ACLS 2016 Flashcards

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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?

One Shock Protocol for VF or Pulseless VT. Signup and view all the answers

What are critical situations needing a Rapid Response Team (RRT) or Medical Emergency Team (MET)?

Threatened airway, respiratory rate less than 6 or greater than 30, heart rate less than 40 or greater than 140, systolic BP less than 90 mmHg, symptomatic hypertension, unexpected decrease in LOC, unexplained agitation, seizure, significant decrease in urine output, subjective concern over patient. Signup and view all the answers

What are H's and T's in ACLS?

Hypovolemia, hypoxia, hydrogen ions (acidosis), hypokalemia, hypothermia, tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis. Signup and view all the answers

How do you size an OPA?

From the corner of the mouth to the angle of the jaw. Signup and view all the answers

How do you size an NPA?

From the tip of the nose to the earlobe. Signup and view all the answers

What is the difference in capnography in CPR vs. normal circulation?

Waveform smaller in CPR. Signup and view all the answers

What is a possible indicator of ROSC during CPR with capnography?

A sudden increase in end tidal CO2 reading. Signup and view all the answers

When is the first dose of Epinephrine administered?

After the second defibrillation. Signup and view all the answers

When should IV or IO be established?

After the first shock. Signup and view all the answers

When should advanced airway be considered?

After first dose of Epinephrine has been given. Signup and view all the answers

What is pharmacokinetics of Amiodarone?

Anti arrhythmic agent affecting Na, K, Ca, alpha and beta adrenergic blocking, lowers defib threshold. Signup and view all the answers

What medications are used in PEA/Asystole?

Only Epinephrine every 3 to 5 minutes. Signup and view all the answers

What is the definition of bradycardia?

Heart rate less than 50 beats per minute. Signup and view all the answers

What are possible underlying causes of bradycardia?

Maintain patent airway, assist breathing, oxygen if hypoxemic, cardiac monitor, IV access, 12-lead ECG. Signup and view all the answers

What are symptoms of bradyarrhythmia?

Hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure. Signup and view all the answers

What is the treatment for poor perfusion with bradycardia?

Atropine; if Atropine is ineffective, consider transcutaneous pacing, dopamine, or epinephrine infusion. Signup and view all the answers

When is tachycardia considered unstable?

Causes hypotension, acutely altered LOC, signs of shock, ischemic chest discomfort, acute heart failure. Signup and view all the answers

What is the treatment for unstable tachycardia?

Immediate synchronized cardioversion, consider sedation. Signup and view all the answers

If a tachycardia is stable, regular, and monomorphic, what is the treatment?

Consider adenosine only if regular and monomorphic. Signup and view all the answers

What is a possible use of adenosine in atrial fibrillation or atrial flutter?

It will slow AV conduction and allow the underlying cause to show up. Signup and view all the answers

What are the post ROSC goals?

Maintain oxygen saturation greater than or equal to 94%, consider advanced airway and waveform capnography, do not hyperventilate. Signup and view all the answers

What is the post ROSC treatment of hypotension?

Treat anything less than 90 systolic with IV/IO bolus, vasopressor infusion. Signup and view all the answers

Post ROSC, if a patient cannot follow simple commands, what is the intervention?

Targeted temperature management, cool to 32 to 36 degrees Celsius for 24 hours. Signup and view all the answers

What are contraindications to IO access?

Fractures and crush injuries near access site, conditions with fragile bones, previous attempts in the same bone, if infection is present. Signup and view all the answers

What is the aspirin dose?

160 to 324 mg, non-enteric coated. Signup and view all the answers

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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Description

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.