Term
|
Definition
1. Hypoxia
2. Hypovolemia
3. Hypothermia
4. Hypoglycemia
5. Hypo/HyperKalemia
6. Hydrogen Ion - Acidosis |
|
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Term
|
Definition
1. Toxins
2. Tamponade - cardiac tension
3. Tension Pneumothorax
4. Thrombosis
5. Trauma |
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Term
| In a case of a patient in respiratory arrest with a pulse, how many breaths do you give per minute? |
|
Definition
| 1 breath every 5-6 seconds -- 10-12 breaths per minute |
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Term
| The systematic approach of the BLS survey is…. |
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Definition
|
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Term
| When stopping CPR to take a pulse check, what is the maximum amount of time you should take for a pulse check? |
|
Definition
|
|
Term
List the steps of the BLS survey...
|
|
Definition
1. Check responsiveness ("Are you alright?" -- check for absent of abnormal breathing"
2. Activate the emergency response system/getAED
3. Circulation (check the carotid pulse for 5-10 seconds)
4. Defibrillation (if no pulse, check for shockable rhythm with AED, follow each shock with CPR starting with compressions) |
|
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Term
| What are the ventilation rates when using a Bag-Mask during Cardiac Arrest? Respiratory Arrest? |
|
Definition
Cardiac Arrest: 2 ventilations after every 30 compressions
Respiratory Arrest: 1 ventilation every 5-6 seconds (10-12 breaths per minute) |
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Term
| What are the ABCS's of the ACLS survey? |
|
Definition
A - Airway
B - Breathing
C - Circulation
D - Differential Diagnosis |
|
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Term
| When delivering assisted ventilation, it is critical to avoid what type of ventilation? Why? |
|
Definition
Excessive Ventilation.
1. In can increase intrathoracic pressure.
2. Decrease venous return to the heart
3. Decrease Q |
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Term
| Do NOT use the Oropharyngeal Airway (OPA) in patients that are…? |
|
Definition
Conscience.
Always check to see if patient has an intact cough and gag reflex. |
|
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Term
Nasopharyngeal Airways devices (NPA) may only be used in unconscious patients.
True or False?
Explain. |
|
Definition
FALSE
The NPA is a soft rubber or plastic uncuffed tube that provides airflow between the nares and the pharynx. |
|
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Term
| When would you use a NPA vs. a OPA? |
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Definition
| You may use a NPA on a conscious or semi-conscious patient, a patient with trismus, massive trauma around the mouth, or wiring of the jaws. |
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Term
| A quick way to measure the appropriate sized NPA is? |
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Definition
| The length of the NPA should be the same as the distance from the tip of the patients nose to the earlobe. |
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Term
| You find a patient laying on the ground, unresponsive. You are alone. What BLS steps are taken? |
|
Definition
1. Activate emergency response system and get an AED machine
2. Check carotid pulse for 5-10 seconds.
3. If no pulse, begin chest compressions (30:2)
4. Hook up AED machine to patient chest.
5. Rhythm is shockable, give 1 shock and resume CPR immediately for 2 minutes (if rhythm is not shockable, resumeCPR immediatly and check rhythm every two minutes) |
|
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Term
A patient in VT has just had a successful defibrillation and has begun normal sinus rhythm. You can now stop chest compressions.
True or False? |
|
Definition
FALSE
It is important to continue chest compressions immediately after a shock for several minutes until adequate heart function resumes. |
|
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Term
| Use AEDs only when a patient has what 3 clinical findings? |
|
Definition
1. No response
2. No pulse
3. Abnormal or absent breathing (no breathing or only gasping) |
|
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Term
| If a patient has collapsed, but is gasping…what steps should be taken to treat? |
|
Definition
| Call emergency response team, check pulse, if patient is gasping, that is not normal ventilation. If no pulse, use AED machine to shock. |
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Term
As soon as a AED has been delivered, rescuer must resume CPR, starting with checking for a pulse, followed by 30 chest compressions and two breaths.
