Term
|
Definition
chest compressions
airway
breathing |
|
|
Term
|
Definition
1. Check pt for responsiveness and breathing
2. Call for help and get AED
3. Check pulse
4. Give 30 compressions
5. Open airway and give 2 breaths
6. Resume compressions |
|
|
Term
| depth of compression for adults: |
|
Definition
|
|
Term
| depth of compressions for children: |
|
Definition
| - at least 1/3 the depth of the chest, 2 inches or 5 cm |
|
|
Term
| depth of compressions for infants: |
|
Definition
| - at least 1/3 the depth of the chest, approximately 1.5 inches (4 cm) |
|
|
Term
| ACLS indications for continuous quantitative waveform capnography: |
|
Definition
- Intubated patients through the periarrest period
- Confirming endotracheal tube placement
- Monitoring CPR quality and detecting ROSC based on ent-tidal carbon dioxide values |
|
|
Term
| best way to assess endotracheal tube placement: |
|
Definition
| Continuous Quantitive Waveform Capnography |
|
|
Term
| recommended initial biphasic energy dose for cardioversion of atrial fibrillation: |
|
Definition
|
|
Term
| initial monophasic dose for defib of A. fib: |
|
Definition
|
|
Term
| defib dose for A. flutter or other supraventricular rhythms: |
|
Definition
| 50-100 J (mono or biphasic) |
|
|
Term
| Defib dose for stable monomorphic VT: |
|
Definition
|
|
Term
| symptomatic unstable bradycardia: |
|
Definition
| chronotropic drugs can be used to alternative to pacing |
|
|
Term
| stable, wide complex, undifferentiated, monomorphic tachycardia with regular rhythm: |
|
Definition
|
|
Term
| are chronotropic drugs or transcutaneous pacing more effective for symptomatic unstable bradycardia? |
|
Definition
|
|
Term
| Morphine is inidcated in __ when chest discomfort is unresponsive to nitrates. Morhpine should be used with cautin in pts with __ __ __ due to increased mortality in a large registry. |
|
Definition
- STEMI
- unstable angina/NSTEMI |
|
|
Term
| During cardiac arrest, providers should administer a vasopressor every __ to __ minutes. |
|
Definition
|
|
Term
| what should be given for refractory VF or VT? |
|
Definition
|
|
Term
| first line for ALL symptomatic bradycardia: |
|
Definition
| Atropine (but atropine is NOT used for PEA or cardiac arrest) |
|
|
Term
| Critical Actions for Post-Cardiac Arrest Care: |
|
Definition
HATMO
- Hemodynamic optimization, focus on treating hypotension
- Acquisition of 12 lead EKG
- Therapeutic hypothermia
- Monitioring advanced airway placement with quantitative waveform capnography in intubated patients
- Optimizing arterial oxygen saturation |
|
|
Term
| ACLS post-cardiac arrest care: |
|
Definition
- Optimizing cardiopulmonary function and vital organ perfusion, esp heart and brain
- Transport out of hospital pts to facility with post cardiac arrest care including acute coronary interventions, neuro care, goal directed critical care, and hypothermia
- Transporting in hospital arrest pts to critical care units capable of provideing comprehensive post cardiac arrest care
- Identifying and treating causes of arrest and preventing recurrence
- Considering therapeutic hypothermia to optimize survival and neuro recovery and comatose pts
- Identifying and treating acute coronary syndromes
- Optimizing mechanical ventilation to minimize lung injury
- Gathering data for prognosis
- Assisting patiesn and families with rehab services if necessary |
|
|
Term
| adenosine does not convert: |
|
Definition
- Atrial Fibrillation
- Atrial Flutter
- Ventricular Fibrillation
(ADENOSINE WILL NOT WORK ON THESE) |
|
|
Term
| indications for adenosine: |
|
Definition
- stable narrow-complex SVT
- effective at terminated tachycardias due to reentry at the AV or sinus node
- may consider for unstable narrow-complex reentry tachycardia while prepping for cardioversion
- regular monomorphic wide complex tachycardia, previously known as reentry SVT |
|
|
Term
| stable narrow complex SVT; |
|
Definition
|
|
Term
| Adenosine contraindications: |
|
Definition
- poison/drug-induced tachycardia
- second degree heart block
- third degree heart block |
|
|
Term
|
Definition
- Flushing
- Chest pain/tightness
- Brief asystole or bradycardia
- Ventricular ectopy |
|
|
Term
| Adenosine is less effective in pts taking __ or __ (these pts may need higher doses). |
|
Definition
|
|
Term
| Is adenosine safe and effective during pregnancy? |
|
Definition
|
|
Term
| Adenosine is used to terminate SVT, what commonly occurs after this? |
|
Definition
| - transient periods of sinus bradycardia and ventricular ectopy |
|
|
Term
| Adenosine IV Rapid push dosing: |
|
Definition
- Pt in mild reverse Trendelenburg position
- Initial bolus of 6 mg over 1-3 seconds followed by NS bolus of 20 mL, then elevate extremity
