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welcome to nursing with professor b in

today's video i will be going over an

acls cheat sheet you will pass your acls

if you review this carefully make sure

that you stay until the end because i

will be going over

acls medical emergencies i will be


which rhythms are shockable as well as

what you are supposed to do for for

example sbt

which drugs are you pushing etc etc

this is for this is if you are taking

the acls

class with the american heart


my name is bridget i have a master's

degree in nursing education

and i went back to graduate school in

order to become a family nurse

practitioner i am board certified i'm

going to start with a comprehensive

review and as we go on we'll focus more

on the

acls portion of it initially it's going

to be

the bls review too but you always want

to do

compression airway breathing so they

changed the recommendation from abcs a

while back

to cab which is compression airway and


compression first being the key there

you want to recognize an unresponsive


you check for responsiveness if no

response you proceed with the assessment

you activate 9-1-1 you get the aed

if help is around request their

assistance to activate 911 emergency


and get the aed you're going to check

for a pulse

this should take at least five seconds

but no

more than 10 seconds you should check

for breathing during this time

this is a test question like your pulse

check should take no more than 10

seconds that has been a question on


you want to check to see if they are


not breathing or not breathing normally

and agonal gasping is not considered a


that has also been on the exam and this

is not considered breathing

cpr sequence you want to start cpr

beginning with chest compressions

they always ask about the compression

rate you want to do at least 100 to 120

compressions a minute

with hand placement at the mid nipple


slash lower half of the breastbone

compression depth should be at least 2

inches but not more than 2.4

inches they love to ask about the

compression depth

as well this is another frequently

tested question

they ask about chest recoil you want to

allow for

full chest recoil between compressions

you don't want to just

think of if you're squeezing something

and you're not letting it

pump right it's only if you're squeezing

it if you're

compressing you're making the heartbeat

too fast so that whatever little blood

is in there

it's not it's barely squirting anything


so you want more to be pressed out in

order for more to be pressed out you

have to allow the

full chest to recoil so this will allow

for the heart to adequately

adequately refill between each


compression interruptions you want to

minimize interruptions and chest

compressions it is recommended that

interruptions be limited to less than 10


and rotate the person providing

compressions every two minutes if no

trauma is suspected you're going to


the head tilt chin lift if suspected


if no trauma you're going to utilize the


tilt chin lift if you suspect

trauma you utilize the jaw thrust

maneuver where you

you don't move the spine if there's

trauma so that you don't

risk injury and you just thrust

the jaw forward while the spine stays

in the same direction the compression to

ventilation ratio is 30 to 2

so for every 30 compressions you're

doing two breaths during single rescuer

or multiple rescuer cpr and this is for

adults ventilations with advanced airway

when an advanced airway is placed you

ventilate the patient

one time every six seconds for a total

of 10

per minute you always want to look for

visible rise of the chest

to confirm adequate ventilations


once an aed defibrillator is available

use it immediately immediately upon


start cpr beginning with chest


you immediately start you don't wait you


just start right away after you

defibrillate that actually rhymes

start right away after you defibrillate

i just made that up right there basic

life support for healthcare providers

high quality cpr will increase the

chance of victim survival

you want to start compressions

immediately after confirmation that a

patient has no pulse

so always no pulse boom boom boom we're


this should take a minimum of five

seconds but no more than 10 seconds to


there it is again i'm telling you that

is usually tested on no more than 10


compress at a rate of 100 to 120 per

minute for all

patients that's usually tested on two

the depth is tested on

push to a depth of 2 inches in a maximum

of 2.4

allow for full chest recoil provide

breaths until you see visible rise of

the chest

and all patients and you want to avoid

excessive ventilations as this can lead

to decreased blood flow

okay so with an aed which stands for

automated external defibrillator

you want to turn it on very important

turn the aed on you follow the prompts

honestly they make

these aeds very idiot proof when the aed

