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Acls Study Guide

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93 views3 pages

Acls Study Guide

Uploaded by

emacc250
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ACLS Study Guide (2020 Guidelines)

Pre-Course Requirements
The ACLS course now requires a mandatory Precourse Self-Assessment and Precourse Work with a passing score of
at least 70%. Students may take the self-assessment as many times as needed. Please bring your Certificate of
Completion with you to the ACLS class or email in advance to [email protected]. Instructions for
accessing the Precourse Requirements are included in your registration confirmation.

ACLS Written Exam


The ACLS Provider exam is 50 multiple-choice questions, with a required passing score is 84%. All AHA exams are now
“open resource” which means student may use the ACLS manual, study guides, handouts and personal notes during
the exam. Using the ACLS Provider Manual ahead of time with the online resources is very helpful.

BLS Review
Assessment Steps for BLS Compressions
1. Make sure scene is safe • At least 2 inches with a rate between 100 – 120/min
2. Tap/shout to check for responsiveness • Allow for full recoil
3. Call for help if patient is unresponsive • PEtCO2 (intubated) < 10 mmHg indicates poor compressions
4. Check for pulse and breathing for at least 5 but no • Interruptions in compressions should be < 10 seconds
more than 10 seconds • Switch compressors every 2 min.
5. If no pulse (or not sure if there is a pulse) begin CPR • Waveform Capnography is the most reliable method of
confirming placement and monitoring of ETT
• Pre-charging the defibrillator 15 seconds before the rhythm
can improve CCV
Breaths During CPR Rescue Breathing
• Limit interruptions to less than 10 seconds • For a patient who is not breathing or breathing effectively
• Ratio of compressions to breaths 30:2 or other give 1 breath every 6 seconds
advanced protocols that maximize CCF • Give breaths gently, over 1 second
• Each breath given over 1 second • An effective breath will result in visible rise/fall of the chest
• An effective breath will result in visible chest rise • Excessive ventilation decreases cardiac output
• CPR with ETT: 1 breath every 6 seconds with
• Difficulty positioning airway for patency, place NPA or OPA
continuous compressions
• OPA Placement = Measure from the corner of the mouth to
the angle of the mandible
• Excessive ventilation = decreased cardiac output

ACS and Stroke


ACS - STEMI Stroke
• Assessment: Pale, cool, diaphoretic, chest pain, • Noncontrast Head CT within 20 min. of hospital arrival. A
dyspnea, anxiety, hypotension, poor perfusion normal CT may rule out hemorrhagic stroke
• Aspirin 162-325 mg • To better facilitate care, notify receiving hospital in advance
• Time frame to start Coronary Reperfusion (PCI) • Ischemic Stroke: start fibrinolytic therapy ASAP if there are
should be < 90min from ER arrival no contraindications
• Hemorrhagic Stroke: neuro consult

RRT and MET (Rapid Response Team / Medical Emergency Team)


• MET / RRT focuses on prevention of deuteriation to cardiac arrest
• Improve patient care by identifying and treating early clinical deterioration

Express Training Solutions | www.ExpressTraining.com | 888.815.0313

Updated: JAN 2021


ACLS Study Guide (2020 Guidelines)
Effective Team Dynamics
1. Clear roles and responsibilities: Team leader should clearly delegate tasks
2. Knowing your limitation: Stay in scope of practice / ask for a new role if inappropriately assigned
3. Constructive interventions: if someone is about to make a mistake address that team member immediately
4. Knowledge sharing
5. Summarizing and Re-evaluation
6. Clear and Closed loop communication: Repeat back the order, clarify if intervention or dosage is incorrect
7. Mutual respect
8. Team Roles: Team Leader, Compressor, Airway, Medications, Monitor/Defib, Recorder/Timer, CPR Coach
• CPR Coach focuses on ensuring high quality CPR

Bradycardia and Tachycardia


Bradycardia with a Pulse Tachycardia with a Pulse
• If symptomatic, give Atropine, 1 mg every 3-5 min, • If unstable, immediate synchronized cardioversion
max total dose of 3 mg • If stable, 12-lead and expert consultation
• If stable, 12-lead and get expert consultation • If stable w/narrow QRS:
• Adenosine 1st dose 6 mg / 2nd dose 12 mg

Cardiac Arrest (No Pulse)


Assessment Findings pVT/VF ASYSTOLE/PEA
• Unresponsive • CPR first and while defib is charging • CPR first
• No pulse & no breathing • 1 mg epinephrine q 3-5 min (1st drug) • Not shockable
• May have agonal gasps • Amiodarone 1st dose 300 mg / 2nd 150 mg • 1 mg epinephrine q 3-5 min
• Only 2 shockable rhythms in cardiac arrest • If no pulse and not pVT, VF, or
• May use Lidocaine instead of Amiodarone asystole, then you have PEA
Manual Defibrillation Post Resuscitation / After ROSC
• Immediately after you shock → compressions 1. Optimize ventilation and oxygenation
• Immediately if no shock indicated → compressions 2. Treat Hypotension, SBP < 90 mmHg
• While setting up defibrillation to shock → 3. If STEMI → Cath Lab
compressions 4. If unable to follow command: targeted temperature
• Continue CPR while the defib is charging management
• Charge defibrillator before conducing a rhythm check • 32-36 C for at least 24 hours
can help increase chest compression fraction

Tachycardia Rhythms with a Pulse


Stable = good BP and good mentation / Unstable = low BP and poor mentation (Follow Tachycardia Algorithm)
Sinus Tachycardia Atrial Fibrillation

Supraventricular Tachycardia Monomorphic Ventricular Tachycardia

Express Training Solutions | www.ExpressTraining.com | 888.815.0313

Updated: JAN 2021


ACLS Study Guide (2020 Guidelines)
Atrial Flutter Polymorphic Ventricular Tachycardia

Bradycardia Rhythms with a Pulse


Non-symptomatic = good BP & good mentation / Symptomatic = low BP and poor mentation (Follow Bradycardia Algorithm)
Sinus Bradycardia 2nd Degree Heart Block, Type 2

1st Degree Heart Block 3rd Degree Heart Block

2nd Degree Heart Block, Type 1

Pulseless Rhythms (Cardiac Arrest)


1st Start CPR | 2nd Shock pVT/VF Immediately | 3rd Establish IV Access & give Epi | 4th Treat Reversible Causes (H/T)
Pulseless Ventricular Tachycardia (Monomorphic) Asystole

Pulseless Ventricular Tachycardia (Polymorphic) PEA (Pulseless Electrical Activity)

Ventricular Fibrillation PEA is any organized rhythm without a pulse that is not VF or pVT

Express Training Solutions | www.ExpressTraining.com | 888.815.0313

Updated: JAN 2021

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