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ACLS Heartcode
Questions & Answers
Updated Latest (Verified Answers)
- in cardiac arrest when do you first introduce medical intervention? which drug? ANSWER after 2 rounds of CPR/shock after 2nd shock give 1 mg epinephrine every 3-5 minutes
- when do you introduce amiodarone during cardiac arrest? ANSWER after the 3rd shock give 300 mg bolus of amiodarone if second dose is needed give 150mg as second dose
- what rhythms are shockable in cardiac arrest ANSWER VF VT
- what rhythms are not shockable in cardiac arrest ANSWER asystole PEA
- if you are in an unshockable rhythm arrest when do you give epi ANSWER 1mg epi every 3-5 minutes after 1st round of CPR
- what do you do after return of spontaneous circulation
ANSWER maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion
- what are the 5 h's and 5 t's ANSWER hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia
tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary
- how do you treat non-symptomatic bradycardia ANSWER monitor and observe
- what constitutes symptomatic bradycardia ANSWER hypotension altered mental status
transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2- 10mcg/minute epinephrine infusion
- what is considered a tachycardia requiring treatment ANSWER over 150 per minute
- when do you consider cardioversion ANSWER if persistent tachycardia is causing ANSWER hypotension altered mental status signs of shock chest pain acute heart failure
- if persistent tachycardia does not present with symptoms what do you need to consider ANSWER wide QRS? greater than 0.12 seconds
- If persistent tachycardia without symptoms DOES have a wide QRS what to do you do?
ANSWER IV access and 12 lead if available 6mg adenosine followed by NS flush only IF regular and monomorphic consider anti- arrhythmic infusion ANSWER
- 20-50mg/min procainamide (max 17mg/kg)
- 150mg amiodarone over 10 minutes
- 100mg sotalol over 5 minutes
- which anti-arrhythmic drugs can be used if prolonged QT ANSWER only amiodarone 150mg over 10 minutes, repeat if VT occurs follow by maintenance infusion 1mg/min for first 6 hours
- if persistent tachycardia without symptoms and without wide QRS what do you do ANSWER IV access and 12 lead EKG if available vagal maneuvers
6mg adenosine followed by NS flush only IF regular
Beta blocker or calcium channel blocker
- patient comes in with symptoms of ACS what do you do first ANSWER chew 325mg aspirin
get 12 lead EKG IV access
- IF ACS patient has EKG showing ST elevation and symptoms are less than 12 hours then what ANSWER re-perfusion door to balloon 90 minutes door to needle 30 minutes
- If ACS patient has EKG showing non ST elevation MI or high risk unstable angina then what ANSWER early invasive strategy? adjunctive treatment? -nitroglycerin -heparin -beta blockers -clopidogrel -glycoprotein IIb / IIIa inhibitor
- what are the contraindications to fibrinolytics in ACS treatment ANSWER systolic > 180
diastolic > 100 right arm left arm systolic difference > 15 history of structural central nervous system disease recent head/facial trauma stroke more than 3 hours or less then 3 months ago recent trauma, surgery or bleed any history of intracranial hemorrhage bleeding, clotting problem or on blood thinners serious systemic disease
- adenosine ANSWER used in tachy
6mg bolus followed by 20mL normal saline
12mg can be used after 1-2 minutes
- amiodirone ANSWER In VF/VT arrest AFTER trying CPR shock and epi/vasopressin ANSWER 300mg then 150mg
In life threatening arrhythmias
do not use if hypothermia
- dopamine ANSWER 2nd line drug for symptomatic bradycardia use for hypotension with signs of shock
2-20 mcg/kg per minute
- epinephrine ANSWER in cardiac arrest ANSWER 1mg every 3-5 minutes
in bradycardia or hypotension ANSWER 2-10mcg/minute infusion
- lidocaine ANSWER alternative to amiodirone in cardiac arrest ANSWER 1-1.5 mg/kg IV
