ACLS HELP

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?

Start chest compressions of at least 100 per min.

What is the appropriate procedure for ET suctioning after the catheter is selected?

Suction during withdrawl, but not for longer than 10 seconds.

What is the appropriate intervalfor an interruption in chest compressions?

10 seconds or less

What is the recommended dose for adenosine for pt's in refractory, but stable narrow complex tachycardia?

12mg

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

What is the recommended IV fluid (NS or LR) bolus dose for a pt. who achieves ROSC but is hypotensive during the post-cardiac arrest period?

1 to 2 Liters

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

What is the usual post-cardiac arrest target range for PETCO2 who achieves return of spontaneous circulation (ROSC)?

35-40mm Hg

What is the proper ventilation rate for a pt. in cardiac arrest who has an advanced airway in place?

8-10 breaths per minute

What is the minimum systolic BP one should attempt to achieve with fluid, Inotropic, or vasopressor administration in a hypotensive post-cardiac arrest who achieves ROSC?

90mm Hg

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 have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the pt. has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority?

Administer 1mg of epinepherine

Which action is a componant of high-quality chest comressions?

Allowing complete chest recoil

The use of quantitative capnography in intubated pt's does what?

Allowsfor monitoring CPR quality

Which drug and dose are recommended for the management of a pt. in refractory V-FIB?

Amioderone 300mg

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

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

Which is a safe and effective practice within the defibrillation sequence?

Be sure O2 is NOT blowing over the pt's chest during shock.

An AED does not promptly analyze a rythm. What is your next step?

Begin chest compressions.

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.

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.

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

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.

What action is recommended to help minimize interruptions in chest compressions during CPR?

Continue CPR while charging the defibrillator.

What is the most reliable method of confirming and montioring correct placement of an ET tube?

Continuous waveform capnography

What is the initial priority for an unconscious pt. with any tachycardia on the monitor?

Determine if a pulse is present.

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.

Which action is included in the BLS survey?

Early defibrillation

Choose an appropriate inidication to stop or withhold resuscitive efforts.

Evidence of rigor mortis.

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 an advantage of using hands-free d-fib pads instead of d-fib paddles?

Hands-free allows for more rapid d-fib.

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 primary purpose of a medical emergency team or rapid response team?

Identifying and treating early clinical deterioration.

Which situation BEST describes PEA?

Sinus rythm without a pulse

What is the potential danger to using ties that pass circumfrentially around the pt's neck when securing an advanced airway?

Obstruction of veneous return from the brain

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 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 58 year old man with chest pain. The BP is 92/50 and a heart rate of 92/min, non-labored respiratory rate is 14 breaths/min and the pulse O2 is 97%. What assessment step is most important now?

Obtaining a 12 lead ECG.

What is the 1st treatment priority for a pt. who achieves ROSC?

Optimizing ventilation and oxygenation.

Which of the following is a sign of effective CPR?

PETCO2 = or > 10mm Hg

What is the preferred method of access for epi administration during cardiac arrest in most pts?

Peripheral IV

What is acommon but sometimes fatal mistake in cardiac arrest management?

Prolonged interruptions in chest compressions.

What is the best strategy for perfoming high-quality CPR on a pt.with an advanced airway in place?

Provide continuous chest compressionswithout pauses and 10 ventilations per minute.

Which action increases the chance of successful conversion of ventricular fibrillation?

Providing quality compressions immediately before a defibrillation attempt.

Which conditionis a contraindication to theraputic hypothermia during the post-cardiac arrest period for pt's who achieve return of spontaneous circulation (ROSC)?

Responding to verbal commands

During a pause in CPR, you see a narrow complex rythm on the monitor. The pt. has no pulse. What is the next action?

Resume compressions

Which action improves the quality of chest compressions delivered during resuscitave attemepts?

Shitch providers about every 2 min or every 5 compression cycles.

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.

Which rythm requires synchronized cardioversion?

Unstable SVT

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.