CPR.ACLS

Question 1

Ratio of compressions to breaths when starting CPR

Answer 1

30:2

Question 2

Intervention as soon as available during CPR

Answer 2

1. AED (shockable vs non-shockable)
2. Oxygen (either advanced airway or facemask/ambu-bag)

Question 3

Measures of CPR quality (rate, depth, EtCO2, Diastolic BP)

Answer 3

1. 100-120 BPM
2. 2 in
3. < 10 mm Hg, then improve quality
   4.

Question 4

Reversible causes of sudden cardiac arrest (5H5T)

Answer 4

1. Hypovolemia
2. Hypoxia
3. Hydrogen ion (acidosis)
4. Hypo/hyperkalemia
5. Hypothermia
6. Tension PTX
7. Tamponade
8. Toxins
9. Thrombosis, PE
10. Thrombosis, cardiac

Question 5

Shockable rythms

Answer 5

1. Ventricular fibrillation
2. Pulseless ventricular tachycardia.

Question 6

8 Steps of ACLS with shockable rhythm

Answer 6

1. CPR
2. Assess rhythm (Vfib/Pulseless Vtach)
3. Shock (Biphasic
4. CPR 2 min, assess rhythm
5. Shock
6. CPR 2 min, Epinephrine 1 mg 3-5 min, airway, capnography, assess rhythm
7. Shock
8. CPR 2 min, Amiodarone

Question 7

Energy for shock in ACLS (Biphasic, monophasic)

Answer 7

1. 120-200 J Biphasic
2. 360 J Monophasic

Question 8

Frequency of breaths with advanced airway

Answer 8

1 breath every 6 seconds (10/min)

Question 9

Signs of unstable bradyarrythmia

Answer 9

1. Hypotension
2. AMS
3. Signs of end organ perfusion
4. Ischemic chest pain
5. Acute heart failure

Question 10

Dosing of atropine for unstable bradycardia (consider while setting up for transcutaneous pacing)

Answer 10

0.5 mg, repeat 3-5 min, max 6 doses (3 mg)

Question 11

Dosing of epinephrine infusion for unstable bradycardia

Answer 11

2-10 mcg per minute

Question 12

Heart block poem

Answer 12

Question 13

Tachyarrythmia (HR > 150) with instability (2 options)

Answer 13

1. Adenosine (if regular)
   
   1. 6 mg first dose
   2. 12 mg second dose
2. Synchronized cardioversion
   
   1. Narrow regular (50-100 J)
   2. Narrow irregular (120-200 J)
   3. Wide regular (100 J)
   4. Wide irregular (Defibrillate)

Question 14

Tachyarrythmia (stable) with wide QRS (> 0.12s)

Answer 14

1. Adenosine if regular
2. Antiarrhytmic infusion
   
   1. Procainamide, Amiodarone, Sotalol
      
      1. Amio dose 150 mg over 10 min, 1 mg/min for 6 hours.

Question 15

Stable tachyarrhythmia (>150) with normal QRS

Answer 15

1. Vagal maneuvers
2. Adenosine (if regular)
3. B blocker or calcium channel blocker