NURS 418 - ACLS

10 seconds

during CPR, minimize interruptions in chest compressions to less than _____

> 80%

during CPR, maintain a chest compression fraction (CCF) of _____

100-120 beats per minute

during CPR, provide compressions at an adequate rate of _____

6 seconds

during CPR, give 1 breath every _____

2 minutes

during CPR, switch compressors every _____ or earlier if fatigued

30:2

during CPR, maintain a _____ compression to breath ratio

for synchronized cardioversion on patients WITH a pulse. we want to synchronize the shock on the R wave. if we shocked them on a T wave, we could send them into Vtach/Vfib. we do NOT use the sync button on patients without a pulse because they will not have an R wave, therefore the machine will never deliver a shock.

when should you use the Sync button on the defibrillator?

aspirin

with a STEMI/NSTEMI, administer 1 dose of 162-325 mg _____ ASAP, must be chewed

nitroglycerine

with a suspected STEMI/NSTEMI, administer up to 3 doses of _____ outside the hospital setting with vital sign monitoring, wait 5-7 minutes in between doses

PDE inhibitors

with a suspected STEMI/NSTEMI, do NOT administer nitroglycerine if the patient had any _____ within the last 24 hr

SBP > 90 and HR > 50

with a suspected STEMI/NSTEMI, ONLY administer nitroglycerine with SBP _____ and HR _____

90 minutes

the best time for coronary reperfusion for a STEMI/NSTEMI is within _____ of arrival to ED

ST depression or T wave inversion, but may have a completely normal ECG

ECG changes present with an NSTEMI (1)

1. ST elevation in 2 leads that touch (contiguous leads) and/or new onset left bundle branch block

2. may see reciprocal ST depression

3. pathological Q waves present in leads showing ST elevation

ECG changes present with a STEMI (3)

20 minutes

with a suspected stroke, a non-contrast head CT should be completed within _____ of arrival to ED

fibrinolytic therapy

for an ischemic stroke, start _____ ASAP (within 2 hours is best) if no contraindications are present

Cincinnati Prehospital Stroke Scale

for a stroke, assess the patient using the _____

facial droop

arm drift

abnormal speech

top 3 stroke symptoms

atropine

epinephrine

dopamine

medication for adult bradycardia

atropine

what is the first drug that should be used for adult bradycardia?

pace

electricity for adult bradycardia

adenosine

medication for supraventricular tachycardia with a pulse

cardioversion

electricity for supraventricular tachycardia or ventricular tachycardia with a pulse

amiodarone

lidocaine

medication for ventricular tachycardia with a pulse

epinephrine

amiodarone

lidocaine

medication for ventricular fibrillation or ventricular tachycardia without a pulse

epinephrine

what is the first drug used for ventricular fibrillation or ventricular tachycardia without a pulse

defibrillation

electricity for ventricular fibrillation or ventricular tachycardia without a pulse

epinephrine

medication for asystole or pulseless electrical activity

none!

electricity for asystole or pulseless electrical activity

hypovolemia

Hs/Ts: increased HR, decreased BP, bleeding

1. fluid bolus

2. blood infusion

interventions for hypovolemia (2)

hypoxemia

Hs/Ts: cyanosis, decreased SpO2

1. supplement oxygen

2. open airway

3. bag/intubate

interventions for hypoxemia (3)

hyperkalemia

Hs/Ts: peaked T waves, wide QRS

1. calcium chloride

2. insulin + D50

3. sodium bicarb

interventions for hyperkalemia (3)

hypokalemia

Hs/Ts: flat T waves, U wave

potassium infusion of 0.5 mEq/kg/hr, never push

interventions for hypokalemia (1)

H+ ion excess

Hs/Ts: increased CO2, low amplitude QRS

1. sodium bicarb

2. ventilator management

interventions for H+ ion excess (2)

hypothermia

Hs/Ts: temperature < 35C or 95F, shivering

slow active warming (0.5-1° per hour)

interventions for hypothermia (1)

flumazenil

interventions for benzo toxicity (1)

1. insulin + glucagon

2. calcium

3. ECMO

interventions for beta blocker toxicity (3)

1. insulin + calcium

2. glucagon

3. ECMO

interventions for calcium channel blocker toxicity (3)

B12 injection/IV

interventions for cyanide toxicity (1)

IV lipids

interventions for local anesthetic toxicity (1)

naloxone (Narcan)

interventions for narcotic toxicity (1)

sodium bicarb

interventions for tricyclic antidepressant toxicity (1)

N-acetylcysteine

interventions for acetaminophen toxicity (1)

tamponade

Hs/Ts: increased HR, muffled heart sounds, JVD, narrow QRS, no pulse if severe

1. pericardiocentesis

2. thoracotomy

interventions for tamponade (2)

tension pneumothorax

Hs/Ts: decreased HR, asymmetrical chest movement, muffled to no breath sounds on the affected side, tracheal deviation, narrow QRS

1. needle decompression

2. chest tube insertion

interventions for tension pneumothorax (2)

thrombosis MI

Hs/Ts: 12-lead changes, chest pain

1. anticoagulation

2. fast PCI (within 90 min)

3. CABG

interventions for thrombosis MI (3)

thrombosis PE

Hs/Ts: SOB, increased HR, decreased SpO2, chest pain

1. fibrinolytics

2. embolectomy

3. anticoagulation

interventions for thrombosis PE (3)

flumazenil

interventions for benzo toxicity (1)

> 10 mmHg

during a code, if a patient is intubated or has an LMA, the EtCO2 should be _____

inadequate compressions

what does an EtCO2 < 10 indicate during a code?

stop mag and administer calcium chloride or gluconate

during the cardiac arrest in pregnancy algorithm, if the patient is receiving IV magnesium, what should be done?

32-36.5 C

if you must institute targeted temperature management, the range is _____ C for a minimum of 24 hours

hypovolemia

hypoxemia

hyperkalemia

hypokalemia

H+ ion excess

hypothermia

toxins

tamponade

tension pneumothorax

thrombosis MI

thrombosis PE

the H's and T's in ACLS. the main causes of pulseless arrest (11)