ACLS STUDY GUIDE EXAM , POST TEST EXAMS 1,2,3 ,PRACTICE EXAMS, Exams of Nursing

Download ACLS STUDY GUIDE EXAM , POST TEST EXAMS 1,2,3 ,PRACTICE EXAMS and more Exams Nursing in PDF only on Docsity! ACLS STUDY GUIDE EXAM , POST TEST EXAMS 1,2,3 ,PRACTICE EXAMS (ADVANCED CARDIOVASCULAR LIFE SUPPORT) WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS |LATEST UPDATE 2024| ALREADY GRADED A+| 100% GUARANTEED PASS!!! What should be done to minimize interruptions in chest compressions during CPR? Perform pulse checks only after defibrillation. Safety threat to providersSafety threat to providers Administer IV medications only when breaths are given. Continue to use AED even after the arrival of a manual defibrillator. Safety threat to providers 2. Which condition is an indication to stop or withhold resuscitative efforts? Unwitnessed arrest Safety threat to providers Patient age greater than 85 years No return of spontaneous circulation after 10 minutes of CPR Safety threat to providers 3. 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? IV or IO access Endotracheal tube placement Consultation with cardiology for possible PCI Application of a transcutaneous pacemaker IV or IO access 4. After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action? Retrieve an AED. Check for a pulse. Deliver 2 rescue breaths. Administer a precordial thump. Check for a pulse. 5. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? Not recommended for routine use Recommended during every resuscitation attempt Recommended when the patient is vomiting Recommended only for supraglottic airway insertion Not recommended for routine use 6. What survival advantages does CPR provide to a patient in ventricular fibrillation? Increases the defibrillation threshold Directly restores an organized rhythm Opposes the harmful effects of epinephrine Produces a small amount of blood flow to the heart Produces a small amount of blood flow to the heart 7. What is the recommended compression rate for performing CPR? 60 to 80 per minute 80 to 100 per minute About 100 per minute At least 100 per minute At least 100 per minute 8. 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? Defibrillation Endotrachealintubation Epinephrine administration Antiarrhythmic administration Defibrillation 9. A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to Defibrillation Transcutaneous pacing Epinephrine 20. An AED advises a shock for a pulseless patient lying in snow. What is the next action? Place a backboard beneath the patient and administer the shock. Move the patient off the snow to bare ground and deliver the shock. Remove any snow beneath the patient and then administer the shock. Administer the shock immediately and continue as directed by the AED. Administer the shock immediately and continue as directed by the AED. 21. What is the minimum depth of chest compressions for an adult in cardiac arrest? 1 inch 11⁄2 inches 2 inches 21⁄2inches 2 inches 22. A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? Check for a pulse. Administer an IV antiarrhythmic. Start chest compressions at a rate of at least 100/min. Repeat the unsynchronized shock, increasing to 200 J. Start chest compressions at a rate of at least 100/min. 23. You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action? Administer normal saline at 20 mL/kg. Administer epinephrine at 1 mg/kg IV. Obtain a blood pressure and oxygen saturation. Have a team member attempt to palpate a carotid pulse. Have a team member attempt to palpate a carotid pulse. 24. Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? Intraosseous (IO) Endotracheal(ET) Intramuscular (IM) Central venous access Intraosseous (IO) 25. What is the appropriate rate of chest compressions for an adult in cardiac arrest? At least 150/min At least 100/min Approximately 100/min Approximately 120/min At least 100/min 26. You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? Contact the patient's family to see what they would prefer. Have the EMS crew choose an appropriate patient disposition. Accept the report and provide care within your present capability. Divert the patient to a hospital 15 minutes away with CT capabilities. Divert the patient to a hospital 15 minutes away with CT capabilities. 27. A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient's blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action? Acquisition of a 12-lead ECG Vagal maneuvers Procedural sedation Immediate defibrillation Vagal maneuvers 28. 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? Administer an additional dose of aspirin. Administer an additional nitroglycerin tablet. Administer high-flow oxygen via an oxygen mask. Administer 2 to 4 mg of morphine by slow IV bolus. Administer 2 to 4 mg of morphine by slow IV bolus. 29. 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? Administration of IV epinephrine Seeking expert consultation Procedural sedation Synchronized cardioversion Seeking expert consultation 30. A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? Administer an IV fluid bolus and obtain arterial blood gas. Start dopamine at 2 mcg/kg per minute and obtain a chest x-ray. Send blood to the laboratory for chemistry and cardiac enzymes. Obtain a 12-lead ECG and administer aspirin if not contraindicated. . Obtain a 12-lead ECG and administer aspirin if not contraindicated. 31. 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? Give an IV fluid bolus. Give atropine and monitor for changes in mental status. Start an epinephrine infusion and titrate to patient response. Conduct a problem-focused history and physical examination. Conduct a problem-focused history and physical examination. 32. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? 2 to 4mg 40. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? Defibrillation Adenosine 6 mg IV push Epinephrine 1 mg IV push Synchronized cardioversion Defibrillation 41. What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? 50to75J 75to100J 120to200J 200to300J 120 to 200J 42. Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? Estimate by using the size of the patient's thumb. Estimate by using the formula Weight (kg)/8 + 2. Measure from the thyroid cartilage to the angle of the mandible. Measure from the corner of the mouth to the angle of the mandible. Measure from the corner of the mouth to the angle of the mandible. 43. Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? Heart rate greater than 80/min Right ventricular infarction and dysfunction Phosphodiesterase inhibitor use more than 72 hours ago Systolic blood pressure greater than 100 mm Hg Right ventricular infarction and dysfunction 44. What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? Atropine bolus Administration of IV or IO fluid bolus Placement of a central line to monitor pulmonary wedge pressure Phenylephrine hydrochloride titrated to keep systolic blood pressure >100 mm Hg Administration of IV or IO fluid bolus 45. Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation? Initiate an antiarrhythmic infusion. Transport the patient to a facility capable of performing PCI. Replace any supraglottic airway with an endotracheal tube. Place a central venous catheter for hemodynamic monitoring. Transport the patient to a facility capable of performing PCI. 46. What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC? Oxygen toxicity Pulmonary hypertension Decreased cerebral blood flow Ventilation/perfusion mismatch Decreased cerebral blood flow 47. What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? 26°C to 28°C 29°C to 31°C 32°C to 34°C 35°C to 37°C 32°C to 34°C 48. What is the recommended duration of therapeutic hypothermia after reaching the target temperature? 0 to 12 hours 12 to 24 hours 24 to 36 hours 36 to 48 hours 12 to 24 hours 49. What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? Potential oxygen toxicity Adverse hemodynamic effects Decrease in cerebral blood flow Increased intrathoracic pressure Potential oxygen toxicity 50. What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC? 2 to 10 mg/min IV infusion 0.1 to 0.5 mcg/kg per minute IV infusion 1 mg IV push every 3 to 5 minutes 10 mg IV push every 3 to 5 minutes 0.1 to 0.5 mcg/kg per minute IV infusion 1. You find an unresponsive patient who is not breathing. After activating the emergency response system, you determine that there is no pulse. What is your next action? Open the airway with a head tilt-chin lift. Administer epinephrine at a dose of 1 mg/kg. Deliver 2 rescue breaths each over 1 second. Start chest compressions at a rate of at least 100/min. Start chest compressions at a rate of at least 100/min. 2. 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? PETCO2 Chest x-ray Laboratory testing Obtaining a 12-lead ECG Obtaining a 12-lead ECG 3. What is the preferred method of access for epinephrine administration during cardiac arrest in most patients? Intraosseous Endotracheal Central intravenous Peripheral intravenous 14. 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? Apply a transcutaneous pacemaker. Administer 1 mg of intravenous atropine. Administer 40 units of intravenous vasopressin. Consider terminating resuscitative efforts after consulting medical control. Consider terminating resuscitative efforts after consulting medical control. 15. Which is a safe and effective practice within the defibrillation sequence? Stop chest compressions as you charge the defibrillator. Be sure oxygen is not blowing over the patient's chest during the shock. Assess for the presence of a pulse immediately after the shock. Commandingly announce "clear" after you deliver the defibrillation shock. Be sure oxygen is not blowing over the patient's chest during the shock. 16. 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? Leave and get an AED. Begin chest compressions. Deliver 2 quick ventilations. Check the patient's mouth for the presence of a foreign body. Begin chest compressions. 17. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? Hands-free pads deliver more energy than paddles. Hands-free pads increase electrical arc. Hands-free pads allow for a more rapid defibrillation. Hands-free pads have universal adaptors that can work with any machine. Hands-free pads allow for a more rapid defibrillation. 18. What action is recommended to help minimize interruptions in chest compressions during CPR? Continue CPR while charging the defibrillator. Perform pulse checks immediately after defibrillation. Administer IV medications only when delivering breaths. Continue to use an AED even after the arrival of a manual defibrillator. Continue CPR while charging the defibrillator. 19. Which action is included in the BLS Survey? Early defibrillation Advanced airway management Rapid medication administration Preparation for therapeutic hypothermia Early defibrillation 20. Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? Atropine 2 mg Amiodarone 300 mg Vasopressin 1 mg/kg Dopamine 2 mg/kg per minute Amiodarone 300 mg 21. What is the appropriate interval for an interruption in chest compressions? 10 seconds or less 10 to 15 seconds 15 to 20 seconds Interruptions are never acceptable 10 seconds or less 22. Which of the following is a sign of effective CPR? PETCO2 ≥10 mm Hg Measured urine output of 1 mL/kg per hour Patient temperature >32°C (89.6°F) Diastolic intra-arterial pressure <20 mm Hg PETCO2 ≥10 mm Hg 23. What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)? Identifying and treating early clinical deterioration Rapidly intervening with patients admitted through emergency department triage Responding to patients during a disaster or multiple-patient situation Responding to patients after activation of the emergency response system Identifying and treating early clinical deterioration 24. Which action improves the quality of chest compressions delivered during a resuscitation attempt? Observe ECG rhythm to determine depth of compressions. Do not allow the chest to fully recoil with each compression. Compress the upper half of the sternum at a rate of 150 compressions per minute. Switch providers about every 2 minutes or every 5 compression cycles. Switch providers about every 2 minutes or every 5 compression cycles. 25. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min? 1 breath every 3 to 4 seconds 1 breath every 5 to 6 seconds 2 breaths every 5 to 6 seconds 2 breaths every 6 to 8 seconds 1 breath every 5 to 6 seconds 26. A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? Atropine 0.5 mg Oxygen 12 to 15 L/min Epinephrine 0.5 mg Aspirin 160 mg chewed Atropine 0.5 mg 27. A patient presents to the emergency department with dizziness and shortness of breath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? 2 to 10 mg/min 2 to 10 mcg/kg per minute 10 to 15 mg/min 10 to 15 mcg/kg per minute 2 to 10 mcg/kg per minute 28. A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below: What is the next appropriate intervention? Vagal maneuvers Metoprolol 5 mg IV 12-lead ECG assessment Administration of 100% supplementary oxygen Cincinnati Prehospital Stroke Scale assessment Administration of a low-dose aspirin Cincinnati Prehospital Stroke Scale assessment 37. 