acls

PEA (pulseless electrical activity)

Any organized rhythm without a palpable pulse

1mg Epinephrine

As soon as IV/IO access is available, the patient should be given:

True

Atropine doses of less than 0.5 mg may paradoxically result in further slowing of the heart rate.

true

Chest compressions should be continued while the defibrillator is charging

epinephrine, amiodarone, lidocaine, and magnesium sulfate

Drugs used in the VF/Pulseless VT Algorithm included:

Rhythm check

During PEA, what step occurs after CPR and medication administration

Increase in coronary blood flow resulting from vasoconstriction

Epinephrine is used during resuscitation primarily for its alpha-adrenergic effects. Alpha-adrenergic effects include:

true

Even a 5 to 10 second pause in chest compressions can reduce the chance that a shock will terminate VF.

True

Fine Ventricular Fibrillation may appear as asystole. If this is unclear an initial attempt at defibrillation may be warranted.

1 shock

For VF/Pulseless VT how many shocks should initially be given?

IV/IO access

For a patient in asystole which has the higher priority?

epinephrine

For bradycardia unresponsive to atropine, what other drug should be considered?

300mg

For the pulseless VF/VT algorithm, the proper first dose of IV Amiodarone is ___________.

set 2 mA above capture doseo

For transcutaneous pacing, the current millamperes (mA) output should be:

started at 60/min with adjustment based on clinical response

For transcutaneous pacing, the demand rate should be set at:

early defibrillation, effective CPR (hard and fast), secure the airway, establish IV/IO access

Four important aspects to the Pulseless VF/VT algorithm are:

fluid resuscitation

Hypvolemia Which is a common cause of PEA can be rapidly reversed by _____

shock at the previously successful energy level

If VF is initially terminated by a shock but recurs later in the resuscitation attempt you should:

replace the AED because continued use of the AED may result in unnecessary prolonged interruptions in chest compression for rhythm analysis and shock administration

If an AED is on the patient and a manual defibrillator is available you should

Nonshockable/no pulse

If during VF/VT after a shock, the rhythm check reveals a __________ rhythm and _________, you then should proceed with the asystole/PEA pathway of the ACLS Pulseless Arrest.

Tranvenous pacing

If transcutaneous pacing and drugs fail, what would be your next intervention?

prepare for transvenous pacing

If transcutaneous pacing is ineffective for symptomatic bradycardia, the next step would be to prepare for:

360

If using a monophasic defibrillator for Pulseless VF/VT the first dose and all subsequent doses should be _____J.

the maximal energy dose that is available

If you do not know the effective biphasic dose range for the defibrillator that you are using, you should deliver a first shock and all subsequent shocks at ____.

False

In PEA, advanced airway placement is a priority over establishing IV/IO access.

true

In patients with PEA/cardiac arrest and without known pulmonary embolism (PE), routine fibrinolytic treatment given during CPR shows no benefit and is not recommended.

True

Life threatening hypokalemia is uncommon but can occur in the setting of gastrointestinal and renal losses and is associated with hyomagnesemia. Treatment with magnesium may help during cardiac arrest.

wide QRS complex, smaller P-waves, and T-waves taller and peaked

PEA caused by HYPERkalemia may present with which of the following rhythm changes?

B. flattened T-waves, prominent U waves, wide QRS, prolonged QT

PEA caused by HypOkalemia may present with which if the following symptoms?

A. renal failure B. dialysis recipient C. elderly D. diabetes C. elderly

Patients that you might more commonly see with PEA caused by HYPERkalemia are all the following except which one?

patients using diuretics

Patients that you might more commonly see with PEA caused by HypOkalemia are:

A) unstable sinus bradycardia B) third degree AV block C) Mobitz type II second-degree AV block D) all of the above D) all of the above

Preparation for transcutaneous pacing should be made for which of the following?

a. ensure all team members are clear b. charge the defibrillator c. minimize time delay between chest compressions and shock delivery d. all of the above d. all of the above

Prior to defibrillation which of the following should be done?

