Questions and Answers
How often should the person doing chest compressions be switched out?
Every 2 minutes.
What is CCF?
Chest Compression Fraction.
What is considered an appropriate tidal volume for the BVM?
500 to 600 mL.
What does the AHA recommend for AED use?
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What are critical situations needing a Rapid Response Team (RRT) or Medical Emergency Team (MET)?
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What are H's and T's in ACLS?
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How do you size an OPA?
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How do you size an NPA?
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What is the difference in capnography in CPR vs. normal circulation?
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What is a possible indicator of ROSC during CPR with capnography?
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When is the first dose of Epinephrine administered?
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When should IV or IO be established?
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When should advanced airway be considered?
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What is pharmacokinetics of Amiodarone?
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What medications are used in PEA/Asystole?
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What is the definition of bradycardia?
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What are possible underlying causes of bradycardia?
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What are symptoms of bradyarrhythmia?
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What is the treatment for poor perfusion with bradycardia?
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When is tachycardia considered unstable?
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What is the treatment for unstable tachycardia?
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If a tachycardia is stable, regular, and monomorphic, what is the treatment?
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What is a possible use of adenosine in atrial fibrillation or atrial flutter?
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What are the post ROSC goals?
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What is the post ROSC treatment of hypotension?
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Post ROSC, if a patient cannot follow simple commands, what is the intervention?
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What are contraindications to IO access?
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What is the aspirin dose?
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Study Notes
Chest Compressions
- Switch out personnel performing chest compressions every 2 minutes to maintain effectiveness.
- Aim for a Chest Compression Fraction (CCF) of at least 60%, ideally above 80%.
Ventilation
- Appropriate tidal volume for Bag-Valve-Mask (BVM) is 500 to 600 mL, approximately half a squeeze of an adult BVM.
AED Protocol
- AHA recommends a One Shock Protocol for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Rapid Response Team (RRT) Criteria
- Activate RRT for situations such as threatened airway, abnormal respiratory rates (less than 6 or greater than 30), significant changes in heart rate, hypotension (systolic BP less than 90 mmHg), unexpected changes in level of consciousness, unexplained agitation, seizures, reduced urine output, or subjective concerns over the patient's condition.
Hs and Ts
- Consider potential reversible causes in CPR known as Hs and Ts:
- Hypovolemia
- Hypoxia
- Acidosis (hydrogen ions)
- Hypokalemia
- Hypothermia
- Tension pneumothorax
- Cardiac tamponade
- Toxins
- Pulmonary thrombosis
- Coronary thrombosis
Airway Management
- Size an Oropharyngeal Airway (OPA) from the corner of the mouth to the angle of the jaw.
- Size a Nasopharyngeal Airway (NPA) from the tip of the nose to the earlobe.
Capnography
- Capnography during CPR displays a smaller wave form compared to normal circulation.
- A sudden increase in end-tidal CO2 can indicate return of spontaneous circulation (ROSC) during CPR.
Pharmacology
- Epinephrine is administered after the second defibrillation attempt.
- Establish IV or IO access after the first shock.
- Consider advanced airway placement after the first dose of epinephrine.
- Amiodarone is an antiarrhythmic agent affecting sodium, potassium, calcium, and it lowers defibrillation threshold.
PEA/Asystole Treatment
- Treat PEA and asystole with epinephrine, given every 3 to 5 minutes.
Bradycardia
- Defined as a heart rate of less than 50 beats per minute.
- Possible underlying causes include respiratory issues, oxygen deficiency, and need for cardiac monitoring and access to IV, while prioritizing urgent treatment.
Symptoms & Treatment
- Symptoms of bradyarrhythmia: hypotension, altered mental status, shock signs, ischemic chest discomfort, and acute heart failure.
- For poor perfusion with bradycardia, administer atropine; if ineffective, consider transcutaneous pacing, dopamine, or epinephrine infusion.
Tachycardia Management
- Tachycardia is unstable when it leads to hypotension, altered LOC, shock signs, ischemic discomfort, or acute heart failure.
- For unstable tachycardia, immediate synchronized cardioversion is essential; sedation may be considered.
- Stable, regular, and monomorphic tachycardia may be treated with adenosine.
Post ROSC Care
- Maintain oxygen saturation at or above 94%, consider advanced airway management, and avoid hyperventilation.
- Treat hypotension (systolic less than 90 mmHg) with IV/IO bolus, vasopressor infusion, and assess treatable causes.
- If the patient is unresponsive, implement targeted temperature management, cooling them to 32-36 degrees Celsius for 24 hours.
IO Access Contraindications
- Avoid IO access in cases of fractures or crush injuries near the site, fragile bones, prior access attempts in the same bone, or signs of infection.
Aspirin Dosage
- Administer 160 to 324 mg of non-enteric coated aspirin, contraindicated for those with aspirin allergies or recent bleeding.
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Test your knowledge with these ACLS 2016 flashcards that cover essential topics such as chest compressions, compression fraction, and BVM tidal volume. Perfect for anyone preparing for ACLS certification or studying emergency protocols. Dive into critical information that can enhance your lifesaving skills.