Quiz 9 Key

How should magnesium sulfate be prepared for administration to a pt in Torsades? A. 2gm in 16mL of NS B. 4gm in 10mL of NS C. 5gm in 15mL of NS D. 10gm in 50mL of NS

A. 2gm in 16mL of NS

An unconscious and unresponsive pulseless and nonbreathing older adult is found in a chair by their caregiver. The pt was last seen well 5 mins ago. There is no history of a respiratory condition or distress. There is no POLST order, the jaw is not stiff, there is no dependent lividity, and the skin is warm. Which of these is indicated FIRST? A. Begin high perfusion CPS with manual compressions only B. Begin chest compressions using an automated CPR device C. Start manual CPR w/ a compression ventilation ratio of 30:2

A. Begin high perfusion CPS with manual compressions only

Which of these is indicated w/ respect to performing manual chest compressions if no automated CPR is deployed? A. Change compressions every 2 minutes B. Rotate compressors every 3-5 minutes C. Change only when the person doing compressions feels tired D. Rotating compressors is unnecessary if the monitor reveals effective compressions

A. Change compressions every 2 minutes

What can be implied if the capnography reading remains at 30 during CPR? A. Compression quality is good B. Resuscitation (ROSC) is unlikely C. The pt is profoundly hypoxic D. Need to switch person doing the compressions

A. Compression quality is good

An unconscious, pulseless adult presents in VF w/ a LifeVest. What EMS intervention is indicated first? A. Disconnect the batteries and resuscitate as usual B. Do NOT disconnect the batteries; allow the LifeVest to continue firing while starting EMS resuscitation

A. Disconnect the batteries and resuscitate as usual

How frequently should epinephrine be given to a pt in cardiac arrest in the NWC EMSS? A. Every 6 min B. Every 3-5 min C. After every defib D. Every 2 min when the rhythm is checked

A. Every 6 min

A conscious and stable adult presents w/ chest pain and palpitations. After confirming V-tach, amiodarone slow IVP is begun. Midway through the dose, you note a reversion in the ECG. VS remain stable. What intervention is indicated next? A. Finish the amiodarone dose B. Stop the amiodarone and transport

A. Finish the amiodarone dose

Why is delayed defib recommended for some pts found in a shockable rhythm? A. Hypoxic and acidotic hearts are less responsive to electrical therapy B. High quality continuous compressions replace the need for defib C. Defib is typically more effective after advanced airways have been placed D. Sustainable rhythms are more likely after 3 rounds of epi have been given

A. Hypoxic and acidotic hearts are less responsive to electrical therapy

An adult experienced ROSC and now shows sinus rhythm on the monitor with a palpable carotid pulse. The pt is unconscious and unresponsive, remains intubated; and EtCO2 is 62 w/ a square waveform. The pt is attempting to breathe spontaneously. VS: BP 70/40; P 76; R 12; SpO2 93% Which of these is indicated FIRST to support perfusion? A. IV fluid challenge; norepinephrine IVPB to MAP 90-100 B. 30 sec of hyperventilation to wash out respiratory acids C. Rapid external warming with activated hot packs and blankets D. Epi (1mg/10mL) 0.01mg/kg increments to a max of 2mg IVP/IO

A. IV fluid challenge; norepinephrine IVPB to MAP 90-100

What is the significance of a sudden, dramatic EtCO2 increase during CPR? A. May signal impending ROSC B. Pt needs to be hyperventilated C. Pt needs a dose of sodium bicarbonate D. Poor quality CPR and the need to change compressors

A. May signal impending ROSC

Which of these is an expected side effect of sodium bicarbonate administration? A. Metabolic alkalosis B. Increased VF threshold C. Decreased sodium levels D. Increased potassium levels

A. Metabolic alkalosis

Which of these is NOT indicated if the EtCO2 reading does not register in a pt found in V-fib? A. Stop all ApOx efforts; ventilate w/ 15L O2/BVM and defibrillate ASAP B. Reposition mandible, ensure open airway; correctly place NPA/OPA; suction C. Switch to inline EtCO2 sensor above RQP; transition to a regular NC running O2 15L D. Ventilate x 2 (15L O2/BVM); after reading obtained, stop ventilating if during ApOx period

