ACLS stands for
Advanced Cardiac Life Support
CAB stands for
Compressions, airway, breathing
In an unresponsive patient or a patient who is not breathing, one rescuer should initiate a cycle of _____ chest compressions as soon as possible, followed immediately by _ rescue breaths.
- Cycle of 30 chest compressions
2. Followed immediately by 2 rescue breaths.
CPR stands for
Cardiopulmonary Resuscitation
CPR should have a compression rate of ____ compressions/minute at a depth of at least __ inches and allow complete _____
- 100-120 compression/minute
- Depth of at least 2 inches
- Allow complete chest recoil
Electricaly therapy (by an automated external defibrillator or a defibrillator) should be initiated ______
As soon as it is available
Interruptions in chest compressions should be _____ and ____ as possible
Interruptions in chest compressions should be minimal and as short as possible.
These three common procedures should not interrupt chest compressions and defibrillation
- Vascular access
- Medication administration
- Airway placement
What is the best route of medication administration in ACLS?
Central venous administration
What is the second best route of medication administration in ACLS?
Intraosseus
Why is intraosseus preferred over endotracheal?
- More predictable drug delivery
2. More predictable pharmacologic effect
How to perform endotracheal drug administration?
- Administer 2-2.5 times the standard IV dose, and dilute in 5-10 mL of sterile water
List five drugs which can be administered through an endotracheal tube
- Naloxone
- Atropine
- vasopressin
- Epinephrine
- Lidocaine
If medications are administered through a peripheral vein, follow the medicationsn with _______ to faciliate drug flow from the extremity to central circulation.
20 mL of IV fluid
What is ROSC?
Return of spontaneous circulation
After ROSC, _______ can improve survival and quality of life
Systematic post-cardiac arrest care
Initial therapy following ROSC should optimize what three things?
- ventilation
- Oxygenation
- Blood pressure
SaO2 should be maintained at ___% of higher in systematic post-cardiac arrest care
94% or higher
In order to maintain an adequate SaO2, _____ may be required
Insertion of an advanced airway may be necessary
Regarding: oxygenation:_______ and _______ are harmful and should be avoided, especially afte ROSC
- Hyperventilation
2. Excess oxygen delivery
Hypotension (SBP of ___ or less) should be treated with what two treatments?
- 90 mm Hg or less
- Fluid boluses
- vasopressors
What does TTM stand for?
Target temperature management (therapeutic hypothermia)
For whom should TTM be considered?
Consider hypothermia in patients who have been successfully resuscitated after a cardiac arrest but who remain comatose (usually defined as a lack of meaningful response
Cooling should be continued for at least ________ hours
24 hours
Describe benefit of TTM
Inducation of hypothermia (32 C-36 C for at least 24 hours) beginning as soon as possible after ROSC can improve neurologic recovery and mortality.
What temperature should be used for TTM?
One study has shown that a standard target temperature of 33 C does not confer benefit over a higher temperature of 36 C. AHA guidelines allow clinician to select the exact target temperature.
List five methods of inducing hypothermia
- Surface cooling devices
- Endovascular catheters
- Cooling blankets
- Ice packs
- Cold IV fluids
How should temperature be monitored in TTM?
Continuously
Many patients will need what two adjunctive therapies for TTM?
- Sedation
2. Analgesia
Rewarming should be done at what rate?
0.3 C to 0.5 C every hour
List 8 complications of TTM
- Shivering
- Altered drug metabolism (hepatic)
- Coagulopathy (hepatic)
- Increased renal excretion of water and subsequent volume depletion (renal)
- Arrhythmia and hypotension (heart)
- Hyperglycemia and hypoglycemia (metabolic)
- Infection
- Electrolyte disturbances (renal, metabolic)
Why should shivering be treated and prevented?
- Excess heat production
- Increased oxygen consumption
- General stress response
List seven drug/drug classes used for treating and preventing shivering
- Sedatives
- Anesthetics
- Analgesics
- Steroid
- Serotonin drugs
- Magnesium
- Paralytics
List three sedatives for treating/preventing shivering
- Dexmedetomidine
- Clonidine
- Ketamine
List three analgesics used for shivering
- Meperidine
- Fentanyl
- tramadol
What steroid is used for preventing and treating shivering?
Dexamethasone
What serotonin drugs are used for shivering?
- Ondansetron
2. Buspirone
When is risk of shivering the greatest?
- Induction of hypothermia
2. During rewarming
Describe use of paralytics in preventing shivering
- Not mandatory and should be avoided if possible
- May be most beneficial during induction of hypothermia and during rewarming
- Should be continually reevaluated and discontinued if posisble once goal temperature is achieved.
List two broad effects of altered drug metabolism in TTM
- Decreased clearance
2. Altered distribution
Decreased clearance of drugs can occur due to ______ in TTM
Depressed activity of CYP 3A4 and CYP 3A5
The altered distribution of _______ can have a clinically significant effect in TTM
Propofol
The effects of altered drug metabolism in TTM are more pronounced at ______ temperatures
Cooler temperatures
Use ____ dosing during the induction of hypothermia
Bolus dosing
Reduce maintenance doses ______ in TTM
As needed
What is the most common arrhythmia in TTM?
Bradycardia
How to treat arrhythmia and hypotension in TTM?
Discontinue or slightly warm patient if life-threatening arrhythmias or persistent hemodynamic instability develops
____glycemia occurs during hypothermia, _____ocurs during rewarming.
- Hyperglycemia during hypothermia
2. Hypoglycemia during rewarming
How to treat hyperglycemia, hypoglycemia in TTM?
Monitor blood glucose often (i.e. every 1-2hours) and adjust insulin accordingly.
What electrolyte disturbances happen during TTM cooling?
Reductions in K+, Mg2+ and phosphate during cooling
What electrolyte disturbances happen during rewarming?
Hyperkalemia during rewarming
Why should special electrolyte protocols be used in TTM?
- Electrolyte shifts occur during the induction and rewarming phases of TTM.
- Special protocols ensure patients do not receive too much potassium during cooling such that they are hyperkalemic during rewarming.
- Frequent monitoring and careful repletion is important to prevent complications.