Advanced Cardiac Life Support - Review Flashcards

Flashcards covering ACLS concepts from the lecture notes, including code management, ECG basics, rhythm classifications, pharmacology, defibrillation/cardioversion, pediatrics, and obstetric considerations.

What is the primary goal of Advanced Cardiac Life Support (ACLS)?

To achieve the best possible outcome for individuals experiencing a life-threatening cardiac event by guiding timely, structured interventions.

What is the composition of a typical code team (5-person) and each member’s role?

Leader/captain (directs the code), airway management, chest compressions, IV line/medication administration, and monitoring/recording the events.

List the code colors and their meanings as taught in ACLS training.

Blue: medical emergency; Red: fire; Black: bomb threat; White: evacuation; Green: activation; Pink: missing child/infant; Orange: hazardous spill; Violet: violent individual; Yellow: disaster; Brown: severe weather; Silver: active shooter.

What are the non-shockable rhythms in ACLS?

Asystole and pulseless electrical activity (PEA).

What rhythms are considered shockable in ACLS?

Ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), and torsades de pointes.

What does defibrillation aim to accomplish?

Deliver an electrical shock to briefly depolarize the heart so the SA node can re-establish a normal sinus rhythm.

Name the three modes of an AED/defibrillator.

Defibrillation mode, cardioversion mode (synchronized), and pacemaking/pacemaker mode.

Where are the SA and AV nodes located and what are their normal rates?

SA node: in the right atrial wall near the superior vena cava; intrinsic rate 61–100 bpm. AV node: in the septum between the atria; intrinsic rate 40–60 bpm.

What are Purkinje fibers and their intrinsic rate?

Autorhythmic ventricular conducting fibers that can initiate rhythm at about 20–35 bpm if the SA/AV nodes fail.

What are the standard limb leads and chest (precordial) leads in a 12-lead ECG?

Limb leads: I, II, III; augmented leads: aVR, aVL, aVF. Chest leads: V1–V6.

What are the placements for V1 and V2 chest leads?

V1: 4th intercostal space at the right sternal border; V2: 4th intercostal space at the left sternal border.

Where are V3–V6 placed on the chest?

V3: midway between V2 and V4; V4: 5th intercostal space at the left midclavicular line; V5: 5th intercostal space at the left anterior axillary line; V6: 5th intercostal space at the left midaxillary line.

What do the P wave, QRS complex, and T wave represent on an ECG?

P wave: atrial depolarization; QRS complex: ventricular depolarization; T wave: ventricular repolarization.

What does the U wave indicate and when is it clinically significant?

Represents repolarization of the Purkinje fibers; often not seen, may be seen in hypokalemia.

What is the normal ST segment, and how depressed should it not be typically?

ST segment reflects early ventricular repolarization and should not be depressed more than 0.5 mm in standard leads.

What are the normal ranges for PR interval and QT interval?

PR interval: 0.12–0.20 seconds. QT interval: from the start of QRS to the end of T, reflecting ventricular depolarization and repolarization.

What is considered a normal adult heart rate on ECG?

60–100 beats per minute.

How is heart rate estimated from a 6-second ECG strip?

Count the number of R waves in 6 seconds and multiply by 10.

What are essential nursing responsibilities before obtaining a 12-lead ECG?

Verify physician’s order, inform the patient, remove metal objects, position the patient, place leads correctly, determine rhythm, and calculate heart rate.

What should you do if the rhythm is irregular when calculating the heart rate?

Count the number of R waves in a 6-second strip and multiply by 10.

What are the two main non-shockable rhythms and their key characteristics?

Asystole: flat line with no pulse; PEA: electrical activity but no effective cardiac contraction.

What are the critical steps in starting ACLS CPR?

Call a code, begin high-quality CPR at 100–200 compressions per minute for about 2 minutes, and prepare for defibrillation if indicated.

What is the recommended initial ventilation strategy during CPR before advanced airway?

Ambu bagging with a mask to provide oxygenation; proceed to advanced airway as needed.

How is epinephrine administered during an ACLS code with IV access?

1 mg IV every 3–5 minutes (repeated as needed); via ET tube, double the dose.

What is a typical amiodarone loading dose after failed defibrillation attempts?

300 mg IV as a loading dose, then 150 mg IV after 3–5 minutes if VF/VT persists.

What is the typical dosing for adenosine in stable SVT?

First dose 6 mg rapid IV push; if no response, second dose 12 mg.

What energy levels are used for synchronized cardioversion of SVT and atrial flutter/fibrillation?

Narrow regular SVT: 50–100 J; Narrow irregular (biphasic): 120–200 J; Monophasic: up to 200 J; for VT with pulse: 100–200 J; Synchronize to the R wave.

What is the key difference between defibrillation and synchronized cardioversion?

Defibrillation is unsynchronized and used for nonperfusing rhythms (VF/VT); synchronized cardioversion is timed to the R wave to treat certain tachyarrhythmias with a perfusing rhythm.

What is the management sequence for a patient with pulseless VF/VT after an initial defibrillation attempt?

If still shocked and not converted, administer epinephrine every 3–5 minutes and consider amiodarone; continue CPR and rhythm checks every 2 minutes.

What should you know about pediatric emergency drug dosing in ACLS (examples: adenosine, epinephrine, atropine, amiodarone)?

Adenosine: 0.1 mg/kg (max 6 mg) then 0.2 mg/kg (max 12 mg). Epinephrine: IV/IO 0.01 mg/kg (1:10,000); repeat every 3–5 minutes; intratracheal dose is doubled. Atropine: 0.02 mg/kg; repeat up to 0.5 mg per dose. Amiodarone: 5 mg/kg for tachyarrhythmias; repeat as needed.

How should obstetric patients in cardiac arrest be handled according to ACLS guidance?

Treat as a CPR emergency; involve OB, Peds, NICU early; aim to deliver the baby if ongoing maternal arrest and condition allows; multi-team approach with cesarean delivery considered when feasible to optimize outcome.

What is the ‘ET tube double-dose’ rule and why is it used?

Medications given via the endotracheal tube are often given at double the IV dose because absorption is less predictable through the pulmonary route.

What is the recommended approach to chest compressions if the sternum is intact but ribs are fractured?

Continue standard CPR with careful hand placement to minimize further injury; if fracture is open or severe, consult surgical options as appropriate.

What is the role of transcutaneous pacing in symptomatic bradycardia when atropine and drugs fail?

If ongoing symptomatic bradycardia persists after atropine and inotrope/vasopressor support, transcutaneous pacing is a bridge to possible transvenous pacing.

What are the key steps for defibrillator paddle use and safety during defibrillation?

Lubricate paddles, place at apex and sternum, ensure contact with skin, charge to the recommended joules (e.g., 200–360 J depending on model), announce and ensure all staff are clear before delivering shock.