Last updated: July 28, 2021 Show
Version control: Our ACLS, PALS & BLS courses follow 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association guidelines are updated every five years. If you are reading this page after December 2025, please contact for an update. Version 2021.01.c To test for stroke probability, instruct the patient to show their teeth or smile. Evaluate for facial droop. It is abnormal if one side of the face does not move as well as the other. Next, evaluate arm drift. Instruct the patient to close their eyes and extend both arms straight out, with the palms up for 10 seconds. It is abnormal if one arm does not move or one arm drifts down compared with the other. Third, evaluate for abnormal speech. Have the patient say “you can’t teach an old dog new tricks.” It is abnormal if the patient slurs words, uses the wrong words, or is unable to speak. If any one of the 3 signs is abnormal, the probability of a stroke is 72%. PDF VersionPrint PDF Order the full set of printed crash cart cards Identify signs and symptoms of a possible stroke and activate the emergency response system. Pre-hospital interventions by EMS will focus on supporting ABCs and giving oxygen if indicated, performing a prehospital stroke assessment using an approved tool such as the Cincinnati Stroke Scale, checking glucose, establishing time of symptom onset (or last seen normal), triaging to a stroke center, and alerting the hospital to activate the stroke team. Within 10 minutes of ED arrival perform immediate general assessment within 10 minutes of patient arrival to the ED and stabilize ABCs if necessary. Provide oxygen therapy if hypoxic. Obtain IV access and perform laboratory assessments. Check glucose and treat if indicated. Obtain a 12-lead ECG and perform neurologic screening assessment. Do not delay CT, obtain CT without contrast within 20 minutes of patient arrival. A neurologic assessment by the stroke team or designee should be done within 20 minutes of patient arrival to the ED. Review patient history, establish the time of symptom onset or last known normal, and perform a neurological examination using a standardized tool such as the NIH Stroke Scan or Canadian Neurological Scale. If the CT scan shows hemorrhage, consult a neurologist or neurosurgeon and consider a transfer. Begin stroke or hemorrhage pathway. Admit to a stroke unit or intensive care. If the CT scan shows no hemorrhage, consider fibrinolytic therapy. Check the fibrinolytic exclusions, repeat the neurologic exam to determine if symptoms are improving or worsening. Candidates with the onset of symptoms within 3 hours or 4.5 hours in selected patients are eligible. If the patient is a candidate for rTPA review the risks and benefits with the patient and family. Begin fibrinolytic therapy within 60 minutes of patient arrival to the ED. Consider endovascular therapy for the onset of symptoms up to 24 hours and large vessel occlusion. Admit the patient to stroke care within 3 hours of arrival to the ED. Begin post-rTPA stroke care. Monitor blood pressure and neurological symptoms. Monitor for adverse reactions to fibrinolytic therapy. 자랑스럽게 또 까먹었따. 게으른 나를 위해 2년후엔 잘 시험을 준비하라고^^ google에 ACLS test치면 quizlet이었던가 거기에 엄청난 양이 있으니 온라인필기는 떨어질 이유가 없다. 메가메가 메가코드가 문제.. 요건 필기시험 (나 잘보라고 기록^^) How often do you bag mask a breath? 1 every 5-6 sec (10-12 per minute) Chest compression rate? 100-120 bpm Which is an action taken by the team to avoid any deficiencies during a resuscitation attempt? Clearly delegate tasks Lead II rhythm (Sinus). You have completed 2 minutes of CPR, ECG displays the rhythm shown here. The patient has no pulse. Another member of your team resumes chest compressions and qp facility is the most appropriate EMS destination for cardiac arrest patient who has returned to ROSC in the field? Coronary reperfusion capable medical center Reliable method to monitor appropriate placement of ET tube? Contnuous waveform capnography When to switch chest compressions Every 5 sets or 2-min Your rescue team arrives to find a 59 y.o. man lying on the kitchen floor. He is unresponsive. What is the next best step in your assessment and management of this patient? Check for breath and pulse Which of the following sign’s is a likely indicator of cardiac arrest in an unresponsive patient? Agonal gasps 3 minutes into a cardiac arrest resuscitation attempt 1 member of your team insets an ET tube while another performs chest compressions. Capnography shows a persistent waveform, and an end tidal CO2 of 8. What is significance of this finding? Chest compression may not be effective Which of these tests should be performed for a patient with a suspected stroke within 25 minutes of hospital arrival. CT without contrast Which is 1 way to minimize interruptions during chest compressions