ACLS Study Guide

Barbara J Aehlert, RN, BSPA, Southwest EMS Education Inc., Phoenix, AZ and Pursley, TX, USA

Pretest

Pretest Answers

PART I: PREPARATORY

1. The ABCDs of Emergency Cardiovascular Care

Introduction

Risk Factors for Coronary Artery Disease

Sudden Cardiac Death

Chain of Survival

- Early Recognition and Activation

- Early CPR

- Early Defibrillation

- Early Advanced Cardiac Life Support

- Integration of Post-Cardiac Arrest Care

Phases of Cardiopulmonary Resuscitation

Patient Assessment

- Scene Safety

- General Impression

- Primary Survey

- Secondary Survey

Stop and Review

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2. Airway Management: Oxygenation and Ventilation

Anatomy of the Respiratory System

- Upper Airway

- Lower Airway

Lung Volumes and Capacities

- Lung Volumes

- Lung Capacities

- Ventilation Rates

Devices for Assessing Oxygenation and Ventilation

- Pulse Oximetry

- Carbon Dioxide Monitoring

Oxygen Delivery Devices

- Nasal Cannula

- Simple Face Mask

- Partial Rebreather Mask

- Nonrebreather Mask

Manual Airway Maneuvers

- Head Tilt-chin Lift

- Jaw Thrust

- Jaw Thrust without Head Tilt

Suctioning

- Purpose of Suctioning

- Suction Catheters

- Upper Airway Suctioning

- Lower Airway Suctioning

Airway Adjuncts

- Oral Airway

- Nasal Airway

Techniques of Positive Pressure Ventilation

- Mouth-to-Barrier Device Ventilation

- Mouth-to-Mask Ventilation

- Bag-Mask Ventilation

Advanced Airways

- Esophageal-Tracheal Combitube

- King Laryngeal Tube Airway

- Laryngeal Mask Airway

- Tracheal Intubation

Stop and Review

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3. Rhythms and Management

Introduction

Section 1: Anatomy Review and Basic Electrophysiology

Coronary Arteries

Basic Electrophysiology

- Myocardial Cell Types

- Properties of Cardiac Cells

- Cardiac Action Potential

- Refractory Periods

- Conduction System

The Electrocardiogram

- Electrodes

- Leads

- Electrocardiogram Paper

- Waveforms and Complexes

- Segments and Intervals

Rhythm Recognition

- Sinus Rhythm

- Sinus Arrhythmia

Section 2: Tachydysrhythmias: Too Fast Rhythms

Narrow-QRS Tachycardias

- Sinus Tachycardia

- Atrial Tachycardia

- AV Nodal Reentrant Tachycardia

- AV Reentrant Tachycardia

- Junctional Tachycardia

Wide-QRS Tachycardias

- Intraventricular Conduction Defects

- Accelerated Idioventricular Rhythm

- Ventricular Tachycardia

Irregular Tachycardias

- Multifocal Atrial Tachycardia

- Atrial Flutter and Atrial Fibrillation

- Polymorphic Ventricular Tachycardia

Section 3: Bradydysrhythmias: Too Slow Rhythms

Sinus Bradycardia

- What Causes It?

- What Do I Do About It?

Junctional Escape Rhythm

- What Causes It?

- What Do I Do About It?

Ventricular Escape Rhythm

- What Causes It?

- What Do I Do About It?

Atrioventricular (AV) Blocks

- First-Degree AV Block

- Second-Degree AV Blocks

- Third-Degree AV Block

Section 4: Cardiac Arrest Rhythms

Ventricular Tachycardia

Ventricular Fibrillation

Asystole (Cardiac Standstill)

Pulseless Electrical Activity

The Resuscitation Team

- Goals of the Resuscitation Team

- Configuration of the Resuscitation Team

- Code Organization - "Phase Response"

- Helping the Caregivers

Stop and Review

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4. Electrical Therapy

Introduction

Defibrillation

- Definition and Purpose

- Energy, Voltage, and Current

- Monophasic versus Biphasic Defibrillation

- Transthoracic Impedance

- Defibrillation � Procedure

Automated External Defibrillators (AEDs)

- AED Features

- AED Operation

- Special Considerations

- Maintenance

Synchronized Cardioversion

- Description and Purpose

- Procedure

Defibrillation and Cardioversion

- Special Considerations

- Possible Complications

- Possible Errors

Transcutaneous Pacing

- Procedure

- Limitations

- Possible Complications

- Pacemaker Malfunction

Stop and Review

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5. Acute Coronary Syndromes

Introduction

Pathophysiology of Acute Coronary Syndromes

- Plaque Rupture

- Thrombus Development

- Coronary Artery Obstruction

- Other Causes of Acute Coronary Syndromes

Forms of Acute Coronary Syndromes

- Unstable Angina

- Myocardial Infarction

History and Clinical Presentation

- Patient History

- Typical Symptoms

- Anginal Equivalents

- Atypical Presentation

- Physical Examination

Patient Evaluation

- Electrocardiogram Findings

- Cardiac Biomarkers

- Imaging Studies

Initial Management of Acute Coronary Syndromes

- General Measures

- Analgesic and Anti-ischemic Therapy

- Antiplatelet Therapy

- Aspirin and Clopidogrel

- Glycoprotein IIb/IIIa Inhibitors

- Anticoagulant Therapy

- Percutaneous Coronary Intervention

- Fibrinolytic Therapy

- Coronary Artery Bypass Graft Surgery

Complications of Acute Myocardial Infarction

- Dysrhythmias

- Ventricular aneurysm

- Ventricular septal rupture

- Papillary muscle rupture

- Cardiac wall rupture

- Hypotension

- Ventricular Failure

- Pericarditis

- Embolic Complications

Stop and Review

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6. Acute Stroke

Objectives

Introduction

Stroke Facts

Classification of Stroke by Anatomic Location

Ischemic and Hemorrhagic Stroke

- Ischemic Stroke

- Hemorrhagic Stroke

Stroke Chain of Survival

- Detection

- Dispatch

- Delivery

- Door

- Data

- Decision

- Drug

- Disposition

Stop and Review

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PART II: CASE STUDIES

Case 1: Respiratory Arrest

Case 2: Pulseless Ventricular Tachycardia/Ventricular Fibrillation with an AED

Case 3: Pulseless Ventricular Tachycardia/Ventricular Fibrillation

Case 4: Asystole

Case 5: Pulseless Electrical Activity

Case 6: Acute Coronary Syndromes

Case 7: Symptomatic Bradycardia

Case 8: Unstable Tachycardia� NEW!

Case 9: Stable Tachycardia� NEW!

Case 10: Acute Ischemic Stroke� NEW!

Posttest

- Posttest Answers

Answer Appendix

Glossary