ACLS Flashcards: Recognizing Clinical Deterioration

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Questions and Answers

What are signs of clinical deterioration that would prompt activation of the rapid response system? (Select all that apply)

Seizure (correct)

Symptomatic hypertension (correct)

Unexplained agitation (correct)

Stable vital signs

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 amount of time you should simultaneously perform pulse and breathing checks?

10 seconds

What does the BLS assessment stress?

Early CPR and defibrillation Signup and view all the answers

What action in the primary assessment should you perform first when the AED does not recommend a shock?

Determine if the patient's airway is patent Signup and view all the answers

What action should you perform next if the initial assessment reveals a conscious patient with a patent airway?

Administer oxygen as needed Signup and view all the answers

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

Formulate a differential diagnosis Signup and view all the answers

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

Hypoxia, Hypothermia, Hypovolemia, Hyperkalemia/hypokalemia, Acidosis Signup and view all the answers

What are the 'T' causes of reversible cardiac arrest?

Tension pneumothorax, Cardiac tamponade, Coronary thrombosis, Pulmonary thrombosis, Toxins Signup and view all the answers

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

Retrosternal chest pain Signup and view all the answers

What is the time goal for completing a fibrinolytic checklist once the patient arrives in the emergency department?

10 minutes Signup and view all the answers

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

Oral antiplatelet medications Signup and view all the answers

What electrocardiographic finding is suggestive of high-risk non-ST segment elevation acute coronary syndrome?

Dynamic T-wave inversion Signup and view all the answers

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

Confirmed right ventricular infarction Signup and view all the answers

Within the first 10 minutes, what should your first actions include for a patient showing symptoms suggestive of myocardial ischemia?

Administer aspirin, use the fibrinolytic checklist, provide prehospital notification, consider oxygen, nitroglycerin, and morphine if needed, obtain a 12-lead ECG Signup and view all the answers

What additional questions help you determine next steps?

Do you take medication? When did the symptoms start? Do you have any allergies? Signup and view all the answers

What treatment can you repeat for a patient who continues to say he has chest discomfort, as long as it is not contraindicated by vital signs?

Nitroglycerin sublingual or translingual every 3 to 5 minutes Signup and view all the answers

What is the time goal for initiation of fibrinolytic therapy after hospital arrival?

45 minutes Signup and view all the answers

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

60 minutes Signup and view all the answers

What is the highest level of stroke center certification?

Comprehensive stroke center Signup and view all the answers

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

90 minutes Signup and view all the answers

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

110 mm Hg Signup and view all the answers

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

24 hours Signup and view all the answers

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

6 hours Signup and view all the answers

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

185 mm Hg Signup and view all the answers

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

180 mg/dL Signup and view all the answers

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

Using a 2 person technique Signup and view all the answers

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

Just under the angle of the lower jaw Signup and view all the answers

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

500-600 Signup and view all the answers

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

Conscious patient Signup and view all the answers

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

Clear the mouth and pharynx Signup and view all the answers

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

Pushing the base of the tongue back Signup and view all the answers

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 Signup and view all the answers

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

Entering the esophagus Signup and view all the answers

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 Signup and view all the answers

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

While withdrawing the catheter Signup and view all the answers

What action is not part of the acute stroke pathway?

Seizure prophylaxis Signup and view all the answers

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

6 to 8 mL/kg Signup and view all the answers

How would you categorize a 75 year old patient with a history of emphysema who is drowsy, having difficulty breathing with increased respiratory effort, bilateral wheezing on auscultation, RR 38 bpm, SpO2 is 85% and PETCO2 is 49 mm Hg?

Respiratory failure Signup and view all the answers

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

Hypercapnia Signup and view all the answers

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

Quantitative waveform capnography Signup and view all the answers

What initial actions should be taken?

Assess airway, breathing, and circulation; Check for responsiveness; Call for additional help Signup and view all the answers

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

Open the patient's airway via head tilt chin lift or jaw thrust Signup and view all the answers

Study Notes

Clinical Deterioration and Rapid Response

Signs prompting rapid response activation: unexplained agitation, seizure, symptomatic hypertension.
Rapid assessment and intervention can decrease in-hospital cardiac arrests.

