ACLS Review

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42 <strong>ACLS</strong> (Advanced Cardiac Life Support) <strong>Review</strong> ... ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ What is the differential diagnosis of a flatline on an ECG monitor? Asystole, isoelectric V-fib/V-tach, failed connection, no power, and loose leads. What are the indications for unsynchronized countershock? Pulseless ventricular tachycardia, ventricular fibrillation, sustained torsades de pointes, and ventricular tachycardia with a pulse if the clinical condition has deteriorated. What energy level is used to treat an unstable patient with atrial flutter? Synchronized countershock with 50, 100, 200, 300, and 360 J. What is the electrical treatment for an unstable patient with ventricular tachycardia? 100, 200, 300, and 360 J. What are the most common complications of transcutaneous pacing? Skin burns, pain, coughing, and interference with sensing as a result of patient agitation or muscle contractions. How do you confirm asystole with quick look paddles? Check by positioning the paddles for lead 2 then rotate the paddles 90 degrees to simulate placement for lead 1 or lead 3. What is the electrical therapy for an unstable patient with atrial fibrillation? Synchronized countershock at 100, 200, 300, and 360 J. What is the distance that defibrillation paddles must be placed from a pacemaker? At least 1 inch. Why shock first in ventricular fibrillation or pulseless ventricular tachycardia? Electroshock therapy is more important than drug therapy in the treatment of ventricular fibrillation and pulseless ventricular tachycardia. What are the indications for transcutaneous pacing? Bradycardia with unstable vital signs unresponsive to pharmacological therapy, asystolic cardiac arrest, and overdrive pacing of SVT. Describe the various types of vagal maneuvers. Carotid sinus pressure, coughing, eyeball pressure, breath holding, facial immersion in ice water, Valsalva, and gag reflex stimulation. What is the effect of a vagal maneuver? Vagal maneuvers slow conduction through the AV node by increasing parasympathetic tone.
... CHAPTER 2 Arrhythmias, Defibrillation, and Pacing 43 ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ Describe the placement of defibrillation paddles. The sternum paddle is placed just to the right of the upper sternum and below the clavicle and the apex paddle is placed in the mid-axillary line just to the left of the nipple. What are the complications of carotid sinus pressure? Ventricular dysrhythmias, bradycardia, seizures, syncope, and CVA. What is the level of shock therapy recommended for paroxysmal SVT? Synchronized countershock at 50, 100, 200, 300, and 360 J. What are the contraindications to transcutaneous pacing? Chest trauma, barrel chest, weight less than 15 kg, and cervical spine injury. Transcutaneous pacing may be used if pediatric pacing beds are available. Explain the difference between defibrillation and synchronized countershock. Defibrillation, also known as unsynchronized countershock, has no relationship to the cardiac cycle, whereas a synchronized countershock is delivered a few milliseconds after the peak of the R wave.ve. Why use synchronized shock? Because it reduces the risk of delivering the shock during the vulnerable period of the T wave. Why must transdermal nitroglycerin patches be removed prior to delivering countershock? Transdermal patches may lead to electrical arcing, resulting in smoke, burns, explosive noises, and paired delivery of current. In a 30-kg child, what would be the initial energy level for defibrillation? 60 J with monophasic defibrillator or manufacturers setting for biphasic defibrillator or AED. In an adult, what is the initial energy level used to defibrillate ventricular fibrillation? 360 J if using a monophasic defibrillator. If using a biphasic defibrillator, the initial energy setting depends on the manufacturers energy setting. What factors decrease resistance to transthoracic flow of a defibrillating current? Use of a conductive medium, successive countershocks, and lower patient body weight. In what two situations is synchronized cardioversion indicated? Symptomatic SVT and symptomatic ventricular tachycardia. T/F: Synchronized countershock is indicated for unstable patients with polymorphic ventricular tachycardia. False. Use unsynchronized countershock.
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