ACLS Study Guide - E-Book , livre ebook

ACLS Study Guide
SIXTH EDITION
Barbara Aehlert, MSEd, BSPA, RN
Table of Contents
Cover image
Title page
Copyright
Preface to the sixth edition
Acknowledgments
About the author
1.  Chain of survival and high-quality cardiopulmonary resuscitation
References
2.  Teams
References
3.  Patient assessment and resuscitation therapies
References
4.  The patient with respiratory compromise
Case study 4.1
Case study 4.1 Answers
References
5.  Bradycardias
Case study 5.1
Case study 5.2
Case study 5.1 Answers
Case study 5.2 Answers
References
6.  Tachycardias
Case study 6.1
Case study 6.2
Case study 6.1 Answers
Case study 6.2 Answers
References
7.  Cardiac arrest rhythms
Case study 7.1
Case study 7.2
Case study 7.1 Answers
Case study 7.2 Answers
References
8.  Acute coronary syndromes
Matching
Case study 8.1
Matching
Case study 8.1 Answers
References
9.  Acute ischemic stroke
Case study 9.1
Case study 9.1 Answers
References
10.  Posttest
Posttest Answers
Glossary
Index
Copyright

Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
ACLS STUDY GUIDE, SIXTH EDITION         ISBN: 978-0-323-71191-3
Copyright © 2022 by Elsevier, Inc. All rights reserved.
Previous editions copyrighted 2017, 2012, 2007, 2002.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
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Preface to the sixth edition
I took my first Advanced Cardiac Life Support (ACLS) class many years ago. I was terrified (and lost) throughout the entire course. Although I spent weeks studying before the course, the information I read seemed to be written in a foreign language. I could find no resources to “translate” the information into something useful to me. The course consisted of very long lectures by instructors who read slides and offered little useful insight. The most memorable part of the course was the “Patient Management” station in which each course participant was evaluated one-on-one by an instructor. (For those of you who have been around awhile, you are probably having flashbacks of those days). I will never forget that experience.
Despite the time spent studying, I was a mental wreck as soon as the door closed behind me. The instructor proceeded to methodically strip away any self-confidence I might have had in treating a patient who had a cardiac-related emergency. I answered the questions asked of me until I was presented with a patient who had symptomatic bradycardia. Atropine had not worked (transcutaneous pacing was not a readily available option that many years ago), and the next drug that was recommended at that time was isoproterenol. I knew that I could not recall whether isoproterenol was given in mcg/min (correct) or mg/min. I took a “50/50” guess and said mg/min. Because that was the wrong decision, I was told I had failed the course and would need to schedule myself to attend another two-day class.
Before driving home, I sat outside for a few minutes, contemplating what had happened and what I could have done to change the outcome. On that day, I promised myself that I would become an ACLS instructor someday and find a way to teach the information in a more user-friendly atmosphere. I also promised myself that I would be a part of teaching courses useful for practicing healthcare professionals and delivered in an environment where the participants looked forward to the class—instead of dreading it.
As the years passed, I did become an ACLS instructor, and I loved it. After each course, participants would often write on their course evaluations that a study guide would have helped them prepare for class. Those suggestions resulted in writing a few pages of information and ultimately became a book— this book.
The ACLS Study Guide is designed for paramedic, nursing, and medical students; electrocardiogram monitor technicians; nurses; and other allied health personnel working in emergency departments, critical care units, postanesthesia care units, operating rooms, and telemetry units preparing for an ACLS course. This edition is based on current science, treatment recommendations, and guidelines cited in the reference section of relevant chapters. Medicine is a dynamic field, and resuscitation guidelines change, new medications and technology are being developed, and medical research is ongoing. As a result, be sure to learn and follow local protocols as defined by your medical advisors. The author and publisher assume no responsibility or liability for loss or damage resulting from using the information contained within.
I genuinely hope you find the information in the pages that follow helpful and wish you success in your ACLS course and clinical practice.
