ACLS

In a pt with PEA/Asystole, As soon as IV/IO access is available, the patient should be given:

1 mg epinephrine

The purpose of a Rapid Response Team is: 1. improve patient outcomes by identifying and treating early clinical deterioration 2. reduce hospital costs related to expense of emergency treatment 3. keep floor nurses from having to be involved in emergency situations. 4. all of the above

1. improve patient outcomes by identifying and treating early clinical deterioration

The maximum time chest compressions should be interrupted is ______seconds.

10

EndTitle Co2 of _______ is providing effective CPR. What is the adequate coronary perfusion pressure?

10 15

During CPR with an advanced airway in place the compression rate is

100 -120/min

The initial energy dose delivered in Pulseless Arrest (VF/VT) with a biphasic defibrillator is typically _________:

120-200 J

For the pulseless VF/VT algorithm, the proper second dose of IV Amiodarone is ________

150mg.

The correct dose of epinephrine given in the bradycardia algorithm is

2-10 mcg/min

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

2-20 mcg/kg/min infusion

According to the Guidelines for CPR, which of the following is in the correct order for the patient with sudden cardiac arrest? 1. open airway, provide ventilations, give 30 chest compressions, attach AED as soon as possible 2. give 30 compressions, open airway, provide ventilation, attach AED as soon as possible 3. open airway, check breathing, check pulse , attach AED as soon as possible 4. none of the above

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

The H's and T's that are possible causes of PEA include all the following except: 1. hypovolemia, toxins, thrombosis 2. hypoxia, thrombocytopenia, hypoglycemia 3. hydrogen ion, hypokalemia, tamponade 4. hypothermia, tension pneumothorax, hydrogen ion (acidosis)

2. hypoxia, thrombocytopenia, hypoglycemia (thrombocytopenia???? you know better than that!)

Mobitz II AKA

2nd degree block type 2

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

300mg. During cardiac arrest, the bolus doses can be pushed as fast as you can push syringe plunger without compromising the IV catheter.

therapeutic hypothermia temperature range is

32*C-36*C

Desired target temperature for therapeutic hypothermia (now called Targeted Temperature Management) in the post-cardiac arrest phase is a single target temperature between _______________.

32-36 C ( for a period of 24 hours)

When using waveform capnography during CPR what (end-tidal CO2) ETCO2 value would most likely indicate a return of spontaneous circulation (ROSC)?

35-40 mmHg

capnography of _____________________ = ROSC

35-45

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

360 J for pulseless VF/VT monophasic defibrillator

Some common causes of PEA are: 1. Hypovolemia, Hypoxia, and Hydrogen Ion (Acidosis) 2. Hypovolemia and Hypothermia 3. Hypothermia and Hyperkalemia 4. All of the above

4. All of the above

The goal of resuscitation interventions for a patient in respiratory or cardiac arrest is to: 1. restore effective oxygenation 2. restore effective ventilation 3. restore effective circulation 4. all of the above

4. all of the above

When hypovolemia is the primary cause of PEA what clues may be noted on assessment? 1. narrow complex rapid rate on ECG 2. flat neck veins 3. dropping blood pressure prior to PEA 4. all of the above

4. all of the above

Reversing HYPERkalemia is done using which of the following medications? 1. sodium bicarbonate 2. glucose and insulin 3. albuterol 4. any of the above

4. any of the above

minimum blood systolic bp to reach carotid?

60 mmHg

The chest compression fraction (CCF) during cardiac arrest should be at least 60% and ideally ____%

80%

minimum blood systolic bp to reach radial?

90 mmHg

When using waveform capnography, what is the desired level of end-tidal CO2 that indicates adequate chest compressions during CPR?

>10 mmHg

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

Adequate perfusion

Prior to defibrillation which of the following should be done? 1. ensure all team members are clear 2. charge the defibrillator 3. minimize time delay between chest compressions and shock delivery 4. all of the above

All of the above

PEA is defined as

Any organized rhythm without a palpable pulse.

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

Are the symptoms caused by bradycardia or some other illness?