A. Stop all ApOx efforts; ventilate w/ 15L O2/BVM and defibrillate ASAP

Where should adults in cardiac arrest be resuscitated if the scene is safe and there is no trauma? A. Where they are found B. In the ambulance as all of the required equipment is located there C. Enroute to the hospital, as more sophisticated measures are available in the ED

A. Where they are found

What is the optimal CPR compression rate/minute for an adult when a ResQPod is being used? A. Approximately 120 B. 100-110 C. 80-100 D. 60

B. 100-110

What is the dose of sodium bicarbonate to be given to an adult in cardiac arrest? A. 0.5mcg/kg B. 1mEq/kg 2-10mcg/kg/min D. 1 amp q 2min

B. 1mEq/kg

Ventricular tachycardia persists in an unstable adult after receiving one synchronized cardioversion. Amiodarone is being administered. When is a second cardioversion indicated? A. Immediately, without delay B. After 1/2 of the amiodarone dose C. When the amiodarone dose is complete

B. After 1/2 of the amiodarone dose

What is the repeat dose and timing of administration of amiodarone for adults in persistent VF? A. After 3min: 50mg B. After 5min: 150mg C. After 10min: 300mg

B. After 5min: 150mg

Which of these should be done by the PM in charge of medication administration when a drug has been given during cardiac arrest? A. Defib within 10 sec B. Call out drug name and dose C. Check the pulse in 30-60sec D. Immediately check the ECG rhythm

B. Call out drug name and dose

A conscious, pulseless adult presents in VF w/ a VAD. What EMS intervention is indicated first? A. Disconnect the batteries and resuscitate as usual B. Do NOT disconnect the batteries; call the VAD coordinator on the pt's referral info sheet for instructions

B. Do NOT disconnect the batteries; call the VAD coordinator on the pt's referral info sheet for instructions

Which of these is a potentially harmful side effect when giving amiodarone IVP to a conscious patient w/ a pulse? A. Tachycardia B. Hypotension C. Short QT syndrome D. Dry mouth and flushed skin

B. Hypotension

What is the main reason for giving epinephrine to a pt in cardiac arrest? A. Activate beta receptors in the heart B. Improve blood flow to the heart and brain C. Bronchodilate the lungs to enable better gas exchange D. Decrease myocardial irritability and treat the dysrhythmia

B. Improve blood flow to the heart and brain

Which of these statements is true regarding the benefits of using a ResQPod during CPR? A. The red timing light blinks every 2 minutes to remind the crew to check for a pulse B. It improves cardiac output by maintaining negative intrathoracic pressure during CPR C. It slows forceful BVM ventilations, decreasing the chance of barotrauma to the lungs D. It creates a vacuum that closes the esophageal sphincter, eliminating gastric distention

B. It improves cardiac output by maintaining negative intrathoracic pressure during CPR

Which of these is correct regarding chest compression location and depth in adults? A. Over the xiphoid process; 1/2 to 3/4 inches B. Lower half of the sternum; 2 to 2.4 inches C. Upper half of the sternum; 2 1/2 to 3 inches D. Just above the nipple line; 1 to 1 1/2 inches

B. Lower half of the sternum; 2 to 2.4 inches

An adult experienced ROSC and now shows sinus rhythm on the monitor with a palpable carotid pulse. The pt is unconscious and unresponsive, remains intubated; and EtCO2 is 62 w/ a square waveform. The pt is attempting to breathe spontaneously. VS: BP 70/40; P 76; R 12; SpO2 93% Which of these is indicated first? A. Extubate the pt B. Remove the RQP ITD C. Obtain a 12L ECG D. Check a blood glucose

B. Remove the RQP ITD

A pt is in persistent cardiac arrest after 25min of resuscitation. Which of these is NOT one of the Hs and Ts to be considered by the team leader? A. Toxins B. Tonicity C. Hypovolemia D. Hydrogen ion

B. Tonicity

What is the amiodarone dose in mg and administration rate for an adult in V-tach w/ a pulse? A. 50mg mixed w/ 100mL NS fast IVP B. 100mg mixed w/ 10mL NS slow IVP C. 150mg mixed w/ 7mL NS slow IVP over 10 min D. 300mg undiluted, given rapid IVP