A. no pulse with CPR B. distended neck veins C. narrow QRS complex on ECG D. all of the above D. all of the abovev

Pulmonary Thrombosis (massive pulmonary embolism) induced PEA may manifest itself with which symptoms?

A. sodium bicarbonate B. normal saline bolus

Recommended treatment to reverse PEA caused by acidosis is:

A. sodium bicarbonate B. glucose and insulin C. albuterol D. any of the above D. any of the above

Reversing Hyperkalemia is done using which of the following medications?

Pericardiocentesis

Reversing PEA caused by Tamponade is performed by:

True

Signs of symptomatic bradycardia include hypotension, orthostatic hypotension, diaphoresis, pulmonary congestion, runs of PVC's or VT.

Recent Trauma

Some clues for PEA caused by acidosis (hydrogen ion) would be all of the below except:

Hypovolemia Hypoxia Hydrogen Ion (Acidosis) Hypothermia Hyperkalemia Tension pneumothorax Tamponade (cardia) Toxins Thrombosis (pulmonary) thrombosis (cardia)

Some common causes of PEA are

high quality cpr

Success of any resuscitation attempt is built on:

True

Symptoms of bradycardia can include chest discomfort or pain, shortness of breath, decreased level of consciousness, weakness, fatigue, lightheadedness, dizziness, and presyncope or syncope

A. wide QRS complex on ECG B. neck vein distension C. tracheal deviation D. unequal breath sounds A. wide QRS complex on ECG

Tension pneumothroax which can be a cause of PEA may be recognized by all of the following symptoms except:

Thrombosis

The "T" in PEA representing Acute MI or massive pulmonary embolism stands for

Toxins

The "T" that represents drug overdose and chemical exposure among frequent causes of PEA stands for:

hypovolemia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypothermia

The H's of treatable contributing factors are:

150mg

The appropriate dosage for the 2nd administration of amiodarone in the left branch of the cardiac arrest algorithm is _____.

0.5 mg atropine, may repeat up to 3 mg

The correct dose of atropine given in the bradycardia algorithm is:

2-10 mcg/min

The correct dose of atropine given in the bradycardia algorithm is:

2-10 mcg/kg/min infusion

The correct dose of dopamine given in the bradycardia algorithm is:

Epinephrine

The first drug to be used in the pulseless arrest-PEA/asystole branch is ________.

120J-200J

The initial energy dose delivered in Pulseless Arrest (VF/VT) with biphasic defibrillator is typically _______.

whether the defibrillator is monophasic or biphasic

The initial energy dose used during defibrillation is dependent upon ______.

Are the symptoms caused by bradycardia or some other illness

The key clinical question when determining steps to take for the patient with symptomatic bradycardia is:

Cardiac arrest

The most important algorithm to know for adult resuscitation is:

Early defibrillation

The most important intervention with witnessed sudden cardiac arrest is:

High energy unsynchronized shock

The primary ACLS traetment for VF and Pulseless VT is:

adequate perfusion

The primary decision point in the bradycardia algorithm is the determination of:

True

The systematic approach with a person in cardiac arrest should include the BLS survey and ACLS survey?

periods of uninterrupted (5 cycles or 2 minutes), high quality CPR

The therapy pathway for asystole/PEA is designed around _______.

trancutaneous pacing

The treatment of choice for symptomatic bradycardia with signs of poor perfusion is ____.

prepare for transcuataneous pacing, consider atropine while preparing TCP, use epinephrine or dopamine while awaiting pacemaker or if pacing is ineffective.

The treatment sequence for bradycardia with poor perfusion is:

Provide effective CPR and correct the underlying cause of the rhythm

The two most important aspects to treating PEA are:

severe hypothermia

Transcutaneous pacing is contraindicated in the patient with ___.

aystole

Transcutaneous pacing is not recommended for which of the following?