- A second dose of 12 mg can be given in 1 to 2 minutes if needed |
|
|
Term
| Injection technique for adenosine administration: |
|
Definition
- Record rhythm strip during administration
- Draw up adenosine dose and flush in 2 separate syringes
- Attach both syringes to IV injection port closest to the patient
- Clamp IV tubing above the injection port
- Push IV adenosine as quickly as possible (1-3 seconds)
- While maintaining pressure on adensosine plunger, push NS flush as rapidly as possible after adenosine
- Unclamp IV tubing |
|
|
Term
| VF or VT unresponsive to CPR, shock, and vasopressor: |
|
Definition
|
|
Term
| Recurrent hemodynamically unstable VT: |
|
Definition
|
|
Term
| rapid infusion of amiodarone may lead to ___. |
|
Definition
|
|
Term
| With mulitple dosings of amiodarone, cumulative doses > __grams/24 hours are associated with significant __ in clinical trials. |
|
Definition
- > 2.2 grams/24 hours
- hypotension |
|
|
Term
| Do NOT administer amiodarone with other drugs that prolong the __ __, such as __. |
|
Definition
- QT interval
- Procainamide |
|
|
Term
| Terminal elimination of amiodarone is extremely long, the half life lasts up to _ __. |
|
Definition
|
|
Term
| indication for amiodarone: |
|
Definition
| VF/VT cardiac arrest unresponsive to CPR, Shock, and Vasopressors |
|
|
Term
| Dosing of amiodarone for refractory VT/VF: |
|
Definition
- First dose: 300 mg IV/IO push
- Second dose if needed: 150 mg IV/IO push |
|
|
Term
| Rapid infusion dosing for amiodarone: |
|
Definition
| 150 mg IV over first 10 minutes (15 mg/minute). May repeat rapid infusion of 150 mg as needed every 10 minutes. |
|
|
Term
| Slow infusion dosing of amiodarone: |
|
Definition
| 360 mg IV over 6 hours (1 mg/minute) |
|
|
Term
| Maintenance infusion dose of amiodarone: |
|
Definition
| 540 mg over 18 hours (0.5mg/minute) |
|
|
Term
| 4 drugs that can be given via endotracheal tube: |
|
Definition
- Atropine
- Epinephrine
- Lidocaine
- Vasopressin |
|
|
Term
| drug needed in large dosing with organophosphate poisoning: |
|
Definition
|
|
Term
| Atropine may be effective for __ __ __ or __ __, but will NOT be effective for __ __ __ __ block. |
|
Definition
- AV nodal block or ventricular asystole
- infranodal Mobitz Type II block |
|
|
Term
| this drug should be used with caution in myocardial ischemia and hypoxia because it increases the myocardial oxygen demand: |
|
Definition
|
|
Term
| Avoid atropine with ___ __. |
|
Definition
|
|
Term
| In pts with type II blocks or third degree blocks be prepared to: |
|
Definition
| - pace or give catecholamines |
|
|
Term
| Dosings of atropine less than ___mg may result in paradoxical slowing of the heart rate. |
|
Definition
|
|
Term
| Atropine dosing for bradycardia witho or without ACS: |
|
Definition
| 0.5 mg every 3-5 minutes as needed, not to exceed total dose of 0.04mg/kg or a total of 3 mg |
|
|
Term
| Second line drug for symptomatic bradycardia: |
|
Definition
|
|
Term
| Indications for dopamine: |
|
Definition
- 2nd line drug for symptomatic bradycardia after atropine
- Use for hypotension with signs and symptoms of shock |
|
|
Term
| Dopamine should be used with caution in __ shock with accompanying __. |
|
Definition
- cardiogenic shock
- CHF |
|
|
Term
| do NOT mix dopamine with : |
|
Definition
|
|
Term
|
Definition
- tachyarrhythmias
- excessive vasoconstriction |
|
|
Term
|
Definition
2-20 mcg/kg/minute
- titrate to patient response, taper slowly |
|
|
Term
| Indications for epinephrine: |
|
Definition
- Cardiac arrest: VF, pulseless VT, asystole, PEA
- Symptomatic bradycardia after atropine as an alternative to dopamine
- Severe hypotension: can be used after pacing and atropine fail, when hypotension accompanies bradycardia, or with phosphodiesteraase enzyme inhibitor
- Anaphylaxis, severe allergic reactions: combine with large fluid volume, corticosteroids, and antihistamine |
|
|
Term
|
Definition
1st: Atropine
2nd: Dopmamine or Epinephrine |
|
|
Term
| Severe hypotension and patient is on phosphodiesterase enzyme inhibitor: |
|
Definition
|
|
Term
|
Definition
| - Epi causes the blood pressure and heart rate to increase which may result in myocardial ischemia, angina, and increased myocardial oxygen demand |
|
|
Term
| What does evidence show about higher doses of epinehprine: |
|
Definition
- do NOT improve survival or neurologic outcome
- may contribute to postresuscitation myocardial dysfunction
(higher doses may be needed with poising/drug induced shock) |
|
|
Term
| IV/IO dose of epinehprine for cardiac arrest: |
|
Definition
- 1 mg (10mL of 1:10,000 solution) administered every 3-5 minutes during resuscitation.