True or False? |
|
Definition
FALSE
Do not stop to check pulse after shock has been delivered. Immediately begin 30 chest compressions followed by 2 breaths. After two minutes of CPR, the AED machine will prompt you to clear patient to analyze rhythm and shock if needed. |
|
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Term
| If AED does not promptley analyze the rhythem (5-15 seconds) what should the rescuer do? |
|
Definition
Resume chest compressions and ventilations.
Check all connections between the AED and the patient to make sure they are intact. |
|
|
Term
Is is ok to use an AED in patient with a implanted defibrillator or pacemaker.
True or False? |
|
Definition
|
|
Term
List the basic cardiac arrest algorithm
(patient is in VF/VT). |
|
Definition
1. Start CPR with AED
2. Shockable - "CLEAR"
3. CPR (30:2) - Establish IV/IO access
4. Shockable - "CLEAR"
5. CPR (30:2) - give EPI (1 mg) OR VASOPRESSIN (40 units) every 3-5 minutes
6. Shockable - "CLEAR"
7. CPR (30:2) - give AMIODARONE (300 mg bolus -- second dose 150 mg bolus)
REPEAT STEPS 2 - 7 |
|
|
Term
List basic cardiac arrest algorithm.
(Asystole/PEA) |
|
Definition
1. CPR - 30 compressions to 2 breaths
2. NOT shockable
3. CPR (30:2) - establish IV/IO assess - give EPI (1 mg or 40 unites of VASOPRESSIN) every 3-5 minutes
4. NOT shockable
5. CPR (30:2)
6. NOT shockable
7. If no signs of ROSC, begin cycles again. If ROSC, go to post cardiac arrest care. |
|
|
Term
| What are the appropriate dosing for a patient in VF/VT? |
|
Definition
EPI - 1 mg, 3-5 minutes
VASOPRESSIN - 40 units
AMIODARONE - 300 mg bolus
(2nd dose, 150 mg bolus)
If Amiodarone is not available...
LIDOCAINE - 1-1.5 mg/kg IV/IO
(2nd dose, .5 -.75 mg/kg max 3 mg/kg)
MAGNESIUM SULFATE (only for torsades) - 1-2 g |
|
|
Term
A patient is in asystole, TCP is recommended to eliminate cardiac arrest.
True or False? |
|
Definition
FALSE
The AHA does not recommend the use of TCP for patients with asystolic cardiac arrest. |
|
|
Term
| A patient is in asystole. At what phase in the cardiac arrest cycle do you determine a differential cause to treat? |
|
Definition
| During the second cycle of CPR, if the patient is not responding to EPI dose and CPR, consider 6H's and/or 5 T's. |
|
|
Term
| What drugs are used to treat patients with ACS? |
|
Definition
Oxygen
Aspirin
Nitroglycerin
Morphine
Fibrinolytic Therapy
Heparin |
|
|
Term
| "Clot-Buster" Drugs are called? And are used for patients with what problem? |
|
Definition
Fibrinolytics
Used in patients with ACS. |
|
|
Term
|
Definition
| Percutaneous Coronary Intervention |
|
|
Term
| PCI performed as the initial reperfusion method is called….? |
|
Definition
PRIMARY PERCUTANEOUS CORONARY INTERVENTION
(PPCI) |
|
|
Term
| It is important to remember that for STEMI... |
|
Definition
1. The ECG is central to the initial risk and treatment stratification process.
and
2. Healthcare personnel do not need evidence of elevated cardiac markers to make a decision to administer fibrinolytic therapy in STEMI patients. |
|
|
Term
| For a patient with STEMI, the goals of reperfusion are to give fibrinolytics within how many minutes of arrive to ED? or to perform PCI (balloon etc.) within how many minute? |
|
Definition
Administer fibrinolytics within 30 minutes.
