nDf3BA"!b3]`(ApE7=;B0kxY~OY"o=MO/T endstream endobj 31 0 obj<. You see, every symphony needs a conductor 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. what may be expected next and will help them, perform their role with efficiency and communicate 0000018707 00000 n Following the simulation exercise, the rescue team must engage in a debriefing session during which each team member has the opportunity to critically examine every aspect of the exercise and. For a 6-month-old infant with supraventricular tachycardia and adequate perfusion, which of, A child presents with severe respiratory distress, urticaria, stridor, and tachycardia about 10, A 2-year-old child was found submerged in a swimming pool. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate PostCardiac Arrest Care Case > Application of the Immediate PostCardiac Arrest Care Algorithm > Targeted Temperature Management; page 151], B. What would be an appropriate action to acknowledge your limitations? [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. C. Performing synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. You have completed 2 minutes of CPR. The patient's pulse oximeter shows a reading of 84% on room air. Clear communication between team leaders and team members is essential. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Application of the Tachycardia Algorithm to the Unstable Patient > Identify and Treat the Underlying Cause; page 134]. When you stop chest compressions, blood flow to the brain and heart stops. as it relates to ACLS. Improving patient outcomes by identifying and treating early clinical deterioration, B. 0000014579 00000 n A 45-year-old man had coronary artery stents placed 2 days ago. However, if you're feeling fatigued, it's better to not wait if the quality of chest compressions has diminished. A. Question 3 from the first paper of 2001 (and no other question since) asked the candidates about the role and responsibilities of the medical team leader in a cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > Management of Respiratory Arrest > Critical Concepts: Avoiding Excessive Ventilation; page 47]. The patient does not have any contraindications to fibrinolytic therapy. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. Synchronized cardioversion uses a lower energy level than attempted defibrillation. About every 2 minutes Switch compressors about every 2 minutes, or earlier if they are fatigued. This awareness will help you anticipate What actions will be performed next How to communicate and work as a member or as a leader of a high-performance team The CT scan should be completed within 25 minutes of the patients arrival in the emergency department and should be read within 45 minutes from emergency department arrival. Address the team member immediately During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? Refuse to administer the drug A A 3-year-old child presents with a high fever and a petechial rash. ACLS begins with basic life support, and that begins with high-quality CPR. interruptions in compressions and communicates. 0000018905 00000 n You have the team leader, the person who is 0000058159 00000 n A properly sized and inserted OPA results in proper alignment with the glottic opening. Your patient is in cardiac arrest and has been intubated. Not only do these teams have medical expertise leader should primarily focus on team management rather than interventional skills during a resuscitation attempt, regardless of neonatal, pediatric, or adult situations. In the initial hours of an acute coronary syndrome, aspirin is absorbed better when chewed than when swallowed. You determine that he is unresponsive. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Critical Concepts: Quality Compressions; page 37]. [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]. 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. Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? Resuscitation Roles. pediatric surgery fellow who acts as the surgical team leader, a surgical attending, and one emergency medicine (EM) phy-sician who collaborates with the surgery team to direct the resuscitation. You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. Respiratory support is necessary for infants that are bradycardic, have inadequate breathing, or demonstrate signs of respiratory distress. 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. that that monitor/defibrillator is already, there, but they may have to moved it or slant Which rate should you use to perform the compressions? ensuring complete chest recoil, minimizing. Big Picture mindset and it has many. A 2-year-old child is in pulseless arrest. 0000014948 00000 n Today, he is in severe distress and is reporting crushing chest discomfort. 0000021212 00000 n D. 100 to 120/min When performing chest compressions, you should compress at a rate of 100 to 120/min. Which is the next step in your assessment and management of this patient? [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Foundational Facts: Resume CPR While Manual Defibrillator Is Charging; page 96], D. Ask for a new task or role Not only should everyone on the team know his or her own limitations and capabilities, but the team leader should also be aware of them. In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube? A. Epinephrine 1 mg For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. A team member thinks he heard an order for 500 mg of amiodarone IV. play a special role in successful resuscitation, So whether youre a team leader or a team This includes opening the airway and maintaining it. The AHA recommends using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. C. Decreased cardiac output Excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > CT Scan: Hemorrhage or No Hemorrhage > Introduction; page 84]. It's vitally important that each member of a resuscitation team: 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 A. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. What should be the primary focus of the CPR Coach on a resuscitation team? Another member of your team resumes chest compressions, and an IV is in place. When IV/IO access is available, give epinephrine 1 mg IV/IO during CPR after the second shock and repeat epinephrine 1 mg IV/IO every 3 to 5 minutes. It is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters. [ACLS Provider Manual, Part 2: Systems of Care > Cardiopulmonary Resuscitation > Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15], This ECG rhythm strip shows second-degree atrioventricular block type I. Your assessment finds her awake and responsive but appearing ill, pale, and grossly diaphoretic. The childs ECG shows the rhythm below. Respectfully ask the team leader to clarify the doseD. successful delivery of high performance resuscitation Measure from the thyroid cartilage to the bottom of the earlobe, C. Estimate by using the formula Weight (kg)/8 + 2, D. Estimate by using the size of the patients finger, A. If no one person is available to fill the role of time recorder, the team leader will assign these duties to another team member or handle them herself/himself. It is unlikely to ever appear again. B. During a resuscitation attempt, the team leader asks you to administer an initial dose of Epinephrine at 0.1 mg/kg to be given IO. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36]. The team leader is the one who when necessary, Javascript is disabled on your browser. 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. Hold fibrinolytic therapy for 24 hours, D. Start fibrinolytic therapy as soon as possible, D. Start fibrinolytic therapy as soon as possible Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? She is unresponsive, not, A 3-year-old child is unresponsive, not breathing, and pulseless. 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? The first rhythm, A 3-year-old child is in cardiac arrest, and a resuscitation attempt is in progress. Whether you are a team member or a team leader during a resuscitation attempt, you should understand not only your role but also the roles of other members. Which immediate postcardiac arrest care intervention do you choose for this patient? Improving patient outcomes by identifying and treating early clinical deterioration. Based on this patients initial assessment, which adult ACLS algorithm should you follow? If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? After your initial assessment of this patient, which intervention should be performed next? Which drug and dose should you administer first to this patient? A. And for a resuscitation attempt to be successful, all parts must be performed correctly by a high-performing team of highly trained, organized, and communicative healthcare professionals. Closed-loop communication. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137], A. ACLS resuscitation ineffective as well. Combining this article with numerous conversations The team leader is required to have a big-picture mindset. Which of the, A mother brings her 7-year-old child to the emergency department. Which is the best response from the team member? Alert the hospital 16. Which immediate postcardiac arrest care intervention do you choose for this patient? When you know the roles and responsibilities of each team member, you can anticipate what's coming next, which will increase the ability of the team to communicate, improve the efficiency and performance of the resuscitation, and the chances for the patient to have a positive outcome. Specific keywords to include in such spooge would be "situational . Check the patients breathing and pulse, B. Which of the following is a characteristic of respiratory failure? Assign most tasks to the more experienced team members, D. Assign the same tasks to more than one team member, C. Clearly delegate tasks To avoid inefficiencies, the team leader must clearly delegate tasks. Compressor every 5 cycles or approximately, every 2 minutes or at which time where the 0000023390 00000 n Which treatment approach is best for this patient? Which drug and dose should you administer first to this patient? all the time while we have the last team member The childs mother says the infant has not been, A 3-month-old infant presents with lethargy and a 3-day history of vomiting, diarrhea, and poor, A 3-year-old child is unresponsive, gasping, and has no detectable pulse. Which action should the team member take? Which is the best response from the team member? Compressor is showing signs of fatigue and. The endotracheal tube is in the esophagus, B. Another member of your team resumes chest compressions, and an IV is in place. She is responsive but she does not feel well and appears to be flushed. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Recommendations; page 137], This ECG rhythm strip shows a monomorphic ventricular tachycardia. Ask for a new task or role. A responder is caring for a patient with a history of congestive heart failure. Team members should question a colleague who is about to make a mistake. But perhaps the biggest responsibility of the team leader centers on his or her ability to communicate clearly and effectively and explain to team members the specifics of resuscitation care, such as: The team leader assigns the remaining roles to the other team members and makes appropriate treatment decisions based on proper diagnosis and interpretation of the patient's signs and symptoms. An alert toddler presents with a barking cough, moderate stridor, and moderate retractions. [ BLS Provider Manual, Part 4: Team . to ensure that all team members are doing. That means compressions need to be deep enough, Provide rescue breaths at a rate of 12 to 20/min, C. Reassess breath sounds and clinical status, B. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. The patient's lead Il ECG is displayed here. Which action should the team member take? D. Once every 5 to 6 seconds For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. 0000038803 00000 n In addition to defibrillation, which intervention should be performed immediately? An 8-year-old child presents with a history of vomiting and diarrhea. then announces when the next treatment is Administration of adenosine 6 mg IV push, B. It not only initiates vascular access using :r(@G ')vu3/ IY8)cOY{]Yv$?KO% Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). 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. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Caution: Agonal Gasps; page 35], D. Second-degree atrioventricular block type II, C. Continue CPR while the defibrillator charges, D. Use an AED to monitor the patients rhythm, C. Continue CPR while the defibrillator charges Shortening the interval between the last compression and the shock by even a few seconds can improve shock success (defibrillation and return of spontaneous circulation). The leader should state early on that they are assuming the role of team leader. After your initial assessment of this patient, which intervention should be performed next? The compressions must be performed at the right depth and rate. Code Leader: Senior resident/nursing lead responsible for reviewing ECPR criteria, ensuring CPR quality metrics, mechanical CPR device placement, and run ACLS (if applicable) Airway physician: Places definitive airway when . that those team members are authorized to Inadequate oxygenation and/or ventilation, B. A. Administer IV medications only when delivering breaths, B. Today, he is in severe distress and is reporting crushing chest discomfort. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; page 130]. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Which do you do next? 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. 0000013667 00000 n 0000058017 00000 n 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. Coronary reperfusioncapable medical center. e 5i)K!] amtmh [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36], B. Today, he is in severe distress and is reporting crushing chest discomfort. However, a Code Blue in a hospital may bring dozens of responders/providers to a patient's room. You are performing chest compressions during an adult resuscitation attempt. If 2 rescuers are present for the resuscitation attempt of an infant or child, use a compression-to-ventilation ratio of _____. Give adenosine 0.1 mg/kg rapid IV push, D. IV fluid bolus of 20 mL/kg normal saline, A. whatever technique required for successful. A patient in respiratory distress and with a blood pressure of 70/50 mmHg presents with the lead II ECG rhythm shown here. Today, he is in severe distress and is reporting crushing chest discomfort. Whatis the significance of this finding? everything that should be done in the right Which response is an example of closed-loop communication? 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. A compressor assess the patient and performs A patient is being resuscitated in a very noisy environment. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. The cardiac monitor shows the rhythm seen here. and operates the AED/monitor or defibrillator. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]. Agonal gasps may be present in the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]. 0000023143 00000 n 0000005612 00000 n skills, they are able to demonstrate effective The team leader asks you to perform bag mask ventilation during a resuscitation attempt, but you have not perfected that skill. The defibrillator operator should deliver the shock as soon as the compressor removes his or her hands from the patients chest and all providers are clear of contact with the patient. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > The BLS Assessment > Ventilation and Pulse Check; page 46]. As you might have guessed, this team member is in charge of bringing an AED to the scene (unless one is already present) and operating the AED. Start fibrinolytic therapy as soon as possible, C. Order an echocardiogram before fibrinolytic administration, Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36]. [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: VT/pVT Pathway > Principle of Early Defibrillation; page 97], D. 90 minutes 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. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > Roles; page 29]. Resume CPR, beginning with chest compressions, A. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. How should you respond? 0000004212 00000 n with most of the other team members are able