COMPLETE BLS AND ACLS NOTES

BLS Flashcards (23 cards)

Category Front Back

1) Patient unresponsiveness and 2) Absent or abnormal breathing (including

Recognition & What are the 2 key criteria lay rescuers use agonal breathing). If both are present, assume cardiac arrest and begin CPR
Assessment to recognize cardiac arrest? immediately.

What percentage of OHCA victims exhibit 40-60% of OHCA victims exhibit agonal breathing. This is clinically
Recognition & agonal breathing, and why is this clinically significant because it's commonly misinterpreted by lay rescuers as normal
Assessment significant? breathing, leading to delayed CPR initiation.

How long should healthcare providers No more than 10 seconds. If pulse is not definitively palpated within 10
Recognition & spend checking for a pulse in cardiac seconds, immediately begin chest compressions. Prolonged pulse checks
Assessment arrest? delay critical interventions.

What is the risk-benefit analysis of Benefits vastly outweigh risks. Studies show only 1.7% bone fracture risk,
Recognition & providing CPR to someone who may not be 0.3% rhabdomyolysis, with no visceral injuries. The risk of withholding CPR
Assessment in cardiac arrest? when needed is fatal.

At least 5 cm (2 inches) but not exceeding 6 cm. Compression depth <4 cm

CPR Quality What are the 2024 AHA compression depth is associated with poor outcomes, while >5 cm improves survival to
Metrics guidelines for adults? discharge.
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100-120 compressions per minute. Rates >120 are associated with decreased
CPR Quality What is the optimal compression rate and depth due to incomplete recoil. Rates <100 provide inadequate coronary
Metrics why is this range specified? perfusion pressure.

Percentage of time during cardiac arrest spent performing chest

CPR Quality What is chest compression fraction and compressions. Target >80%. Higher compression fraction correlates with
Metrics what is the target percentage? improved ROSC and survival.

Complete return of chest wall to neutral position between compressions.

CPR Quality Define complete chest recoil and explain its Essential for venous return and coronary perfusion. Leaning prevents
Metrics physiological importance. complete recoil and reduces effectiveness.

≤50% (compression phase should be ≤50% of the total compression-

CPR Quality What is the optimal duty cycle for chest relaxation cycle). Shorter duty cycles improve coronary and cerebral
Metrics compressions? perfusion pressures.

Describe the correct hand placement for Lower half of the breastbone (sternum), between the nipples. Heel of one
adult chest compressions with anatomical hand on sternum, second hand interlocked. This position is over the left
CPR Technique landmarks. ventricle for optimal circulation.

Circulation-Airway-Breathing. Prioritizes chest compressions over airway

What is the C-A-B sequence and why did it management. Studies show C-A-B reduces time to first compression and
CPR Technique replace A-B-C? completion of first CPR cycle.
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Every 2 minutes or every 5 cycles of 30:2. Prevents compressor fatigue

How often should the person performing which leads to decreased compression depth and rate. Rotation should take
CPR Technique compressions be rotated and why? <5 seconds.

What is the compression-to-ventilation

ratio for single rescuers and two rescuers in 30:2 for both single and two-rescuer CPR in adults. Pause for ventilations
CPR Technique adults? should be <5 seconds to maintain compression fraction >80%.

Head-tilt chin-lift: Standard airway opening for non-trauma patients. Jaw-

Airway Compare head-tilt chin-lift vs jaw-thrust thrust: Used when cervical spine injury is suspected, maintains spinal
Management maneuvers. When is each indicated? alignment.

1 second per breath, just enough to make chest rise visibly. Avoid excessive
Airway What are the ventilation parameters for ventilation which increases intrathoracic pressure and decreases venous
Management rescue breathing during CPR? return.

What is the recommended ventilation rate 10 breaths per minute (1 breath every 6 seconds) with continuous chest
Airway for adults with an advanced airway during compressions. No need to pause compressions for ventilation with advanced
Management CPR? airway.

AED & What are the 4 shockable and non- Shockable: Ventricular Fibrillation (VF), Pulseless Ventricular Tachycardia
Defibrillation shockable rhythms in cardiac arrest? (pVT). Non-shockable: Asystole, Pulseless Electrical Activity (PEA).
Category Front Back

What is the optimal timing for first Witnessed arrest: Immediate defibrillation if VF/pVT present. Unwitnessed
AED & defibrillation in witnessed arrest vs arrest: Brief CPR while preparing defibrillator is acceptable, but minimize
Defibrillation unwitnessed arrest? delays.

