CPR and Cardiac Arrest Management: Best Practices and Strategies, Exams of Cardiology

Download CPR and Cardiac Arrest Management: Best Practices and Strategies and more Exams Cardiology in PDF only on Docsity! ACLS Advanced Cardiovascular Life Support WRITTEN EXAM 136 QUESTIONS AND ANSWERS You find an unresponsive pt. who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action? - answer Start chest compressions of at least 100 per min. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now? - answer Obtaining a 12 lead ECG. What is the preferred method of access for epi administration during cardiac arrest in most pts? - answer Peripheral IV An AED does not promptly analyze a rythm. What is your next step? - answer Begin chest compressions. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority? - answer Administer 1mg of epinephrine During a pause in CPR, you see this lead II ECG rhythm on the monitor. The patient has no pulse. What is the next action? - answer Resume compressions What is a common but sometimes fatal mistake in cardiac arrest management? - answer Prolonged interruptions in chest compressions. Which action is a componant of high-quality chest comressions? - answer Allowing complete chest recoil Which action increases the chance of successful conversion of ventricular fibrillation? - answer Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes pulseless electrical activity? - answer Sinus rythm without a pulse What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? - answer Provide continuous chest compressions without pauses and 10 ventilations per minute. Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding? - answer Chest compressions may not be effective. The use of quantitative capnography in intubated patients - answer allows for monitoring of CPR quality. For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? - answer Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? - answer Be sure oxygen is not blowing over the patient's chest during the shock. A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? - answer Simple airway manuevers and assisted ventilations. What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected? - answer Suction during withdrawal but for no longer than 10 seconds. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention ? - answer Atropine 0.5mg A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next? - answer Cincinnati Prehospital Stroke Scale assessment EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next? - answer Head CT scan What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? - answer 8-10 breaths per minute A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next? - answer Obtain a 12 lead ECG. You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next? - answer Synchronized cardioversion What is the initial priority for an unconscious patient with any tachycardia on the monitor? - answer Determine whether pulses are present. Which rhythm requires synchronized cardioversion? - answer Unstable supraventricular tachycardia What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia? - answer 12mg What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)? - answer 35-40mm Hg Which condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? - answer Responding to verbal commands What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway? - answer Obstruction of venous return from the brain What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? - answer Continuous waveform capnography hat is the recommended IV fluid (normal saline or Ringer's lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? - answer 1 to 2 Liters What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? - answer 90mm Hg What is the first treatment priority for a patient who achieves ROSC? - answer Optimizing ventilation and oxygenation. What should be done to minimize interruptions in chest compressions during CPR? - answer Continue CPR while the defibrillator is charging. Which condition is an indication to stop or withhold resuscitative efforts? - answer Safety threat to providers After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action? - answer IV or IO access After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action? - answer Check for a pulse. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? - answer Not recommended for routine use What survival advantages does CPR provide to a patient in ventricular fibrillation? - answer Produces a small amount of blood flow to the heart What is the recommended compression rate for performing CPR? - answer At least 100 per minute EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention? - answer defibrillation A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? - answer Administer 2 to 4 mg of morphine by slow IV bolus. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? - answer Seeking expert consultation A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? - answer Obtain a 12-lead ECG and administer aspirin if not contraindicated. An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action? - answer Conduct a problem-focused history and physical examination. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? - answer 160 to 325 mg A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below. - answer stable supraventricular tachycardia What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? - answer Synchronized cardioversion What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? - answer Improving patient outcomes by identifying and treating early clinical deterioration What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? - answer 10 to 12 breaths per minute Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? - answer Performing a head tilt-chin lift maneuver A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? - answer Synchronized cardioversion A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? - answer Defibrillation What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? - answer 120to200J Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? - answer Measure from the corner of the mouth to the angle of the mandible. Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? - answer Right ventricular infarction and dysfunction What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? - answer Administration of IV or IO fluid bolus Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation? - answer Transport the patient to a facility capable of performing PCI. What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC? - answer Decreased cerebral blood flow What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? - answer 32°C to 34°C What is the recommended duration of therapeutic hypothermia after reaching the target temperature? - answer 12 to 24 hours What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? - answer Potential oxygen toxicity What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC? - answer 0.1 to 0.5 mcg/kg per minute IV infusion You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority? - answer Administer 1mg of epinephrine A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ? - answer 150 mg IV push A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was acute heart failure if persistent tachycardia does not present with symptoms what do you need to consider - answer wide QRS? greater than 0.12 seconds Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route? - answer Lidocaine, epinephrine, vasopressin reentry supraventricular tachycardia - answer polymorphic ventricular tachycardia - aka torsades - answer atrial fibrilation - answer sinus tachycardia - answer coarse ventricular fibrillation - answer atrial flutter - answer reentry supraventricular tachycardia - answer sinus bradycardia - answer monomorphic ventricular tachycardia - answer fine ventricular fibrillation - answer second degree AV block type 1 wenckenbach - answer second degree AV block mobitz type 2 - answer third degree AV block - answer asystole - answer normal sinus rhythm - answer pulseless electrical activity - answer agonal rhythm/asystole - answer The five links in the adult Chain of Survival - answer 1- Immediate activation of EMS 2- Early CPR 3- Rapid defibrillation (not in peds) 4- Effective advanced life support 5- Integrated post-cardiac arrest care Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest - answer Agonal gasps To place the pads on the victims bare chest, Place one pad on the upper-right chest (below the collarbone) and place the other pad - answer to the side of the left nipple, with the top edge of the pad a few inches below the armpit If the heart muscle resets and initiates an organized rhythm this is called - answer ROSC return of spontaneous circulation