ACLS RENEWAL TEST 2022

ACLS RENEWAL TEST 2022 Therapeutic Hypothermia cooling goals post ROSC VF Cardiac Arrest ans: 32C-34C or 89.6F - 93.2F for 12-24 hours in order to protect brain and other organs. May be 24 hrs. Pt core temp taken via esophageal thermometer or bladder catheter in non anuric pts or pulm artery catheter. Ventilation Optimization goals ans: PETCO2 35-40 PACO2 40-45 If PETCO2 10 mm Hg attempt to improve CPR quality Post cardiac arrest MAP goal ans: 65 mmHG Glycemic Control post ROSC w/ cardiac arrest ans: 144-180 mg/dL no titrating to 80-110 d/t risk of hypoglycemia RRT criteria ans: -threatened airway -RR 6 or 30 bpm -HR 40 or 140 -SBP 90 -symptomatic HTN -dec. LOC -unexplained agitation -seizure -low UO -subjective concern for pt Ventilation Rates ans: -Bag Mask: 2 ventilations every 30 compressions -Advanced Airway: 1 ventilation every 6-8 seconds (8-10 breaths per min) -Resp. Arrest w/ pulse present: 1 ventilation every 5-6 seconds (10-12 breaths/min) Monitoring to improve CPR quality ans: Quantitative waveform capnography -PETCO2 10mmHg (improve CPR QUALITY) Intra-arterial pressure 20mmHg diastolic pressure (improve CPR quality and implement vasopressor therapy) PaCO2 40-45 mmHg ScvO2 norm 60-80%... 30% improve chest compression and vasopressor therapy PETCO2 determinant ans: End tidal CO2 is the conc. of carbon dioxide in exhaled air at end of expiration. PETCO2 determines blood delivery to the lungs during CPR. partial pressure of end-tidal CO2, a measure of the amount of carbon dioxide present in the exhaled air 35-40mmHg = ROSC Most reliable method of confirming and monitoring correct placement of ET tube ans: waveform capnography Nasopharyngeal Airway sizing guide ans: distance from the tip of the nose to the earlobe Quality CPR ans: compress center of chest (lower half of sternum) 100 compressions/min depth of 2 inches Allow complete chest recoil after each compression avoid excessive ventilation PEA ans: Pulseless electrical activity Biphasic Shock energy ans: 120-200 J - if unknown use max available Monophasic Shock energy ans: 360 J Cardiac Arrest ACLS Drug Therapy ans: -Epinephrine IV/IO Dose 1mg Q3mins -Vasopressin IV/IO dose (40U can replace 1st or 2nd dose of epinephrine) -Amiodarone IV/IO Dose- 1st dose: 300mg bolus 2nd dose 150mg bolus... if amio is not available providers may admin lidocaine Epinephrine hydrochloride ans: used during resuscitation for its alpha-adrenergic effects, ie, vasoconstriction. Vasoconstriction increases cerebral and coronary blood flow during CPR by increasing MAP and aortic diastolic pressure Vasopressin ans: nonadrenergic peripheral vasoconstrictor that increases arterial blood pressure. amiodarone ans: first line anti-arrythmic agent given in cardiac arrest for refractory VF/VT... Used in tx of VF or pulseless VT unresponsive to shock delivery, CPR and vasopressors -Amio is a complex drug that affects na, k, and ca channels. also has alpha-adrenergic and beta-adrenergic blocking properties Lidocaine ans: used if amio is not available 1-1.5mg/kg IV/IO first dose 0.5-7.5mg/kg at 5-10 min intervals max dose of 3 mg/kg if no iv/io available ET dose 2-4mg/kg Mag Sulfate ans: is an adjunctive agent used to prevent recurrent or treat persistent VT assoc. w/ torsades de pointes indicated for pts with known/suspected low serum mag. -alcoholism or other conditions assoc. w/ malnutrition/hypomag states loading dose 1-2g IV/IO diluted in 10mL typically over 5-20mins Reversible Causes H's and T's ans: Hypovolemia Hypoxia Hydrogen Ion (acidosis) Hypo/Hyperkalemia Hypotheria Tension Pneumothorax Tamponade (Cardiac) Toxins Pulmonary Thrombosis Coronary Thrombosis IO ans: intraosseus route provides access to a non-collapsable marrow venous plexus which serves as a rapid, safe and reliable route for admin of drugs, crystalloids, and blood druing resuscitation. priorities ans: 1. cpr and defibrillation 2. advanced airway and drug admin IV-drug acls admin ans: -always give bolus unless specified -always follow with 20 mL bolus IV fluid -elevate extremity 10-20 secs for delivery of drug into central circulation Endotracheal route- ans: IV/IO preferred before ET route. typucal dose is 2-2.5x IV route dilute dose in 5-10mL of sterile water/NS BP Goals during ROSC ans: Systolic 90 mmHg MAP 65 mmHg Norepinephrine ans: potent vasoconstrictor and inotropic agent. May be effective for management of patients w/ severe hypotension and a low total peripheral resistance who fail to respond to less potent adrenergic drugs such as dopamine, phenylephrine and methoxamine. Hypovolemia - ekg clues, hx clues, intervention ans: EKG Clues: narrow complex, rapid rate Clues from HX/ PHYSICAL: History, flat neck veins, high HR, low BP Intervention: Vol. Infusion Hypoxia ans: EKG Clues: slow rate (hypoxia) HX/PHYS Clues: Cyanosis, blood gases, airway problems Intervention: oxygenation, ventilation, advanced airway Hydrogen ion (acidosis) ans: EKG Clues: smaller amplitude QRS complexes HX/PHYS Clues: DM, bicarbonate-responsive preexisting acidosis, renal failure Interventions: Ventilation, sodium bicarbonate Hyperkalemia ans: EKG CLUES: T-waves taller and peaked P-waves get smaller, QRS widens, Sine-wave PEA HX/PHYS: renal failure, DM, recent dialysis, dialysis fistulas, meds Hypokalemia ans: EKG clues: abnormal loss of potassium, diuretic use HX/PHYS: Abnormal loss of potassium, diuretic use Interventions: add mag if cardiac arrest Hypothermia ans: EKG: J &Osborne waves Hx/phys: exposure to cold, central body temp