Resume CPR immediately after shock without pulse check. Even successful
AED & How should CPR be modified immediately defibrillation often followed by asystole/PEA. Check rhythm/pulse after 2
Defibrillation after shock delivery? minutes of CPR.

Lower impedance improves success: larger pad size (8-12 cm), proper skin
AED & What factors affect defibrillation success preparation, adequate pressure, appropriate pad placement. Biphasic
Defibrillation and transthoracic impedance? waveforms more effective than monophasic.

1) Recognition and activation of EMS 2) Early bystander CPR 3) Rapid

List the 5 links in the Adult Chain of defibrillation 4) Advanced life support 5) Post-cardiac arrest care and
Chain of Survival Survival for OHCA. recovery.

What are the survival statistics for OHCA 10.4% survive to discharge, 8.2% with good neurological outcome. Limited
Chain of Survival and what are the key limiting factors? by: only 39.2% receive bystander CPR, only 11.9% receive public AED use.

IHCA has superior outcomes: 25.8% survive to discharge, 82% with good
How do IHCA outcomes compare to neurological function. Due to faster recognition, immediate CPR, and
Chain of Survival OHCA and why? reduced delays to defibrillation.
Anatomical diagram showing correct hand placement on the sternum for adult CPR chest compressions in BLS.

Categories covered:

• Recognition & Assessment (4 cards): Cardiac arrest recognition, agonal breathing significance, pulse check timing

• CPR Quality Metrics (5 cards): 2024 AHA compression depth (≥5cm), rate (100-120/min), compression fraction (>80%)

• CPR Technique (4 cards): Hand placement, C-A-B sequence, compression rotation protocols

• Airway Management (3 cards): Head-tilt chin-lift vs jaw-thrust techniques

• AED & Defibrillation (4 cards): Shockable vs non-shockable rhythms, optimal shock timing

• Chain of Survival (3 cards): OHCA vs IHCA survival statistics and limiting factors
Illustration of chin lift and jaw thrust maneuvers for airway management showing hand positions and airway anatomy changes to maintain airflow.

ACLS Flashcards (28 cards)

Category Front Back

What are the initial 3 steps in the ACLS 1) Start high-quality CPR, 2) Give oxygen, 3) Attach
Cardiac Arrest Cardiac Arrest Algorithm before rhythm monitor/defibrillator. These occur simultaneously and should not delay
Algorithm assessment? rhythm assessment.
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How does management differ between Shockable: Immediate defibrillation → CPR → IV/IO →
Cardiac Arrest shockable (VF/pVT) vs non-shockable Epinephrine → Antiarrhythmics. Non-shockable: CPR → IV/IO →
Algorithm (Asystole/PEA) rhythms? Epinephrine ASAP → treat reversible causes.

Cardiac Arrest When should rhythm and pulse checks occur Every 2 minutes after completing CPR cycles. Minimize interruptions
Algorithm during ACLS? <10 seconds. If organized rhythm appears, check pulse immediately.

Return of Spontaneous Circulation: organized rhythm + palpable pulse +

Cardiac Arrest What defines ROSC and what are the measurable blood pressure. Priorities: maintain airway, optimize
Algorithm immediate priorities? ventilation, treat hypotension, 12-lead ECG.

MOA: Alpha-1 vasoconstriction (increases coronary/cerebral perfusion),

What is the mechanism of action, dose, and Beta-1 inotrophy. Dose: 1mg IV/IO q3-5min. Timing: ASAP for
Vasopressors timing for epinephrine in cardiac arrest? asystole/PEA, after failed shock for VF/pVT.

What does the evidence show about Increases ROSC and survival to admission but NO improvement in
epinephrine's effect on cardiac arrest neurologically intact survival to discharge. May increase survival in
Vasopressors outcomes? non-shockable rhythms subgroup.