C. 150mg mixed w/ 7mL NS slow IVP over 10 min

Which of these is the preferred dose and route of epinephrine for an adult in pulseless arrest? A. 1mg/1mL 1mg IVP/IO B. 1mg/1mL 0.5mg increments IVP/IO C. 1mg/10mL 1mg IVP/IO D. 1mg/10mL 0.01mg increments IVP/IO

C. 1mg/10mL 1mg IVP/IO

Which of these is the first dose of amiodarone to be given to an adult in VF? A. 50mg fast IVP/IO B. 1.5mg/kg slow IVP/IO C. 300mg rapid IVP/IO (undiluted) D. 150mg diluted per V-tach protocol given rapid IVP/IO

C. 300mg rapid IVP/IO (undiluted)

What is the best method to detect re-arrest? A. Set monitor HR alarms B. Watch the ECG monitor C. Continuous palpation of pulse D. Set auto-BP to every 5min

C. Continuous palpation of pulse

Which of these is the prescribed technique for ventilating a pt in cardiac arrest w/ a BVM? A. Compress the bag to collapse it entirely B. Hyperventilate for 1 min then reduce to normal rate C. Deliver only enough tidal volume to see the chest rise D. Continue to compress the bag for 2-3 sec after chest rises

C. Deliver only enough tidal volume to see the chest rise

Which of these is an indicator for immediate defib in a pt found in cardiac arrest w/ a shockable rhythm? A. SpO2 < 85% B. Fine V-fib C. EtCO2 > 20mmHg D. Downtime > 6 minutes

C. EtCO2 > 20mmHg

Which of these has the greatest impact on the success of cardiac arrest resuscitation? A. Administration of vasopressors B. Administration of antidysrhythmics C. High quality CPS w/ minimal interruptions in compressions D. Advanced airway placement and vascular access performed as quickly as possible

C. High quality CPS w/ minimal interruptions in compressions

Which of these is generated by the slowest and least reliable cardiac pacemaker site? A. Sinus arrhythmia B. Junctional bradycardia C. Idioventricular rhythm D. Wandering atrial pacemaker

C. Idioventricular rhythm

Which of these is indicated first for a stable pt w/ Torsades de Pointes? A. Amiodarone IVP B. Immediate defibrillation C. Magnesium sulfate slow IVP D. Synchronized cardioversion at lowest J setting

C. Magnesium sulfate slow IVP

An adult experienced ROSC and now shows sinus rhythm on the monitor with a palpable carotid pulse. The pt is unconscious and unresponsive, remains intubated; and EtCO2 is 62 w/ a square waveform. The pt is attempting to breathe spontaneously. VS: BP 70/40; P 76; R 12; SpO2 93% How should the pt's oxygenation/ventilatory status be supported now? A. O2 to achieve an SpO2 of 100% B. Hyperventilate to an EtCO2 of 30 C. O2 just to achieve an SpO2 of 94%

C. O2 just to achieve an SpO2 of 94%

Which of these is a contraindication for giving amiodarone? A. Coarse ventricular fibrillation B. Monomorphic ventricular tachycardia w/ a normal QT interval C. Polymorphic ventricular tachycardia w/ a prolonged QT interval

C. Polymorphic ventricular tachycardia w/ a prolonged QT interval

If the underlying rhythm cannot be identified while compressions re provided and the EtCO2 values remain in acceptable ranges, what should EMS do? A. Assume a shockable rhythm and defib every 2 mins B. Pause compressions for 10-15sec to assure accurate rhythm identification C. Print a strip during the normal pause, resume compressions, and ID printed strip D. Maintain uninterrupted CPR until the capnography reading falls to < 20, then defib

C. Print a strip during the normal pause, resume compressions, and ID printed strip

What addition to EMS cardiac arrest resuscitation has shown to improve CPR quality and more than double patient survival to discharge? A. Beta doses of epinephrine B. Use of anterior/lateral defibrillation C. Real time CPR audiovisual feedback device D. Transporting earlier for more sophisticated interventions at the hospital