BLS termination of resuscitation rule" was established to consider terminating BLS support before ambulance transport if all of the following criteria are met:

Arrest not witnessed by EMS provider or first responder No ROSC after 3 complete rounds of CPR and AED analyses No AED shocks delivered

What rhythms are non-shockable?

Asystole and PEA

What is the drug of first choice for symptomatic bradycardia?

Atropine 0.5mg (with a max of 3mg)

Which drugs are involved in the Bradycardia Algorithm?

Atropine is an IV push medication that is used to increase heart rate. Epinephrine and dopamine are both used as an alternative to TCP and are infusions.

What is treated with transcutaneous pacing and atropine 0.5mg (max 3mg)?

Bradycardia

The most important algorithm to know for adult resuscitation is:

Cardiac Arrest

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

Complete block is generally the most important and clinically significant degree of block. It is also the most likely block to cause cardiovascular collapse.

Transcutaneous pacing should be started immediately if: A. there is no response to atropine B. atropine is unlikely to be effective or if IV access cannot be quickly established C. the patient is severely symptomatic D. all of the above

D-do not delay TCP while preparing atropine

(True or False) The drug Vasopressin can be used as a substitute for epinephrine for the first or second dose during resuscitation.

False

Which come first in PEA? Establishing an advanced airway or the IV access?

IV access is FIRST! Placing an advanced airway is secondary to establishing IV access for several reasons: 1. adequate ventilation can be given with a BVM (bag valve mask) 2. Placing an advanced airway is time consuming. 3. Use of IV fluids and medications are interventions for some of the reversible causes of PEA.

Wenckebach AKA

Mobitz I AKA 2nd degree block type 1

Which ECG rhythm is commonly associated with bradycardia?

Mobitz II (Second-degree AV block (Type 2)) can rapidly progress to complete heart block.

During CPR after an advanced airway is in place

One breath every 6 seconds should be given

1 degree block AKA

PR prolongation

The two most important aspects to treating PEA are:

Provide effective CPR and correct the underlying cause of the rhythm

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

What rhythm is first treated with vagal maneuvers then adenosine 6mg 20 cc fluid flush followed by 12mg adenosine if 6 not effective. After both adenosine injxns fail to convert rhythm, will need to do synchronized cardioversion with 50 joules?

Supraventricular tachycardia

Synchronized cardioversion uses a lower energy level than attempted defibrillation.

TRUE... Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating VF."

Name the T's that are reversible causes of cardiac arrest?

Tension pneumo tamponade, cardiac toxins thrombosis-pulmonary, coronary

The decision point for performing immediate synchronized cardioversion is:

The patient is unstable and no other reversible causes are identified

(True or False) A precordial thump may be considered for patients with witnessed, monitored, unstable VT if a defibrillator is not immediately available for use.

True

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

True

(True or False) Fine Ventricular Fibrillation may appear as asystole. If this is unclear an initial attempt at defibrillation may be warranted.

True

(True or False) The systematic approach with a person in cardiac arrest should include the BLS Assessment and the Primary Assessment?

True

True of False) Atropine is no longer recommended for routine use in the management of PEA and asystole.

True

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

True

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

True

Synchronized shocks are recommended for patients with unstable SVT, unstable atrial fibrillation, unstable atrial flutter, unstable regular monomorphic tachycardia with pulses.

Unsynchronized shocks are recommended for a patient who is pulseless, for a patient demonstrating clinical deterioration (in prearrest) when you think a delay in converting the rhythms will result in cardiac arrest, and when you are unsure whether monomorphic or polymorphic VT is present in the unstable patient."

Treatment for which dyshhythmia consists of: give 1 shock, 5 cycles CPR, check for pulse and rhythm, give 1 shock, 5 cycles CPR, check for pulse and rhythm after 2nd shock give 1mg epinephrine IV push

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

Preparation for transcutaneous pacing should be made for which of the following? 1. unstable sinus bradycardia 2. third degree AV block 3. Mobitz type II second-degree AV block 4. all of the above

all of the above

Transcutaneous pacing has been show to have little or no effect on the patient with ________________.

asystole

If a tachyarrhythmia is causing a patient to become unstable what is the most important intervention?

cardioversion

3rd degree block AKA

complete block

If a patient has polymorphic VT and is unstable, treat the rhythm as VF and

deliver high-energy unsynchronized shocks (ie, defibrillation doses).