Sincerely,
Barbara Aehlert
Acknowledgments
My sincerest thanks to Danielle Frazier for her development of this text and a special thanks to all instructors who share the same philosophy about teaching ACLS as I do.
About the author
Barbara Aehlert, MSEd, BSPA, RN, has been a registered nurse for more than 40 years with clinical experience in medical/surgical nursing, critical care nursing, prehospital education, and nursing education. Barbara is an active CPR and ACLS instructor who enjoys teaching dysrhythmia recognition and ACLS to nurses and paramedics.
List of Tables
TABLE 1.1 Phases of Cardiac Arrest and Resuscitation
TABLE 2.1 Essential Resuscitation Team Roles and Responsibilities
TABLE 3.1 Primary Assessment
TABLE 3.2 Signs of Adequate and Inadequate Breathing
TABLE 3.3 Manual Airway Maneuvers
TABLE 3.4 Pharyngeal Airways
TABLE 3.5 Mouth-to-Mask Ventilation
TABLE 3.6 Oxygen Percentage Delivery by Device
TABLE 3.7 Leads and Heart Surfaces Viewed
TABLE 3.8 Electrocardiogram Components—Waveforms and Complexes
TABLE 3.9 Electrocardiogram Components—Segments and Intervals
TABLE 3.10 Common Medications Used in Cardiovascular Emergencies
TABLE 7.1 Adult Nontraumatic Out-of-Hospital Cardiac Arrest Survival Rates (2017 data) a
TABLE 7.2 The Hs and Ts: Possible Reversible Causes of Cardiac Arrest
TABLE 7.3 Components of Postcardiac Arrest Syndrome
TABLE 8.1 Possible Causes of Elevated Cardiac Troponin Values Because of Myocardial Injury
TABLE 8.2 Diagnostic Criteria for Type 1 and Type 2 Myocardial Infarction
TABLE 8.3 Relationships Among Ventricular Surfaces, Facing Leads, and Coronary Arteries
TABLE 8.4 Nitroglycerin
TABLE 8.5 Morphine Sulfate
TABLE 8.6 Beta Blockers
TABLE 8.7 Calcium Channel Blockers
TABLE 8.8 Lipid Management
TABLE 8.9 Renin-Angiotensin-Aldosterone System Inhibitors
TABLE 8.10 Antiplatelet Medications
TABLE 8.11 Aspirin
TABLE 8.12 Anticoagulants
TABLE 9.1 Cerebral Vessels and Neurologic Deficits
TABLE 9.2 The 8 Ds of Stroke Care
TABLE 9.3 Immediate Diagnostic Studies for Suspected Stroke
List of Illustrations
Fig. 1.1 Heart disease is the leading cause of death for men and women in the United States.
Fig. 1.2 A drone carrying an automated external defibrillator can reduce the interval from patient collapse to defibrillation time.
Fig. 1.3 Waveform capnography during cardiac arrest. (A) End-tidal carbon dioxide partial pressure (PETCO 2 ) diagram showing a typical ventilation cycle and CO 2 waveform. The point that represents PETCO 2 is marked with an arrow . (B) PETCO 2 recording during cardiopulmonary resuscitation. This image demonstrates the use of capnography during ongoing resuscitation. The chest compression waveform is shown in red (top panel), and the PETCO 2 waveform is shown in blue (bottom panel). EtCO 2 , End-tidal CO 2 .
Fig. 1.4 Several defibrillators, such as the MRx-QCPR shown here, are equipped with a chest compression pad that enables monitoring of the quality of chest compressions and provides corrective feedback to rescuers.
Fig. 1.5 This Zoll R Series Monitor defibrillator filters cardiopulmonary resuscitation artifact, enabling the rescuer to analyze a patient’s cardiac rhythm without interrupting chest compressions.
Fig. 2.1 Rapid Response Systems can be useful in reducing the incidence of cardiac arrest.
Fig. 2.2 Key elements of effecti