- Follow each dose with a 20 mL flush
- elevate arm for 10-20 seconds after dose |
|
|
Term
| higher doses of epinephrine, __mg/kg, may be indicated for __ __ or __ __ __ overdose. |
|
Definition
- 0.2mg/kg
- beta blocker
- calcium channel blocker |
|
|
Term
| continuous infusion dosing for epinephrine: |
|
Definition
| - 0.1-0.5mcg/kg/minute, titrate to response |
|
|
Term
| Trach tube dosing of epinephrine: |
|
Definition
| 2-2.5 mg diluted in 10 mL NS |
|
|
Term
| Epinephrine dosing for profound bradycardia or hypotension: |
|
Definition
| - 2 to 10 mcg/minute, titrate to patient response |
|
|
Term
| Alternative to amiodarone for cardiac arrest from VT/VF: |
|
Definition
|
|
Term
|
Definition
- Alternative to amiodarone for VT/VF
- Stable monomorphic VT with preserved ventricular function
- Stable polymorphic VT with normal baseline QT inerval and preserved LV function when ischemia is treated and electrolyte balance is corrected
- Can be used for stable polymorphic VT when baseline QT interval is prolonged and torsades is suspected |
|
|
Term
|
Definition
| - CI as prophylactic use in AMI |
|
|
Term
| when should lidocaine MAINTENANCE dose be reduced: |
|
Definition
| - impaired liver/LV function |
|
|
Term
| lidocaine adult dosing for cardiac arrest from VT/VF: |
|
Definition
Initial dose 1-1.5 mg/kg IV/IO
- For refractory VF may give addition 0.5-0.75 mg/kg IV push, repeat in 5-10 minutes, maximum of 3 doses or 3 mg/kg |
|
|
Term
| Lidocaine dose for stable VT, wide complex tachycardia of uncertain type, or significant ectopy (all perfusing arrhythmias): |
|
Definition
- 0.5 to 0.75 mg/kg and up to 1 to 1.5mg/kg may be used
- Repeat 0.5 to 0.75 mg/kg every 5-10 minutes with max total dose of 3mg/kg |
|
|
Term
| Maintenance infusion of lidocaine: |
|
Definition
| 1 to 4 mcg/minute (30-50 mcg/kg/minute) |
|
|
Term
| Magnesium sulfate indications; |
|
Definition
- Torsades de pointes
- Hypomagensemia
- Digitalis toxicity |
|
|
Term
|
Definition
- occasional fall in blood pressure with rapid administration
- use with caution if renal failure is present |
|
|
Term
| Magnesium sulfate dosing for cardiac arrest from Torsades de pointes or Hypomagnsemia: |
|
Definition
| - 1-2 grams (2-4 mL of 50% solution) diluted in 10 mL of D5W IV/IO |
|
|
Term
| Magnesium sulfate dosing with Torsades with a pulse or AMI with hypomagensemia: |
|
Definition
- Loading dose 1-2 g mixed in 50-100 mL of D5W, over 5-60 minutes
- Follow with 0.5 to 1 gram/hour IV (titrate to control torsades) |
|
|
Term
|
Definition
- Alternative to epinephrine for adult shock- refractory VF
- Alternative to epinephrine for asystole, PEA
- May be used for hemodynamic support in vasodilatory shock (septic shock) |
|
|
Term
| Vasopressin is a potent __ __ which increases peripheral vascular resistance. This may provoke __ __ and __. |
|
Definition
- peripheral vasoconstrictor
- cardiach ischemia and angina |
|
|
Term
| Vasopressin is NOT recommended for __ patients with coronary artery disease. |
|
Definition
|
|
Term
| IV dose administration of Vasopressin for cardiac arrest: |
|
Definition
| - One dose of 40 units IV/IO push may replace first or second epinephrine dose, epi can be administered every 3-5 minutes during cardiac arrest |
|
|
Term
| Vasodilatory (aka septic) shock dosing of vasopressin: |
|
Definition
| 0.02-0.04 units/minute continuous infusion |
|
|
Term
|
Definition
| potentially fatal condition when body temperature falls below 95F/35C |
|
|
Term