becomes available you use it

this is the only time that stopping cpr

is appropriate

mid two-minute cycle after this point

you will use the aed on the two minute

pause slash pulse check if the

aed analyzes and determines the victim

requires defibrillation

do so only after clearing all bystanders

and health care providers from the

victims so

we look around we say i'm clear you're

clear we're all clear

and then the shock will be delivered

immediately upon defibrillation

resume cpr beginning with chest


adult pads should be used on adult


the aed can be used for a patient lying

in snow

clear the victim's chest the aed

can be used on a victim submerged in


first remove the victim from the water

and wipe the victim's chest

a while back there was

so the rules have changed a little bit

with snow and water

ed can experience difficulty if the

victim's chest is hairy

when possible the victim's chest should

be shaved with a medical razor or

pads firmly placed to ensure chest

contact and there are razors in the aed

for you to do this foreign body airway


choking victims in a responsive choking


perform abdominal thrusts until the item


dislodged if the patient becomes

unresponsive assist the victim to the

floor carefully supporting their head

activate the emergency response system

and start cpr beginning with chest


so you're going to do the heimlich

essentially until

they pass out and once they pass out

then you're going to start cpr

for chest compressions we're telling you

the same thing over and over again

you always want to make sure the scene

is safe number one before you approach a


and you're going to remember that

typical you tap them on the shoulder

hello hello can you hear me

if the victim has no pulse and is not

breathing cpr is required

again in order for you to do cpr they

have to have

no pulse if you feel a pulse no

when assessing a pulse no longer than 10

seconds palpate a pulse on the adults on

the carotid artery either side right you

never want to palpate both sides because

you're shutting off

the circulation um and essentially that

you're making the situation worse

right so always when you check even when

you're a nurse or whatever

you're always assessing one carotid

artery at a time

right here i can feel mine so i'm gonna

go over on this side and i can feel my


palpate a pulse on palpate a pulse on

infants at the brachial artery underside

of the bicep so in infants you're going

to palpate the brachial artery

blood flow is needed to refuse the

patient's brain and vital arteries

this this is successful when we compress

to a depth of two inches on adult

all patients should receive 100 to 120

compressions per minute

remember to the song of a

that's how much you should be compressed


the rescuers providing chest compression

should alternate every

two minutes when one rescuer is

providing chest compressions the other

rescuer should be providing breaths

when performing chest compressions on an


single rescuer the two finger techniques

should be utilized

when performing chest compressions on an

infant to

rescuer the thumb encircling hands

technique should be utilized

compressions adult 30 compressions to

two breaths what you need to do with


if the patient has no suspected neck

injury you do the

head tilt chin maneuver if the patient

has a suspected neck injury

the jaw thrust maneuver i can't really

do it myself but you don't want to move


you just thrust the jaw open you don't

want to move the spine

when i used to work as a lifeguard we

would just do the jaw thrust maneuver

because we didn't want to risk with the

head tilt

chin lift to provide adequate breaths

the rescuer should

make best seal to the patient's nose and

mouth when providing breaths

if no method for safely providing

breaths is available

such as a bag mask device or a pocket


then hands only should then hands only

cpr should be used at a rate of 100 to

120 compressions per minute

that's interesting right so if you don't

have some kind of shield

you're only supposed to do cpr

with your hands suctioning of a patient

should be limited to less than 10


and an oropharyngeal airway should be

measured from the corner of the mouth

to the angle of the mandible to ensure

adequately size placement

breathing we've gone over visible rise

of the chest is a key

indicator that breaths are effective do

not provide

excessive ventilations it can cause

gastric inflation i do remember that

being part

of a question something about that

with an advanced airway in place

compressions are constant with no pauses

and ventilations are provided

once every not very once every six

seconds for all patients

continuous waveform capnography is the

preferred method

for monitoring the placement of an

endotracheal tube that is a test

question okay

so continuous waveform capnography

is the preferred method for monitoring

the placement of an