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? Head CT scan Transfer to the stroke unit Immediate rtPA administration Administration of 100% oxygen Head CT scan 38. What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? 4 to 6 breaths per minute 8 to 10 breaths per minute 12 to 14 breaths per minute 16 to 18 breaths per minute 8 to 10 breaths per minute 39. 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? Obtain a 12-lead ECG. Give 150 mg of amiodarone. Administer 160 mg of aspirin. Administer 6 mg of adenosine. Obtain a 12-lead ECG. 40. 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? Procedural sedation 12-lead ECG Amiodarone administration Synchronized cardioversion Synchronized cardioversion 41. What is the initial priority for an unconscious patient with any tachycardia on the monitor? Review the patient's home medications. Evaluate the breath sounds. Determine whether pulses are present. Administer sedative drugs. Determine whether pulses are present. 42. Which rhythm requires synchronized cardioversion? Unstable supraventricular tachycardia Atrial fibrillation Sinus tachycardia NSR on monitor but no pulse Unstable supraventricular tachycardia 43. What is the recommended second dose of adenosine for patients in refractory but stable narrow- complex tachycardia? A. 3mg B. 6mg C. 9mg D. 12mg D. 12mg 44. What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)? A. 30to35mmHg B. 35to40mmHg C. 40to45mmHg D. 45to50mmHg B. 35to40mmHg 45. Which condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? Initial rhythm of asystole Responding to verbal commands Patient age greater than 60 years Desire to provide coronary reperfusion (eg, PCI) Responding to verbal commands 46. What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway? May interfere with effective ventilation Places the patient's cervical spine at risk Obstruction of venous return from the brain Does not adequately secure the airway device Obstruction of venous return from the brain 47. What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? 5-point auscultation Colorimetric capnography Continuous waveform capnography Use of esophageal detection devices Continuous waveform capnography 48. What 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? 250 to 500 mL 500 to 1000 mL 1 to 2 L 2 to 3 L 1 to 2 L 49. 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? 90 mm Hg 85 mm Hg 80mmHg 75mmHg 90 mm Hg 50. What is the first treatment priority for a patient who achieves ROSC? Coronary reperfusion 27. You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now? C) Obtaining a 12-lead ECG. 28. A patient in respiratory distress and with a blood pressure of 70/50 mmHg presents with the lead IIECG rhythm shown here. Which is the appropriate treatment? B) Performing synchronized cardioversion. 29. During post-cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? B) At least 24 hours. 30. Three minutes into a cardiac resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mmHg. Which is the significance of this finding? A) Chest compressions may not be effective. 31. Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? C) 160 to 325 mg. 32. A team member is unable to perform an assigned task because it is beyond the team member's scope of practice. Which action should the team member take? A) Ask for a new task or role. 33. As the team leader, when do you tell the chest compressors to switch? B) About every 2 minutes. 34. You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? C) 100 to 120/min. 35. A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response? D) I have an order to give 500 mg of amiodarone IV. 36. A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? B) 12 mg. 37. A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? C) Defibrillation 38. Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? D) Noncontrast CT scan of the head. 39. What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation? D) 90 mm Hg. 40. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What do you do next? C) Give epinephrine 1 mg IV. 41. Based on this patient's initial presentation, which condition do you suspect led to the cardiac arrest? A) Acute Coronary Syndrome. 42. In addition to defibrillation, which intervention should be performed immediately? C) Chest Compressions. 43. Despite 2 Defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A) Epinephrine 1 mg. 44. Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next? D) Amiodarone 300 mg. 45. The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post-cardiac arrest care intervention do you choose for this patient? A) Initiate targeted temperature management. 46. Which would you have done first if the patient had not gone into ventricular fibrillation? D) Performed synchronized cardioversion. 47. Based on this patient's initial assessment, which adult ACLS algorithm should you follow? B) Tachycardia. 48. The patient's pulse oximeter shows a reading of 84% on room air. Which initial action do you take? C) Apply oxygen. 49. After your initial assessment of this patient, which intervention should be performed next? A) Synchronized cardioversion. 50. If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority? D) Perform defibrillation. BLS Assessment 1. Check responsiveness 2. Shout for nearby help, activate the emergency response system, get the AED (defibrillator) 3. Check breathing and pulse (if no pulse, start cpr) 4. Defibrillate (if no pulse and rhythm is shockable. Follow each shock with cpr) Quality compressions (depth, rate, recoil) 2in depth, 100-120/min, allow complete chest recoil after each compression H's (most common causes of cardiac arrest) Hypovolemia, hypoxia, hydrogen ion(acidosis), hypo/hyperkalemia, hypothermia T's (most common causes of cardiac arrest) Tension pneumothorax, tamponade(cardiac), toxins, thrombosis(pulmonary and/or coronary) 2 most common cause of PEA Hypovolemia and hypoxia Respiratory failure signs Marked tachypnea, bradypnea, apnea(late), changes or no respiratory effort, poor to absent distal air movement, tachycardia(early), bradycardia(late), cyanosis, coma (late) tidal volume (definition) amount of air inhaled (lungs) tidal volume (for person in respiratory arrest) 500-600ml ventilation rate (bag-mask) once every 5-6 seconds management of respiratory arrest giving oxygen, opening the airway, providing basic ventilation, using opa and npa, suctioning minimum oxygen saturation 94% (for patients in respiratory or cardiac arrest, strive for 100% oxygen saturation) Cardiac arrest Correct treatments for unstable bradycardia? Identify and treat underlying cause - maintain patent airway, ventilate and give O2 Atropine 1mg IVP q3-5 min (max 3mg) Transcutaneous pacemaker Dopamine drip 5-20mcg/kg/min or Epinephrine drip 2-10mcg/kg/min What IV infusions can be given for unstable bradycardia? Drip rates? Dopamine: 2-10 mcg/kg/min Epi: 2-10 mcg/min What is true about the PR interval in a second degree type 2 block? Second degree type 1? - type 1 is characterized by a gradual prolongation of the PR interval until there is a drop - The PR interval is constant and elongated with a drop Describe the relationship between the p wave and the QRS in third-degree or complete heart block. "If P and Q don't agree then you have a third degree" What is the most common cause of bradycardias hypoxia Preferred medication route for a pulseless patient? 