ACLS Prep. Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep.

November, 2013

ACLS Prep Preparation is key to a successful ACLS experience. Please complete the ACLS Pretest and Please complete this ACLS Prep.

ACLS Prep Preparation is key to a successful ACLS experience. An ACLS Pretest is required for admission to the course. NO ONE will be admitted without printed pretest results. The pretest must be accessed online at: www.heart.org/eccstudent and enter code: compression. Eighty percent achievement is recommended on the pretest. **Because this test is online, we recommend you attempt to access it about 1-week before your course date**.

ACLS Prep Preparation is key to a successful ACLS experience. This Powerpoint program has more questions that will highlight key points not addressed in the pretest. Please take the time to look up the information in the Provider Manual. The answers to the questions can be found on the page numbers provided. As of January, 2014, we will no longer ask these questions in the class. Your opportunity to review them is now.

ACLS Prep Please be familiar with: 1. The algorithms: Bradycardia, Tachycardia, Pulseless Arrest, ROSC. 2. These drugs: adenosine, amiodarone, atropine, epinephrine, vasopressin. 3. These drips: Dopamine for bradycardia and hypotension and Epinephrine for bradycardia and hypotension. 4. The reversible causes: the Hs and Ts.

ACLS: BLS Q. Why are chest compressions advantageous for a pulseless patient? R. Page 14.

ACLS: BLS Q. Why are chest compressions advantageous for a pulseless patient? R. Chest compressions provide circulation especially through the heart and brain. Page 14

ACLS: BLS Q. Chest compressions are started within how many seconds of determining unresponsiveness? R. Page 13.

ACLS: BLS Q. Chest compressions are started within how many seconds of determining unresponsiveness? R. 10 seconds. Page 13

ACLS: BLS Q. Chest compressions may be interrupted for procedures, chest compressions are re-started within how many seconds? R. Page 14.

ACLS: BLS Q. Chest compressions may be interrupted for procedures, chest compressions are re-started within how many seconds? R. 10 seconds. Page 14

ACLS: General Principles Q. What is the purpose of the Rapid Response Team? R. Page 26

ACLS: General Principles Q. What is the purpose of the Rapid Response Team? R. Rapid Response Teams provide early assessments and interventions for a person who is declining physiologically with the hope of stabilizing the person and preventing a code blue. Q. 26

ACLS: Airway Q. The new standard is to maintain SpO2 between 94% and 99%. Do not leave a patient with an SpO2 of 100% for a prolonged period of time; the PO2 will be between 80 and 300 mmhg. Why is a high PO2 problematic? R. The patient may develop oxygen toxicity and coronary arteries constrict in the presence of high oxygen concentrations. Think of oxygen as a drug and just as with most drugs too high of a dose will cause toxicity. Pages 28, 96-97

ACLS: Airway Q. How is an oropharangeal airway measured? R. Pages 42-43.

ACLS: Airway Q. How is an oropharangeal airway measured? R. Measure an OPA from the corner of the mouth to the angle of the mandible. Pages 42-43

ACLS: Airway Q. Review the process for suctioning a patient. The step of applying suction while the suction tube is in the airway is limited to how many seconds? R. Page 45-46

ACLS: Airway Q. Review the process for suctioning a patient. The step of applying suction while the suction tube is in the airway is limited to how many seconds? R. 10 seconds. Q. Page 45-46

ACLS: Defibrillation Q. During a pulse check the patient has no pulse and is still in ventricular fibrillation and the decision is made to defibrillate. What order is given while the defibrillator is set up and charged? R. Page 63.

ACLS: Defibrillation Q. Why is it a bad idea to allow oxygen to blow over the chest during defibrillation? R. Page 64

ACLS: Defibrillation Q. Why is it a bad idea to allow oxygen to blow over the chest during defibrillation? R. Fire may result Q. Page 64

ACLS: Defibrillation Q. Why are pads preferred over paddles for defibrillation and synchronized cardioversion? R. Page 64.

