ACLS exam with complete solutions 2024_2025, Exams of Numismatics

Download ACLS exam with complete solutions 2024_2025 and more Exams Numismatics in PDF only on Docsity! ACLS exam with complete solutions 2024/2025 In which situation does bradycardia require treatment? - ANSWER-Hypotension Which intervention is most appropriate for the treatment of a patient in asystole? - ANSWER-Epinephrine You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? - ANSWER-Establish IV or IO access A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirm a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. what is your next action? - ANSWER-Administer adenosine 6mg IV push A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a toal does of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated? - ANSWER-Epinephrine 2 to 10 mcg/min A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? - ANSWER-Epinephrine 1 mg IV/IO A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain si ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? - ANSWER-Hold aspirin for at least 24 hours if rtPA is administered A patient is in refractory ventricular fibrillation and has received multiple appropriate defribillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300mg IV. The patient is intubated. Which best describe the recommended second does of amiodarone for this patient? - ANSWER-150 mg IV push A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60mm Hg. What is the initial does of atropine? - ANSWER- 0.5mg A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? - ANSWER- Adenosine 6mg A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred? - ANSWER-IV or IO What is the indication for the use of magnesium in cardiac arrest? - ANSWER- Pulseless ventricular tachycardia-associated torsades de pointes A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What action is recommended next? - ANSWER-Seeking expert consultation Your patient is not responsive and is not breathing, You can palpate a carotid pulse. Which action do you take next? - ANSWER-Start rescue breathing You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now? - ANSWER-Epinephrine 1 mg IV You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the patient was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IV access has been established, Which intervention would be your next action? - ANSWER-Epinephrine 1mg What is recommended depth of chest compressions for an adult victim? - ANSWER-At least 2 inches How does complete chest recoil contribute to effective CPR? - ANSWER-Allows maximum blood return to the heart What is the recommended compression rate for high-quality CPR? - ANSWER- 100-120 compressions per minute A patient becomes unresponsive. You are uncertain if a faint pulse is present. They rhythm shown here is seen on the cardiac monitor. An IV is in pace. Which action do you take next? - ANSWER-Start high-quality CPR A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. Which action is indicated next? - ANSWER-Give an immediate unsynchronized high-energy shock (defibrillation dose) How often should you switch chest compressors to avoid fatigue? - ANSWER- About every 2 minutes 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. During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action? - ANSWER-Begin chest compressions. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? - ANSWER-Hands-free pads allow for a more rapid defibrillation. What action is recommended to help minimize interruptions in chest compressions during CPR? - ANSWER-Continue CPR while charging the defibrillator. Which action is included in the BLS survey? - ANSWER-Early defibrillation Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? - ANSWER-Amioderone 300mg What is the appropriate interval for an interruption in chest compressions? - ANSWER-10 seconds or less Which of the following is a sign of effective CPR? - ANSWER-PETCO2 ≥10 mm Hg 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 patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to - ANSWER-administer a second shock. What is the recommended next step after a defibrillation attempt? - ANSWER- Begin CPR, starting with chest compressions. Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? - ANSWER-Antecubital vein Which finding is a sign of ineffective CPR? - ANSWER-PETCO2 <10 mm Hg How often should the team leader switch chest compressors during a resuscitation attempt? - ANSWER-. Every 2 minutes IV/IO drug administration during CPR should be - ANSWER-given rapidly during compressions What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? - ANSWER-300 mg A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? - ANSWER-Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? - ANSWER-5 to 10 seconds Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? - ANSWER-Check the patient's pulse. An AED advises a shock for a pulseless patient lying in snow. What is the next action? - ANSWER-Administer the shock immediately and continue as directed by the AED. Which treatment or medication is appropriate for the treatment of a patient in asystole? - ANSWER-Epinephrine What is the minimum depth of chest compressions for an adult in cardiac arrest? - ANSWER-2 inches 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 given immediately after the the third shock. What drug should the team leader request to be prepared for administration next? - ANSWER-second dose of epinephrine 1 mg A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer? - ANSWER-amiodarone 300 mg You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action? - ANSWER-Give a single shock what do you do after return of spontaneous circulation - ANSWER-maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion what are the 5 h's and 5 t's - ANSWER-The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest.