Acute Coronary Disease

The number one killer  for both men and. Women  estaments  38% of  all will not survive thier MI include numerous  problems  many  of which  are  realated to process called Atherosclerosis, is  a condition  that develops  when a substaince  called plaque  builds up  in the  walls of the  arteries. Making it harder for blood to flow through . This can cause hart attack or stroke.


Heart attack

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

ACLS Study Guide 2011
See 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 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
• Recoil
• 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
synchronized cardioversion
• 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
Cardiac Arrest
Shockable Rhythms:
– Ventricular Fibrillation (VF)
– Ventricular Tachycardia (VT) without pulse
Biphasic: 120-200J Monophasic: 360J
Non-Shockable Rhythms:
– Asystole
• 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)
Tamponade, cardiac
Tension pneumothorax
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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Travel Nursing Interview tips


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.

 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
  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.

                         VACAY PICTURES JULY 2012 012


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Clipping newspaper grocery coupons from mailings and news papers can offer double the saving compile the best money- saving  deals including milk, bread, pet food, coffee, meat and detergent coupons for use at supermarkets across the country 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


NO IT IS NOT…… 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 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 (

 Review environmental cleaning procedures and provide education/refresher training for cleaning staff (

□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 ( Ensure laboratories review procedures for appropriate specimen collection, transport, and testing of specimens from patients who are suspected to be infected with Ebola virus ( (

 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

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