ACLS: Defibrillation Q. Why are pads preferred over paddles for defibrillation and synchronized cardioversion? R. Even though paddles and pads deliver the same amount of electricity, pads allow for a more rapid shock and reduces the likelihood of arcing. Page 64

ACLS: Airway Q. Continuous Wave Form Capnography (CWFC) is recommended after intubation. There are three uses for capongraphy during resuscitation. What are the three uses? R. 1. Assess placement of ET tube (capnography is the gold standard for assessing placement of ET tubes). 2. Assess quality of chest compressions (PETCO2 > 10 mm Hg) 3. Assess Return of Spontaneous Circulation (ROSC) (PETCO2 = 35 40 mmhg) Q. Pages 67, 73, 74, 75, 76

ACLS: General Principles Q. A visitor has collapsed in the lobby of the hospital; IV access is needed. Where is the IV started? R. Pages 69-70.

ACLS: General Principles Q. A visitor has collapsed in the lobby of the hospital; IV access is needed. Where is the IV started? R. A peripheral IV is preferred; if an peripheral IV cannot be establish use an IO. Avoid starting a central line because CPR must be interrupted; an existing central line may be used. Pages 69-70

ACLS: ROSC Q. What is the ACLS Survey? R. Pages 14 to16, 62.

ACLS: ROSC Q. What is the ALCS Survey? R. The ACLS Survey is: A Airway B Breathing C Circulation D Differential Diagnosis. Please look at the content on pages 14 to 16 especially Table 2. Pages 14 to 16, 62

ACLS: ROSC Q. What are the top 2 treatment priorities for a patient who has achieved ROSC? R. Page 73 and 74.

ACLS: ROSC Q. What are the top 2 treatment priorities for a patient who has achieved ROSC? R. Airway and breathing are the top 2 treatment priorities for someone with a pulse; ensure the airway is secured and the patient is supported with ventilations and oxygen if needed. Page 73 and 74

ACLS: ROSC Q. Nimrod Jones was resuscitated successfully, but remains hypotensive even after a fluid bolus. Dopamine drip is ordered; what is the starting dose range for a Dopamine drip for hypotension? R. Page 73 and 76.

ACLS: ROSC Q. Nimrod Jones was resuscitated successfully, but remains hypotensive even after a fluid bolus. Epinephrine drip is ordered; what is the starting dose range for a Epinephrine drip for hypotension? R. Page 73 and 76.

ACLS: General Principles Q. According to the AHA, what is the target systolic blood pressure? R. Pages 73, 76.

ACLS: General Principles Q. According to the AHA, what is the target systolic blood pressure? R. 90 mm Hg (we understand that certain specialties will tolerate higher or lower target blood pressures, but for the purposes of the course we will use 90 mm Hg for the standard for SBP). Pages 73, 76

ACLS: ROSC Q. Nimrod Jones has been successfully resuscitated; in the immediate post-code period Nimrod s BP is 78/52. A fluid bolus of NS has been ordered. According to the AHA what is the appropriate fluid volume range for a fluid bolus? R. One to two liters (we understand that some specialties will want to give smaller volumes of fluid; for the purposes of the course we need a standard volume and we will use 1-2 L. In real life adjust the fluid volume for the individual patient). Page 73, 76

ACLS: ROSC Q. A resuscitation patient has ROSC, but remains unconscious. What order is considered? R. Pages 73 and 77.

ACLS: ROSC Q. A resuscitation patient has ROSC, but remains unconscious. What order is considered? R. Therapeutic hypothermia is considered; if ordered lower the body temperature to 32 degrees C to 34 degrees C for 12 to 24 hours. Pages 73 and 77

ACLS: Airway Q. Avoid hyperventilation. Why? R. Page 75

ACLS: Airway Q. Avoid hyperventilation. Why? R. Hyperventilation may lead to: 1. increased intrathoracic pressure and limit cardiac output 2. cerebral artery constriction thus reduced blood flow through the brain. NOTE: hyperventilation causes a loss of CO2 Q. Page 75

ACLS: Airway Q. Read the tips for securing an ET tube. Why is it a bad idea to secure an ET tube around the neck? R. Page 75

ACLS: Airway Q. Read the tips for securing an ET tube. Why is it a bad idea to secure an ET tube around the neck? R. Do not secure the ties around the neck obstructing the jugular veins and venous return from the brain. Q. Page 75

ACLS: ROSC Q. Some patients who are resuscitated have an acute MI or STEMI. What is a top priority for those patients? R. Page 77.

