundly hypotensive)
answer
Immediately synchronized cardioversion starting at 100 joules (or biphasic equivalent)
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If equipment is available, the management of a witnessed arrest of V-Fib or pulseless V-Tach
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Immediately defibrillation at 360 joules or biphasic equivalent
question
In addition to the clinical assessment, ________________ is the most reliable method of confirming and monitoring correct placement of an endotracheal tube.
answer
Continuous Waveform Capnography
question
High quality chest compressions are achieved when the PETCO2 value reaches
answer
At least, 10-20 mmHg
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The indication of a PETCO2 level < 10 mmHg
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Potential poor perfusion from ineffective CPR
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PETCO2 target range for the patient with return of spontaneous circulation
answer
35-40 mmHg
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Algorithm indicated for the tachycardic patient with a pulse
answer
ACLS Tachycardia Algorithm
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If a patient has respiratory failure but is perfusing and gradually becomes bradycardic, the management and treatment focus
answer
Treat the respiratory cause of the bradycardia by airway maneuvers and assisting ventilation
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The rationale for defibrillation of pulseless ventricular tachycardia
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Pulseless ventricular tachycardia is treated like ventricular fibrillation because both are non-perfusing shockable rhythms
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The initial priority for an unconscious patient with a tachycardia
answer
Determine rather or not a pulse is present
question
Signs and symptoms of decreased perfusion
answer
• Hypotension
• Chest pain
• Change in Level of Consciousness
• New or worsening heart failure
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Management of a patient is in a bradycardic rhythm (even 3rd degree AV Block) who is asymptomatic with stable vital signs
answer
• Conduct a problem-focused history and physical exam
• Consider having a transcutaneous pacemaker on stand-by
question
The first medications to be given in any cardiac arrest
answer
Oxygen and epinephrine
question
The next recommended medication after epinephrine is administered for refractory ventricular fibrillation or pulseless ventricular tachycardia
answer
Amiodarone 300 mg
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Medication that is NO longer used in the management of pulseless electrical activity (PEA) or asystole
answer
Atropine
question
Indications for Adenosine
answer
Initial diagnosis and treatment of stable, undifferentiated regular, monomorphic wide complex tachycardia (ventricular tachycardia) and SVT
question
Dosing of Adenosine
answer
Adenosine is 6 mg IVP rapidly followed by 12 mg IVP rapidly
question
Dosing range for Dopamine
answer
2 to 20 mcg/Kg/min
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The treatment priority for patients who achieve return to spontaneous circulation
answer
Optimize ventilation and oxygenation
question
SBP goal is to achieve by using fluid administration or vasoactive agents.
answer
At least 90 mmHg,
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Initial management of hypotension with return to spontaneous circulation
answer
1 to 2 liters of NS or LR
question
The recommended dose of an Epinephrine infusion, for management of hypotension with return to spontaneous circulation
answer
0.1 to 0.5 mcg/Kg/min
question
An important intervention to manage an out-of-hospital resuscitation that achieves return to spontaneous circulation
answer
Transport to a facility capable of coronary reperfusion (performing a PCI)
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Danger if you routinely administer high concentration of oxygen in the post arrest management of patients
answer
Oxygen toxicity
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The cardiopulmonary and neurologic support during the post arrest
answer
Therapeutic hypothermia and percutaneous coronary interventions (PCIs),
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Therapeutic hypothermia should be considered in these populations of adult patients who achieves return to spontaneous circulation
answer
Patients who remain comatose after the arrest defined as the lack ability to follow commands without contraindications to inducing hypothermia
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Contraindications to inducing hypothermia
answer
• Patients responding to verbal commands
• Patients with potential to bleed or recent bleeding
• Hemorrhagic stroke
• Arrest due to trauma
question
Target temperature goal and duration when inducing therapeutic hypothermia who achieves return to spontaneous circulation after an arrest
answer
32 Degrees C to 36 Degrees C for a recommended duration of at least 24 hours.
question
Once the patient with chest discomfort is assessed as being stable, the most important assessment or next step
answer
Obtain a 12-Lead ECG
question
The recommended goal from door-to-balloon inflation time for percutaneous coronary intervention (PCI)
answer
90 minutes.
question
Management of a patient who is hemodynamically stable without chest pain in a tachycardic rhythm
answer
12-lead done before another procedure to different the cause of the tachycardia (AMI).
question
The recommended dose of aspirin for a patient with chest pain
answer
160 to 325 mg.