for stable VT, wide complex VT ANSWER 0.5 - 0.75 mg.kg every 5-10 minutes max of 3mg/kg
- magnesium sulfate ANSWER use in cardiac arrest only if hypomagnesemia or torsades ANSWER 1-2g diluted in 10mL of D5W
use in torsades with a pulse or AMI with hypomagnesia ANSWER 1-2g in 50 to 100 mL of D5W maintenance with 0.5g per hour infusion
- vasopressin ANSWER cardiac arrest ANSWER 40 units can replace either 1st or 2nd dose of epi
- what meds can go down the endotrachial tube ANSWER atropine epinephrine lidocaine vasopressin
- reentry supraventricular tachycardia
ANSWER
- hyperkalemia ANSWER 1mEq of sodium bicarb
- hypokalemia ANSWER 10-20 mEq of potassium
- hypomagnesemia ANSWER give mag sulfate 1-2g
- The five links in the adult Chain of Survival ANSWER 1- Immediate activation of EMS 2- Early CPR 3- Rapid defibrillation (not in peds) 4- Effective advanced life support 5- Integrated post-cardiac arrest care
- The five links in the pediatric Chain of Survival
- sinus bradycardia:
- monomorphic ventricular tachycardia:
- fine ventricular fibrillation:
- second degree AV block mobitz type 2:
- second degree AV block mobitz type 2:
- coarse ventricular fibrillation:
- asystole:
- normal sinus rhythm:
- third degree AV block:
ANSWER an AED equipped with a pediatric dose attenuator
- For pediatric patients if there is no pediatric AED available you may use an AED... ANSWER AED without a pediatric dose attenuator
- BLS consists of these main parts ANSWER Chest compressions, Airway, Breathing and Defibrillation
- If patient is not responding and not breathing or no normal breathing (only gasping), you should... ANSWER Shout for help
- Ifgthegadultgpatientgisgnotgrespondinggandgnotgbreathinggandgyougaregalone,gyougshould.. . ANSWERgActivategthegemergencygresponsegsystemgandggetgangAEDgandgreturngtogthegpatient
- After you call for help on the non responsive, non breathing patient, you should... ANSWER Check the victim's pulse for 5 to 10 seconds
- If you don't feel a pulse within 10 seconds, you should... ANSWER 5 cycles of compressions and breaths
- The ratio of compressions to breaths for one rescuer is... ANSWER 30 compressions to 2 breaths
- The first rescuer who arrives at the side of the victim must quickly be sure that ANSWER The scene is safe
- Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest ANSWER Agonal gasps
- In the adult patient you should check the ....... pulse ANSWER Palpate the carotid pulse
- If you do not definitely feel a pulse within 10 seconds... ANSWER Start chest com- pressions
ANSWER Dangerous environment
- The two methods of opening the airway are ANSWER Head tilt-chin lift and jaw thrust
- To open the airway using a jaw thrust and provide breaths with a bag-mask device, you need generally.... ANSWER 2 rescuers
- If you suspect a head or neck injury, open the airway using ANSWER Jaw thrust
- If the jaw trust does not open the airway, use ANSWER Head tilt chin lift maneuver
- When a victim is unresponsive, the ............... can block the upper airway ANSWER Tongue can block the upper airway
- When performing a head tilt-chin lift be careful not to ANSWER Press deeply into the soft tissue under the chin, do not use the thumb to lift the chin, do not close the victims mouth completely
- The purpose of the one way valve when using a mask is to ANSWER Divert exhaled air, blood, or bodily fluids away from the rescuer
- When using a mask to ventilate a patient, position yourself at the victim's side and open the airway using a ANSWER Head tilt chin lift maneuver
- Deliver air over......to make the victims chest rise ANSWER 1 second
- Bag-mask ventilation technique requires instruction and practice and Is not recommended by ANSWER Lone rescuer during CPR
- When using a Bag-Mask to ventilate a patient, position yourself ... ANSWER Above the victim's head
- Use the.......technique to hold the mask in place when you lift the jaw to hold the airway open ANSWER E-C clamp technique
