BLS Survey: page 13
1. Check response/scan for breathing 5-10 secs
2. Activate Emergency response system
3. Check pulse 5-10 seconds
4. AED- Defibrillate ASAP
Key points:
 Depth of compressions: At least 2 inches (Push Hard)
 Rate of compressions: At least 100/min (Push Fast)
 Ratio compression/breaths 30:2
 Minimize interruptions in compressions to 10 secs or
less
ACLS Survey: ABCD page 15-16
A. Airway: Make or maintain patent
o Advanced Airway: must weigh the benefit
o Suction as needed, Suction on withdrawal for advanced
airway
o For trach’s don’t tie to tight may cut off venous blood
flow
B. Breathing: Are ventilations and O2 sat adequate
o O2 sat ≥ 94% if pulse is present
o Avoid excessive ventilations
o Breaths should just make the chest rise
o Waveform capnography (ETCO2)
 Normal is 35-40 mm Hg
 <10 mm Hg Improve your CPR
C. Circulation: Monitor CPR quality
o What is the rhythm
o IV or IO access
o Medications: Epinephrine, Vasopressin, Atropine,
Amiodorone, Adenosine pages 165-167
o Fluids
D. Differential Dx.: Why did this person Code or is Crashing
o Know your H’s and T’s page 83
o Which ones are probable and easily reversible
Other Helpful Items
VOMIT
Vitals, O2, Monitor (12 lead), IV/IO, Time to Decide
MONA
Morphine, O2, Nitroglycerin, Asprin
Acute Coronary Syndrome page 94
VOMIT + MONA
Cath Lab ASAP for STEMI
Nitro precautions:
 Systolic BP at least 90mmHg
 Right Ventricle Infarct (don’t give it)
 Inferior wall MI (don’t give it)
 Viagra talk
Morphine precautions:
 Same as Nitro
 May affect ventilations
 Do not give in Unstable Angina (NSTEMI)
Stroke
 Recognize the signs and symptoms page 133
o 8 D’s
 Cincinnati Pre-hospital Screen page136
o FAST
 Face: Have them smile
 Arms: arm drift
 Speech: You can’t teach an old dog new tricks
 Time: 3 hour window
 They need a CT Scan
Ventilations
 Rescue breathing 1 breath every 5-6 secs
 CPR with advanced airway 1 breath every 6-8 secs no pause
and continuous compressions
Team Dynamics: Page 17-24
 Closed-loop communications
 Clear messages
 Clear roles and responsibilities
 Know your limitations
 Knowledge sharing
 Constructive intervention
 Reevaluate an summarize
 Mutual respect
Team Roles:
 Team Leader ( in charge )
o Team member (do what leader says)
 Airway
 Chest Compressor
 Recorder
 Medications
 Monitor/Defibrillator
ROSC (return of spontaneous circulation) page 73
 VOMIT and BLS and ACLS Survey as needed
 Advanced Airway if needed
 Therapeutic Hypothermia is pt remains unresponsive
 Labs
 12 lead EKG looking or STEMI
Defibrillation: Not Synched
 Biphasic use manufacturer recommended
o Typically 120-200j
 Biphasic unknown use max available
 Monophasic 360j
Cardioversion: (Sync each time)
 (narrow regular) SVT 50-100j
 (narrow irregular) AFIB 120-200j
 (wide regular) VTACH 100j
 (wide irregular) Torsades (Defibrillate like v-fib)
Terminating Resuscitative Efforts Page 89
 Stop resuscitating dead people
 When in doubt start
Codes made simple
1.
2.
3.
4.
5.
6.
CPR (2 minute intervals)
Use your 2 minutes to solve your H’s and T’s
If you see v-fib on the monitor shock it
Anytime you defib always return to CPR immediately
Epinephrine is the first drug if your pt does not have a pulse
Use your reference cards
Be sure to study the following
Pages 151-163
It is what you will have to demonstrate and be tested