2nd choice? - Intravenous line (IV), Meds given rapidly during compressions. -2nd choice: Intraosseous When during the CPR cycle should meds be given? During compressions (at start) What is the FIRST drug all pulseless patients get? Dose? -Epinephrine 1mg IVP- given every 3-5 minutes: Follow with a saline flush (5cc) What two drugs can be given for refractory pulseless VT or VF rhythms? Dose? Frequency? First drug: Epinephrine 1mg IVP q3-5 min Second drug: Amiodarone 300mg IVP, second dose 150 mg q3-5 min What antiarrhythmic is recommended for polymorphic VT/torsades? Dose? 1-2 Gm in 50-100mL D5W over 5-20 min What diagnostic tool should we use to first screen stable SVT? -Vitals (BP <90), Oxygen (<94%), Monitor (EKG), IV, Treatment What is the recommended treatment for stable SVT? For Unstable SVT? STABLE SVT: Vagal Maneuvers (cough, deep breath), Adenosine 6mg IVP SLAMMED, flush 20mL NS rapid slam, may repeat with Adenosine 12mg in 1-2 min, flush with 20 mL NS, RAPID SLAM Unstable SVT: Synchronized Cardioversion What is the recommended treatment for stable VT with a pulse? - Amiodarone 150mg in 100 mL of D5W over 10 min can repeat if needed OR - Adenosine 6mg IVP then 12mg IV/IO SLAMMED with 20 mL NS flush slammed What is first treatment option for ALL unstable bradycardias and blocks? -Atropine 1mg IVP every 3-5 minutes (max 3mg) How is closed loop communication used in medication administration during a code? Lead says: Give 1mg epi IV push Follower: repeat drug and dose and time. What should you do/say if told to give the wrong dose or wrong medication? To MINIMIZE ERRORS and ENHANCE COMMUNICATION WITHIN THE TEAM/ speak up if wrong dose or medication said List the 5 H's and 5 T's (or PATCH 5MD) H's: Hypoxia, Hypovolemia, Hypothermia, Hydrogen ion excess, Hypoglycemia, Hypo/Hyperkalemia. T's: Tension Pneumothorax, Toxins, Tamponade, Thrombosis (cardiac and pulmonary) What is the most frequent cause of PEA/Asystole? 1. hypovolemia 2. Hypoxemia Describe what PEA is pulseless electrical activity How do you confirm a patient is really in asystole? 1) Confirm asystole in 2 leads. 2) CAB (compression, airway, breathing) and Epi 3) Search for and treat identifiable cause During a code of PeTCO2 reading of 8 could indicate what? 8 could indicate ineffective CPR What does a PeTCO2 reading that jumps to 35 during compressions indicate? 35 indicates ROSC What does ROSC stand for? Return of spontaneous circulation What is first treatment priority after ROSC? -Check airway/breathing -Transport to facility capable of performing PCI List the other 3 assessment done immediately after ROSC: - maintain ventilation/o2 (>92-98%) - monitor and treat hypotension (>90 sys, MAP 65) - 12 lead EKG What BP reading is the target for ROSC? 90 systolic MAP 65 If the BP reading after ROSC is less than the target, what is the initial treatment? 2nd tx? Give 1-2 L NS or LR then vasopressors Epi drip 2-10 mcg/min or norepinephrine 0.1-0.5 mcg/kg/min or dopamine 5-10 mcg/min If a patient is non-responsive, what is the recommended treatment? How long? Target temperature range? 32-36 Celsius for at least 24 hours If the 12 lead ECG shows ST elevation, what is the treatment plan? Coronary reperfusion and transport to PCI facility Excessive hyperventilation can lead to what Can decrease cerebral perfusion and decrease CO - 1 ventilation q6 seconds (rescue breathing) If out of hospital arrest, what kind of hospital should patient be transported to? PCI- capable facility (Percutaneous coronary intervention) What electric therapy can be used for unstable bradycardia? Transcutaneous pacing Synch cardioversion can be used on what rhythms? Dose of joules for each rhythm? Unstable A-fib/aflutter120-200J because of its vasopressor effects that result from stimulation of alpha-1 receptors. In conjunction with high-quality CPR, epinephrine's vasoconstrictive effects improve coronary and cerebral perfusion, thus keeping these organs viable until the underlying cardiac dysrhythmia can be terminated Brainpower Read More A 54-year-old woman is pulseless and apneic. Your partner and an emergency medical responder are performing well-coordinated CPR. After 2 minutes of CPR, the cardiac monitor reveals coarse ventricular fibrillation. You should:· A: deliver a single shock and immediately resume CPR.· B: shock the patient three times with 360 monophasic joules.· C: defibrillate at once and then reassess the rhythm and pulse.· D: assess for a carotid pulse for no longer than 10 seconds. answer is A; Reason: A single shock (360 monophasic joules or the biphasic equivalent) should be administered to the patient with V-Fib or pulseless V-Tach cardiac arrest. Immediately following this single shock, begin or resume CPR, starting with chest compressions. Assessing the patient's cardiac rhythm and pulse immediately following defibrillation causes an unnecessary delay in CPR, and delays in CPR have been directly linked to poor patient outcomes. Most patients who are defibrillated—especially if their arrest interval is prolonged—remain in V-Fib/pulseless V-Tach or convert to another non-perfusing rhythm (ie, asystole, PEA). Either way, the patient is still in cardiac arrest and needs immediate CPR. After 2 minutes of CPR, reassess the patient's rhythm, and if necessary, a pulse (if an organized cardiac rhythm appears), and repeat defibrillation (single shock) if indicated, followed immediately by CPR. Your first action after establishing return of spontaneous circulation (ROSC) in a patient—regardless of his or her arrest rhythm and duration—is to assess the patient's ________________________. a) ventilatory status b) cardiac status c) level of consciousness d) none of the above Answer is A Your first action after establishing return of spontaneous circulation (ROSC) in a patient—regardless of his or her arrest rhythm and duration—is to assess the patient's ventilatory status. During the ________________ cycles of CPR, vascular access can be obtained, cardiac drugs