ACLS: ROSC Q. Some patients who are resuscitated have an acute MI or STEMI. What is a top priority for those patients? R. Coronary reperfusion is an important priority after the airway, breathing, and blood pressure are stabilized. Page 77

ACLS: Pulseless Arrest Q. Nimrod Jones is in Sinus Rhythm with a HR of 78, but has no pulse. What is the condition and how is it treated? R. Page 82 to 85.

ACLS: Pulseless Arrest Q. Nimrod Jones is in Sinus Rhythm with a HR of 78, but has no pulse. What is the condition and how is it treated? R. Nimrod is in PEA and the treatment is CPR, epinephrine 1 mg every 3-5 minutes, and treat the cause. Page 82 to 85

ACLS: Pulseless Arrest Q. Analyze this strip. This flat line may be one of three things. What are the three things? R. Pages 86 to 89.

ACLS: Pulseless Arrest Q. Analyze this strip. This flat line may be one of three things. What are the three things? R. This flat line may be: 1. Equipment failure like the leads have popped off of the patient. 2. Asystole. 3. Fine ventricular fibrillation. If the equipment is OK, check the rhythm in a second lead, if the rhythm remains flat the patient is in asystole, if it gets bigger and wigglier it is VF. Page 86 to 89

ACLS: Pulseless Arrest Q. Nimrod Jones is in asystole and has no pulse. What is the treatment? R. Page 82, 86 to 89.

ACLS: Pulseless Arrest Q. Nimrod Jones is in asystole and has no pulse. What is the treatment? R. The treatment is CPR, epinephrine 1 mg every 3-5 minutes, and treat the cause. Page 82, 86 to 89

ACLS: ACS Q. Nimrod Jones is on your unit and complains of epigastric pain. The blood pressure is 120/70; respirations are 14/min., non-labored, and easy; and SpO2 is 96% on room air. What is the next intervention? R. A 12 lead EKG. If the patient is stable the next step is assessment; not all chest pain is cardiac in nature. This principle applies to all situations, if the patient is stable conduct assessments first. Q. Page 96-97, 119, 136, & 140

ACLS: ACS & Stroke Q. The Nimrod Jones Memorial hospital is a STEMI center. Currently all of the cardiac cath lab staff are involved in emergent STEMI cases and no one is left to care for any more patients. A patient is in an ambulance on the way to the STEMI Center; what needs to happen to the patient in the ambulance? R. Page 96, 139

ACLS: ACS & Stroke Q. The Nimrod Jones Memorial hospital is a STEMI Center. Currently all of the cardiac cath lab staff are involved in emergent STEMI cases and no one is left to care for any more patients. A patient is in an ambulance on the way to the STEMI Center; what needs to happen to the patient in the ambulance? R. Divert the patient to a STEMI Center who can take the patient right away. This principle applies to Stroke Centers when a stroke center cannot provide prompt care. Q. Page 96, 139

ACLS: ACS Q. What are contraindications for nitroglycerin? R. Page 97.

ACLS: ACS Q. What are contraindications for nitroglycerin? R. The contraindications for nitroglycerin are: 1. Inferior wall MI and RV failure, 2. Hypotension, 3. Bradycardia, 4. Tachycardia, 5. Phosphodiesterase* inhibitor use within 24 to 48 hours. Page 97 *Sildenafil, tadalafil, vadenafil, udenafil, anavafil. NOTE: phosphodiesterase inhibitors are used for erectile dysfunction and pulmonary hypertension.

ACLS: Bradycardia Q. Your patient is in respiratory distress and becomes apneic. His HR drops from 122 to 48. How is the bradycardia treated? R. Page 111.

ACLS: Bradycardia Q. Your patient is in respiratory distress and becomes apneic. His HR drops from 122 to 48. How is the bradycardia treated? R. Your patient has an identifiable cause of the bradycardia, respiratory arrest and hypoxia. Thus treat the cause by supporting the patient with ventilations and oxygen. Page 111

ACLS: Bradycardia Q. Nimrod Jones is hypotensive, pale, cool, and diaphoretic after his HR drops from 95 to 40. The cause of the bradycardia is not known, what is the first intervention? R. Page 109 and 110.

