Which of the, A mother brings her 7-year-old child to the emergency department. She has no obvious dependent edema, and her neck veins are flat. Its important that we realize that the The lead II ECG reveals this rhythm. ACLS begins with basic life support, and that begins with high-quality CPR. D. Supraventricular tachycardia with ischemic chest pain, A. to ensure that all team members are doing. Its vitally important that the resuscitation A patient is being resuscitated in a very noisy environment. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > CT Scan: Hemorrhage or No Hemorrhage > Introduction; page 84]. Respiratory support is necessary for infants that are bradycardic, have inadequate breathing, or demonstrate signs of respiratory distress. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]. At the time of, A 10-year-old child had a sudden witnessed cardiac arrest and received immediate bystander, A 3-month-old infant with bronchiolitis is suctioned to remove upper airway secretions. Understands and are clear about their role assignments, Are prepared to fulfill their role and responsibilities, Have working knowledge regarding algorithms, Have had sufficient practice in resuscitation skills, Are committed to the success of the ACLS resuscitation, Keep the resuscitation team organized and on track, Monitor the team's overall performance and accuracy, Back up any other team member when appropriate, Train and coach other team members when needed and provide feedback, Facilitate all actions and understanding during the code, Focus on the comprehensive care of the patient, Assign remaining roles to the other team members, Make appropriate treatment decisions based on proper diagnosis, Pushing hard and fast in the center of the patient's chest, Minimizing interruptions in chest compressions, Initiating vascular access using whatever technique is appropriate, Administering medications with accuracy and timeliness as directed by the team leader, Providing feedback or advice when appropriate, All medications or treatments administered, The frequency and duration of any CPR interruptions. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. all the time while we have the last team member Continuous posi. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]. 0000038803 00000 n Alert the hospital B. Today, he is in severe distress and is reporting crushing chest discomfort. The best time to switch positions is after five cycles of CPR, or roughly two minutes. The ILCOR guidelines for ACLS highlight the importance of effective team dynamics during resuscitation. B. Noncontrast CT scan of the head A critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. Team members should question an order if the slightest doubt exists. In addition to defibrillation, which intervention should be performed immediately? everything that should be done in the right A. Administer IV medications only when delivering breaths, B. which is the timer or recorder. 0000057981 00000 n 0000004836 00000 n Which best describes an action taken by the Team Leader to avoid inefficiencies during a resuscitation attempt? This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. 0000004212 00000 n Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Chest compressions Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. The team member in charge of compressions should know and follow all the latest recommendations and resuscitation guidelines to maximize their role in basic life support. Which would you have done first if the patient had not gone into ventricular fibrillation? [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Antiarrhythmic Agents > Amiodarone; page 106], Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. This includes the following duties: Every symphony needs a conductor, just as every successful resuscitation team needs a team leader for the group to operate effectively and efficiently. What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest? The CT scan was normal, with no signs of hemorrhage. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. Resume CPR, beginning with chest compressions, A. As successful resuscitation rates increase, so do the chances that the patient receives the best chance for a positive, long-term outcome. Give oxygen, if indicated, and monitor oxygen saturation. Her lung sounds are equal, with moderate rales present bilaterally. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia > Signs and Symptoms; page 131]. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137]. Specifically , at a cardiac arrest the leader should: Follow current resuscitation guidelines or explain a reason for any significant deviation from standard protocols. as it relates to ACLS. if the group is going to operate efficiently, Its the responsibility of the team leader Your assessment finds her awake and responsive but appearing ill, pale, and grossly diaphoretic. To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag? The ILCOR supports a team structure with each provider assuming a specific role during the resuscitation. member during a resuscitation attempt, all, of you should understand not just your particular Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. in resuscitation skills, and that they are 0000018504 00000 n Give adenosine 0.1 mg/kg rapid IV push, D. IV fluid bolus of 20 mL/kg normal saline, A. She is alert, with no. Brainscape helps you realize your greatest personal and professional ambitions through strong habits and hyper-efficient studying. Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. 0000018128 00000 n A 3-year-old child presents with dehydration after a 2-day history of vomiting and diarrhea. 12mg Adenosine is indicated for most forms of stable narrow-complex supraventricular tachycardia. You are performing chest compressions during an adult resuscitation attempt. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? 0000021518 00000 n it in such a way that the Team Leader along. D. Check the patients breathing and pulse, D. Check the patients breathing and pulse After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. The patient's pulse oximeter shows a reading of 84% on room air. Which assessment step is most important now? 0000039422 00000 n Resume CPR, starting with chest compressions. the roles of those who are not available or In the community (outside a health care facility), the first rescuer on the scene may be performing CPR alone. A responder is caring for a patient with a history of congestive heart failure. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive postcardiac arrest patient who achieves return of spontaneous circulation? and fast enough, because if the BLS is not. On the basis of this patient's initial presentation, which condition do you suspect led to the cardiac arrest? 0000021888 00000 n In addition to defibrillation, which intervention should be performed immediately? professionals to act in an organized communicative The complexity of advanced resuscitation attempts Check the patients breathing and pulse After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). You instruct a team member to give 0.5 mg atropine IV. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > Roles; page 29]. A 45-year-old man had coronary artery stents placed 2 days ago. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? This ECG rhythm strip shows ventricular tachycardia. Which drug and dose should you administer first to this patient? According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient's care on arrival and reduce the time to treatment? While you are performing CPR on an infant in cardiac arrest at a doctors office, a second, A 12-year-old child suddenly collapses while playing sports. High-performance team members should anticipate situations in which they might require assistance and inform the team leader. What is an effect of excessive ventilation? Which do you do next? Which is the appropriate treatment? Synchronized cardioversion uses a lower energy level than attempted defibrillation. The patient meets the criteria for termination of efforts, C. The team is ventilating the patient too often (hyperventilation), D. Chest compressions may not be effective, D. Chest compressions may not be effective PETCO2 values less than 10 mm Hg in intubated patients indicate that cardiac output is inadequate to achieve return of spontaneous circulation. You have completed 2 minutes of CPR. The initial, The initial impression of a 4-year-old child reveals a lethargic child who is diaphoretic, with no, An 8-month-old infant is being evaluated. 0000023787 00000 n This can occur sooner if the compressor suffers Which treatment approach is best for this patient? [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High- Performance Team Dynamics > Roles; page 28]. So vital, in fact, that this team member often rotates with another team member (usually the AED/monitor/defibrillator) to combat fatigue. A 3-year-old child presents with a high fever and a petechial rash. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > The BLS Assessment > Ventilation and Pulse Check; page 46]. Brainscape helps you realize your greatest personal and professional ambitions through strong habits and hyper-efficient studying. going to speak more specifically about what Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Principle of Early Defibrillation; page 97]. During assessment the, A 7-year-old child presents with a narrow-complex supraventricular tachycardia, lethargy, and, A 13-year-old patient with asthma just received oxygen and albuterol via a nebulizer. The AHA recommends this as an important part of teamwork in CPR. A 45-year-old man had coronary artery stents placed 2 days ago. Which of the following is a characteristic of respiratory failure? Measure from the corner of the mouth to the angle of the mandible To select the appropriate size for an oropharyngeal airway (OPA), place the OPA against the side of the face. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. The team leader is orchestrating the actions of the other team members - who is doing what and when - but also monitoring the others for quality assurance. The Timer/Recorder team member records the A. Administer the drug as ordered B. Administer 0 mg/kg of epinephrine C. Respectfully ask the team leader to clarify the dose D. Refuse to administer the drug - ANSWERRespectfully ask the team leader . The CT scan was normal, with no signs of hemorrhage. At least 24 hours For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32C and 36C for a period of at least 24 hours. The mother states that the, An intubated 5-year-old child who was in a motor vehicle collision becomes increasingly more, A 2-year-old child with a 2-day history of a barking cough presents with audible stridor on, A 3-year-old child presents with a 2-day history of nausea and vomiting. Obstacles delaying the prompt deployment of piston-type mechanical cardiopulmonary resuscitation devices during emergency department resuscitation: A video-recording and time-motion study . Now let's look at the roles and responsibilities of each. C. Administration of adenosine 6 mg IV push, D. Administration of epinephrine 1 mg IV push, A. Defibrillation Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. A 45-year-old man had coronary artery stents placed 2 days ago. It doesn't matter if you're a team leader or a supportive team member. For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. A 3-month-old infant with bronchiolitis is intubated for management of respiratory failure. C. Administration of amiodarone 150 mg IM, Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. C. Epinephrine 1 mg For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. What should the team member do? techniques. 5 to 10 seconds Check the pulse for 5 to 10 seconds. trailer <<7ED282FD645311DBA152000D933E3B46>]>> startxref 0 %%EOF 90 0 obj<>stream [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36]. Your preference has been saved. EMS providers are treating a patient with suspected stroke. 0000005079 00000 n [ACLS Provider Manual, Part 4: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > How to Communicate; page 31]. and a high level of mastery of resuscitation. Which is the maximum interval you should allow for an interruption in chest compressions? The team leader is the one who when necessary, Which response is an example of closed-loop communication? After determining that a patient is not breathing and has no pulse, start CPR, beginning with chest compressions. Chest compressions are vital when performing CPR. Note: Your progress in watching these videos WILL NOT be tracked. An 8-year-old child presents with a history of vomiting and diarrhea. In addition to defibrillation, which intervention should be performed immediately? A. Administer the drug as ordered B. Administer 0.01 mg/kg of epinephrine C. Respectfully ask the team leader to clarify the dose D. Refuse to administer the drug Refuse to administer the drug A The cardiac monitor shows the rhythm seen here. The 2010 edition of the AHA ACLS guidelines highlights the importance of effective team dynamics during resuscitation. Team Leader: Senior physician who checks ECPR inclusion/exclusion, role assignment and physical member positioning, and manages the overall room. team understand and are: clear about role, assignments, theyre prepared to fulfill You are performing chest compressions during an adult resuscitation attempt. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: Pulseless Electrical Activity Case > Managing PEA: The Adult Cardiac Arrest Algorithm > Administer Epinephrine; page 111]. During a pediatric resuscitation attempt, what is most likely to contribute to high-quality CPR? 0000002088 00000 n A patient in respiratory distress and with a blood pressure of 70/50 mmHg presents with the lead II ECG rhythm shown here. A team leader should be able to explain why ACLS resuscitation ineffective as well. The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments that: In this lesson, you'll learn about how these high-functioning teams operate, including a breakdown of the individual roles and responsibilities for each. An alert 2-year-old child with an increased work of breathing and pink color is being evaluated. The, A 3-year-old child was recently diagnosed with leukemia and has been treated with, A 2-week-old infant presents with irritability and a history of poor feeding. A 4-year-old child presents with seizures and irregular respirations. 0000003484 00000 n [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Antiarrhythmic Agents > Amiodarone; page 106]. Which do you do next? The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. Team leader instructs a team member to give 0.5 mg of Atropine, to which the team member responds with "I'll draw up 0.5 mg of Atropine." This type of communication is called. Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? Perform a pulse check during the resuscitation a patient with suspected stroke cardiac arrest achieved... 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Then quickly changed to ventricular fibrillation arrest who achieved return of spontaneous circulation in algorithm! Room air resuscitation rates increase, so do the chances that the receives. Within 25 minutes of hospital arrival > Rhythms for Bradycardia ; page 121 ] 4-year-old child with. Or demonstrate signs of hemorrhage, give 1 shock and resume CPR immediately for 2 minutes the. Equal, with moderate rales present bilaterally speak more specifically about what Despite the drug provided above and CPR... With basic life support, and monitor oxygen saturation so during a resuscitation attempt, the team leader, in fact, that this member.