C. Real time CPR audiovisual feedback device

Which of these is indicated immediately after defibbing a pt in pulseless arrest? A. Check for a pulse B. Assess the rhythm C. Resume chest compressions D. Give 2 quick breaths and then resume compressions

C. Resume chest compressions

During manual CPR, if ventilations are indicated, which of these is also the responsibility of the team member who is performing chest compressions? A. Insert OP/NPA B. Maintain tight face-mask seal C. Squeeze the bag to deliver ventilations D. Connect capnography and ResQPod to BVM

C. Squeeze the bag to deliver ventilations

What is the clinical significance for a pt experiencing multi-formed or repetitive PVCs? A. There is a temporary increase in cardiac output B. They are usually benign and of no consequence C. There is an increased risk of VF and sudden death

C. There is an increased risk of VF and sudden death

A normothermic adult has remained in persistent monitored asystole during 30 min of resuscitation. Extraglottic airway (I-gel) and IO are placed and the pt has received a total of 10mg epi IO. Hs and Ts are negative for reversible causes of arrest and EtCO2 is 8. What further orders should paramedics request from OLMC? A. Pacing at 60BPM B. Intracardiac epi C. To discontinue resus efforts D. Dual sequential defib at 360J

C. To discontinue resus efforts

Why is releasing pressure off the chest completely between cardiac compressions important? A. Allows the lungs to fully deflate B. Prevents rescuer injury during defibrillation C. Prevents compressions that are too fast/deep D. Allows venous return so the heart can fill with blood

D. Allows venous return so the heart can fill with blood

If a pt has an EtCO2 > 55 2 min post ROSC, what should be done? A. Decrease ventilation rate B. Immediately hyperventilate C. Administer sodium bicarbonate D. Assess rate and volume of ventilations

D. Assess rate and volume of ventilations

Per SOP, which of these is indicated if a pt remains in persistent refractory VF prior to meeting indications for termination of resuscitation (TOR)? A. Double the dose of amiodarone B. Ask OLMC for early use of norepinephrine to increase chance of ROSC C. Switch to continuous compressions and stop ventilating the pt D. Change defib pad location to A-P; consider dual sequential defibrillation

D. Change defib pad location to A-P; consider dual sequential defibrillation

Which of these is indicated if a pt remains in persistent refractory VF? A. Double the dose of amiodarone B. Ask OLMC for authorization to terminate resuscitation C. Switch to continuous compressions and stop ventilating the pt D. Change defib pad location to A-P; consider dual sequential defibrillation

D. Change defib pad location to A-P; consider dual sequential defibrillation

When using the pit-crew approach to team resuscitation, what is the responsibility of the 1st team member to reach the pt? A. BLS and ALS airway management B. Establish vascular access: IV or IO C. Turn on the ECG monitor and attach electrodes D. Determine downtime, check responsiveness and pulse, begin chest compressions

D. Determine downtime, check responsiveness and pulse, begin chest compressions

Manual CPR w/ ApOx has been initiated for an adult in cardiac arrest w/ a downtime >6min. After pad placement, the monitor shows VF. Which of these actions should be done next? A. Do 2 minutes of CPR and then defibrillate B. Immediately charge monitor and prepare to defib C. Pause compressions, call "clear," charge monitor, and defib D. Gather information to determine need for immediate or delayed defib

D. Gather information to determine need for immediate or delayed defib

After defib pads are placed and CPR is paused to assess the rhythm, an adult is assessed to be in asystole with no pulse. Which of these is indicated next? A. Check breathing B. Defib at 360J C. Full vagolytic dose of atropine D. Immediately resume CPR compressions

D. Immediately resume CPR compressions

Which of these is indicated FIRST immediately after starting CPR in pts 13 years and older when the cardiac arrest is not caused by a hypoxic event (asthma, anaphylaxis, submersion)? A. Insert an I-gel and give passive flow O2 through BVM w/ no ventilations B. Intubate ASAP as long as compressions are not interrupted for >60 sec C. Provide assisted ventilations w/ 15L O2/BVM for 2 min prior to a rhythm check D. Jaw thrust; NPA/OPA; NC EtCO2 at 15L O2 under BVM mask (no ventilations yet)

