ACLS Rhythm Identification

Adenosine 6 mg

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. What drug should be administered IV?

Perform immediate electrical cardioversion.

A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex ORS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm Hg. The next action is to:

Do not give aspirin for at least 24 hours if rtPA is administered.

A 62-year-old man suddenly experienced difficulty speaking and left-side weakness. He was brought to 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>

Seeking expert consultation.

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. Which of the following actions is recommended?

Start epinephrine 2 to 10 mcg/min.

A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 110/60 mm Hg. Which of the following is now indicated?

Epinephrine 1 mg or vasopressin 40 units IV or IO.

A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated and an IV has been started. The rhythm is asystole. Which is the first drug/dose to administer?

Epinephrine 1 mg

A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Of the following, which drug and dose should be administered first by the IV/IO route?

IV or IO

A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?

Amiodarone 300 mg

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?

150 mg IV push.

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:

Second dose of epinephrine 1 mg

A patient is in refractory ventricular fibrillation. High-quality CPR is in progress, and shocks have been given. One does 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?

Give aspirin 160 to 325 mg chewed immediately.

A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. Aspirin was not taken by the patient because he had a history of gastritis treated 5 years ago. Your next action is to:

Give normal saline 250 mL to 500 mL fluid bolus.

A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 sublingual nitroglycerin tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. You should:

Use of a phosphodiesterase inhibitor within 12 hours

A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication to the administration of nitrates?

0.5 mg

A patient with sinus bradycardia and heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?

Sinus Tachycardia

A pt. with *regular* narrow-complex QRS at a rate >150bpm in which vagal maneuvers are ineffective should be given 6mg adenosine IV Synchronized cardioversion is indicated if the pt. is hypotensive, AMS, shock, ischemic CP, or acute HF

Agonal Rhythm/Asystole

Asystole is treated with high quality CPR and epi 1mg or vasopressin 40mg IV/IO

Chest pain or shortness of breath is present.

Bradycardia requires treatment when:

Sinus Bradycardia

Sinus bradycardia can be treated with atropine at an initial dose of 0.5mg *Not ALL cases of sinus brady needed to be treated with atropine! If pt. is symptomatic (chest pain, SOB) it requires treatment.

Fine Ventricular Fibrillation

VFib should be treated with defibrillation followed by 1mg epi if necessary...and of course CPR

Magnesium is indicated for VF/pulseless VT associated with torsades de pointes.

Which of the following statements about the use of magnesium in cardiac arrest is most accurate?

The correct dose of vasopressin is 40 units administered by IV or IO.

Which of the following statements is most accurate regarding the administration of vasopressin during cardiac arrest?

Gain IV or IO access.

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:

Lidocaine, epinephrine, vasopressin

Your patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route?