A) there is no response to atropine B) atropine is unlikely to be effective or if IV access cannot be quickly established C) the pateint is severely symptomatic D) all of the above D) all of the above

Transcutaneous pacing should be started immediately if:

True

Unstable tachycardia exists when the heart rate is too fast for the patient's clinical condition and the excessive heart rate causes symptoms

True

Vasopressin was completely removed from the 2015-2020 Cardiac Arrest Algorithm for the treatment of pulseless VT and VF.

if there is rigor mortis, DNR status, living will directives, threat to safety of rescuers

What are 4 reasons that BLS and ACLS should be stopped or withheld?

A. loose leads or leads not connected to the patient B. no power to the monitor C. low signal gain on the ECG monitor D. all of the above D. all of the above

What are some causes of isoeletric ECG (false asystole)?

third-degree AV block

What is generally considered the most important and clinically significant degree block?

Atropine

What is the drug of first choice for symptomatic bradycardia?

2-10 micrograms/min

What is the infusion rate for epinephrine in the bradycardia algorithm?

. other causes of isoelectric ECG

What must be ruled out before a patient's rhythm can be classified as "true asystole"?

A. narrow complex rapid rate on ECG B. flat neck veins C. dropping blood pressure prior to PEA D. all of the above D. all of the above

When hypovolemia is the primary cause of PEA what clues may be noted on assessment?

slow rate in ECG

When hypoxia is the primary cause of PEA what clues may be noted on assessment?

True

When starting an IV or administering

a. ensure full chest recoil b. push hard and fast (100/min) c. search for treatable contributing factors (H and T's) d. all of the above all of the above

When treating pulseless VF/VT remember to ______.

Morbitz 2

Which ECK rhythm is commonly associated with bradycardia

atropine, epinephrine, dopamine

Which drugs are involved in the Bradycardia Algorithm?

underlying causes for the asystole & possibility of termination of CPR

Which of the following is a consideration for a patient is asystole?

A) complete block = third degree AV block B) second degree AV block type II = Mobitz I C) second degree AV block type 1 = Wenckebach D) Wenckenbach = Mobitz I B) second degree AV block type II = Mobitz I

Which of the following is not correct?

open the airway

While conducting the BLS Survey, you should do all of the following except: A) get an AED B) open the airway C) check patient responsiveness D) active emergency response system

check rythm

You have given a patient the 1st shock and CPR 5 cycles, your next step is to _____

Plapate for pulse

You have given a patient the 1st shock, CPR for 5 cycles, and now they have an organized rhythm. Your next step is to

give the patient a second shock

You have shocked the patient, given 5 cycles of CPR and have done a rhythm check. Now, the patient remains in VT with no pulse. What should you do next:

Vt/VF

give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, check rhythm after 2nd shock give 1mg epinephrine IV PUSH

hypovolemia and hypoxia

the two most common and easily reversible causes of PEA are:

prolonged QT interval

A clue that PEA could be caused by drug overdose "Toxins" is

150mg

A second dose of ________ IV Amiodarone can be given.

100

A tachyarrhythmia is defines as "any rhythm other than sinus tachycardia with a rate greater than _________."

Symptomatic bradycardia exists when

A) the heart rate is slow B) the patient has symptoms C) the symptoms are due to a slow heart rate D) all of the above are needed for symptomatic bradycardia to exist

give 30 compressions, open airway, provide ventilation, attach AED as soon as possible

According to new 2010 Guidelines for CPR, which of the following is in the correct order for the patient with sudden cardiac arrest?

Epinephrine

According to the 2015-2020 guidelines, drugs used in the asystole include:

give atropine while awaiting transcutaneous pacer

After it is determined that the patient does not have adequate perfusion your first step is to:

Start CPR, beginning with chest compressions

After providing a shock with an AED you should:

consider giving antiarrhythmic drugs

After the third shock during CPR in the pulseless VF/VT algorithm, you should ______.

High quality CPR, gain IV/IO access, advance airway

All of the following are important in the asystole pathway of the cardiac arrest algorithm. Which is the correct order of importance?

True

All resuscitation team members must simultaneously conduct a search for an underlying and treatable cause of the PEA in addition to their roles.

Bradyarrhythmia

any rhythm disorder with a heart rate less than 60 beats per minute