D. Jaw thrust; NPA/OPA; NC EtCO2 at 15L O2 under BVM mask (no ventilations yet)

Should a pt in cardiac arrest be ventilated right before defibrillation? A. Only if it is time to ventilate the pt B. Yes, a pause in compressions allows for full ventilation C. Yes, if more than 5 sec have elapsed since the last ventilation D. No, an inflated chest decreases cardiac output and defib effectiveness

D. No, an inflated chest decreases cardiac output and defib effectiveness

Which of these best defines PEA? A. IVR at any rate B. IVR w/ HR less than 60 C. Bradycardic rhythm w/ hypotension D. Organized ECG rhythm on the monitor w/ no palpable pulse

D. Organized ECG rhythm on the monitor w/ no palpable pulse

Which of these reflects correct defib technique if a CPR device is NOT deployed? A. Deliver 3 stacked shocks at 200-300-360J as close together as possible B. Stop compressions and check ECG for 10sec in at least 2 leads before defib C. Stop compressions for up to 10sec, pre-charge monitor; assess ECG and pulse and defib during the same pause in compressions D. Pause compressions for < 5sec; assess ECG, resume compressions while charging monitor; pause briefly for shock delivery

D. Pause compressions for < 5sec; assess ECG, resume compressions while charging monitor; pause briefly for shock delivery

What is an acceptable reason to pause CPR when a mechanical CPR device is in use? A. Defibrillation B. IO insertion C. Intubation D. ROSC

D. ROSC

Which of these is a likely side effect if magnesium sulfate is administered too rapidly? A. Seizures B. Bronchoconstriction; irritability C. Peripheral vasoconstriction and hypertension D. Respiratory depression; weakness or paralysis

D. Respiratory depression; weakness or paralysis

Why is it important to obtain a 12L ECG ASAP after ROSC? A. To get the best possible rhythm analysis B. To look for evidence of benign early repolarization C. To see if the resuscitation efforts caused heart damage D. To determine the need for an urgent cardiac catheterization (STEMI)

D. To determine the need for an urgent cardiac catheterization (STEMI)

When resuscitating a pt in VF, which of these is indicated after placing an advanced (I-gel) airway? A. Change the compression/ventilation ratio to 5:1 B. Increase the ventilatory rate to 12-16 breaths/minute C. Pause compressions to suction the gastric port as needed D. Ventilate once every 6 seconds (10 BPM) with continuous compressions

D. Ventilate once every 6 seconds (10 BPM) with continuous compressions

Which of these is likely to occur if the ventricles are depolarized again during the vulnerable period of repolarization (R on T phenomenon)? A. Absent T wave B. Short QT interval C. Prominent U wave D. Ventricular dysrhythmias

D. Ventricular dysrhythmias

In which of these dysrhythmias is IVP/IO epinephrine contraindicated? A. Ventricular fibrillation B. Pulseless ventricular tachycardia C. Pulseless electrical activity (PEA) D. Ventricular tachycardia w/ a pulse

D. Ventricular tachycardia w/ a pulse

Which of these is indicated first for an unconscious pt whose implantable cardioverter defibrillator is firing? A. PMs should don insulated gloves B. EMS should call OLMC for orders C. Call the cardiac surgeon and ask for the code to deactivate D. Wait 30-60sec for cycle to complete; place pads at least 1" from implanted device

D. Wait 30-60sec for cycle to complete; place pads at least 1" from implanted device

Under what circumstances should sodium bicarbonate be given to a pt in VF? A. If CPR continues longer than 6min B. If the pt is a witnessed, monitored arrest C. After the first doses of epi and amiodarone D. When the dysrhythmia may be caused by a pre-existing acidosis

D. When the dysrhythmia may be caused by a pre-existing acidosis

When should defib pads be placed on a pulseless pt in cardiac arrest? A. Before CPR is initiated B. During a brief pause in CPR C. After the initial rhythm is found to be VF D. While CPR is in progress, without interrupting chest compressions

D. While CPR is in progress, without interrupting chest compressions

After ROSC, PMs should start targeted temperature management with cold packs when A. capnography levels drop to normal B. IV fluids and vasopressors have been given C. an advanced airway and ventilations are needed D. the pt remains unresponsive to verbal commands

D. the pt remains unresponsive to verbal commands