ACLS Review Flashcards
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Questions and Answers

What are the 6 principles behind AHA's definition of 'High-Quality CPR'?

Rate of at least 100 chest compressions/minute, compression depth of at least 2 inches in the adult victim, complete chest recoil after each chest compression, minimizing interruption in compressions, switching providers every 2 minutes (5 cycles of CPR), avoiding excessive ventilations.

What does the AHA suggest as a target for CPP (coronary perfusion pressure) to increase the chances of SROC (spontaneous return of circulation)?

10 mm/Hg

An end-tidal CO2 reading of ____ will not achieve ROSC according to the AHA.

10 mm Hg or less

An intra-arterial relaxation pressure of < ____ indicates ineffective compressions.

<p>20 mm Hg</p> Signup and view all the answers

The recommended sternal compression depth for an adult during resuscitation is _____ inches.

<p>2 inches</p> Signup and view all the answers

AHA recommends that, during resuscitation, the tidal volumes for adults be between ______ and ______ mmHg.

<p>500 and 600 mmHg</p> Signup and view all the answers

What are the 4 negative consequences of excessive ventilation emphasized by the AHA?

<p>Gastric inflation, increased intrathoracic pressures, decreased venous return, lower overall survival.</p> Signup and view all the answers

What are the 5 'critical concepts' for BLS according to the AHA?

<p>Push hard and fast (100+/min), allow complete chest recoil, minimize interruptions in compressions, switch providers every 2 minutes, avoid excessive ventilations.</p> Signup and view all the answers

In what cardiac rhythm is Adenosine recommended and when is it not recommended by the AHA?

<p>Recommended for 'regular', monomorphic, wide-complex tachycardias; not recommended for 'irregular', wide-complex tachycardias.</p> Signup and view all the answers

When Atropine is ineffective in resolving bradycardias, what treatment methodology is considered an equally effective alternative?

<p>IV infusion of chronotropic drugs such as Epinephrine or Dopamine.</p> Signup and view all the answers

For all symptomatic bradycardias, regardless of type, this is now considered the 'first-line' treatment.

<p>Atropine</p> Signup and view all the answers

What is the new initial J (joule) selection for biphasic defibrillators in synchronized cardioversion of 'unstable SVT or unstable A-flutter'?

<p>50 to 100 J</p> Signup and view all the answers

What is the new initial J selection for biphasic defibrillators in synchronized cardioversion of 'unstable A-fib'?

<p>120 to 200 J</p> Signup and view all the answers

Cardioversion with monophasic waveforms should begin at ______ J and increase in step-wise fashion.

<p>200 J</p> Signup and view all the answers

The new recommended initial J selection in synchronized cardioversion of unstable monomorphic VT with either monophasic or biphasic defibrillators is..

<p>100 J</p> Signup and view all the answers

This post-arrest intervention is the only one that has been clinically proven to improve neurologic recovery according to the AHA.

<p>Therapeutic hypothermia</p> Signup and view all the answers

Therapeutic hypothermia should be considered for which two subsets of patients with ROSC post-resuscitation?

<p>Patients who remain comatose and those who have ROSC from out-of-hospital arrest with VF as the presenting rhythm.</p> Signup and view all the answers

What is the exception to the recommendation of therapeutic hypothermia post-resuscitation?

<p>STEMI patients should be transported to the cath lab as quickly as possible.</p> Signup and view all the answers

What are the 4 critical actions for post-cardiac arrest care according to the AHA?

<p>Optimizing hemodynamics and arterial oxygen saturation, monitoring airway with quantitative waveform capnography, acquiring a 12-lead EKG, inducing therapeutic hypothermia.</p> Signup and view all the answers

What 4 benefits of qualitative waveform capnography does the AHA emphasize in the 2010 guidelines?

<p>Reliable indicator of ETT placement, monitor quality of chest compressions, assess ROSC, gauge coronary perfusion.</p> Signup and view all the answers

What might you look for on your ETCO2 reading that would indicate ROSC?

<p>An abrupt increase in the ETCO2 waveform.</p> Signup and view all the answers

What are the two primary reperfusion therapy goals to target in patients with cardiac events?

<p>Fibrinolytic therapy within 30 minutes of arrival at the ED; PCI within 90 minutes of arrival at the ED.</p> Signup and view all the answers

The AHA recommends that all eligible patients who are victims of stroke receive fibrinolytic therapy within ____ hours of onset of symptoms.

<p>3 hours</p> Signup and view all the answers

The AHA recommends that all victims of acute stroke be transported to a _____________ stroke center.

<p>comprehensive</p> Signup and view all the answers

This medication is no longer recommended by the AHA for the routine treatment of patients in PEA or asystole.

