ACLS

Question 1

ACLS

Cardiac Arrest shockable rhythm

8

Answer 1

• Start CPR and attach monitor
• Shockable rhythm: VF/ pVT
• Shock and restart CPR for 2 min
• Obtain IV/IO access
• if shockable: shock and give epinephrine q3-5min, consider intubation and restart CPR
• if shockable again: shock and give amiodarone or lidocaine
• if not shockable (asystole/ PEA): epinephrine, intubate and CPR
• if ROSC manage airway, breathing and circulation and obtain EKG

Question 2

ACLS

Cardiac Arrest non-shockable rhythm

6

Answer 2

• Start CPR and attach monitor
• Not shockable: Aystole/ PEA
• Give epinephrine, obtain IV/IO access, consider intubation and restart CPR
• If not shockable again: continue CPR and treat reversable causes
• If shockable: shock and give amiodarone or lidocaine
• If ROSC manage airway, breathing and circulation and obtain EKG

Question 3

ACLS

ROSC

5

Answer 3

• Pulse and blood pressure, spontaneous arterial waves, abrupt and sustained increase in PETCO2
• Mainage airway, breathing and circulation
• Obtain EKG
• Consider for emergent cardiac intervention
• If not following commands: hypothermia, brain CT, EEG and ICU

Question 4

ACLS

Reversible Causes

11

Answer 4

6 H’s and 5 T’s
* Hypovolemia
* Hypoxia
* Hydrogen ion (acidosis)
* Hypokalemia
* Hyperkalemia
* Hypothermia
* Tension pneumothorax
* Tamponade
* Toxins
* Thrombosis, pulmonary
* Thrombosis, cardiac

Question 5

ACLS

Drugs

4

Answer 5

• Epinephrine: 1mg every 3-5 minutes
• Amiodarone: 300mg x1 then 150mg
• Lidocaine: 1mg/kg x1 then 0.5mg/kg
• Atropine: 1mg x3 then stop

Question 6

ACLS

Bradycardia causes

4

Answer 6

• MI
• Drugs: CCB, BB, digoxin
• Hypoxia
• Hyperkalemia

Question 7

ACLS

Concerning Symptoms with Bradycardia

5

Answer 7

• Hypotension
• Altered mental status
• Signs of shock
• Ischemic chest discomfort
• Acute heart failure

Question 8

ACLS

Concerning Symptoms with Tachycardia

5

Answer 8

• Hypotension
• Altered mental status
• Signs of shock
• Ischemic chest discomfort
• Acute heart failure

Question 9

ACLS

Tachycardia treatment

3

Answer 9

• Concerning symptoms: synchronized cardioversion
• If wide QRS (>0.12s): Antiarrhytmic, adenosine if monomorphic
• If narrow QRS: vagal maneuvers, adenosine, BB or CCB

Question 10

ACLS

Myocardial Infarction

2

Answer 10

• ABCs and prepare to start CPR
• Give aspirin and oxygen, consider nitroglycerin and morphine

Question 11

BLS

Pt found down

Answer 11

• varify scene is safe
• shout ‘are you okay’
• check for breathing and pulse (5-10sec)
• Have someone call 911 and get a AED
• start compressions (100-120/h; 5cm) for 30 compressions (15 if 2 rescuers are present
• lift chin, tilt head back and give 2 rescue breaths
• Give breath over 1 second and watch for chest rise

Question 12

BLS

AED

Answer 12

• turn on AED
• Rip off hair (if 4 pads total) or shave if needed
• Place pads on patient (right chest below clavicle and left lower rib/flank or center of chest and center of back)
• clear when analyzing rhythm
• shock if indicated
• resume CPR

Question 13

Capnography

Answer 13

35-45 is normal
55 means bagging too slow