question
Target goal for oxyhemoglobin saturations in patients with acute coronary syndromes and/or stroke
answer
Greater than or equal to 94%
question
The next step once the primary survey is performed on a potential stroke victim
answer
Perform the Cincinnati Prehospital Stroke Scale assessment
question
According to the Adult Suspected Stroke Algorithm a critical action that should be performed by the EMS team to expedite the patient's care on arrival and reduce time to treatment
answer
Alert the hospital
question
Recommended time for a noncontrast CT scan of the head should be performed once a potential stroke victim arrives at the hospital
answer
Within 25 minutes
question
Meaning of F.A.S.T. Acronym in a potential stroke victim
answer
• Facial Droop
• Arm Drift
• Speech ineffective
• Time of onset of symptoms
question
Action if a radio report is received in the pre-hospital setting that the CT scanner is inoperable and you are transporting a potential stroke patient
answer
Diverted to a hospital that has CT capabilities
question
One of the first intervention in the ED, once a CT scan is obtained, for a stroke victim
answer
Start fibrinolytic therapy as soon as possible as long as
• CT is normal without signs of hemorrhage
• The patient has arrived within the 3 to 4 ½ hours from the onset of symptoms
• No assessed contraindications are present
question
Target range for Blood pressure prior to administering thrombolytics in a stroke victim
answer
SBP less than 185 mmHg
DBP less than 110 mmHg
question
Right ventricular infarcts are most often associated with __________ myocardial infarctions
answer
Inferior MI (Leads II, III, AVF)
question
Considerations if right ventricular infarct suspected
answer
• Obtain right-sided ECG
• Nitrates and morphine may be contraindicated
• Patient may require IV fluids for hypotension
question
Caveat to obtain vascular access, drug delivery, or advanced airway placement
answer
Should NOT interrupt CPR
question
The location and leads used by Bob Page's mnemonic "I See All Leads" to describe location of infarcts
answer
• I = Inferior ( Leads II, III, AVF)
• See = Septal (V1 and V2)
• All = Anterior left ventricle (V3 and V4)
• Leads = High lateral (I and AVL)
Low lateral left ventricle (V5 and V6)
question
ECG changes associated with an acute MI (Injury)
answer
ST segment elevation
question
ST segment elevation in lead I and III considered
answer
Nondiagnostic
question
The preferred access for medications in the arrest is a large peripheral vein such as the antecubital. If unable to obtain a peripheral access, the next most preferred route
answer
Intraosseous (IO)
question
What the team leader should do to avoid inefficiencies during resuscitation
answer
Clearly delegate tasks
question
Team leader instructs a team member to give 0.5 mg of Atropine, to which the team member responds with "I'll draw up 0.5 mg of Atropine." This type of communication is called
answer
Closed-loop communication
question
Action the team leader or other team members should do if a team member is about to make a mistake during resuscitation attempt
answer
Address the team member immediately
question
The action that a Team Member is responsible to perform they feel they are unable to perform an assigned task because it is beyond the team member's scope of practice
answer
Ask for a new task or role
question
Action required by the Team Member Team member if they are uncertain if the correct amount of amiodarone was order by team leader, so the team member because of noise or other distractions
answer
Should repeat the order and ask for verification
question
Medical Emergency Teams (MET) or rapid response teams (RRT) have demonstrated the reduction of cardiac arrest in the inpatient environment. The primary purpose of a MET or RRT
answer
Improving patient outcomes by identifying and treating early clinical deterioration
question
Conditions where resuscitation efforts should be withheld
answer
• There is a perceived safety threat to the provider
• Signs of irreversible death (e.g., decapitation, rigor mortis, or decomposition) are present
• If the patient has a medical directive excluding advanced cardiac life support techniques.
question
ST elevation in V1 through V4
answer
Anterior MI (anteroseptal)
question
ST depression in V1 through V4
answer
Potential Posterior MI
question
Considerations with return of spontaneous circulation
answer
• Ventilation and Vital Signs
• Oxygenation
• Medications
• IV access, IV fluid administration
• Therapeutic interventions (Induction of hypothermia, 12-Lead ECG, Chest x-ray
question
Antidote Tricyclic Overdose
answer
Sodium Bicarb
question
Dose of Sodium Bicarb in an arrest
answer
1 meq/Kg
question
Management hyperkalemia in the emergency
answer
• Sodium Bicarb
• Insulin and D50%
• Calcium Chloride
question
ECG changes associated with hyperkalemia
answer
• Tall peaked T waves
• Wide QRS
question
ECG changes associated with hypokalemia
answer
• Flat T waves
• U wave
question
Antidote for opioid overdose
answer
• Narcan
question
Antidote for benzodiazepines
answer
• Flumazenil
question
Antidote for digoxin toxicity
answer
• Digibind
question
Antidote for organophosphate poisoning
answer
• Atropine
• Pralidoxime (2 PAM)
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