<p>Atropine</p> Signup and view all the answers

What is the recommended initial IV infusion dose of epinephrine in the 'Adult Immediate Post-Cardiac Arrest Care' algorithm?

<p>0.1-0.5 mcg/kg/min</p> Signup and view all the answers

What is the recommended initial IV infusion dose of dopamine in the 'Adult Immediate Post-Cardiac Arrest Care' algorithm?

<p>5-10 mcg/kg/min</p> Signup and view all the answers

What is the recommended initial IV infusion dose of Levophed in the 'Adult Immediate Post-Cardiac Arrest Care' algorithm?

<p>0.1-0.5 mcg/kg/min</p> Signup and view all the answers

What are the 10 reversible causes one should consider during CPR?

<p>Hypovolemia, hypoxia, acidosis, hypo/hyperkalemia, hypothermia, tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis.</p> Signup and view all the answers

What is the ventilation rate in a code scenario once an advanced airway has been established?

<p>1 every 6-8 seconds (8-10/min)</p> Signup and view all the answers

What is the ventilation rate in a respiratory arrest scenario?

<p>1 every 5-6 seconds (10-12/min)</p> Signup and view all the answers

What percent of patients suffering blunt trauma, forceful enough to require spinal imaging in ERs, have radiographically confirmed spinal injury?

<p>Approximately 2%</p> Signup and view all the answers

Name the 6 sites acceptable for establishing IO access.

<p>Sternum, humeral head, anterior superior iliac spine, distal femur, proximal tibia, medial malleolus.</p> Signup and view all the answers

According to the AHA, what percentage of acute coronary syndrome patients die before ever reaching the hospital?

<p>Up to 70%</p> Signup and view all the answers

What dose range of 'non-enteric coated' ASA is recommended by the AHA as initial treatment for patients suspected of suffering an acute myocardial ischemia?

<p>160 - 325 mg</p> Signup and view all the answers

What are the 2 contraindications against administering ASA to a patient suspected of suffering ACS?

<p>Allergies to ASA and recent history of GI bleed.</p> Signup and view all the answers

What are the 5 contraindications to giving Nitroglycerin in the setting of ACS according to the AHA?

<p>Severe bradycardia, tachycardia, hypotension, PDE-I's within the last 24-48 hours, right ventricular infarction.</p> Signup and view all the answers

Right ventricular infarction can often initially present as this type of STEMI.

<p>Inferior wall STEMI</p> Signup and view all the answers

Re-perfusion goals for STEMI patients include PCI within _____ minutes of arrival at the ER.

<p>90 minutes</p> Signup and view all the answers

Re-perfusion goals for STEMI patients include fibrinolytics within _____ minutes of arrival at the ER.

<p>30 minutes</p> Signup and view all the answers

According to the AHA, studies show that ED evaluations are responsible for up to _____% of the delay of time-to-treatment of ACS patients.

<p>33%</p> Signup and view all the answers

Adjunctive therapy for ACS patients include these five treatments.

<p>Continuous NTG infusion, unfractionated or LMWH, beta-blockers, Clopidogrel (Plavix), glycoprotein inhibitors.</p> Signup and view all the answers

What general action does Clopidogrel (Plavix) have?

<p>It inhibits platelet aggregation.</p> Signup and view all the answers

Which classification of stroke, ischemic or hemorrhagic, is most common?

<p>Ischemic stroke</p> Signup and view all the answers

The AHA recommends beginning fibrinolytic therapy within _____ hours of onset of symptoms of CVA.

<p>3 hours</p> Signup and view all the answers

If any one of the indicators for stroke on the CSS are positive, the probability of a stroke is _____%.

<p>72%</p> Signup and view all the answers

What are the AHA recommendations for both time a patient should receive CT and time that CT should be read by radiology for victims of suspected stroke?

<p>CT completed within 25 minutes and read within 45 minutes of ER arrival.</p> Signup and view all the answers

How is Nicardipine administered in the management of hypertension (>185/>110) in the setting of suspected CVA?

<p>Started at 5 mg/hr with titrations up by 2.5 mg/hr every 5 - 15 minutes.</p> Signup and view all the answers

How is Labetalol administered in the management of hypertension (>185/>110) in the setting of suspected CVA?

<p>10 - 20 mg IVP over 1 - 2 minutes, may repeat once.</p> Signup and view all the answers

For hypertensive patients with acute ischemic stroke who are NOT candidates for thrombolytic therapy, what blood pressure limits should clinicians consider?

<blockquote> <p>220 / &gt;120</p> </blockquote> Signup and view all the answers

What are the two pressures considered in defining CPP (coronary perfusion pressure)?

