BLS/ACLS Algorithm Review

Question 1

First 3 steps of BLS

Answer 1

• verify scene safety
• check responsiveness
• shout for help, activate emergency response system

Question 2

The 4th step of BLS is dependent on the age, if they are an adult then…..
If they are a child then….

Answer 2

….Get AED if alone or otherwise send another to get it

….Immediately start 2 min CPR compressions first before going to get an AED

Question 3

The 5th step of BLS is to do what?

Answer 3

Assess the breathing and pulse at the same time WITHIN 10 seconds, and depending on assessment of these determines the next directional step of the algorithm

Question 4

If a patient after the 5th step of BLS assessment has pulse and breathing, what should be done?

Answer 4

Wait with patient

Question 5

If a patient after 5th step of BLS assessment has a pulse but no breathing, what should be done?

Answer 5

Provide rescue breaths every 5-6 seconds in adults or 3-5 seconds in kids, and check the pulse the next 2 minutes to see if it goes away, consider moving to the opioid overdose algorithm if suspected

Question 6

If a patient after the 5th step of BLS assessment has no pulse and no breathing, what should be done?

Answer 6

CPR 30 compressions 100-120bpm and 2 breaths (head tilt or jaw thrust) 5-6 seconds each in adults or 15 compressions 100-120bpm and 2 breaths 3-5 seconds each in children, move into the primary survey and repeat CPR until AED arrives

Question 7

Primary survey BLS (ABCDE)

Answer 7

Airway (Maintain airway patency using assisted airway device if needed and secure it, ensure continuous quantitative waveform capnography (CO2 35-45), use adjuncts as necessary (OPA,NPA, suctioning))
Breathing (Give supplemental O2, 100% for arrest, titrate to at least 94% otherwise, agonal gasps don’t cout as breathing)
Circulation (Obtain IV/IO access, check blood glucose/temp/caprefill/BP (90 systolic at least))
Disability (Assess pupils and neuralogic functioning, look for AVPU (alert, voice, pain, unresponsive))
Exposure (Remove clothing look for bleeding/trauma/burns/bracelets)

Question 8

In BLS, once the AED arrives, what is the next 2 steps to take?

Answer 8

• Turn it on

- Place pads avoiding hairy chest or wet conditions

Question 9

Secondary survey ACLS (SAMPLE)

Answer 9

Signs/symptoms
Allergies
Medications
PMH
Last meal/liquid
Events leading up to

Question 10

5 H’s and T’s of ACLS

Answer 10

Hypovolemia
Hypoxia
H+
Hypo/erkalemia
Hypothermia

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)

Question 11

In ACLS AED use, if the rhythm is analyzed to be shockable, then what 2 rhythms could it be?

Answer 11

• Ventricular fibrillation

- Pulseless ventricular tachycardia

Question 12

After shocking with the AED initially in ACLS, what should be done? What about on the next five consecutive repeats?

Answer 12

• CPR 2 min, then analyze if the rhythm is shockable or not again
• CPR 2 min +1mg epi every 3-5 min IV/IO then analyze if the rhythm is shockable or not again
• CPR 2 min + 300mg bolus amiodarone IV/IO then analyze if the rhythm is shockable or not again
• CPR 2 min +1mg epi every 3-5 min IV/IO then analyze if the rhythm is shockable or not again
• CPR 2 min + 150mg bolus amiodarone IV/IO then analyze if the rhythm is shockable or not again
• CPR 2 min +1mg epi every 3-5 min IV/IO then analyze if the rhythm is shockable or not again

Question 13

In ACLS AED use, if the rhythm is analyzed to be not shockable, then what 2 rhythms could it be?

Answer 13

• Asystole

- Pulseless Electrical Activity (PEA)

Question 14

After a rhythm is analyzed not to be shockable in ACLS (either initial AED determination, switch from a previously shockable rhythm, or failure of signs of ROSC), what should be done? What should be done the next 2 times?

Answer 14

• CPR 2 min +1mg epi every 3 min IV/IO
• CPR 2 min
• if no signs of ROSC repeat the first

Question 15

Upon obtaining ROSC, what is the next steps that should be taken? (3)

Answer 15

• Get o2 to >94%
• Get SBP >90mmHg
• Get 12 lead EKG and analyze

Question 16

Upon ROSC EKG analysis, if a STEMI is present, what is done? After this, or if no STEMI is present, what is done?

Answer 16

Coronary reperfusion, check if the patient can follow commands

Question 17

Upon ROSC checking if the patient can follow commands, if they cannot what should be done initally? After this, or if they can, what should be done?

Answer 17

• Temperature therapy

- Advanced critical care admission

Question 18

In ACLS AED use, if bradycardia (BPM<50) is found, what should be done?

Answer 18

Ask is the patient stable, if yes then monitor O2, IV/IO, BP, and 12 lead EKG, if not administer atropine .5mg bolus every 3-5 min max 3 mg, if still not stable do dopamine infusion 2-10mcg/kg/min, if still not stable consult an expert

Question 19

In ACLS AED use, if tachycardia (BPM>150) is found, what should be done?

Answer 19

If stable, get a 12 lead EKG and begin performing vagal maneuvers, if no, immediate synchronized cardioversion (if narrow regular complex 50-100J, narrow irregular 120-200 J)

Question 20

In ACLS AED use, if stable tachycardia does not resolve with vagal maneuvers, after getting an EKG what should be done?

Answer 20

Ask if it is a wide QRS >.12 sec complex, if wide then give amiodarone 150mg/10min, if narrow do adenosine 6mg IV push, and possibly 2nd dose 12mg

Question 21

What is the 4 steps of the opioid OD ACLS algorithm

Answer 21

• Begin CPR
• administer naloxone 2mg intranasal or .4 IM
• repeat after 4 minutes
• if patient does not respond then begin CPR in the BLS algorithm (if does, stimulate and reasses)

Question 22

What are the 7 steps of the ACLS acute coronary syndrome algorithm

Answer 22

• when suspected clinically, begin O2 to get to 94%
• Gain IV access 2 ports
• 12 lead EKG
• Aspirin 125mg chewable unless GI bleed or true allergy
• Sublingual nitroglycerin every 3-5 min unless RV infarct, hypotension, or PDE5 use (can use morphine alternatively)
• Notify cath lab (if none then give tPA in 30 min)
• Order CXR and troponin levels

Question 23

What are the 7 steps of the ACLS stroke algorithm

Answer 23

• Suspect with facial droop, arm drift, or slurred speech (cincenati stroke scale)
• Find out last known normal
• supportive care
• Within 10 min get stroke team mobilized and CT
• Perform NIH assessment
• If patient doesn’t qualify for ischemia give aspirin
• If does qualify for ischemia give tPA fibrolytic therapy within 3 hours of last known normal