can be administered, and the patient's airway can be secured with an advanced device if necessary. It is absolutely critical to minimize interruptions in chest compressions; if you must interrupt compressions, do so for no longer than ____ seconds. a) 2 minute; 10 seconds b) 4 minute; 15 seconds c) 6 minute; 10 seconds d) immediate obtain vascular access; 15 seconds During the 2-minute cycles of CPR, vascular access can be obtained, cardiac drugs can be administered, and the patient's airway can be secured with an advanced device if necessary. It is absolutely critical to minimize interruptions in chest compressions; if you must interrupt compressions, do so for no longer than 10 seconds. More than 500,000 deaths occur each year as the result of acute myocardial infarction (AMI). Sixty to seventy percent of these deaths occur outside the hospital, usually during the ______________ after the onset of symptoms. Of all deaths from AMI, 90% are due to dysrhythmias—usually ventricular fibrillation—which typically occur during the early hours of the infarct; this should be the paramedic's primary concern. a) first thirty minutes b) first few hours c) first 12 hours d) first 1 to 2 days Answer is b More than 500,000 deaths occur each year as the result of acute myocardial infarction (AMI). Sixty to seventy percent of these deaths occur outside the hospital, usually during the first few hours after the onset of symptoms. Of all deaths from AMI, 90% are due to dysrhythmias—usually ventricular fibrillation—which typically occur during the early hours of the infarct; this should be the paramedic's primary concern. This drug stimulates alpha and beta receptors. However, it is used during cardiac arrest because of its vasopressor effects that result from stimulation of alpha-1 receptors. In conjunction with high-quality CPR, this drug's vasoconstrictive effects improve coronary and cerebral perfusion, thus keeping these organs viable until the underlying cardiac dysrhythmia can be terminated a) atropine b) dopamine c) epinephrine d) bicarbonate answer c Epinephrine stimulates alpha and beta receptors. However, it is used during cardiac arrest because of its vasopressor effects that result from stimulation of alpha-1 receptors. In conjunction with high-quality CPR, epinephrine's vasoconstrictive effects improve coronary and cerebral perfusion, thus keeping these organs viable until the underlying cardiac dysrhythmia can be terminated What is the IO dose of epinephrine in adult cardiac arrest resuscitation? Answer: IV/IO dose 1 mg (10 mL of 1:10,000 solution) administered every 3 to 5 minutes during resuscitation. page 171 ACLS Provider Manual 2015) Which of the following statements is NOT true regarding Dopamine in ACLS protocols? a) First line drug for symptomatic sinus bradycardia b) given after atropine as a second-line drug for symptomatic bradycardia c) use for hypotension (systolic blood pressure =/<70 to 100 mm Hg) with signs and symptoms of shock d) usual infusion rate is 2 to 20 mcg/kg per minute; titrate to patient responses; taper slowly e) do not mix with sodium bicarbonate Answer is a - Dopamine is a second-line drug for symptomatic bradycardia after atropine. (page 171 ACLS manual 2015) Precautions that the ACLS provider should consider when using Dopamine include all of the following except? a) do not correct hypovolemia with volume replacement before initiating dopamine b) use with caution in cardiogenic shock with accompanying CHF c) may cause tachyarrhythmias, excessive vasoconstriction d) do not mix with sodium bicarbonate Which of the following statements is NOT true regarding Dopamine in ACLS protocols? Answer A do correct hypovolemia with volume replacement before initiating dopamine Which of the following statements is NOT true regarding Atropine in ACLS protocols. a) Atropine can not be given through endotracheal tube b) Atropine is the first drug for symptomatic sinus bradycardia c) Avoid using Atropine in hypothermic bradycardia d) Doses of atropine <0.5 mg may result in paradoxical slowing of heart ratee) Adult dose of Bradycardia (with or without ACS) 0.5 mg IV every 3 to 5 minutes as needed, not to exceed a total dose of 0.04 mg/kg (total 3 mg) Answer = A Atropine CAN be given through endotracheal tube (ACLS manual 2015 page 171) List the six medications that can be given via endotracheal tube: Mnemonic for drugs that can be given via endotracheal tube are ALADINA - A Atropine L - Lidocaine A - Adrenaline D - Diazepam I - Isoprenaline N - Naloxone List the reversible causes of PEA a) 50 to 100 j b) 120 to 200 j biphasic or 200 J monophasic c) 100 J d) none of the above B (page 168) The recommended dose for a Synchronized cardioversion is acceptable for patients with ventricular tachycardia (patient with a pulse) with wide regular tachycardia a) 50 to 100 j b) 120 to 200 j c) 100 J d) none of the above c page 168 The recommended dose for a Synchronized cardioversion is acceptable for patients with ventricular tachycardia (patient with a pulse) with wide irregular tachycardia a) 50 to 100 j b) 120 to 200 j c) 100 J d) defibrillate do not cardiovert d page 168 Verbalize the potential reversible causes of asystole and PEA? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Page 164/5 Reversible causes: Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-Hyperkalemia Hypothermia Tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary After recognizing a patient in cardiac arrest, CPR is started and cardiac monitor is applied and the rhythm is determined to be Asystole/PEA. IV access is established, WHAT MEDICATION IS GIVEN FIRST ? a) epinephrine 1 mg every 3 to 5 minutes b) Amiodarone 300 mg bolus; second dose 150 mg c) Atropine 0.5 mg IV d) Dopamine 2 to 10 mcg per minute infusion and titrate to patient's response e) epinephrine IV infusion 2 to 10 mcg per minute; titrate to patient's response a page 188 After recognizing a patient in cardiac arrest, CPR is started and cardiac monitor is applied and the rhythm is determined to be Asystole/PEA. IV access is established, and epinephrine is given every 3 to 5 minutes per AHA protocol. During this first 2 minutes of CPR when establishing IV access and providing medication, the provider should consider an advanced airway. Once advanced airway is established, the provider should: a) give 1 breath every 6 seconds b) give 10 breaths/minute with continuous chest compressions c) waveform capnography or capnometry to confirm and monitor ET tube placement d) all of the above d page 165 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? a) chest compressions are adequate b) airway is not correctly placed c) Chest compressions may not be effective. d) none of the above c Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? Amioderone 300mg a sign of effective CPR includes a PETCO2 reading of _________ ? PETCO2 ≥10 mm Hg Switching providers about every ___ minutes or every ____ compression cycles improves the quality of chest compressions delivered during a resuscitation attempt. Switch providers about every 2 minutes or every 5 compression cycles. