ACLS (practical application)

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How does complete chest recoil contribute to effective CPR?

Allows max blood return to the heart

A pt has been resuscitated from cardiac arrest. During post-ROSC tx, the pt becomes unresponsive, with the rhythm shown here. Which action is indicated next?

Give an immediate unsynchronized high-energy shock (defibrillation dose)

What action minimizes the risk of air entering the victim’s stomach during bag-mask ventilation?

Ventilating until you see the chest rise

A pt was in refractory vfib. A third shock has just been administered. Your team looks to you for instructions. What is your next step?

resume high-quality chest compressions

After initiation of CPR and 1 shock for vfib, this rhythm is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?

Give epinephrine 1 mg IV/IO

A 35-year-old woman presents with a CC of palpitations. She has no chest discomfort, SOB, or light-headedness. Her BP is 120/78 mmHg. Which intervention in indicated first?

Vagal maneuvers

A pt becomes unresponsive. You are uncertain if a faint pulse is present. They rhythm shown here is seen on the cardiac monitor. An IV is in place. Which action do you take next?

Start high-quality CPR

A pt’s 12-lead ECG is transmitted by the paramedics and shows a STEMI. When the pt arrives in the ER, the rhythm shown here is sen on the cardiac monitor. The pt has resolution of moderate (5/10) CP after 3 doses of sublingual nitroglycerin. BP is 104/70 mmHg. Which intervention is most important in reducing this pts in-hospital and 30-day mortality rate?

Reperfusion therapy

What is the maximum interval for pausing chest compressions?

10 seconds

What is the recommended compression rate for high-quality CPR?

100 to 120 compressions per minute

Which action is likely to cause air to enter the victim’s stomach (gastric inflation) during bag-mask ventilation?

Ventilating too quickly

You are a code team leader and arrive to find a pt w/ CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the pt was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilation are producing visible chest rise, and IO access has been established. Which intervention would be your next action?

Epinephrine 1 mg

You are providing bag-mask ventilations to a pt in respiratory arrest. How often should you provide ventilations?

Every 5-6 seconds

Which action should be taken immediately after providing an AED shock?

Resume chest compressions

How often should you switch chest compressors to avoid fatigue?

About every 2 minutes

A 45-year-old woman with a hx of palpitations develops light-headedness and palpitations. She has received adenosine 6mg IV for the rhythm shown here, without conversion of the rhythm. She is now extremely apprehensive. Her blood pressure is 128/70mmHg. What is the next appropriate intervention.

Administer adenosine 12mg IV

You arrive on the scene to find CPR in progress. Nursing staff report the pt was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and and IV has been initiated. What do you administer now?

Epinephrine 1mg IV

Your pt is not responsive and is not breathing. You can palpate a carotid pulse. whICH ACTION DO YOU TAKE NEXT?

Start rescue breathing

What is the recommended depth of chest compressions for an adult victim?

At least 2 inches

Your pt is a 56 year old woman with hx of DM type 2. She is pale and diaphoretic. Her BP is 80/60 mm Hg. The cardiac monitor documents the rhythm shown here. She is on oxygen 4 L/min by nasal cannula and an IV has been established. What do you administer next?

Atropine 0.5mg IV

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