Peform PCI's withint 90 minutes. |
|
|
Term
| What 4 agents are primary used for patients with ischemic type chest discomfort? |
|
Definition
1. Oxygen
2. Aspirin
3. Nitroglycerin
4. Morphine |
|
|
Term
| What are the major contraindications of treating a patient with aspirin? |
|
Definition
GI bleeding
(current or recent) |
|
|
Term
| What are the major contraindications for treating a patient with nitroglycerin and morphine? |
|
Definition
| Patient has hypotension or shows RV infarction. |
|
|
Term
| What are the 4 major points of in-hospital therapy commonly referred to as the "4 D's"? |
|
Definition
1. Door
2. Data
3. Decision
4. Drug |
|
|
Term
| STEMI is characterized how on an ECG? |
|
Definition
1. ST-elevation in 2 or more contiguous leads
2. New development of LBBB
3. J-point elevation is GREATER than 2 mm (men), 1.5 mm in women in leads V2 and V3 (>2.5mm in men <40) |
|
|
Term
| High risk UA/NSTEMI is characterized on an ecg how? |
|
Definition
1. ST depressions of </= .5 mm or dynamic T-wave inversion
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|
|
Term
| Peaked T waves may indicate? |
|
Definition
|
|
Term
| The use of fibrinolytic therapy is used in patients with a J-point ST segment elevation great than? |
|
Definition
| 2 mm in leads V2 and V3, 1 mm in all other leads, or by a new LBBB. |
|
|
Term
| What is the most common agent used for acute STEMI reperfusion therapy? |
|
Definition
|
|
Term
It is appropriate and expected to use fibrinolytic therapy on any patient that shows signs of ischemia.
True or False? |
|
Definition
FALSE
There are contraindications for using fibrinolytic therapy |
|
|
Term
|
Definition
| Rescue PCI is used early after fibrinolytic therapy has been used and has not worked for the patient. |
|
|
Term
| Rescue PCI is referred to now as? |
|
Definition
| Pharmacoinvasive strategy. |
|
|
Term
| According to the AHA, which is the treatment of choice for the management of STEMI? PCI or Fibrinolytic Therapy? |
|
Definition
| PCI -- however, only if it is performed effectivly with a door to balloon time of <90 minutes by a skilled PCI facility. |
|
|
Term
| Define symptomatic bradycardia. |
|
Definition
| Signs and sympotms due to the slow heart rate. |
|
|
Term
|
Definition
| Any rhythm disorder with a heart rate less than 60bpm. |
|
|
Term
| Symptomatic bradycardia exists clinically when what 3 criteria are present? |
|
Definition
1. HR is slow
2. Patient is showing s/s
3. Symptoms are due to the slow HR. |
|
|
Term
| What are the symptoms of possible symptomatic bradycardia? |
|
Definition
Chest Discomfort or Pain
Shortness of Breath
Decreased level of Consciousness
Weakness
Fatigue
Litght Headedness
Dizziness
Presyncope/Syncope |
|
|
Term
| An adult is found with a pulse but has bradycardia. Describe the Bradycardia Algorithm. |
|
Definition
1. Assess that patient has Bradycardia (<50bpms)
2. Identify and treat underlying cause -- ACLS survey...Maintain airway, offer oxygen if hypoxemic, monitor blood pressure and oximetry, establish IV access, 12 lead ecg if available.
3. Determine Persistent bradyarrhythmia causing:
i.e. hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, acute heart failure? YES
4. Give .5 mg bolus of ATROPINE
5. If ATROPINE is ineffective, offer TCP OR EPINEPHRINE (2-10 mcg/min) OR DOPAMINE (2-10 mcg/kg/min).
6. Consider expert consulation/TVP |
|
|
Term
| What is the key critical question you must answer when determining a patient with bradycardia? |
|
Definition
| Determine whether the bradycardia is causing the symptoms OR if another illness is. |
|
|
Term
| In the absence of an immediate reversible cause, what medication is the first line of defense for a patient with bradycardia? dosing? |
|
Definition
Atropine
.5 mg IV/IO MAX 3 mg IV/IO |
|
|
Term
| A patient has second degree heart block (type II) or third degree heart block in bradycardia. How should you proceed? |
|
Definition
| Do not rely on Atropine working. TCP may be useful for treating the patient. |
|
|
Term
| What are the contraindications for TCP? |
|
Definition
| Severe hypothermia and asystole. |
|
|
Term
It is important to assess the carotid pule during TCP to confirm capture.
