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BASIC AND ADVANCED LIFE SUPPORT UPDATED VERSION
- 1. BLS ACLS DR.MANEENDRA MD FNB EDICCCIDC CHCQM COSULTANT AND HOD CRITICAL CARE DEPARTMENT GLOBAL HOSPITAL,LKP and
- 3. CLINICAL SCENARIO You arewaiting for a bus in bus stop, suddenly a person beside you becomes unresponsive and falls down 25 year male patient admitted with dengue fever in your ward with a platelet count of 40000, goes to washroom becomes unresponsive and falls down 30 year male smoker, COPD admitted with a CAP four days back intubated in ER itself and started on BL/BLI and macrolide combination. Clinical condition improved was planned for a discharge next morning. Suddenly patient becomes unresponsive in the early morning at 5am BLS ACLS DRUGS
- 4. BLS OR ACLS: TIMING MOST IMPORTANT
- 5. SEQUENCE OF EVENTS INOHCA and IHCA
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- 7. BLS WHAT IS ANAED? WHAT IS SHOCKABLE RHYTHM? HOW DOES A SHOCK HELP IN CARDIAC ARREST?
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- 9. Sudden cardiac arrest 1.Ventricular fibrillation 2. pulseless ventricular tachycardia 3. Asystole 4. pulseless electrical activity SHOCKABLE
- 10. Effect of shock –It just stops the heart – Effectively SA node takes over and restarts a normal sinus rhythm what is SA node? What is conducting system of heart? How does conducting system influence the ECG?
- 11. CONDUCTING SYSTEM & ECG ECG interpretationis guided by three questions: 1. Is the rhythm fast or slow? 2. Are the QRS complexes wide or narrow? 3. Is the rhythm regular or irregular
- 13. Proper position ofrescuer: shoulders directly over victim's sternum; elbows locked
- 14. Head-Tilt Chin-Lift (No neck injurysuspected)
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- 16. HIGH QUALITY CPR Changesin 2015 : Chest compressions at 100 – 120 /min Depth of 2 inches maximum 2.5 inches Do not lean on patient in between compressions
- 17. Defibrillation bundle 1. Attachand charge the defibrillator while continuing HQ CPR. 2. Stop compressions and assess rhythm (should take no more than 5 seconds). 3. If VF or VT is present, deliver shock; if non- shockable rhythm is present, resume HQ CPR. 4. Resume HQ Chest compressions immediately after the shock is delivered.
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- 21. Antiarrhythmics in VF andpulseless VT – no particular timing – Amiodarone (300 mg IV with a repeat dose of 150 mg IV as indicated) may be administered in VF or pulseless VT unresponsive to defibrillation. – Lidocaine (1 to 1.5 mg/kg IV, then 0.5 to 0.75 mg/kg every 5 to 10 minutes) if amiodarone is unavailable. – Magnesium sulfate (2 g IV, followed by a maintenance infusion) may be used to treat PMVT consistent with torsade de pointes . – not recommended for routine use in adult cardiac arrest patients
- 22. DRUGS REMOVED FROM ACLS ATROPINEIN 2013 VASOPRESSIN IN 2015
- 23. 5Hs and 5Tsof ACLS Hypoxia Tension pneumothorax Hypovolemia Tamponade Hydrogen ions (acidosis) Toxins Hypo/hyper kalemia Thrombosis - MI hypothermia Thrombosis - PE
- 27. 1)Early Morning Aftera Night Duty At 5:00 AM, Suddenly Patients Attenders Comes to you and say her Patient ‘ X’ Is not Responding what is your First Step? a)Activate Code Blue Team b)Connect Defibrillator c)Check for Pulse d)Start Chest Compressions
- 28. 2. when yousee a Patient unresponsive, you should palpable for carotid pulse. What is recommended duration for palpating pulse? a) < 5 sec b) <10sec c) <15 sec d) <20 sec
- 29. 3.An adult patientin respiratory arrest with a pulse is ventilated via bag valve mask ? a)8 to 10 times per minute b)10 to 12 times per minute c)12 to 14 times per minute d)14 to 16 times per minute
- 30. 4. Chest compressionsfor an adult are performed ? a)At a rate between 60 and 80 compressions b)At a rate of at least 80 compressions per minute c)At a rate between 80 and 100 compressions per minute d)At a rate between 100 and 120 compressions per minute
- 31. 5.The ratio ofcompressions to breaths in adults is ? a)15:1 b)10:2 c)20:2 d)30:2