|
Definition
| pts body temperature between 90 and 95F |
|
|
Term
|
Definition
|
|
Term
| Pulseless Electrical Activity (PEA) is continued __ __ of the heart in the absence of effective __ __. |
|
Definition
- continued electrical rhythmicity
- absence of effective mechanical function |
|
|
Term
| rTPA stands for __ __ __ __, what is it? |
|
Definition
- Recombinant Tissue Plasminogen Activator
- clot-dissolving substance produced naturally by cells in the walls of blood vessels |
|
|
Term
|
Definition
|
|
Term
| sinus rhythm is produced by the __ node. |
|
Definition
|
|
Term
| synchronized cardioversion uses a sensor to deliver a shock that is syncrhonized with a peak in the __ __. |
|
Definition
|
|
Term
| very rapid uncoordinated fluttering of ventricles: |
|
Definition
| Ventricular Fibrillation (VF) |
|
|
Term
| scan method for calculating rate: |
|
Definition
| R waves in 6 second strip x 10= bpm |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| atrial depolarization and delay through the AV node |
|
|
Term
|
Definition
| ventricular depolarization |
|
|
Term
|
Definition
| period b/w completion of ventricular depolariaztion and final ventricular repolarizatoin |
|
|
Term
| The T and P waves are normally upright in all leads except __. aVR |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Atrial fibrillation rate: |
|
Definition
atrial: 400-700
ventricular: 160-180 |
|
|
Term
| Junctional Escape Rhythm rate: |
|
Definition
|
|
Term
| Accelerated Junctional Escape Rhythm: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| With supraventricular tachycardia (SVT), the rhythm is __ __ and the rate is greater than __ bpm. |
|
Definition
absolutely regular
> 150 bpm |
|
|
Term
| With Paroxysml Atrial Tachycardia the rate is usually ___. The onset is sudden and often initiated by a __. |
|
Definition
|
|
Term
| Ventricular tachycardia rate: |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Ventricular tachycardia rate: |
|
Definition
| b/w 100 and 220, regular rhythm |
|
|
Term
|
Definition
| - group of 3 PVCs in a row or more at a rate greater than 100 bpm |
|
|
Term
| rate of idioventricular rhythm: |
|
Definition
|
|
Term
| Accelerated Idioventricular Rhythm: |
|
Definition
|
|
Term
|
Definition
ventricular rate= 0
p waves may or may not be present |
|
|
Term
| each small box on an EKG is: |
|
Definition
|
|
Term
| each large box on an EKG is: |
|
Definition
|
|
Term
| First Degree AV Block has a prolonged __ __, it is between __ and __ seconds. |
|
Definition
- PR interval
- 0.2 and 0.4 seconds |
|
|
Term
| With 2nd degree AV Block Type 1 Wenkebach, the __ interval __ __ until a __ is dropped. |
|
Definition
| - PR interval progressively increases until a QRS is dropped |
|
|
Term
| With Type 2 Second Degree AV block, the __ interval is __ and a __ suddenly drops. |
|
Definition
- PR interval is consistent
- QRS suddenly drops |
|
|
Term
| With 3rd degree AV block, the __ interval __ __ and the __ waves are not related to the __ __. |
|
Definition
- PR interval varies greatly
- P waves are not related to the QRS complexes |
|
|
Term
| difference b/w axis deviation b/w v. tachy and SVT with abberancy: |
|
Definition
- V. tachy has extreme axis deviation b/w -90 and +180
- SVT with Aberrancy has normal axis except WPW syndrdome |
|
|
Term
| Valsalva maneuver does/does not slow V. Tachy, but does/does not slow SVT with abberancy. |
|
Definition
- does NOT slow V. Tachy
- does slow SVT with aberrancy |
|
|
