ACLS Provider 2015

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1. The sequence for BLS for an Adult or C-A-B (Chest 16. Components of High- • Compress the chest hard and fast
Child who is unresponsive and compressions, Quality CPR • Allow complete recoil after each
pulseless. Airway, Breathing) compression
• Chest compressions should be
2. A pulse check during the BLS survey 5 to 10 seconds
interrupted 10 seconds or less
should be performed for this length of
• Switching providers every 2
time.
minutes or every 5 compression (if
3. A likely indicator of a cardiac arrest Agonal gasps unable to determine exact time)
in the unresponsive patient. cycles improves the quality of chest
4. After discovering an unresponsive Check the patient's compressions
patient, what is the next step in the breathing and pulse • Continue CPR while the defibrillator
assessment and management of this charges
patient? 17. The AHA position on The guidelines do not recommend
5. Compressions rate in an arrest. 100/min to 120/min routine use of cricoid routine use of cricoid pressure in
pressure in cardiac cardiac arrest.
6. The ratio of compressions to breaths 30 compressions to arrest.
for the Adult, Child and 1 rescuer 2 breaths
infant arrest. 18. The definitive Prompt defibrillation
treatment for
7. The ratio of compressions to breaths 15 compressions to ventricular fibrillation
for Infant 2-rescuer arrest. 1 breath
19. The recommended next Resume CPR, starting with chest
8. What you should do if the patient is Begin compressions step after a compressions
unconscious and apneic and you are defibrillation attempt
uncertain rather or not a patient has a
pulse 20. One measure to Continue CPR while charging the
minimize interruptions defibrillator
9. To properly ventilate a patient with a Once every 5 to 6 in chest compressions
perfusing rhythm, what is the rate to seconds
squeeze the bag (BVM) 21. Action to take if during Continue CPR (starting with chest
the use of an AED you compressions) then check the
10. The potential complication of Decreased cardiac are not directed to equipment.
excessive ventilations. output check the rhythm
11. Where to measure to appropriately Measure from the 22. Measures to provide • Being sure oxygen is not blowing
size an oropharyngeal airway. corner of the mouth electrical safety during over the patient's chest during the
to the angle of the cardioversion or shock
mandible defibrillation. • Verbally and visually "clear" the
12. When an advanced airway is in place, Continuous chest field
how should compressions be compressions • Charge defibrillator when paddles
delivered? without pauses are in place on the chest
• Consider hands free pads
13. In the intubated patient, the technique Monitor the patient's
to assess the quality of CPR. PETCO2 23. An advantage of hands- Hands-free pads allows for more
free pads verses rapid defibrillation
14. Your next action if after 2 minutes of Check a carotid
defibrillator paddles
CPR an organized, nonshockable pulse
rhythm is identified. 24. Physiology of how CPR Supplying a small amount of blood
is a survival advantage flow to the heart and reducing
15. The recommendation for chest At least 2 inches (5
ischemia
compression depth for an Adult and cm) but not more
CHILD. than 2.4 inches 25. Problem and If skin contact is not made AED
management of using pads the machine will not be able to
of an AED with a hairy analyze; remove the hair.
chest
26. Problem and Remove the patient from the water
management of using and dry off
of an AED when the
patient is partially
submerged in water
27. Problem and management of using
of an AED when patient is lying on
snow or ice
28. If a patient has an implantable
device such as a pacemaker/AICD
that is not functioning the location
you should place the universal pads
29. Special consideration where to
locate AED pads if a patient has a
medication patch who requires
defibrillation
30. The recommended initial biphasic
energy dose for cardioversion of
atrial fibrillation
31. The recommended initial
monophasic energy dose for
cardioversion of atrial fibrillation
32. Initial energy recommendation for
an adult in unstable monomorphic
ventricular tachycardia or SVT
33. If rhythm is unresponsive to the
initial cardioversion attempt, the
energy recommendation for next
attempt for an adult in unstable
monomorphic ventricular
tachycardia or SVT
34. Management for a patient who is
rapidly deteriorating in SVT or
monomorphic V-Tach with a pulse
(even if profoundly hypotensive)
35. If equipment is available, the
management of a witnessed arrest
of V-Fib or pulseless V-Tach
36. In addition to the clinical
assessment, ________________ is
the most reliable method of
confirming and monitoring correct
placement of an endotracheal tube.
37. High quality chest compressions
are achieved when the PETCO2
