ACLS Study Guide 2011
See www.heart.org/eccstudent. The code is found in the ACLS Provider Manual page ii.
The ACLS Provider exam is 50-mutiple choice questions. Passing score is 84%. Student may miss 8 questions. For
students taking ACLS for the first time or renewing students with a current card, exam remediation is permitted should
student miss more than 8 questions on the exam. Viewing the ACLS book ahead of time with the online resources is
very helpful. The American Heart Association link is www.heart.org/eccstudent and has an ACLS Precourse Self-
Assessment, supplementary written materials and videos. The code for the online resources is on the ACLS Provider
Manual page ii. Basic Dysrhythmias knowledge is required in relation to asystole, ventricular fibrillation, tachycardias
in general and bradycardias in general. Student does not need to know the ins and outs of each and every one. For
Tachycardias student need to differentiate wide complex (ventricular tachycardia) and narrow complex
(supraventricular tachycardia or SVT).
BLS Overview – CAB
Push Hard and Fast-Repeat every 2 minutes
Anytime there is no pulse or unsure about a pulse – do
Elements of good CPR
• Rate-at least 100
• Compression depth at least 2 inches
• Minimize interruptions (less than 10 seconds)
• Avoid excessive ventilation
• Switch compressors every 2 min or 5 cycles
If AED doesn’t promptly analyze rhythm: compressions.
Tachycardia with a Pulse
• If unstable (wide or narrow) – go straight to
• If stable narrow complex
– obtain 12 lead
– vagal maneuvers
– adenosine 6mg RAPID IVP, followed by 12mg
Cincinnati Pre-Hospital Stroke Scale
Facial Droop, Arm Drift, Abnormal Speech
rtPA can be given within 3 hours from symptom onset.
Important to transport patient to an appropriate
hospital with CT capabilities. If CT not available divert to
the closest hospital (i.e. 15 min away) with CT
Acute Coronary Syndromes
Vital signs, 02, IV,
12 Lead for CP, epigastric pain, or rhythm change
Courtesy Terry Rudd RN, MSN
Key Medical Resources Inc.
November 2011, Page 2
Waveform Capnography in ACLS (PETCO2)
• Allows for accurate monitoring of CPR
• Most reliable indicator for ET tube placement
– Ventricular Fibrillation (VF)
– Ventricular Tachycardia (VT) without pulse
Biphasic: 120-200J Monophasic: 360J
• 2 minute cycles of compressions, shocks (if VF/VT), and rhythm checks.
• Epi 1 mg every 3-5 minutes (preferred method IV)
• NO MORE ATROPINE for Asystole and PEA
• Ventilations – 30:2 Ratio
• Rescue breathing – 1 breath every 5-6 sec
• If advanced airway – 8-10 ventilations/minute
Treat reversible causes (Hs and Ts)
Hypoxia or ventilation problems
Hydrogen ion (acidosis)
Toxins – poisons, drugs
Thrombosis – coronary (AMI) – pulmonary (PE)
Need to assess stable versus unstable.
If stable, monitor, observe, and consult.
If unstable. . .
•Atropine 0.5mg IV. Can repeat Q3-5 minutes. Maximum dose=3mg (Including heart blocks)
• If Atropine ineffective
– Transcutaneous pacing
– Dopamine infusion (2-10mcg/kg/min)
– Epinephrine infusion (2-10mcg/min)
Return of Spontaneous Circulation (ROSC)
Post Resuscitation Care
Points to Ponder
• COMPRESSIONS are very important.
• Rigor mortis is an indicator of termination of efforts.
• Simple airway maneuvers, such as a head-tilt, may help.
• The Medical Emergency Teams (MET) can identify and treat pre-arrest situations.
• Consider terminating efforts after deterioration to asystole and prolonged resuscitation time.
Before you start packing, ask your recruiter to determine amenities in your new housing complex. In most cases you accept company-provided housing, your accommodation will include the basics, bed, nightstand, dresser, dining table and chairs,sofa, lamps but it may vary from one location to another so be sure to find out ahead of time so you can plan accordingly. Once you know whats in your housing package, next step is to make a detailed list of the items you’ll need while you’re on assignment and to check off each item once its packed.
One of the key rules of packing is to know what kind of weather to expect to your destination. If you’re going to be traveling through 2 or more seasons, the rule of thumb is to bring layers of clothes-T-shirts,blouses,sweaters, jackets and coats-that can be added or peeled off as the temperature changes/warm up.
