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CPR
Cardiopulmonary Resuscitation (CPR) for Adults
Steps Before CPR
Scan Scene
Activate Emergency Response System
Check For Breathing (Max 10 Seconds)
Open Airway
Compressions, Airway, Breathing (CAB)
Compressions: 2 Inches Deep (100-120 Compressions/Min)
Airway: Ensure Airway is Still Open
Breathing: Administer 2 Rescue Breaths
Considerations
Repeat C-A-B Sequence (30:2) Until Help Arrives
3 mins
Cardiac Arrest Algorithm
A) Begin CPR, Administer O2, Attach defib/monitor
B) Shockable Rhythm (VF/pVT): SHOCK
C) Continue CPR for 2 minutes
1st time around: IV/IO access
2nd: Epi q3-5 minutes, Consider intubating
3rd+ : Amiodarone + treat reversible causes
C) Non-Shockable Rhythm (PEA, Asystole): CPR 2 minutes
1st time around: IV, EPI q3-5, Intubate
2nd time around: Consider reversible causes
Post-Resuscitation Considerations
Post-resuscitation
A) BP Control
1-2L NS or LRIs
Pressors
Keep systolic above 90
B) Optimize breathing
ET CO2 35-40, PaO2 40-45
C) 12 lead to monitor for ACS, consider cath lab
D) Therapeutic hypothermia
Ventricular Tachycardia (V-tach)
Causes
Heart Disease
Electrolyte Imbalances
Drugs
CNS Disorders
Manifestations
Hypotension
Pulmonary Edema
Decreased Cerebral Blood Flow
Cardiopulmonary Arrest
Treatment
Treat Underlying Cause
Antidysrhythmics (amiodarone)
Cardioversion
CPR
Defibrillation
2 mins
Maslow's Hierarchy of Needs
Physiological Needs
Oxygen, Water, Nutrition
Body temperature, Elimination, Shelter, Sexual Expression
Safety and Security
Physical Safety
Physiological Safety
Love and Belonging
Affection and Companionship
Esteem
Self Respect and Respect for Others
Self Actualization
Fulfillment
2 mins
Airway, Breathing, Circulation (ABC's)
Airway Assessment
Changed Sound of Voice
"See-saw" Respirations
Stridor
Breathing Assessment
Normal Respiratory Rate: 12–20 Breaths/Min
Use of Accessory Muscles in Respiration
Cyanosis
Circulation Assessment
Color of Hands and Digits
Normal Capillary Refill Time (CRT): 2 Seconds
Decreased LOC
Considerations
Initial ‘Look, Listen and Feel” Assessment
Emergency Treatment
Prioritization in Exam Questions
5 mins
Guidelines for Prioritizing
First-level priority problems
Airway, Breathing, Circulation (ABCs)
Second-level Priority Problems
MAA-U-AR
Mental Status Change
Acute Pain
Acute Urinary Elimination Problems
Untreated Medical Problems
Abnormal Laboratory Values
Risk of Infection, Safety or Security
Third-Level Priority Problems
Long-Term Treatments
2 mins
The Nursing Process
ADPIE
Assessment
Diagnosis
Planning
Implementation
Evaluation
2 mins
ACLS Tachycardia
Tachycardia
Regular Tachycardias
Irregular Tachycardias
Narrow Complex
Wide Complex
Supraventricular Tachycardia (Paroxysmal)
Adenosine (Adenocard)
First dose = 6 mg; 2nd dose = 12 mg
AV nodal
Beta Blocker
Metoprolol
5 mg
Calcium Channel Blockers
Verapamil
First dose = 2.5-5 mg; 2nd dose = 5-10 mg
Ectopic Atrial Tachycardia
Junctional Tachycardia
Procainamide
Amiodarone
150 mg over 10 min
20-50 mg/min
Torsades de Pointes
Magnesium (Mg2+)
Ventricular tachycardia/fibrillation
Pre-excitation tachycardia
e.g. Wolf-Parkinson-White
Paced ventricular tachycardia
SVT w/ aberrancy (i.e. bundle branch block)
Irregular, Narrow Complex Tachycardias
Atrial fibrillation
Multifocal Atrial tachycardia
ECG: Sinus Tachycardia
AV nodal blockers
Irregular, wide complex tachycardias
Pre-excitation Atrial fibrillation
Procainamide
Sotalol
Unstable regular tachycardia = 100 J synchronized
Unstable Irregular tachycardias = 200 J shock
ACLS: No pulse, VTach/VFib
Begin CPR
Epinephrine
Pulse check, rhythm check, shock if indicated
Continue 2 min of CPR
Give Amiodarone
Repeat the cycle starting with a pulse, rhythm and shock
2 mins
ACLS Cardiac Arrest Algorithm
Supporting Oxygenation, Ventilation, and Circulation to preserve Neuro Function
Begin CPR! Oxygen/Ventilation, EKG, Defibulator. SHOCKABLE RHYTHM?