value reaches
38. The indication of a PETCO2 level <
10 mmHg
39. PETCO2 target range for the patient
with return of spontaneous
circulation
40. Algorithm indicated for the
tachycardic patient with a pulse
Use the AED 41. If a patient has respiratory Treat the respiratory cause
failure but is perfusing and of the bradycardia by airway
gradually becomes maneuvers and assisting
bradycardic, the management ventilation
Place the AED pads on
and treatment focus
either side not directly
on top of an 42. The rationale for defibrillation Pulseless ventricular
implantable device of pulseless ventricular tachycardia is treated like
tachycardia ventricular fibrillation
Do not place AED
because both are non-
directly over a
perfusing shockable rhythms
medication patch
43. The initial priority for an Determine rather or not a
unconscious patient with a pulse is present
120 to 200 Joules
tachycardia
44. Signs and symptoms of • Hypotension
decreased perfusion • Chest pain
200 Joules
• Change in Level of
Consciousness
• New or worsening heart
Synchronized failure
cardioversion initial
45. Management of a patient is in • Conduct a problem-focused
energy of 100 Joules
a bradycardic rhythm (even history and physical exam
(or biphasic equivalent)
3rd degree AV Block) who is • Consider having a
Increase the dose in a asymptomatic with stable vital transcutaneous pacemaker
stepwise fashion for signs on stand-by
monophasic 200
46. The first medications to be Oxygen and epinephrine
joules, 300 joules, then
given in any cardiac arrest
360 joules (or biphasic
equivalent) 47. The next recommended Amiodarone 300 mg
medication after epinephrine
Immediately
is administered for refractory
synchronized
ventricular fibrillation or
cardioversion starting
pulseless ventricular
at 100 joules (or
tachycardia
biphasic equivalent)
48. Medication that is NO longer Atropine
Immediately
used in the management of
defibrillation at 360
pulseless electrical activity
joules or biphasic
(PEA) or asystole
equivalent
49. Indications for Adenosine Initial diagnosis and
Continuous Waveform
treatment of stable,
Capnography
undifferentiated regular,
monomorphic wide complex
tachycardia (ventricular
tachycardia) and SVT
At least, 10-20 mmHg
50. Dosing of Adenosine Adenosine is 6 mg IVP
rapidly followed by 12 mg
IVP rapidly
Potential poor
51. Dosing range for Dopamine 2 to 20 mcg/Kg/min
perfusion from
ineffective CPR 52. The treatment priority for Optimize ventilation and
patients who achieve return to oxygenation
35-40 mmHg
spontaneous circulation
53. SBP goal is to achieve by At least 90 mmHg,
using fluid administration or
ACLS Tachycardia
vasoactive agents.
Algorithm
54. Initial management of 1 to 2 liters of NS or LR
hypotension with return to
spontaneous circulation
55. The recommended dose of an 0.1 to 0.5 mcg/Kg/min 67. The next step once the primary survey is Perform the
Epinephrine infusion, for performed on a potential stroke victim Cincinnati
management of hypotension Prehospital
with return to spontaneous Stroke Scale
circulation assessment
56. An important intervention to Transport to a facility capable 68. According to the Adult Suspected Stroke Alert the hospital
manage an out-of-hospital of coronary reperfusion Algorithm a critical action that should be
resuscitation that achieves (performing a PCI) performed by the EMS team to expedite
return to spontaneous the patient's care on arrival and reduce
circulation time to treatment
57. Danger if you routinely Oxygen toxicity 69. Recommended time for a noncontrast CT Within 25
administer high concentration scan of the head should be performed minutes
of oxygen in the post arrest once a potential stroke victim arrives at
management of patients the hospital
58. The cardiopulmonary and Therapeutic hypothermia and 70. Meaning of F.A.S.T. Acronym in a • Facial Droop
neurologic support during the percutaneous coronary potential stroke victim • Arm Drift
post arrest interventions (PCIs), • Speech
ineffective
59. Therapeutic hypothermia Patients who remain
• Time of onset
should be considered in these comatose after the arrest
of symptoms
populations of adult patients defined as the lack ability to
who achieves return to follow commands without 71. Action if a radio report is received in the Diverted to a
spontaneous circulation contraindications to inducing pre-hospital setting that the CT scanner is hospital that has
hypothermia inoperable and you are transporting a CT capabilities
potential stroke patient
60. Contraindications to inducing • Patients responding to
hypothermia verbal commands 72. One of the first intervention in the ED, Start fibrinolytic
• Patients with potential to once a CT scan is obtained, for a stroke therapy as soon
bleed or recent bleeding victim as possible as
• Hemorrhagic stroke long as
• Arrest due to trauma • CT is normal