True or False? |
|
Definition
FALSE
TCP may cause muscular jerking that may mimic a carotid pulse. |
|
|
Term
| What are the steps for applying TCP? |
|
Definition
1. Place electrodes on chest
2. Turn on TCP
3. Set the demand rate to approx. 60 bpm
4. Set the current milliamperes output 2 mA about the dose at which consistent capture is observed (safety margin) |
|
|
Term
When beginning TCP with a patient with ACS, turn the pacing level to the highest heart rate that allows for stability.
True or False? |
|
Definition
FALSE
Place pacing at the LOWEST level that allows for clinical stability. Higher heart rates can worsen ischemia which can lead to arrhythmias. |
|
|
Term
| What is unstable tachycardia? |
|
Definition
| When the HR is too fast for the patient's clinical condition and the excessive hear rate causes symptoms or unstable conditions due to the heart beating too fast or beating ineffectively. |
|
|
Term
| What are the signs and symptoms of unstable tachycardia? |
|
Definition
Hypotension
Acutely altered mental Status
Signs of Shock
Ischemic Chest Discomfort
Acute Heart Failure |
|
|
Term
| When should you not consider cardioversion in patients showing signs of tachycardia? |
|
Definition
If the patient has sinus tachycardia due to a physiologic factor such as fever, hypotension etc. (you must first treat these problems)
If a patient has stable tachycardia.
Atrial Flutter -- patients are often stable and a cardioversion is not necessary. |
|
|
Term
| A patient has pulseless tachycardia. Which algorithm should you use? |
|
Definition
|
|
Term
| A patient has tachycardia with a pulse. Which algorithm should you use? |
|
Definition
| Tachycardia with a Pulse Algorithm |
|
|
Term
| To implement the appropriate response to a patient, it is important to determine if a patient has a _____ with tachycardia. |
|
Definition
Pulse
If patient has a pulse, determine if the are stable or unstable. Unstable, continue with Tachycardia Algorithm. |
|
|
Term
| Polymorphic QRS refers to? |
|
Definition
| QRS complex changes in all leads. |
|
|
Term
| Monomorphic QRS refers to? |
|
Definition
| QRS is similar in all leads. |
|
|
Term
| What 5 questions are important to ask yourself when assessing a patient with tachycardia? |
|
Definition
1. Are symptoms present or absent?
2. Is patient stable or unstable?
3. Is the QRS wide or narrow?
4. Is the rhythm regular or irregular?
5. Is the QRS monomorphic or polymorphic? |
|
|
Term
| What are the steps of the Tachycardia with a Pulse Algorithm? |
|
Definition
1. Assess that patient has tachycardia with pulse (>150bpm) and are unstable (showing s/s)
2. Identify and treat underlying cause (ACLS and BLS survey - ABCD's etc….airway open, offer oxygen if hypoxic etc.)
3. Underlying cause? (i.e. hypotension, signs of shock, ischemic chest discomfort, acute heart failure) YES?
4. CARDIOVERSION
IF NO?
5. Determine wide QRS complex (<.12seconds)
YES?
6. Establish IV access, administer adenosine (6 mg push) only if regular and monophasic
IF NO?
7. IV ACESS, VAGAL MANEUVERS, adensone (6 mg push) only if regular, calcium channel blockers, b-blockers |
|
|
Term
| What is the difference between an unsynchronized shock and a synchronized shock? |
|
Definition
A unsynchronized shock is delivered as soon as the operature pushed the shock button, falling randomly anywhere within the cardiac cycle. These are HIGH energy levels.
A synchronized cardioversion uses a sensor that delivers the shock at the peak of a QRS complex. These are LOW energy levels. |
|
|
Term
| When should you use a synchronized shock? |
|
Definition
In patients with:
Unstable SVT
Unstable atrial fib
Unstable atrial flutter
Unstable regular monomorphic
tachycardia with pulse |
|
|
Term
| When should you use a unsynchronized shock? |
|
Definition
In patients with:
No pulse
Clinical deterioration, may result in cardiac arrest
If you are unsure if a patient has monomorphic or polymorphic VT. |
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