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min? a) 2 breaths to 30 compressions b) 1 breath every 10 seconds c) 1 breath every 5-6 seconds d) none of the above c 1 breath every 5-6 seconds A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? a) Epinephrine 1 mg every 3 to 5 minutes b) Atropine 0.5 mg c) Amiodarone 150 mg d) dopamine infusion b Atropine 0.5mg A patient with dizziness and shortness of breath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? a) 2 to 10 mcg/kg/minute b) 5 to 10 mcg/kg/minute c) 2 t0 20 mcg/kg/minute d) 2 to 10 mcg/minute a 2 to 10 mcg/kg per minute A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is showing SVT. The provider should ______. a) instruct the patient on vagal maneuvers b) prepare for IV Adenosine c) prepare for cardioversion d) monitor the patient's vital signs for a decrease in blood pressure Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? Intraosseous (IO) What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? 160 to 325 mg What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? 120to200J Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? Right ventricular infarction and dysfunction What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? Administration of IV or IO fluid bolus What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC? Decreased cerebral blood flow What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? 32°C to 34°C What is the recommended duration of therapeutic hypothermia after reaching the target temperature? 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? Potential oxygen toxicity antiarrhythmic infusion drugs used to treat tachycardia with a pulse in ACLS AHA protocols include which of the following: a) Procanamide b) Amiodarone c) sotalol d) A and B only e) A, B, and C E antiarrhythmic drugs are used to prevent, alleviate, or correct an abnormal heart rhythm page168 antiarrhythmic infusions to treat tachycardia with a pulse in AHA protocols includes Sotalol. What is the dose for stable wide-QRS tachycaridia? a) 100 mg (1.5 mg/kg) over 5 minutes; avoid if prolonged QT b) first dose 150 mg over 10 minutes; repeat as needed if VT recurs. Follow by maintenance infusion of 1 mg/min for first six hours c) 20 to 50 mg/min until arrhythmia suppressed; hypotension ensues, QRS duration increases >50% or maximum dose of 17 mg/kg given. d) 6 mg rapid IV push, followed by an infusion of 12 mg/min. a page 168 antiarrhythmic infusions to treat tachycardia with a pulse in AHA protocols includes Amiodarone IV . What is the dose for stable wide-QRS tachycardia? a) 100 mg (1.5 mg/kg) over 5 minutes; avoid if prolonged QT b) first dose 150 mg over 10 minutes; repeat as needed if VT recurs. Follow by maintenance infusion of 1 mg/min for first six hours c) 20 to 50 mg/min until arrhythmia suppressed; hypotension ensues, QRS duration increases >50% or maximum dose of 17 mg/kg given. d) 6 mg rapid IV push, followed by an infusion of 12 mg/min. b page 168 antiarrhythmic infusions to treat tachycardia with a pulse in AHA protocols includes Procainamide . What is the dose for stable wide QRS tachycardia? a) 1.5 mg/kg/min avoid if prolonged QT b) 100 mg over 10 minutes; repeat as needed if VT recurs. Follow by maintenance infusion of 1 to 4 mg/min; avoid if prolonged QT or CHF c) 20 to 50 mg/min until arrhythmia suppressed; hypotension ensues, QRS duration increases >50% or maximum dose of 17 mg/kg given. d) maintenance infusion 1-4 mg/min, avoid if prolonged QT or CHF. e) both C and D E page 168 Patient has tachycardia with a pulse (rate greater than 150 beats/minute), monitor shows a wide regular tachycardia rhythm on monitor and has signs of hypotension and alerted mental status. The paramedic should: a) synchronized cardiovert at 50 to 100 j b) synchronized cardiovert at 120-200 j biphasic or 200 j monophasic c) synchronized cardiovert at 100 j d) defibrillation dose (not synchronized) e) none of the above c page 168 Patient has tachycardia with a pulse (rate greater than 150 beats/minute), cardiac monitor shows a wide IRREGULAR tachycardia rhythm on monitor and has signs of hypotension and alerted mental status. The paramedic should: a) synchronized cardiovert at 50 to 100 j b) synchronized cardiovert at 120-200 j biphasic or 200 j monophasic c) synchronized cardiovert at 100 j d) defibrillation dose (not synchronized) e) none of the above d page 168 Patient has tachycardia with a pulse of 150 beats/minute, showing tachycardia rhythm on monitor that is narrow and irregular in rhythm; patient has signs of acute heart failure and hypotension. The paramedic should: a) synchronized cardiovert at 50 to 100 j b) synchronized cardiovert at 120-200 j biphasic or 200 j monophasic c) synchronized cardiovert at 100 j d) defibrillation dose (not synchronized) e) none of the above b page 168 Patient has tachycardia with a pulse (rate greater than 150 beats/minute), showing tachycardia rhythm on monitor that is narrow and regular in rhythm; patient has signs of acute heart failure and hypotension. The paramedic should: a) synchronized cardiovert at 50 to 100 j b) synchronized cardiovert at 120-200 j biphasic or 200 j monophasic c) synchronized cardiovert at 100 j d) defibrillation dose (not synchronized) e) none of the above a page 168 Patient has a tachycardia with a pulse (greater than 150 beats/minute) and shows a wide QRS complex greater than 0.12 seconds, but has NO signs of hypotension, alerted mental status, signs of shock, ischemia (chest discomfort), or acute heart failure. how should the paramedic proceed? a) iv access and 12 lead ICG if available b) consider adenosine only if regular and monomorphic c) consider antiarrhythmic infusion a) 32 degrees C to 36 degrees C for at least 24 hours b) 30 degrees C to 40 degrees C for at least 24 hours c) 26 degrees C to 32 degrees C for at least 48 hours d) none of the above a page 174 For cardiac arrest with an advanced airway in place, ventilate once every ___________ seconds. six page 174 The volume of blood pumped from a ventricle of the heart in one beat is known as: a) stroke volume b) cardiac output c) heart rate d) none of the above a stroke volume The volume of blood