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Occurs when the blood flow to a part of the heart is blocked by a blood clot, if this clot cuts off the blood completely the part of the heart the heart muscle supplied by that artery begins to die .
1) Discomfort,pressure heaviness or pain in chest; arm, or below the breast bone.
2) Discomfort. Radiating to the back , jaw or hroat and arm.
3). Fullness intergestion, or choking
4) Shortness of Breath , nausia ,vomitting , sweating
5) Rapid irregular heartbeat
If you or anyone you know that have theses symptms ask them if they help and then dial 911 if nessasary.
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.
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You have landed a great travel nursing assignment! Your contract has been read carefully and signed, now you are eager to head off to your new destination.
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.
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?
□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)