- 32. 6. All areQualities of Effective Chest Compressions Except? a)Hard and Fast b) Depth Of 2 Inches- 2.5 Inches c)Allow Adequate Recoil d)Hyperventilation
- 33. 7.The effectiveness ofCPR can be estimated by ? a)Arterial diastolic blood pressure b)Quantitative waveform capnography c)Central venous oxygen saturation d)All of the above
- 34. 10. Which ofFollowing is a Shockable Rhythm? a) PEA b) VT c) Asystole D) VF Sudden cardiac arrest 1. Ventricular fibrillation 2. pulseless ventricular tachycardia 3. Asystole 4. pulseless electrical activity
- 35. 11. What arethe types of shock a) Cardioversion b) Defibrillation c) Both d) None of the above
- 36. 12. What willshock do to the heart a) Restarts the heart b) Stops the heart c) Improves contractility d) None of the above
- 37. 13. What isCardio-Version ? A)Synchronized Defibrillation B) Asynchronized Defibrillation C) Any of Above D) None of Above
- 38. 14. In cardio-Version, We Synchronize Shock with Which part of ECG? a)P Wave b)QRS Wave c) T Wave d) R Wave
- 39. 15. which Defibrillatoris less Harmful to Patients? A) Biphasic B) Monophasic C) Triphasic D) All are same as we Deliver Shock with all
- 40. 16. Which offollowing Drugs is Not used for cardiac arrest patient as per Latest AHA Guidelines? a)Atropine b)Vasopressin c) Both d) None ATROPINE IN 2013 VASOPRESSIN IN 2015
- 41. 17. The correctsequence for basic life support is ? A)ABC - Airway, Breathing, Compressions B)ACB - Airway, Compressions, Breathing C)BCA - Breathing, Compressions, Airway D)CAB - Compressions, Airway, Breathing
- 42. 18. Pulse lesselectrical activity is treated with _______? a)Epinephrine b)Magnesium c)Atropine d) Unsynchronized cardio version
- 43. 19. Recommended EDdoor to balloon inflation time for a STEMI patient is ? A)No longer than 15 minutes B)No longer than 30 minutes C)No longer than 60 minutes D)No longer than 90 minutes
- 44. 20. An EMTdiscovers STEMI on a 12-lead ECG in the ambulance. The best option is to? a) Take the patient to a hospital capable of providing open-heart surgery, regardless of fibrinolysis or PCI capability b) Take the patient to a hospital capable of providing fibrinolysis only (not PCI), 5 minutes away c) Provide fibrinolysis in the ambulance then take the patient to a hospital capable of providing PCI, 15 minutes away d) Take the patient to a hospital capable of providing PCI, 15 minutes away.
- 45. 21. During cardiopulmonaryresuscitation, deliver oxygen at:? A)2 liters per minute via nasal cannula B)Titrated to keep oxygen saturation ≥ 85% C)Titrated to keep oxygen saturation ≥ 94% D)100%
- 46. 22. You arethe paramedic on an ambulance transporting a 65-year-old female. The patient is connected to the monitor and you see this rhythm; she has a palpable pulse. What is the rhythm? A)Sinus bradycardia B)Sinus rhythm C)PEA D)Second degree heart block
- 47. 23. True orFalse: The initial recommended dosage of atropine for symptomatic bradycardia is 0.5 mg IV.? a)TRUE b)FALSE
- 48. 24. The mostcommon reversible causes of PEA are called the "H's and T's" and include all of the following EXCEPT? A)Hypovolemia B)Hypoxia C)Hypocalcemia D)Tamponade Hypoxia Tension pneumothorax Hypovolemia Tamponade Hydrogen ions (acidosis) Toxins Hypo/hyper kalemia Thrombosis - MI hypothermia Thrombosis - PE
- 49. 25. The goalfor initiation of fibrinolytic therapy in appropriate stroke patients is? a)Within 4 hours of arrival to the ED b) Within 6 hours of arrival to the ED c) Within 3 hours of arrival to the ED d)Within 1 hour of arrival to the ED
- 50. 26. Hypotension followingcardiac arrest is NOT treated with ? a)IV calcium infusion b)IV dopamine infusion c)IV epinephrine infusion d)IV Ringer’s lactate or IV normal saline
- 51. 27. The leaderin team resuscitation must ? a)Be able to perform all the skills if needed b)Be certified as a leader c)Be a physician d)Undergo leadership training
- 52. IF THERE ISSOMEONE BECAUSE OF WHOM A DOCTOR LIVES A COMFORTABLE LIFE ITS YOU GUYS THANK YOU……