Vital Signs Assessment

Pulse and breathing checks should not exceed 10 seconds.
High-quality CPR and early defibrillation are crucial during the BLS assessment.

Primary Assessment Actions

Check airway patency first when initiated high-quality CPR and ventilation assistance.
If the patient is conscious with a patent airway, administer oxygen as needed.

Secondary Assessment

Formulate a differential diagnosis for conscious patients during the secondary assessment.

Reversible Causes of Cardiac Arrest

"H" causes include hypoxia, hypothermia, hypovolemia, hyperkalemia/hypokalemia, and acidosis.
"T" causes include tension pneumothorax, cardiac tamponade, coronary thrombosis, pulmonary thrombosis, and toxins.

Myocardial Ischemia

Most common symptom: retrosternal chest pain.
Fibrinolytic checklist should be completed within 10 minutes upon ED arrival.

Medication Considerations

Morphine administration may adversely affect oral antiplatelet medications in acute coronary syndromes.

Electrocardiographic Features

Dynamic T-wave inversion on ECG suggests high-risk non-ST elevation acute coronary syndrome.

Contraindications for Treatments

Confirmed right ventricular infarction contraindicates nitroglycerin administration.

Initial Actions for Myocardial Ischemia Symptoms

Actions include administering aspirin, using the fibrinolytic checklist, notifying receiving hospitals, and obtaining a 12-lead ECG.

Repeating Treatments

Nitroglycerin (sublingual/translingual) can be repeated every 3 to 5 minutes as long as vital signs allow.

Time Goals for Treatment

Initiate fibrinolytic therapy within 45 minutes after hospital arrival.
Door-to-needle time goal for IV thrombolytics in acute ischemic stroke is 60 minutes.

Stroke Center Certification and Protocols

Highest level of stroke center certification: comprehensive stroke center.
Door-to-device time goal for acute ischemic stroke patients treated with endovascular therapy is 90 minutes.

Blood Pressure Considerations

Diastolic BP > 110 mm Hg and systolic BP > 185 mm Hg can withhold fibrinolytic therapy in ischemic stroke.

Blood Glucose Management

IV or subcutaneous insulin is indicated for acute ischemic stroke patients with blood glucose > 180 mg/dL.

Bag-Mask Ventilation Technique

Most effective delivery method is using a two-person technique for bag-mask ventilation.

Airway Management Techniques

Haw-thrust maneuver placement should be just under the angle of the lower jaw in suspected cervical spine injury cases.
Approximately 500-600 mL tidal volume should be delivered using a bag-mask device.
Oropharyngeal airway is contraindicated in conscious patients, and the airway must be cleared before its use.

Aspirating and Airway Devices

Maximum length for a suction catheter into the oropharynx should coincide with the distance from the tip of the nose to the earlobe, measuring potential complications if too long or small.

Stroke Pathway

Seizure prophylaxis is not included in acute stroke pathway actions.
Tidal volume of 6 to 8 mL/kg maintains normal oxygenation and carbon dioxide elimination.

Respiratory Failure

A patient with emphysema exhibiting increased respiratory effort and wheezing falls into the category of respiratory failure.
Hypercapnia refers to the rise in arterial carbon dioxide levels associated with respiratory failure.

Endotracheal Tube Confirmation

Quantitative waveform capnography is the most reliable method for confirming endotracheal tube placement.
Initial actions in emergencies should assess airway, breathing, circulation, check responsiveness, and call for additional help.

Patient Management for Unresponsive Cases

For unresponsive patients with a strong pulse, begin by opening the airway through head tilt-chin lift or jaw thrust.

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Description

Test your knowledge on Advanced Cardiac Life Support (ACLS) through these flashcards. This quiz covers critical signs of clinical deterioration and the importance of rapid response teams in healthcare settings. Challenge yourself to remember key definitions and concepts essential for effective patient care.

ACLS Flashcards Overview