of CPR? Continue CPR while defibrillator charges Recommended ASA dose with pt of suspected acute coronary syndrome 160-325 mg You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. CT was normal with no sign of hemorrhage. Patient does not have any contraindications for fibrinolytic therapy. Which treatment approach is best for this patient? ` Start fibrinolytic therapy ASAP Your patient is in cardiac arrest and has been intubated. To assess CPR quality, what should you do? Monitor pts end-tidal CO2 A patient in respiratory distress and a BP of 70/50 presents with lead II ECG rhythm as shown. (V-tach with a pulse) What is the appropriate therapy? Synchronized cardioversion What best describes length of time needed to perform pulse check on BLS assessment 5-10 seconds EMS providers are treating a patient with suspected stroke. According to the adult suspected stroke algorithm, which critical action by EMS will expedite the patients care on arrival and reduce the time needed to treat it? Alert hospital ahead of time You are evaluating a 58 y.o. man with chest discomfort. His BP is 92/50 mmHg, HR is 92 bpm, His non-labored respiratory rate is 14 bpm. His pulse ox is 97%. Which assessment step is most important now? Obtain 12-lead EKG Minimum SBP one should attempt with fluid therapy of vasoactive agents in hypotensive CA pt who achieves ROSC? 90 mmHg For a STEMI patient, which best describes the maximum goal time for emergency department door to balloon inflation time for PCI 90 min What is the recommended range for which a temperature should be selected and maintained constantly to maintain targeted temperature management after cardiac arrest? 32-36 degrees During post cardiac arrest care, which is the recommended duration for targeted temperature management after reaching the correct temperature range? At least 24 hrs A patient has a witnessed loss of consciousness. The lead II ECG rhythm is shown below (Torsades des pointe) What is the appropriate treatment? Defibrillate What is the maximal interruption you should allow between chest compressions? 10 seconds Which is an appropriate method in selecting an appropriate sized oropharyngeal airway? Angle of the mandible to the corner of the lip If a team member is about to make a mistake during a resuscitation attempt, which best described actions of the team leader or other team members should take? Address the team member immediately A team member is unable to perform an assigned task because it is beyond that team members scope of practice. Which action should the team member take? Ask for a new task or role Pt is in SVT of 160 bpm, what algorithm do you use? Tachycardia After your initial assessment of this patient (V-tach and still have a pulse), which action should be performed next? Synchronized cardioversion Patient becomes apneic and pulseless, but the rhythm stayed the same. What takes the highest priority Perform defibrillation Patient had coronary stints placed 2 days ago, today he is in sever distress with crushing chest pain. Based on the patient’s initial presentation, which condition do you suspect lead to the cardiac arrest? Acute coronary syndrome In addition to defibrillation, which intervention should be performed immediately? Chest compressions Despite 2 defibrillation attempts the patient remains in ventricular fibrillation. Which drug should you administer first to the patient 1 mg epi Despite epi you continue CPR and patient remains in V-fibrillation. Which other drug can be administered next Amiodarone 300 mg The patient has ROSC but is unable to follow commands. Which post cardiac arrest intervention do you choose for this patient? Initiated targeted temperature management Patient presents with v-tach and when you are hooking up the monitor quickly changes into v-fib. Which would you have done first if they hadn't gone into v-fib? Synchronized cardioversion 여기서부턴 책 정리 (안중요함) Team dynamics -Clear roles and responsibilites -Knowing your limitations -Constructive interventions -Knowledge sharing -Summarizing and reevaluating -Closed-loop communications -Clear messgages -Mutual respect The systematic Approach 1. Initial Impression-> Unconscious pt-> BLS -> Primary assessment -> Secondary assement -> Conscious pt -> Primary assessment -> Secondary assement BLS assessment 1. Verify scene safety. Tap and shout "Bill, hello, Are you OK?" 2. Check for responsiveness. If the victim is unresponsive, shout for nearby help. activate the emergency response system "Go inside help him call 911. Ask front dest to get an AED or defibrillator." (shave pt's hairy chest or use new pad to free wax) 3. Look for no breathing or only gasping and check the pulse. Is a pulse definitely felt within 10 sec? CAROTID PULSE확인하면서 눈으로 가슴이랑 코 훑으면서 숨쉬나 보기 4. If there is no breathing or only gasping and no pluse begin CPR(cycles of 30 compressions and 2 breaths) Use AED as soon as it is available. 