[1] A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts". hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary (PE) thrombosis, coronary Bradycardia require treatment when? - ANSWER-chest pain or shortness of breath is present how do you treat non-symptomatic bradycardia - ANSWER-monitor and observe what constitutes symptomatic bradycardia - ANSWER-hypotension altered mental status signs of shock chest pain acute heart failure A patient with sinus bradycardia and a heart rate of 42 has diaphoresis and blood pressure of 80/60. What is the initial dose of atropine? - ANSWER-0.5 mg how do you treat symptomatic bradycardia - ANSWER-give 0.5mg atropine every 3-5 mins to max of 3mg if that doesn't work try one of the following: transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2-10mcg per minute epinephrine infusion what is considered a tachycardia requiring treatment - ANSWER-over 150 per minute when do you consider cardioversion - ANSWER-if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain 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 A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action? - ANSWER-cardioversion when does bradycardia require treatment? - ANSWER-hypotension You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what? - ANSWER-establish IV or IO access you are caring for a 66 year old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. the ct scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving? - ANSWER-aspirin A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy? - ANSWER-hold aspirin for at least 24 hours if rtPA is administered a 45 year old woman has a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for SVT without conversion. BP 128/70. next step? - ANSWER-adenosine 12 mg STEMI intervention is most important in reducing patients in hospital and 30 day mortality? - ANSWER-reperfusion therapy a patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm VT. What tx is indicated - ANSWER-unsynchronized high energy shock which action should you take immediately after providing an AED shock - ANSWER-resume chest compressions which action causes air to enter victim's stomach (gastric inflation) during bag- mask ventilation - ANSWER-ventilation too quickly, A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm below. What is your next action? - ANSWER-CPR you are the code team leader and arrive to find a patient with CPR in progress. On next rhythm check NSR. Pt reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise and IO access has been established. Intervention? - ANSWER-EPI 1 mg refractory ventricular fibrillation. 3rd shock just administered. what is next action - ANSWER-resume high-quality chest compression 2nd degree mobitz - ANSWER- 2nd degree wenckebach - ANSWER- coarse V fib - ANSWER- PEA - ANSWER- fine V Fib - ANSWER- A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is? - ANSWER- resume high quality chest compressions A patient with sinus bradycardia and a heart rate of 42 bpm has diaphoresis and a BP of 80/60 mm Hg. What is the initial dose of atropine? - ANSWER-0.5 mg When can you use magnesium in cardiac arrest? - ANSWER-VF/pulseless VT associated with torsades de pointes A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do? - ANSWER-Seek expert consultation A patient with possible ST-segment elevation MI has ongoing chest discomfort. What is a containdication to the administration of nitrates? - ANSWER- Phosphodiesterase inhibitor within 12 hours Bradycardia requires treatment when? - ANSWER-Chest pain or shortness of breath You patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route? - ANSWER-Lidocaine, epinephrine, vasopressin A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug and dose should be administered first by the IV/IO route? - ANSWER-Epinephrine 1 mg A patient is in refractory ventricular fibrillation. High quality CPR is in progress, and shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next? - ANSWER-Second dose of epinephrine 1 mg A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy? - ANSWER-Do not give ASA for at least 24 hours if rtPA is administered A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which is the next drug/dose to anticipate to administer? - ANSWER-Amiodarone 300 mg 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 recommended second dose of amiodarone is what? - ANSWER-150 mg IV push