The most important intervention with witnessed sudden cardiac arrest is:

early defibrillation

Four important aspects to the Pulseless VF/VT algorithm are

early defibrillation, effective CPR(hard and fast), 100-120 secure the airway, establish IV/IO access

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

epinephrine

Drugs used in the VF/Pulseless VT Algorithm include:

epinephrine, amiodarone, lidocaine, and magnesium sulfate

PEA caused by HYPOkalemia may present with which EKG findings?

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

Contraindications to IO infusion:

fracture or crush injury fragile bone disease previous attempts in same bone hx of infection in bone

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

give atropine while awaiting transcutaneous pacer DO NOT delay TCP if atropine is not ready

Tachyarrhythmias respond to cardioversion. Sinus tachycardia will not respond to cardioversion. What will often occur if a shock is delivered with sinus tachycardia?

heart rate increases

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

high quality CPR, gain IV/IO access, advanced airway

The primary ACLS treatment for VF and Pulseless VT is

high-energy unsynchronized shocks

Symptoms that may be due to tachycardia include:

hypotension altered mental status chest pain

Name the H's that are reversible causes of cardiac arrest?

hypovolemia hypoxia hypo/hyperkalemia hydrogen ions hypothermia

After the first shock for pulseless VF/VT you should:

immediately resume CPR

Dopamine MOA

increases contractility, makes heart pump harder (positive inotropic)

Adenosine is recommended as safe and potentially effective for both treatment and diagnosis in the initial management of undifferentiated regular ___________________.

monomorphic wide complex tachycardia.

While conducting the BLS Assessment, you should do all of the following except: 1. check patient responsiveness 2. activate emergency response system 3. open the airway 4. get an AED

open the airway

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

palpate for a pulse. Seeing an organized rhythm does not always mean that the rhythm will be a perfusing rhythm. If no pulse is felt after 5-10 seconds, you should resume CPR and treat using the PEA/asystole algorithm.

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

patients using diuretics

The therapy pathway for asystole/PEA is designed around

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

The treatment sequence for bradycardia with poor perfusion is:

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

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

prepare for transvenous pacing

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

prolonged QT interval

What dysrhythmia is treated with the following? shock 200 J epi 1 mg 1:10,000 shock 300 J amiodarone 300 mg shock 360 J epi 1 mg 1:10000 shock 360 J amiodarone 150 mg

pulseless vtach

During PEA, what step occurs after CPR and medication administration?

rhythm check

Transcutaneous pacing is contraindicated in the patient with ________________.

severe hypothermia and is not recommended for asystole

When performing synchronized electrical cardioversion, when is shock delivered?

shock is delivered with the peak of the R-wave in the QRS complex.

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

slow rate on ECG (has already compensated to capacity)

Typically, suctioning attempts in ACLS situations should be:

ten seconds or less

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

transcutaneous pacing

Which is the correct treatment for unstable polymorphic VT?

treat as VF with high-energy unsynchronized shocks

If there is any doubt about whether an unstable patient has monomorphic or polymorphic VT what should you do?

treat with high-energy unsynchronized shocks

Which is the correct treatment of unstable regular monomorphic VT with a pulse

treat with synchronized cardioversion and an initial shock of 100 J

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

true- atropine crosses into the CNS stimulating the vagus nerve causing bradycardia at low doses. At higher doses the muscarinic blocking effects of Atropine out weigh the CNS effects, causing tachycardia.

Unstable polymorphic tachycardia is treated with an

unsynchronized shock

Epinephrine is used during resuscitation primarily for its ability to ______________________________________.

vasoconstriction (increases cerebral and coronary blood flow during CPR).

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

whether the defibrillator is monophasic or biphasic Initial shock dose for Biphasic is 120-200 J and the initial shock dose for monophasic is 360 J. Second, and "subsequent dose of energy for the biphasic should be equivalent, and higher doses may be considered."