BASIC AND ADVANCED LIFE SUPPORT UPDATED VERSION

BLS AND ACLS

1. BLS ACLS DR.MANEENDRA MD FNB EDIC CCIDC CHCQM COSULTANT AND HOD CRITICAL CARE DEPARTMENT GLOBAL HOSPITAL,LKP and

2. CLINICAL SCENARIO You are waiting 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

3. BLS OR ACLS : TIMING MOST IMPORTANT

4. SEQUENCE OF EVENTS IN OHCA and IHCA

5. BLS

6. BLS WHAT IS AN AED? WHAT IS SHOCKABLE RHYTHM? HOW DOES A SHOCK HELP IN CARDIAC ARREST?

7. AED VS DEFIB

8. Monophasic vs biphasic defibrillator

9.  Sudden cardiac arrest Ventricular fibrillation pulseless ventricular tachycardia  Asystole 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 interpretation is guided by three questions: Is the rhythm fast or slow? Are the QRS complexes wide or narrow? Is the rhythm regular or irregular

12. BLS

13. Proper position of rescuer: shoulders directly over victim's sternum; elbows locked

14. Head-Tilt Chin-Lift ( No neck injury suspected) ‏

15. Jaw Thrust (Suspected Spinal Injury) ‏

16. HIGH QUALITY CPR Changes in 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 Attach and charge the defibrillator while continuing HQ CPR. Stop compressions and assess rhythm (should take no more than 5 seconds). If VF or VT is present, deliver shock; if non-shockable rhythm is present, resume HQ CPR. Resume HQ Chest compressions  immediately  after the shock is delivered.

18. Electrode Position

19. ACLS

20. Antiarrhythmics in VF and pulseless 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

21. DRUGS REMOVED FROM ACLS ATROPINE IN 2013 VASOPRESSIN IN 2015

22. 5Hs and 5Ts of ACLS Hypoxia Tension pneumothorax Hypovolemia Tamponade Hydrogen ions (acidosis) Toxins Hypo/hyper kalemia Thrombosis - MI hypothermia Thrombosis - PE

23. 1)Early Morning After a 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

24. 2. when you see 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

25. 3 .An adult patient in 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

26. 4 . Chest compressions for 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

27. 5 .The ratio of compressions to breaths in adults is ? a)15:1 b)10:2 c)20:2 d)30:2

28. 6. All are Qualities of Effective Chest Compressions Except? a )Hard and Fast b ) Depth Of 2 Inches- 2.5 Inches c )Allow Adequate Recoil d )Hyperventilation

29. 7.The effectiveness of CPR can be estimated by ? a )Arterial diastolic blood pressure b )Quantitative waveform capnography c )Central venous oxygen saturation d )All of the above

30. 10. Which of Following is a Shockable Rhythm? a) PEA b) VT c) Asystole D) VF  Sudden cardiac arrest Ventricular fibrillation pulseless ventricular tachycardia  Asystole pulseless electrical activity

31. What are the types of shock Cardioversion Defibrillation Both None of the above

32. 12. What will shock do to the heart Restarts the heart Stops the heart Improves contractility None of the above

33. 13. What is Cardio-Version ? A)Synchronized Defibrillation B) Asynchronized Defibrillation C) Any of Above D) None of Above

34. 14. In cardio-Version , We Synchronize Shock with Which part of ECG? a)P Wave b)QRS Wave c) T Wave d) R Wave

35. 15. which Defibrillator is less Harmful to Patients? A) Biphasic B) Monophasic C) Triphasic D) All are same as we Deliver Shock with all

36. 16. Which of following 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

37. 17. The correct sequence 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

38. 18 . Pulse less electrical activity is treated with _______? a)Epinephrine b)Magnesium c)Atropine d) Unsynchronized cardio version

39. 19. Recommended ED door 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

40. 20 . An EMT discovers 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 .

41. 21 . During cardiopulmonary resuscitation, 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%

42. 22 . You are the 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

43. 23 . True or False: The initial recommended dosage of atropine for symptomatic bradycardia is 0.5 mg IV.? a)TRUE b)FALSE

44. 24. The most common 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

45. 25. The goal for 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

46. 26. Hypotension following cardiac 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

47. 27. The leader in 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 

48. IF THERE IS SOMEONE BECAUSE OF WHOM A DOCTOR LIVES A COMFORTABLE LIFE ITS YOU GUYS THANK YOU……