A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action? - ANSWER-Perform immediate electrical cardioversion A 35 year old woman has palpitations, light headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138 bpm. He is asymptomatic, with a blood pressure of 110/70. He has a history of angina. What action is recommended next? (a) Giving adenosine 6 mg IV bolus (b) Giving lidocaine 1 to 1.5 mg IV bolus (c) Performing synchroniczed cardioversion (d) Seeking expert consultation - ANSWER-(d) Seeking expert consultation A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? (a) Atropine 1 mg IV/IO (b) Epinephrine 1 mg IV/IO (c) Lidocaine 1 mg/kg IV/IO (d) Sodium bicarbonate 50 mEq IV/IO - ANSWER-(b) Epinephrine 1 mg IV/IO You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? (a) Call for a pulse check (b) Establish IV or IO access (c) Insert a laryngeal airway (d) Perform endotracheal intubation - ANSWER-(b) Establish IV or IO access A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? (a) Adenosine 6 mg (b) Amiodarone 300 mg (c) Epinephrine 3 mg (d) Lidocaine 0.5 mg/kg - ANSWER-(b) Amiodarone 300 mg A 35 yr old female has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal manuevers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? (a) Adenosine 6 mg (b) Atropine 0.5 mg (c) Epinephrine 2 to 10 mcg/kg per minute (d) Lidocaine - ANSWER-(a) Adenosine 6 mg Pt is in refractory ventricular fibrilation. CPR is in progress. 1 dose of epinephrine given after second shock. An antiarrhythmic drug was given immediately after third shock. Which med is next? (a) Epinephrine 1 mg (b) Epinephrine 3 mg (c) Sodium bicarb 50 mEq (d) Second dose of antiarrhythmic drug - ANSWER-(a) Epinephrine 1 mg What is the indication for use of magnesium in cardiac arrest? (a) Ventricular tachycardia associated with a normal QT interval (b) Shock-refractory monomorphic ventricular tachycardia (c) Pulseless ventricular tachycardia-associated torsades de pointes (d) Shock-refractory ventricular fibrillation - ANSWER-(c) Pulseless ventricular tachycardia-associated torsades de pointes A pt is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred? (a) Central line (b) Endotracheal tube (c) External jugular vein (d) IV or IO - ANSWER-(d) IV or IO Which intervention is most appropriate for the treatment of a patient in asystole? (a) Atropine (b) Defibrillation (c) Epinephrine (d) Transcutaneous pacing - ANSWER-(c) Epinephrine You are caring for a 66 yr old man with a hx of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scane is negative for hemorrhage. The pt is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His BP is 180/100. Which drug do you anticipate giving to this pt? (a) Aspirin (b) Glucose (D50) (c) Nicardipine (d) rTPA - ANSWER-(a) Aspirin Pt is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. Pt is intubated. Which best describes the recommended second dose of amiodarone for this pt? (a) 1 mg/kg IV push (b) 1 to 2 mg/min infusion (c) 150 mg IV push (d) 300 mg IV push - ANSWER-(c) 150 mg IV push A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 200. Pt's BP is 128/58, PETCO2 is 38, and pulse oximetry reading is 98%. There is vascular access in the left arm, and pt has not been given any vasoactive drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. Heart rate has not responded to vagal manuevers. What is your next action? (a) Administer adenosine 6 mg IV push (b) Administer amiodarone 300 mg IV push (c) Perform synchronized cardioversion at 50 J (d) Perform synchronized cardioversion at 200 J - ANSWER-(a) Administer adenosine 6 mg IV push In which situation does bradycardia require treatment? (a) 12-lead ECG showing a normal sinus rhythm (b) Hypotension (c) Diastolic blood pressure > 90 (d) Systolic blood pressure > 100 - ANSWER-(b) Hypotension A 67 yr old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60. Which action do you take next? (a) Establish IV access (b) Obtain a 12 lead EKG (c) Perform electrical cardioversion (d) Seek expert consultation - ANSWER-(c) Perform electrical cardioversion Pt w/ sinus bradycardia and a heart rate of 42 has diaphoresis and a blood pressure of 80/60. What is the initial dose of atropine? (a) 0.1 mg (b) 0.5 mg (c) 1 mg (d) 3 mg - ANSWER-(b) 0.5 mg (a) Check the carotid pulse (b) Give amiodarone 300 mg IV (c) Give atropine 1 mg IV (d) Resume high-quality chest compressions - ANSWER-(d) Resume high-quality chest compressions A patient has been rususcitated from cardiac arrest. During post-ROSC treatment, pt becomes unresponsive, with ventricular fibrillation. Which action is indicated next? (a) Give an immediate unsynchronized high-energy shock (defibrillation dose) (b) Give lidocaine 1 to 1.6 mg/kg IV (c) Perform synchronized cardioversion (d) Repeat amiodarone 300 mg IV - ANSWER-(a) Give an immediate unsynchronized high-energy shock (defibrillation dose) What is the recommended compression rate for high-quality CPR? - ANSWER- 100-120 compressions per min What action minimizes the risk of air entering the victim's stomach during bag- mask ventilation? (a) Ventilating until you see the chest rise (b) Ventilating as quickly as