IV: Preferred, faster onset. IO: Alternative if IV fails after 2 attempts,

What are the advantages and disadvantages of reliable absorption. Endotracheal: Avoid if possible, requires 2-2.5x
Vasopressors IV vs IO vs endotracheal drug delivery? dose, poor absorption.
Category Front Back

Limited role. May be considered with steroids in IHCA (based on small

What is the role of vasopressin in modern studies), but not superior to epinephrine alone. Not routinely
Vasopressors ACLS protocols? recommended in current guidelines.

Indication: Shock-refractory VF/pVT. Dose: 300mg IV/IO first dose,

When and how should amiodarone be then 150mg if VF/pVT persists. Give after defibrillation and epinephrine
Antiarrhythmics administered in cardiac arrest? have failed.

After successful conversion: 1mg/min for 6 hours (360mg total), then

What are the post-ROSC infusion protocols for 0.5mg/min for 18 hours (540mg). Max 2.2g in 24 hours. Use D5W with
Antiarrhythmics amiodarone? in-line filter.

How does lidocaine compare to amiodarone in Equivalent efficacy to amiodarone for shock-refractory VF/pVT. Dose:
cardiac arrest, and what are the dosing 1-1.5mg/kg initial, then 0.5-0.75mg/kg q5-10min intervals. Max total:
Antiarrhythmics parameters? 3mg/kg.

Indication: Torsades de pointes (especially with suspected

What is the specific indication and dosing for hypomagnesemia). Dose: 1-2g IV/IO diluted in 10ml NS over 5
Antiarrhythmics magnesium sulfate in cardiac arrest? minutes. May repeat if Torsades persists.

Use manufacturer-specified energy (typically 120-200J). If unknown,

What are the current energy recommendations use maximum device setting. For subsequent shocks, use equal or higher
Defibrillation for biphasic defibrillation? energy than previous shock.
Category Front Back

Continue CPR while charging. Clear for <5 seconds for rhythm check
How should CPR be coordinated around and shock. Resume CPR immediately post-shock. Consider pre-charging
Defibrillation defibrillation to minimize hands-off time? strategy to reduce delays.

Limited evidence, reserved for refractory VF/pVT after standard therapy

What is the evidence and protocol for double fails. Two defibrillators placed anterolateral + anteroposterior, shocked
Defibrillation sequential defibrillation? simultaneously or <1 second apart.

Optimize: Firm pad contact, proper placement, remove oxygen sources,

What factors optimize defibrillation success ensure adequate charging. Avoid: Excessive pad pressure, shocking
Defibrillation and what should be avoided? through clothing/jewelry, wet chest.

What are the advantages and disadvantages of ETT: Better ventilation, protection from aspiration, allows suctioning.
endotracheal intubation vs supraglottic airways SGA: Faster insertion, less training required, fewer interruptions. Both
Advanced Airway in cardiac arrest? have similar survival outcomes.

10 breaths/minute (1 every 6 seconds) with continuous chest

How should ventilation be managed once an compressions. Use capnography to monitor ET-CO2. Avoid
Advanced Airway advanced airway is placed? hyperventilation which decreases venous return.

<10mmHg: Poor CPR quality or poor prognosis. >20mmHg: Good CPR

What ET-CO2 values are clinically significant quality, higher ROSC probability. Sudden rise: Suggests ROSC. Target
Advanced Airway during CPR and what do they indicate? >20mmHg with compressions.
Category Front Back

When should advanced airway placement be After establishing IV access and initial medication administration.
attempted and what are the timing Should not delay CPR or defibrillation. If intubation fails after 2
Advanced Airway considerations? attempts, use SGA.

Hypoxia (O2, ventilation), Hypovolemia (fluids, blood),

List the 4 H's of reversible causes in cardiac Hyper/hypokalemia (correct electrolytes), Hypothermia (rewarming).
Reversible Causes arrest and their key treatments. Each requires specific targeted therapy.

Tension pneumothorax (needle decompression), Tamponade

List the 4 T's of reversible causes in cardiac (pericardiocentesis), Toxins (antidotes, supportive care), Thrombosis-
Reversible Causes arrest and their key treatments. pulmonary/coronary (thrombolytics, PCI).

Absent breath sounds, tracheal deviation, difficult ventilation,

What clinical signs suggest tension asymmetric chest expansion. Treatment: immediate needle
Reversible Causes pneumothorax during resuscitation? decompression 2nd intercostal space midclavicular line.