pumped from a ventricle of the heart in one beat page 140 Cardioversion is contraindicated in Sinus tachycardia caused by external influences. Sinus tachycardia can be caused by external influences of the heart, such as: a) fever b) blood loss c) exercise d) blood loss e) hypotension f) all of the above f page 140 Serious symptoms and signs when managing a patient with tachycardia with a pulse include: a) hypotension b) acutely altered mental status c) signs of shock d) ischemic chest discomfort e) Acute Heart Failure f) all of the above f page 140 When evaluating a patient with a sinus tachycardia rhythm, the paramedic is aware that A ventricular rate less than _________ / minute usually do not cause serious signs or symptoms a) 100 beats/minute b) 150 beats/minute c) 200 beats/minute d) 180 beats/minute e) none of the above b page 140 What are common medications that can cause bradycardia? Adenosine, Amiodarone, B-Blockers, Cisplatin, Citalopram, Clonidine, Cocaine, Dexmedetomidine, Digoxin, Diltiazem, Dipyridamole, Disopyramide, Donepezil, Dronedarone, Fingolimod, Flecainide, Fluoxetine, Halothane, Isradipine, Ivabradine, Ketamine, Neostigmine, Nicardipine, Nitroglycerin, Paclitaxel, Pregabalin, Propafenone, Propofol, Remifentanil, Sotalol, Succinylcholine, Thalidomide, Verapamil The ED physician decides that JL needs treatment for symptomatic bradycardia, what medication is used first-line for a patient with symptomatic bradycardia (how much, how often and max dose)? Atropine IV first dose 0.5mg. Repeat every 3-5 minutes. Max dose 3mg. How would this be treated differently if the patient has a transplanted heart? Atropine will likely be ineffective in patients who have undergone cardiac transplantation because the transplanted heart lacks vagal innervation. One small uncontrolled study documented paradoxical slowing of the heart rate and high-degree AV block when atropine was administered to patients after cardiac transplantation. Alternative drugs to consider are dopamine and epinephrine (2-10 mcg/kg) If a peripheral line is used to administer a bolus injection, how much IV flush fluid is needed to facilitate delivery to the central circulation? If a resuscitation drug is administered by a peripheral venous route, it should be administered by bolus injection and followed with a 20-mL bolus of IV fluid to facilitate the drug flow from the extremity into the central circulation. What alternative routes are available for medication administration when IV access is not available (two alternative routes)? It is reasonable for providers to establish IO access if IV access is not readily available. If IV or IO access cannot be established, epinephrine, vasopressin, and lidocaine may be administered by the endotracheal route during cardiac arrest. Although not a preferred method, which 3 medications for ACLS can be given via the endotracheal route? Epinephrine, vasopressin, and lidocaine How much saline is used to dilute an ACLS medication given by the endotracheal route? Providers should dilute the recommended dose in 5 to 10 mL of sterile water or normal saline and inject the drug directly into the endotracheal tube. When giving a medication via the endotracheal route, by what factor should the dose be increased? The optimal endotracheal dose of most drugs is unknown, but typically the dose given by the endotracheal route is 2 to 2½ times the recommended IV dose What is the first-line drug therapy for TdP and how is this administered (dose/volume/duration)? Magnesium sulfate should be administered IV in doses of 1 to 2 g, diluted in 50 to 100 mL 5% dextrose in water (D5W), administered over 15 minutes; doses may be repeated to a total of 6 g. Antiarrhythmic examples sotalol, dofetilide, amiodarone Antipsychotic examples haloperidol, ziprasidone Antibiotic examples Macrolides, fluoroquinolones Antifungal examples azole (ex: fluconazole) Antidepressant examples citalopram Analgesic examples Methadone Antiemetic examples ondansetron, droperidol Anesthetic examples Propofol What is the first-line drug therapy for unstable ("pulseless") ventricular tachycardia/fibrillation (including dose/frequency)? Epinephrine 1mg every 3-5 minutes What additional antiarrhythmic agents (2 drugs) are preferred for unstable VF/pulseless VT unresponsive to vasopressors? 3 min after witnessing a cardiac arrest, one memeber of your team inserts an ET tube while another performs continuous chest comressions. During subsequent bentilation, you notice the presence of a wavefom on the capnogrophy screen and a PETCO2 of 8 mm Hg. What is the significance of this finding? Chest compressions may not be effective. The use of quantitative capnography in intubated pt's does what? Allowsfor monitoring CPR quality For the past 25 min, EMS crews have attemptedresuscitation of a pt who originally presented with V- FIB. After the 1st shock, the ECG screen displayed asystole which has persisted despite 2 doses of epi, a fluid bolus, and high quality CPR. What is your next treatment? Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? Be sure O2 is NOT blowing over the pt's chest during shock. During your assessment, your pt suddenly loses consciousness. After calling for help and determining that the pt. is not breathing, you are unsure whether the pt. has a pulse. What is your next action? Begin chest compressions. What is an advantage of using hands-free d-fib pads instead of d-fib paddles? Hands-free allows for more rapid d-fib. What action is recommended to help minimize interruptions in chest compressions during CPR? Continue CPR while charging the defibrillator. Which action is included in the BLS survey? Early defibrillation Which drug and dose are recommended for the management of a pt. in refractory V-FIB? Amioderone 300mg What is the appropriate intervalfor an interruption in chest compressions? 10 seconds or less Which of the following is a sign of effective CPR? PETCO2 = or > 10mm Hg What is the primary purpose of a medical emergency team or rapid response team? Identifying and treating early clinical deterioration. Which action improves the quality of chest compressions delivered during resuscitave attemepts? Shitch providers about every 2 min or every 5 compression cycles. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse of 80 beats/min? 1 breath every 5-6 seconds A pt. presents to the ER with a new onset of dizziness and fatugue. Onexamination, the pt's heart rate is 35 beats/min, BP is 70/50, resp. rate is 22 per min, O2 sat is 95%. What is the appropriate 1st medication? Atropine 0.5mg A pt. presents to the ER with dizziness and SOB with a sinus brady of 40/min. The initial atropine dose was ineffective and your monitor does not provide TCP. What is the appropriate dose of Dopamine for this pt? 2-10mcg/kg/min A pt. has an onset of dizziness. The pt.s heart rate is 180, BP is 110/70, resp. rate is 18, O2 sat is 98%. This is a reg narrow complex tach rythm. What is the next intervention? Vagal manuever. A monitored pt. in the ICU developed a suddent onset of narrow complex tach at a rate of 220/min. The pt's BP is 128/58, the PETCO2 is 38mm Hg, and the O2 sat is 98%. There is an EJ established for vascular access. The pt. denies taking any vasodialators. A 12 lead shows no ischemia or infarction. Vagal manuevers are ineffective. What is the next intervention? Adenosine 12mg IV You receiving a radio report from an EMS team enroute with a pt. who may be having a stroke. The hospital CT scanner is broken. What should you do? Divert the pt. to a hospital 15 min away with CT capabilities. Choose an appropriate inidication to stop or withhold resuscitive efforts. Evidence of rigor mortis. A 49 y/ofmaile arrives in the ER with persistant epigastric pain. She has been taking antacids PO for the past 6 hours because she she had heartburn. BP is 118/72, heart rate is 92/min, resp. rate is 14 non- labored and O2 sat is 96%. What is the most appropriate next action? Obtain a 12 lead ECG. A pt. in respiratory failure becomes apneic but contineues to have a strong pulse. The heart rate is dropping paridly and now shows a sinus brady rate at 30/min. What intervention has the highest priority? Simple airway manuevers and assisted ventilations. What is the appropriate procedure for ET suctioning after the catheter is selected? Suction during withdrawl, but not for longer than 10 seconds. While treating a stable pt for dizziness, a BP of 68/30, cool and clammy, you see a brady rythm on the ECG. How do you treat this? Atropine 0.5mg A 68 y/o female pt. experienced a sudden onset of right arm weakness. BP is 140/90, pulse is 78/min, resp rate is non-labored 14/min, 02 sat is 97%. Lead 2 in the ECG shows a sinus rythm. What would be your next action? Cinncinati Stroke Scale You are transporting a pt. with a positive stroke assessment. BP is 138, pulse is 80/min, resp rate is 12/min, 02 sat is 95% room air. Glucose levels are normal and the ECG shows a sinus rythm. What is next. Head CT scan What is the proper ventilation rate for a pt. in cardiac arrest who has an advanced airway in place? 8-10 breaths per minute A 62 y/o male pt. in the ER says his heart is beating fast. No chest pain or SOB. BP is 142/98, pulse rate is 200/min, reps rate is 14/min, O2 sats are 95 at room air. What should be the next evaluation? Obtain a 12 lead ECG. You are evaluating a 48 y/o male with crushing sub-sternal pain. He is cool, pale, diaphretic, and slow to respond to your questions. BP is 58/32, pulse is 190/min, resp rate is 18, and you are unable to obtain an 02 sat due to no radial pulse. The ECG shows a wide complex tach rythm. What intervention should be next? Syncronized cardioversion. What is the initial priority for an unconscious pt. with any tachycardia on the monitor? Determine if a pulse is present. Which rythm requires synchronized cardioversion? Unstable SVT What is the recommended dose for adenosine for pt's in refractory, but stable narrow complex tachycardia? 12mg What is the usual post-cardiac arrest target range for PETCO2 who achieves return of spontaneous circulation (ROSC)? 35-40mm Hg Alert the hospital A responder is caring for a patient with a history of congestive heart failure (CHF). The patient is experiencing shortness of breath, a blood pressure (BP) of 68/50 mmHg, and a heart rate of 190/min. The patient's lead II ECG is displayed here. Which best characterizes this patient's rhythm? Unstable supraventricular tachycardia (SVT) Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient? Check the patient's breathing and pulse Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? 5 to 10 seconds You instruct a team member to give 0.5 mg atropine IV. Which response is an example of closed-loop communication? "I'll draw up 0.5 mg of atropine." What is an effect of excessive ventilation? Decreased cardiac output If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take? Address the team member immediately Which best describes this rhythm? Monomorphic ventricular tachycardia For STEMI patients, which best describes the recommended maximum goal time for emergency department door-to-balloon inflation time for percutaneous coronary intervention? 90 minutes Which is the maximum interval you should allow for an interruption in chest compressions? 10 seconds Which is one way to minimize interruptions in chest compressions during CPR? Continue CPR while the defibrillator charges Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt? Clearly delegate tasks Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? Measure from the corner of the mouth to the angle of the mandible 27. You are evaluating a 58-year-old man with chest discomfort, his blood pressure is 92/50 mmHg, his heart rate is 92/min, his nonlabored respiratory rat is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important? Obtaining a 12-lead ECG A patient in respiratory distress and with a blood pressure of 70/50 mmHg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment? Performing synchronized cardioversion During post-cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range? At least 24 hours Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal (ET) tube while another performs chest compressions. Capnography shows a persistent waveform and a PetCO2 of 8mmHg. Which is the significance of this finding? Chest compressions may not be effective Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? 160 to 325 mg A team member is unable to perform an assigned task because it is beyond the team member's scope of practice. Which action should the team member take? Ask for a new task or role As the team leader, when do you tell the chest compressors to switch? About every 2 minutes You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? 100 to 120 per minute A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? "I have an order to give 500 mg of amiodarone IV. Is this correct?" A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? 12mg A patient has a witness loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment? Defibrillation Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival? Noncontract CT scan of the head What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation? 90mmHg You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? Give epinephrine 1 mg IV