without signs of
61. Target temperature goal and 32 Degrees C to 36 Degrees
hemorrhage
duration when inducing C for a recommended
• The patient has
therapeutic hypothermia who duration of at least 24 hours.
arrived within the
achieves return to
3 to 4 ½ hours
spontaneous circulation after
from the onset of
an arrest
symptoms
62. Once the patient with chest Obtain a 12-Lead ECG • No assessed
discomfort is assessed as contraindications
being stable, the most are present
important assessment or next
73. Target range for Blood pressure prior to SBP less than
step
administering thrombolytics in a stroke 185 mmHg
63. The recommended goal from 90 minutes. victim DBP less than
door-to-balloon inflation time 110 mmHg
for percutaneous coronary
74. Right ventricular infarcts are most often Inferior MI
intervention (PCI)
associated with __________ myocardial (Leads II, III,
64. Management of a patient who 12-lead done before another infarctions AVF)
is hemodynamically stable procedure to different the
75. Considerations if right ventricular infarct • Obtain right-
without chest pain in a cause of the tachycardia
suspected sided ECG
tachycardic rhythm (AMI).
• Nitrates and
65. The recommended dose of 160 to 325 mg. morphine may be
aspirin for a patient with contraindicated
chest pain • Patient may
66. Target goal for Greater than or equal to 94% require IV fluids
oxyhemoglobin saturations in for hypotension
patients with acute coronary 76. Caveat to obtain vascular access, drug Should NOT
syndromes and/or stroke delivery, or advanced airway placement interrupt CPR
77. The location and leads used by Bob Page's • I = Inferior ( 87. Conditions where • There is a perceived safety threat to
mnemonic "I See All Leads" to describe Leads II, III, resuscitation the provider
location of infarcts AVF) efforts should be • Signs of irreversible death (e.g.,
• See = Septal withheld decapitation, rigor mortis, or
(V1 and V2) decomposition) are present
• All = Anterior • If the patient has a medical directive
left ventricle excluding advanced cardiac life support
(V3 and V4) techniques.
• Leads = High
88. ST elevation in Anterior MI (anteroseptal)
lateral (I and
V1 through V4
AVL)
Low lateral left 89. ST depression in Potential Posterior MI
ventricle (V5 V1 through V4
and V6) 90. Considerations • Ventilation and Vital Signs
78. ECG changes associated with an acute MI ST segment with return of • Oxygenation
(Injury) elevation spontaneous • Medications
circulation • IV access, IV fluid administration
79. ST segment elevation in lead I and III Nondiagnostic
• Therapeutic interventions (Induction of
considered
hypothermia, 12-Lead ECG, Chest x-ray
80. The preferred access for medications in Intraosseous
91. Ventricular
the arrest is a large peripheral vein such (IO)
Fibrillation
as the antecubital. If unable to obtain a
peripheral access, the next most preferred
92. Complete Heart
route
Block
81. What the team leader should do to avoid Clearly delegate
inefficiencies during resuscitation tasks
82. Team leader instructs a team member to Closed-loop
93. 2nd Degree AV
give 0.5 mg of Atropine, to which the team communication
Block Type II
member responds with "I'll draw up 0.5 mg
of Atropine." This type of communication
is called
83. Action the team leader or other team Address the 94. SVT
members should do if a team member is team member
about to make a mistake during immediately
resuscitation attempt
84. The action that a Team Member is Ask for a new 95. Monomorphic V-
responsible to perform they feel they are task or role Tach
unable to perform an assigned task
because it is beyond the team member's
96. Torsades de
scope of practice
Pointes
85. Action required by the Team Member Team Should repeat
member if they are uncertain if the correct the order and
amount of amiodarone was order by team ask for 97. Antidote Tricyclic Sodium Bicarb
leader, so the team member because of verification Overdose
noise or other distractions
98. Dose of Sodium 1 meq/Kg
86. Medical Emergency Teams (MET) or rapid Improving Bicarb in an
response teams (RRT) have demonstrated patient arrest
the reduction of cardiac arrest in the outcomes by
inpatient environment. The primary identifying and 99. Management • Sodium Bicarb
purpose of a MET or RRT treating early hyperkalemia in • Insulin and D50%
clinical the emergency • Calcium Chloride
deterioration 100. ECG changes • Tall peaked T waves
associated with • Wide QRS
hyperkalemia
101. ECG changes • Flat T waves
associated with • U wave
hypokalemia
102. Antidote for opioid overdose • Narcan
103. Antidote for benzodiazepines • Flumazenil
104. Antidote for digoxin toxicity • Digibind
105. Antidote for organophosphate poisoning • Atropine
• Pralidoxime (2 PAM)
106. Asystole

107. Sinus Brady

108. Wenchebache

109. Atrial Fibrillation

110. Atrial Flutter