endotracheal tube not checking

the acidity or the ph of it

not other methods so the pet

co2 should should maintain above a

reading of 10

during cpr if the numerical reading


below 10 then it is assumed that chess

compressions are not

adequate cardiac arrest team dynamic


the structure or universal approach to

the cardiac arrest emergency

does not change regardless of profession

or setting

cpr should take place in two minute


allowing for approximately 5 cycles of

30 compressions to 2 ventilations

upon completion of a two-minute cpr


a pulse should be palpated for at least

five but no more than 10 seconds so

after doing cpr for two minutes

you track a pulse for at least five to

no more than 10 seconds

if you feel a pulse then post cardiac

care should be initiated if you don't

feel a pulse within 10 seconds

the rescuers should switch positions and

you start compressions again

if the patient requires defibrillation

cpr should be continued while the

defibrillator charges

as to minimize the interruptions when

the aed arrives at a cardiac arrest

incident it is the only acceptable

reason to stop

cpr the defibrillator slash aed should

be used immediately

immediately upon use of electricity or

confirmation that electricity will not

be used

cpr should be started beginning with


compressions i know this is dry material

i know

well now we're getting to the meat and

potatoes of the acls portion

what are shockable rhythms remember i


i actually did a video on this where i

played a beat

um but um so here's my little

here's how i remember what rhythms to


are you ready all right here we go

d fib for v fib and pulseless v attack

don't defib assistedly you won't get

them back

d fib for v fib and post v tech

don't defib assistantly you won't get

them back

so what are shockable rhythms pulseless

right d-fib for v-fib so we're

we're defibrillating ventricular

fibrillation and

d fib for v-fib and pulseless

tac don't defib a systole right that

straight line

beep that flat line we don't that

doesn't really work

so defibrillation if you have a biphasic

you're going to do 120 to 200 up to 360

monophasic you're going to do 360. what

are we giving drug therapy we're going

to give

epinephrine one milligram every three

to five minutes amiodarone

they like to test this too the first

time that you give amiodarone

for either vtoc that's pulseless or


your first dose would be 300 second dose

150 because the max dose is 450 all

right so you add these up

and you get 450 non-shockable rhythms

pea which is pulseless electrical


that's where it appears on a monitor

that these people have a rhythm but they

don't have a pulse

and that hence hence the term pulseless

electrical activity right

and asystole systole is literally that

flat line that beep

a sicily is what you will constantly see


on the movies hey hollywood if you need

some kind of medical consultant for your

movies to make your movies more

realistic i volunteer

so what are we giving for non-shockable

rhythms we're doing

epinephrine one milligram every three to

five minutes

kind of what you saw here right so epi

epinephrine one milligram every three to

five minutes

treat reversible causes you

i don't think on the exam they ask too

much about your h's and t's

it's good to know though if you work on


if you're in the ed or icu

but ages hypoxia hypovolemia hypothermia

hypokalemia hyperkalemia

acidosis white right are there too many

hydrogen ions

and then the t's are tension

pneumothorax toxins tablets thrombosis

cardiac tamponade return of rosk not

ross from friends i never really saw

that show

return of spontaneous circulation or

rosk not ross from friends

indication of life return of pulses so

you've done everything right you've got

this patient back

you want to immediately assess pulse and

ventilate appropriately

you want to begin fluid bolus of normal

saline to obtain a minimum bp of 90


approximately approximately fluid


is one to two liters of normal saline

dopamine two to ten micrograms per

kilogram per minute

for continued hypo tension epi

1.1 epi 0.1 to 0.5

micrograms per kilogram per minute for

continued hypotension

patients who receive patients who

achieve risk

should be transported to a coronary


capable facility cath lab and this is

usually on the test

90 minute this is usually in the exam 90


door to balloon time for known postcode

stemi patients

induced hypothermia

code cool right sometimes they call it

code cool induced hypothermia or

targeted temperature management should

be implemented

in hospital with a target range of 32 to

36 degrees celsius

for at least 24 hours do not begin

temperature management if the patient

is conscious or answering questions


acls medical emergencies thank you so

much for hanging till this point

okay bradycardia first degree

second degree type one type two and

third degree block right

for these kinds of rhythms so someone

