ACLS

What is the recommended dose of epinephrine for the treatment of hypotension in a post-cardiac arrest patient who achieves ROSC?

0.1 to 0.5 mcg/kg per minute IV infusion Treat hypotension (SBP <90 mm Hg)

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

What is the appropriate intervalfor an interruption in chest compressions?

10 seconds or less

What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?

10 to 12 breaths per minute Ventilation Rates

What is the recommended energy dose for BIPHASIC synchronized cardioversion of atrial fibrillation?

120 to 200 J Energy Doses for Cardioversion for monophasic 360J

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

12mg

What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes?

160 to 325 mg Administer Oxygen and Drugs: Aspirin (Acetylsalicyclic Acid)

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?

2-20mcg/kg/min

What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?

300 mg Shock and Antiarrhthmics

What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest?

32 to 36 degrees Celsius

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

35-40mm Hg

How long should it take to perform a pulse check during the BLS Survey?

5 to 10 seconds

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

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 2 to 4 mg of morphine by slow IV bolus Administer Oxygen and Drugs: Morphine

A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to

Administer a second shock The Cardiac Arrest Algorithm

An AED advises a shock for a pulseless patient lying in snow. What is the next action?

Administer the shock immediately and continue as directed by the AED. AED Use in Special Situations

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?

Amiodarone 300mg

Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest?

Antecubital vein

What is the recommended compression rate for performing CPR?

At least 100 per minute (100-120) The BLS Survey

What is the appropriate rate of chest compressions for an adult in cardiac arrest?

At least 100/min. Not approximately 120/min. The BLS Survey

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.

What is the recommended next step after a defibrillation attempt?

Begin CPR, starting with chest compressions.

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.

After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action?

Check for a pulse. The BLS Survey

Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient?

Check the patient's pulse

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

A team leader orders 1 mg of epinephrine and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent?

Closed-loop communication

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 above. After you start an IV, what is the next action? (3rd degree heart block)

Conduct a problem-focused history and physical examination. BLS and ACLS surveys

For the past 25 min, EMS crews have attempted resuscitation 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. Foundational Facts: Resume CPR While Manual Defibrillator is Charging

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

Continuous waveform capnography

What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC?

Decreased cerebral blood flow Caution: Things to Avoid During Ventilation

EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the rhythm strip shown above. What is the most important early intervention? (V-fib)

Defibrillation Principle of Early Defibrillation

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. Foundational Facts: Stroke Centers and Stroke Units

Which action is included in the BLS survey?

Early defibrillation

Which treatment or medication is appropriate for the treatment of a patient in asystole?

Epinephrine Administer Vasopressors

Choose an appropriate inidication to stop or withhold resuscitive efforts.

Evidence of rigor mortis.

IV/IO drug administration during CPR should be

Given rapidly during compressions Routes of Access for Drugs

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 have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action?

Have a team member attempt to palpate a carotid pulse. Rhythm Check

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

After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears above. What is your next action?

IV or IO access The PEA Pathway of the Cardiac Arrest Algorithm

What is the purpose of a medical emergency team (MET) or rapid response team?

Improving patient outcomes by identifying and treating early clinical deterioration. Foundational Facts: Medical Emergency Teams (METs) and Rapid Response Teams (RRTs)

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) Routes of Access for Drugs

Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)?

Measure from the corner of the mouth to the angle of the mandible

What is the recommendation of the use of cricoid pressure to prevent aspiration during cardiac arrest?

Not recommended for routine use

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.

A postoperative patient in the ICU reports new chest pain. What actions have the highest priority?

Obtain a 12-lead ECG and administer aspirin if not contraindicated. EMS Assessment, Care, and Hospital Preparation

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. Identification of Chest Discomfort Suggestive of Ischemia

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

Optimizing ventilation and oxygenation.

What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)?

Oxygenation and ventilation and then Administration of IV or IO fluid bolus Treat Hypotension (SBP <90 mm Hg)

Which finding is a sign of ineffective CPR?

PETCO2 <10 mm Hg Physiologic Monitoring During CPR

Which of the following is a sign of effective CPR?

PETCO2 = or > 10mm Hg

Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique?

Performing a head tilt-chin lift maneuver

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

Peripheral IV

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 Optimize Ventilation and Oxygenation

What survival advantages does CPR provide to a patient in V-Fib?

Produces a small amount of blood flow to the heart. Principle of Early Defibrillation

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 is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?

Right ventricular infarction and erectile dysfunction Administer Oxygen and Drugs: Nitroglycerin (Glyceryl Trinitrate) RV infarction may complicate an inferior wall MI. Patients with acute RV infarction are very dependent on RV filling pressures to maintain CO and BP. If RV infarction cannot be confirmed providers must use caution in administering nitrates to patients with inferior STEMI. If RV infarction is confirmed by right-sided precordial leads or clinical findings by an experienced provider, nitroglycerin and other vasodilators (morphine) or volume-depleting drugs (diuretics) are contraindicated as well.

Which condition is an indication to stop or withhold resuscitative efforts?

Safety threats to providers

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?

Seeking expert consultation. Application of the Tachycardia Algorithm to the Stable Patient: Wide (Broad)-Complex Tachycardias

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

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

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.

Which situation BEST describes PEA?

Sinus rythm without a pulse

A patient with pulseless ventricular tachycardia is defibrillated. What is the next action?

Start chest compressions at a rate of at least 100/min. Resume CPR

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.

A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm above. What is the appropriate next intervention? (Wide, regular Tachycardia with a Pulse)

Synchronized cardioversion Indications for Cardioversion

What is the most appropriate intervention for a rapidly deteriorating patient who has the lead II ECG shown above?

Synchronized cardioversion Indications for Cardioversion

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 is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation?

Transport the patient to a facility capable of performing PCI.

Which rythm requires synchronized cardioversion?

Unstable SVT

A responder is caring for a patient with a history of CHF. The patient is experiencing SOB, BP of 68/50 mm Hg, and a HR of 190/min. The patient's lead II ECG is displayed above. Which of the following terms best describes this patient?

Unstable supraventricular tachycardia The Approach to Unstable Tachycardia Symptoms and Signs

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.

What is the recommended duration of therapeutic hypothermia after reaching the target temperature?

for at least 24 hours