Shockable Rhythm? V-Fib or pulseless V-Tach; Shock(120-200J); CPR (2 min) &have IV. Determine again is this Shockable Rhythm? Repeat with increased joules.
Not Shockable? Signs of ROSC? If yes, then use post Cardiac Arrest algorithm. If ROSC and returned to Shockable Rhythm, Remain in the Shockable Rhythm algorithm.
A Non-Shockable rhythm. Ask “PEA or Asystole?” Continue CPR 2 min, IV Epinephrine Q3-5min, Advanced Airway. Checking again for a shockable rhythm.
Continue in that loop until ROSC or the code is called and the patient is declared deceased.
Shock, Shock, Epi, Shock, Amio, Shock, Sometimes Mag, Shock
4 mins
Ventricular Fibrillation (V-fib)
Causes
Myocardial Infarction
Ischemia
Disease States
Cardiac Catheterization
Pacemaker
Symptoms
Unresponsive
Pulseless
Apnea
Treatment
CPR/ACLS
Defibrillation
Drugs (epinephrine & vasopressin)
2 mins
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
2 mins
Phases of Disaster Management
Mitigation
Preparedness
Response
Recovery
2 mins
FEMA Levels of Disaster
Levels of Disaster
Level I Disaster
Level II Disaster
Level III Disaster
Nurse's Role In Disaster Planning
Personal and Professional Preparedness
2 mins
Triage
Simple Triage And Rapid Treatment (START)
Tags
Red: Immediate (Critical)
Yellow: Delayed (Urgent)
Green: Minor (Ambulatory)
Black: Deceased (Expired)
Step 1: Movement
Ability to Walk
Step 2: Respirations
Spontaneous Breathing
Respiratory Rate
Step 3: Perfusion
Check Circulation
Step 4: Mental Status
Mental Status
4 mins
Fire - Environmental Emergencies
R.A.C.E
Rescue
Alarm
Confine
Extinguish
P.A.S.S.
Nursing Considerations
Fire Exits
Do Not Use Elevators
Manual Ventilation
2 mins
Documentation Guidelines
Factual
Objective Information
Subjective Information from Patient
Objective Supports Subjective
Accurate
Avoid Unnecessary Words and Details
Exact Measurements
Current
Assessments
Document ASAP
Treatment and Response
Change in Status
Admission, Transfer, Discharge or Death
Organized
Document in a Logical Order
Ensure Information Recorded is Complete
4 mins
Parts of an ECG
PQRST
P Wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T Wave
Ventricular Repolarization
2 mins
ECG Interpretation
Rate
Rhythm
P Waves
Upright, Rounded, Before Every QRS
PR Interval (< 0.20 seconds)
Normal QRS (< 0.12 seconds)
2 mins
12 Lead Contiguous Leads - Lateral Wall MI
Leads Elevated
Lead I
Lead aVL
Lead V5
Lead V6
Artery Affected
Circumflex
1 min
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