has bradycardia if they have

first-degree second-degree heart block

type 1 type 2 third degree block you

want to assess the patient

treatment of symptomatic bradycardia

is atropine 0.5 milligrams every three

to five minutes

the max dose is three milligrams okay if

atropine is ineffective consider

transcutaneous pacing

uh consider dopamine two to twenty


happy five to ten mics okay so

the key word here is symptomatic

bradycardia okay

if they're asymptomatic a lot of times

we are just monitoring them

for svt or supra ventricular tachycardia

this is

above a rhythm that is above the

ventricle first thing we're going to

have them do is veil maneuvers just

then we do adenosine

look i don't know i have to make all of

this start to jumble together

so adenosine six milligrams you're going

to wait one to two minutes

so look you wait one to two minutes one

to two

12 is here and then the if not

conversion administer

if no conversion i think that should

read administer 12 milligrams so we give


first we wait one to two minutes and

then one to two together

is twelve i'm not saying one plus two is

twelve i'm saying

take this little hyphen away and it's

twelve i don't know

just silly things like that help me

remember it right or six plus six is

twelve so first we start small

we're giving adenosine six milligrams we

wait one to two minutes i don't know six

plus six is twelve you weigh one to two

i see the number 12 there

if no conversion you give 12 milligrams


svt persists seek expert consultation

if unstable perform synchronized

synchronized cardioversion 50 to 100

200 300 to 360. so with

brady we're doing transcutaneous pacing

with svt we're doing synchronized


for vtec with a pulse that's what's


vtec with a pulse we're giving

150 milligrams of amiodarone remember

the max of amiodarone was

450. for amiodarone we're giving

administer 150 milligrams of amiodarone


10 minutes if unstable perform

synchronized cardioversion if you do not

perform synchronized cardioversion you

could kill them

if it lands if the electrical shock


on the wrong time boom you just killed


afib you already have enough to learn

for this this is usually not tested in

acls so i'm just going to go ahead and

skip over it

a flutter it's telling me here not in

acls not in acls

the rhythms may be but not in regards to

what are we giving them

okay so for a possible stemi acute

coronary syndrome

you want to obtain a 12 lead ekg you're

going to give it 160 to 325 milligrams

of aspirin

you're going to administer nitro going

to administer nitroglycerin

caution if right ventricular ami is


caution if no use of sexual enhancement

drugs aka

viagra administer they could get extreme

hypotension by the way

because of the vasodilation effect

administer oxygen

administer morphine in two milligram

increments for pain relief

think of your mona b okay mona b

morphine oxygen nitroglycerin uh

aspirin and uh b for beta blocker now

so usually for acls they may only be

testing you on mona

but in real life now they're doing mona

b professor b

right here mono b and then

so you're gonna administer morphine in

two milligram increments for pain relief

morphine also helps decrease the

um cardiac demand of the heart so that's

how it helps

and you want to adopt a door to be and

this is often tested

the door to balloon time is 90 minutes

door to balloon time so by the time that

they're going in there that's what they


stroke perform cincinnati stroke scale


you want to alert the receiving hospital

as soon as possible

you want to perform a non-contrast test

ct with 25 minutes arrival ied

you want to start fibroanalytic therapy

if negative for hemorrhage obviously you

would never

do this if they're having a hemorrhagic


never ever ever you would make the

situation worse

team dynamics they always they may test

this at the end

it's kind of like the leftover open loop

communication is used to ask questions

during the resuscitation closed loop


is used to confirm repeat orders team

leaders are

important aspects as they have the

ability to address

team members immediately if an

intervention is incorrect and

orchestrate the entire emergency

situation and clearly delegate tasks

tasks should be directed based on scope

of practice

team members who cannot perform a task

should make the team leader aware

and request an alternate task role

and the medical emergency team or rapid


should be used as a resource if the

patient condition

is worsening not just as a means for

assistance during cardiac

arrest we see this all the time at the

hospital a patient is declining we may

not know what's going on

and we call rapid response i love rapid


okay that material was dry

i yes i admit um if you want a copy of

this powerpoint

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all right sayonara have a great day

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