High index of suspicion with penetrating trauma or recent cardiac

How should suspected cardiac tamponade be procedure. Emergency pericardiocentesis or pericardial window. May
Reversible Causes managed during ACLS? require thoracotomy in refractory cases.

1) Optimize ventilation (avoid hyperventilation) 2) Treat hypotension

What are the immediate priorities in the first (SBP >90mmHg) 3) 12-lead ECG 4) Consider targeted temperature
Post-Arrest Care 20 minutes post-ROSC? management 5) Treat reversible causes.
Category Front Back

Maintain temperature 32-36°C for comatose patients post-ROSC from

What are the current guidelines for targeted VF/pVT arrest. Duration: 12-24 hours. Avoid hyperthermia >37.7°C in
Post-Arrest Care temperature management (TTM)? all post-arrest patients.

Target MAP >65mmHg or SBP >90mmHg. First-line: Norepinephrine

What blood pressure targets and vasopressor or epinephrine. Avoid dopamine (increased mortality). Consider
Post-Arrest Care choices are recommended post-ROSC? vasopressin if catecholamine-resistant shock.

Emergent PCI for STEMI. Consider for non-STEMI if high suspicion of

When should percutaneous coronary acute coronary syndrome. Don't delay for non-cardiac causes or if
Post-Arrest Care intervention (PCI) be considered post-arrest? prognosis is poor.
Adult cardiac arrest algorithm flowchart for ACLS with 2024 evidence-based protocol including CPR, rhythm checks, shock delivery, epinephrine,

and drug administration.

Categories covered:
• Cardiac Arrest Algorithm (4 cards): Initial steps, shockable vs non-shockable management

• Vasopressors (4 cards): Epinephrine mechanism, dosing, evidence base, delivery routes

• Antiarrhythmics (4 cards): Amiodarone vs lidocaine protocols, magnesium for Torsades

• Defibrillation (4 cards): Energy recommendations, timing coordination, double sequential techniques

• Advanced Airway (4 cards): ETT vs SGA comparison, ventilation rates, ET-CO2 monitoring

• Reversible Causes (4 cards): Complete H's and T's with treatments

• Post-Arrest Care (4 cards): ROSC priorities, targeted temperature management, PCI timing
Advanced Cardiovascular Life Support (ACLS) adult cardiac arrest algorithm illustrating stepwise management for shockable and non-shockable

rhythms with CPR, defibrillation, medication, and advanced airway interventions.

Challenging Questions for Excellence Demonstration

10 Expert-Level Questions covering:

Advanced Clinical Reasoning

• Hypothermic VF management: Algorithm modifications for core temperature 32°C

• ET-CO2 interpretation: Sudden drop from 25→8mmHg differential diagnosis

• Refractory VF protocols: Advanced interventions after 20 minutes standard ACLS

Advanced Pharmacology

• IV vs IO pharmacokinetics: Onset differences during low-flow states

• Amiodarone dosing calculations: Biphasic infusion rationale and calculations

Pathophysiology Integration

• Compression fraction physiology: Coronary perfusion pressure equations

• Arrest rhythm pathophysiology: Why treatment algorithms differ for VF/pVT vs PEA/Asystole

Evidence-Based Medicine

• Epinephrine controversy: PARAMEDIC-2 trial analysis and continued use rationale

• Airway device comparison: SGA vs ETT evidence and clinical implications

ECG rhythm strips showing ventricular fibrillation and ventricular tachycardia phases during defibrillation.

Key Differentiators for Modern Medicine Colleagues

Evidence-based approach: All content references 2024 AHA guidelines and landmark trials (PARAMEDIC-2, AIRWAYS-2)[1][2][3]

Quantitative precision: Specific compression depths (≥5cm), rates (100-120/min), energy settings (manufacturer-specified, typically 120-200J)[4][2]

Pathophysiologic reasoning: Mechanistic understanding of why interventions work (coronary perfusion pressure, Frank-Starling mechanism)[2]

Critical literature analysis: Ability to discuss major RCT findings and their clinical implications[5][1]

Systems-based thinking: Quality improvement approaches and outcome optimization strategies[6][4]

These materials demonstrate your mastery of modern emergency medicine principles while showing deep understanding of the evidence base that

guides current practice protocols.