Travel Light! In order to pack light travel nurses need to prioritize what is important to you and determine what you can’t live without for 13 weeks. Pack in bare minimum as you can, traveling will be worthwhile for you. If there is something you forgot or if you want to supplement you household items, you can always find it in WalMart or Target or Ikea.
If you are driving, make sure car maintenance is done, before you leave for your contract, tune-ups, tires checked, breaks, oil changes every 3 months is recommended. Triple A is great to have for discounts over the road.
If you are flying to your assignment, review your itinerary to make sure it is correct. Best thing check in online, usually 24 hours in advance (varies by airline). Check how much your airline is charging per bag/luggage.Obtain information on your destination city including restaurants, shopping , weather, much more..www.citysearch.com
It is definitely OK to travel with your family, the travel company will accommodate you and your family. Almost all contracts will let you bring your pet with you, let your recruiter know you would like to bring one.
Do you know that Travel Nursing is recession proof?……….
After 9 years on the road I would like to tell you our story and maybe you can share a tale or two. Thank you for coming to our site. I know traveling and I know nursing. after 21 years from mental health, trauma ER,ICU, home health , chronic,and acute dialysis. I have worked coast to coast all the way to Hawaii,. Its time to share my experiences that my family and I (yes I said, “family”) have and the discounts that we have learned to use, maybe you have some you would like to share with us.But first let’s start with your needs. Would you like to get to most for your money?
PRINTING MONEY- print coupons is like having your own money machine at home. We get to savings for items we purchase. The cost of printer and paper can be reimbursed right away by: using coupons.com The way it is used is by going to coupons.com and entering your zip code and receiving the discounts in your area, in addition to discount codes that can be used for Wal-Mart- Target and online purchases that makes it convenient to shop from home in your comfort zone.
Clipping newspaper grocery coupons from mailings and news papers can offer double the saving .Coupon.com compile the best money- saving deals including milk, bread, pet food, coffee, meat and detergent coupons for use at supermarkets across the country coupons.com also provides thousands of restaurant and retail coupons, in addition to keeping you informed of today’s best free food offers.For the cost of a printer and paper, check with your local store if they take double coupons.The concept is simple: we want you to save money like we have becoming a smart shopper, and a teacher about how easy it is to get great coupons, deals and cash back from the best shopping strategy that will save you money.
In the news…….
In the news…….
EBOLA AND PERSONAL PROTECTIVE EQUIPMENT (PPE) – IS IT ENOUGH?
NO IT IS NOT……..it looks like you need bio-hazard or haz mat suite to deal with this decease. So if someone is in the ER what do you do?
Can universal precaution protocol enough, are we prepared?
The following checklist highlights some key areas for healthcare facilities to review in preparation for a person with EVD arriving for medical care.The checklist format is not intended to set forth mandatory requirements or establish national standards. □Monitor the situation at CDC’s EVD website http://www.cdc.gov/vhf/ebola/index.html-Assess and ensure availability of appropriate personal protective equipment (PPE) and other infection control supplies (e.g., hand hygienesupplies) to all healthcare personnel (HCP) Review facility infection control policies for consistency with the Centers for Disease Control andPrevention’s Infection Prevention and Control Recommendations for Hospitalized Patients with Knownor Suspected EVD in U.S. Hospitals (http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html).
Review environmental cleaning procedures and provide education/refresher training for cleaning staff (http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html)
□Begin education and refresher training for HCP on EVD signs and symptoms, diagnosis, how to obtain specimens fortesting, appropriate PPE use (including putting on and taking off PPE), triage procedures (including patient placement), HCP sick leave policies, how and to whom EVD cases should be reported,and procedures to take following unprotected exposures (i.e., not wearing recommended PPE) to suspected EVD patients at the facility. Review triage procedures and ensure relevant questions (e.g., exposure to case, travel within 21 days from affected country)are asked during the triage process for patients arriving with compatible illnesses (http://www.cdc.gov/vhf/ebola/hcp/case-definition.html). Ensure laboratories review procedures for appropriate specimen collection, transport, and testing of specimens from patients who are suspected to be infected with Ebola virus (http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebolah. (http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html)
Review policies and procedures for screening and work restrictions for exposed or ill HCP and ensure that HCP have ready accessto medical consultation including via telephone.Designate points of contact within the facility responsible for communicating with public health officials and providing internal updates forHCPs and volunteers.Confirm the local or state health department contacts for reporting EVD cases .EVD is a nationally notifiable disease and must be reported to local,state, and federal public health authorities. recommendation from the CDC