<p>Aortic end-diastolic pressure and right atrial end-diastolic pressure.</p> Signup and view all the answers

Study Notes

High-Quality CPR Principles

  • High-quality CPR includes a chest compression rate of at least 100/min.
  • Compressions must reach a depth of at least 2 inches in adult victims.
  • Complete chest recoil after each compression is essential.
  • Interruptions in compressions should be minimized.
  • Rescuers should switch every 2 minutes (after 5 cycles of CPR).
  • Avoid excessive ventilations during CPR.

Coronary Perfusion Pressure (CPP)

  • A target CPP of at least 10 mm Hg is recommended to enhance chances of spontaneous return of circulation (ROSC).
  • High-quality CPR is crucial to achieve optimal CPP.

End-Tidal CO2 (PETCO2) Levels

  • A PETCO2 reading of 10 mm Hg or less suggests inadequate CPP and poor circulation.

Intra-Arterial Pressure

  • Intra-arterial relaxation pressures under 20 mm Hg indicate ineffective compressions.

Compression Depth and Ventilation

  • Sternal compression depth during adult resuscitation should be 2 inches, ensuring complete chest recoil.
  • Recommended tidal volumes for adults are between 500-600 mm Hg, approximately half of an adult ambu-bag squeeze.

Excessive Ventilation Consequences

  • Excessive ventilation can lead to gastric inflation, increased intrathoracic pressure, decreased venous return, and lower overall survival chances.

Critical Concepts for Basic Life Support (BLS)

  • Key principles include pushing hard and fast (100+/min), allowing complete chest recoil, minimizing interruptions, switching providers every 2 minutes, and avoiding excessive ventilations.

Adenosine Usage

  • Recommended for regular monomorphic wide-complex tachycardias.
  • Not recommended for irregular wide-complex tachycardias to prevent degeneration to ventricular fibrillation.

Bradycardia Treatment

  • Atropine is the first-line treatment for symptomatic bradycardia.
  • If Atropine is ineffective, IV infusion of Epinephrine or Dopamine is an alternative.

Cardioversion Energy Levels

  • Initial biphasic energy for unstable SVT or unstable A-flutter is between 50 and 100 J.
  • For unstable A-fib, the initial biphasic dose is between 120 and 200 J.
  • Monophasic waveform cardioversion starts at 200 J, increasing stepwise if needed.
  • Unstable monomorphic VT requires an initial dose of 100 J for cardioversion.

Post-Arrest Interventions

  • Therapeutic hypothermia is the only intervention proven to improve neurologic recovery.
  • Consider hypothermia for comatose patients with ROSC, especially after out-of-hospital VF arrests.
  • In STEMI cases, transport to the cath lab takes priority over hypothermia.

Post-Cardiac Arrest Care

  • Key actions include optimizing hemodynamics, monitoring airway with capnography, acquiring a 12-lead EKG, and inducing therapeutic hypothermia.

Capnography Benefits

  • Provides reliable indicators for ETT placement, quality of chest compressions, ROSC status, and coronary perfusion.

Stroke Treatment Recommendations

  • Fibrinolytic therapy within 3 hours of symptom onset for acute stroke.
  • Transport all stroke victims to a comprehensive stroke center.

ACLS Considerations

  • Up to 70% of acute coronary syndrome (ACS) patients may die before hospital arrival.
  • Recommended dose of non-enteric coated ASA for ACS is 160-325 mg, with contraindications for allergies or recent GI bleeds.
  • Nitroglycerin is contraindicated in severe bradycardia, tachycardia, hypotension, PDE-I use, or right ventricular infarction.
  • Right ventricular infarction often mimics inferior wall STEMI.

Reperfusion Therapy Goals

  • PCI should occur within 90 minutes for STEMI patients.
  • Fibrinolytics should be administered within 30 minutes for STEMI cases.

Stroke Evaluation

  • CT scans for suspected strokes must be performed within 25 minutes of ER arrival, read within 45 minutes.

Hypertension Management

  • Nicardipine starts at 5 mg/hr, titrating up to 15 mg/hr maximum.
  • Labetalol is administered at 10-20 mg IVP for hypertension in suspected CVA.

Definitions and Mechanisms

  • Coronary perfusion pressure (CPP) is defined as the difference between aortic end-diastolic pressure (AEDP) and right atrial end-diastolic pressure (RAEDP), preferably maintained at 10-15 mm Hg for optimal chances of ROSC.

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Description

Test your knowledge on the principles of high-quality CPR as defined by the AHA. This quiz covers essential guidelines that ensure effective chest compressions and overall performance in emergency situations. Perfect for preparing for ACLS certification and improving lifesaving skills.

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