you can (c) Squeezing the bag with both hands (d) Delivering the largest breath you can - ANSWER-(a) Ventilating until you see the chest rise Which action should you take immediately after providing an AED shock? (a) Check pulse rate (b) prepare to deliver a second shock (c) Resume chest compressions (d) Start rescue breathing - ANSWER-(c) Resume chest compressions After initiation of CPR and 1 shock for ventricular fibrillation, pt is still in ventricular fibrillation at next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. BBag-mask ventilations are producing visible chest rise. What is your next intervention? (a) Administer 3 sequential (stacked) shocks at 360 J (monophasic defibrillator) (b) Give amiodarone 300 mg IV/IO (c) Give epinephrine 1 mg IV/IO (d) Intubate and administer 100% oxygen - ANSWER-(c) Give epinephrine 1 mg IV/IO What is the maximum interval for pausing chest compressions? - ANSWER-10 seconds A 35 yr old woman presents w/ a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her BP is 120/78. On EKG, it shows she is in SVT. Which intervention is indicated first? (a) Adenosine 3 mg IV bolus (b) Adenosine 12 mg IV slow push (over 1 to 2 min) (c) Metoprolol 5 mg IV and repeat if necessary (d) Vagal manuevers - ANSWER-(d) Vagal manuevers Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next? (a) Apply an AED (b) Obtain a 12 lead EKG (c) Start an IV (d) Start rescue breathing - ANSWER-(d) Start rescue breathing What is more important to start for a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing? - ANSWER-Starting rescue breathing You arrive on scene to find CPR in progress. Nursing staff report the pt was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now? (a) Atropine 0.5 mg IV (b) Epinephrine 1 mg IV (c) Endotracheal intubation (d) Transcutaneous pacing - ANSWER-(b) Epinephrine 1 mg IV A patient becomes unresponsive. You are uncertain if a faint pulse is present. An IV is in place. Which action do you take next? (a) Begin transcutaneous pacing (b) Start high-quality CPR (c) Administer atropine 1 mg (d) Administer epinephrine 1 mg IV - ANSWER-(b) Start high-quality CPR If cases where ______ is the likely cause of cardiac arrest, VENTILATION becomes much more important - ANSWER-hypoxia ___________ correlates w/ ROSC - ANSWER-High quality CPR What are the consequences of interrupting CPR? - ANSWER-coronary perfusion falls __________ can help indicate coronary perfusion pressure - ANSWER- Capnography Adequate CPR compression are at least - ANSWER-2 inches Why should chest compressions recoil? - ANSWER-To ensure adequate coronary perfusion pressure Chest compression fraction should be around - ANSWER-60-80% Don't spend more than ____ seconds without compressions - ANSWER-10 seconds What should the tidal volume be for adequate ventilations? - ANSWER-500-600 mL or half of a bag squeeze What should be the first thing you do when you arrive on scene? - ANSWER-See if patient is conscious or unconscious What do you do next If the patient is unconscious when you first arrive on scene? - ANSWER-Initiate BLS If a patient is not responsive when you first arrive on scene, what should you do next? - ANSWER-Call code Get AED During BLS, should you check breathing and pulse (a) Separately (b) Simultaenously - ANSWER-(b) Simultaenously If pt is not breathing normally but has pulse, what should you do? - ANSWER- Bypass chest compressions and ventilate every 5-6 seconds After intubating someone, what should you do next? - ANSWER-Provide 1 ventilation every 6 seconds Most symptomatic tachycardias will present with a HR of greater than - ANSWER- 150 If a tachycardia patient is hemodynamically stable, what is the next thing you should assess? - ANSWER-If QRS is wide (>= 0.120 sec) If QRS is not wide for a tachycardia patient, what should you do next? - ANSWER- (1) Vagal manuevers (2) Adenosine (3) Bblock or CCB (4) Expert consultation What things do you need to do after ROSC? - ANSWER-(1) Optimize ventilation and oxygenation (2) Treat Hypotension (3) EKG (4) See if pt follows commands During post ROSC, what things do you need to do to optimize ventilation and oxygenation? - ANSWER-- O2 > 94% - Advanced airway + capnography - Don't hyperventilate During post ROSC, if a pt cannot follow commands, what do you need to do? - ANSWER-Initiate targeted temperature management If a patient is responsive and talking, what is the next step of the ACS algorithm? - ANSWER-Obtain a 12 lead ECG What is the dosing of nitroglycerin according to the ACS algorithm? - ANSWER- Every 3-5 minutes for a maximum of 3 doses What are the contraindications of nitroglycerin according to the ACS algorithm? - ANSWER-- Severe bradycardia - Tachycardia - Hypotension - Phosphodiesterase inhibitors Initiation of fibrinolytic therapy, if appropriate, within _____ of hospital arrival and ______ from onset of symptoms - ANSWER-Initiation of fibrinolytic therapy, if appropriate, within 1 hour of hospital arrival and 3 hours from onset of symptoms In ACS algorithm, what determines whether or not a STEMI gets reperfusion or not? - ANSWER-Whether or not the sxs of onset are less than 12 hrs