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ACLS 2024.
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Exam of 11 pages for the course Immunology Chapter 7 Kuby at Immunology Chapter 7 Kuby (ACLS 2024.)
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ACLS 20244 levels of stroke certification - ANS-Acute Stroke Ready Hospital
Primary Stroke Center
Thrombecotmy-Capable Stroke Center
Comprehensive Stroke Center
49 yo M arrives to ED with chest discomfort. States that he was working in the garden
this morning when his chest started hurting. Last episode lasted about 25 minutes, he
was sweaty. Chest discomfort is not received with rest.
Within first 10 minutes, on basis of the patient showing symptoms suggest of myocardial
ischemia, what will first actions include ( if not completed by EMS before arrival)? -
ANS-obtain 12 lead ECG
administer aspirin and establish Iv access
activate STEMI team
consider nitroglycerin, morphine, and P2Y inhibitor
Assess airway, breathing, circulation
if SpO2 < 90% start oxygen
5 H's and T's - ANS-causes of reversible PEA, cardiac arrest
Hypovolemia
Hypoxia
Hydrogen ion (acidosis), Hypoglycemia
Hypo/hyperkalemia, Hypothermia (< 95F)
Tension PTX
Tamponade
Toxins
Coronary/ Pulmonary Thrombosis
PE, MI
8 D's of stroke care - ANS-1. Detection
2. Dispatch
3. Delivery
4. Door
5. Data
6. Decision
7. Drug
, 8. Disposition
Administering Aspirin - ANS-162 to 325 mg non-enteric-coated or chewed aspirin
causes immediate or near total inhibition of thromboxane A2 production by inhibiting
platelet cyclooxyrgenase (COX-1)
Administering Morphine Indications - ANS-severe chest discomfort that does not
respond to sublingual or translingual nitroglycerin
indicated in STEMI when chest discomfort does not respond to nitrates
Use with caution in NSTE-ACS bc of association with increased mortality
Administering Nitroglycerin - ANS-Give patient 1 sublingual nitroglycerin tablet ( or
translingual dose) every 3 to 5 minutes for ongoing symptoms if permited by medical
control and no contraindications exist. You may repeat the dose twice ( total of 3 doses)
Administering oxygen indications - ANS-patient is dyspneic or hypoxemic
signs of heart failure
arterial oxygen saturation less than 90% or unknown
After Recognizing the Stroke - ANS-1. Assess ABCs
2. Initiate stroke protocol
3. Perform physical exam
4. Prehospital stroke screen and severity tool
5. Establish time of symptom onset (last known normal)
6. Triage
7. Check glucose
8. Provide prehospital notification on arrival
supplemental oxygen to hypoxemic stroke patients ( O2 saturations is 94% or less) or
oxygen saturation is unknown
Airway - ANS-unconscious patients - maintain patent airway, consider inserting
advanced airway device
ensure proper placement, use quantitative waveform capnography to monitor
effectiveness.
Conscious patients often maintain integrity of their own airway
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