ACLS: Bradycardia Q. Nimrod Jones is hypotensive, pale, cool, and diaphoretic after his HR drops from 95 to 40. The cause of the bradycardia is not known. In spite of 2 doses of 0.5 mg Atropine, he remains bradycardic and symptomatic. What are the choices for the second intervention? R. Page 109 to 114.

ACLS: Bradycardia Q. Nimrod Jones has a HR of 38 in spite of 2 doses of 0.5 mg Atropine IV push. Dopamine drip is ordered; what is the starting dose range for a Dopamine drip for bradycardia? R. Pages 109 and 110.

ACLS: Bradycardia Q. Nimrod Jones has a HR of 38 in spite of 2 doses of 0.5 mg Atropine IV push. Epinephrine drip is ordered; what is the starting dose range for a Epinephrine drip for bradycardia? R. Pages 109 and 110.

ACLS: Tachycardia Q. Nimrod Jones has a regular narrow complex tachycardia with a HR of 179. He is pale, cool, diaphoretic with a BP of 80/60. What is the first intervention? R. Page 118 to 120.

ACLS: Tachycardia Q. Nimrod Jones has a regular narrow complex tachycardia with a HR of 179. He is pale, cool, diaphoretic with a BP of 80/60. What is the first intervention? R. The first intervention is immediate synchronized cardioversion. Page 118 to 120

ACLS: Cardioversion Q. Complete this sentence: Synchronize cardiovert the and defibrillate the. R. Page 121.

ACLS: Cardioversion Q. Complete this sentence: Synchronize cardiovert the and defibrillate the. R. Synchronize cardiovert the living and defibrillate the dead (or soon to be dead/very, very, very unstable). Page 121

ACLS: Cardioversion Q. What are the recommended energy settings during synchronized cardioversion for atrial fibrillation, SVT/atrial flutter, and VT? R. Pages 121-122. Page 121

ACLS: Cardioversion Q. What are the recommended energy settings during synchronized cardioversion for atrial fibrillation, SVT/atrial flutter, and VT? R. The answers are given for biphasic defibrillators. For less serious rhythms like SVT/Aflutter start at 50 to 100J. For more serious rhythms like VT start at 100J. For atrial fibrillation start at 120 to 200 J. Page 121-122

ACLS: Tachycardia Q. Nimrod Jones has a regular narrow complex tachycardia with a HR of 179, but is stable. What are the first 2 interventions. R. Page 127 and 129.

ACLS: Tachycardia Q. Nimrod Jones has a regular narrow complex tachycardia with a HR of 179, but is stable. What are the first 2 interventions. R. Start with vagal maneuvers and if needed Adenosine 6 mg rapid IV push (second dose is 12 mg). Page 127 and 129

ACLS: Tachycardia Q. Nimrod Jones has a regular wide complex tachycardia with a HR of 180, but is stable. What are the suggested interventions. R. Page 127 to 129.

ACLS: Tachycardia Q. Nimrod Jones has a regular wide complex tachycardia with a HR of 180, but is stable. What are the suggested interventions. R. Always assume a regular wide complex tachycardia is VT until proven otherwise. The treatment for stable VT is Amiodarone 150 mg IV over 10 minutes. This is an appropriate first intervention. The regular wide complex tachycardia may be SVT with aberrancy (SVT with a wide QRS complex) and the AHA recommends Adenosine as an appropriate drug for this rhythm, if Adenosine is not successful use an antidysrhythmic like Amiodarone 150 mg IV over 10 minutes. Adenosine works on SA node and the AV node and is appropriate for SVT, but not for VT. Page 127 to 129

ACLS: Tachycardia Q. Irregular rhythms are complex, who are you going to call? R. Page 127 to 130.

ACLS: Tachycardia Q. Irregular rhythms are complex, who are you going to call? R. An expert. Page 127 to 130

ACLS: Airway Remember there needs to be a fair amount of anxiety about keeping chest compressions going when someone is pulseless.

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