숨안쉬면 걍 CPR ㄱㄱ 애기일 경우 2분 CPR하고 AED가지러 가기(혼자일경우) 5. When the AED arrives check the rhythm. Is the rhythm shockable? Apply patch, charging -> clear -> shocking -> shock delivered -> resume the CPR. 이거시 채점기준의 키 Start compressions within 10 seconds of recognition of cardiac arrest. Push hard, push fast: Compress at a rate of 100 to 120/min with a depth of at least 2 inches (5 cm) for adults. Allow complete chest recoil after each compression. Minimize interruptions in compressions (try to limit interruptions to less than 10 seconds). Give effective breaths that make the chest rise. Avoid excessive ventilation. <애기 chocking> If you find an infant choking, and he or she is responsive, first sit or kneel with the infant in your lap. Hold the infant facedown and resting on your forearm, with the head slightly lower than the chest. Note: If it is easy to do, remove clothing from the infant’s chest. Support the head and jaw with your hand. Avoid compressing the soft tissues of the infant’s throat. Rest your forearm on your thigh to provide support. Deliver up to 5 back slaps forcefully between the infant’s shoulder blades, using the heel of your hand. Deliver each slap with sufficient force to attempt to remove the foreign body. Place your free hand on the infant’s back, supporting the head with the palm of your hand. This will cradle the infant between your 2 forearms as you turn the infant over while carefully supporting the head and neck. Keep the infant’s head lower than the chest, and deliver up to 5 quick downward chest thrusts in the same location that you perform compressions—just below the nipple line, over the lower half of the breastbone. Do this at the rate of about 1 per second. Repeat the sequence of 5 back slaps and 5 chest thrusts until the object is removed or until the infant becomes unresponsive. <Primary assessment> Airway - head tilit-chin lift Breathing - monitor O2 Circulation - Attach montir/defibrillator for arrhythmias or cardiac arrest rhythms. Obtain IV/IO access, Give appropriate drugs and fluid if needed, Check BGL, perfusion issues. Disability - Check for neurologic fuction, Assess LOC, pupil dilation, AVPU(alert, voice, painful, unresponsive) Exposure - Looking for obious signs of trauma, bleeding, nurns unusual marking or medical alert braceltes. Remove clothing or perform a physical examination. <Secondary Assessment> Signs and symptoms Allergies Medication Past medical history Last meal consumed Event H's and T's Hypovolemia Hypoxia Hydrofen ion(acidosis) Hypo-Hyperkalemia Hypothermia Tension pneumothorax Tamponate(cardiac) Toxins Thrombosis(pulnonary/coronary) O2 주고, Aspirin 160-325mg PO, rectal 300mg, morphine, Nitroglycerin 0.5mg IV q 3 to 5 mins( Inferior wall MI and RV infactrion, hypotension > 90, recent phosphodiesterase inhibitor use => NONONO don't give Nitro) STEMI일때 NSAID 주면 reinfarction hypotension, HF, myocardial rupture 생길수 있음. 조심 12-lead ECG찍고, STEMI면 10-60분 이내 닥터 노티, Fibrinolytic check list(reperfusion)해주시고 PCI는 ED온 순간부터 90분 이내 시행되어야함. PCI못하는 곳에서 PCI하기까진 120분 이내 시행 stroke(NIH 6점이상) 생기고 25분 이내 ED 오는 것이 관건 CT는 pt 온지 25분 이내, 45분이내 reading 끝나야함 Hemorrhage 없으면 fibrinolytic therapy가능 rtPA 준 후 24시간동안은 anticoagulats나 antiplatelet약 먹음 안됨. onset of symptone 3- 4.5 hours before만 rtPA가능함. 글루코즈는 185 이상임. stroke걸리면.. 요것이 가장 중요하지요 shock shock epie shock amio~ 10초이내 compression, rhythm asseess하고, CPR은 2분(5round)임. Epinephrine 1mg repeat every 3 to 5 mins Amiodarone 300mg IV boluse, additional 150mg Which is the most appropriate destination for patients with suspected acute ischemic stroke?For patients with suspected LVO, a CSC is the preferred destination over TSC if the CSC is accessible within acceptable transport times per local protocol. Minimize on-scene times to < 15 min, provide prehospital notification and encourage family to go directly to ED if not transported with patient.
Which is a stroke severity tool that helps EMS differentiate large vessel occlusion stroke?The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field.
What is the most common type of stroke ACLS?There are two major types of stroke, they are ischemic stroke which accounts for almost 87% of all strokes and is usually caused by an embolism which occludes an artery and affects the subsequent tissue of the brain that particular artery effects. The second is called hemorrhagic stroke.
What is the time goal for neurological assessment by the stroke team or designee?A neurologic assessment by the stroke team or designee should be done within 20 minutes of patient arrival to the ED.
|
What is the most appropriate destination for patients with suspected acute ischemic stroke
zusammenhängende Posts
Urheberrechte © © 2024 nguoilontuoi Inc.
