Rhythm Identification and Pharmacology

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

0.5 mg

what is the maximum interval for pausing chest compressions

10 seconds

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 what?

150 mg IV push

what is the recommended depth of compression to an adult victim

2 inches

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?

Amiodarone 300 mg

You arrive on the scene to find a 56-year-old diabetic woman with dizziness. She is pale and diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm below. (s. bradycardia) She is receiving oxygen at 4 L/min by nasal cannula and an IV has been established. Your next order is:

Atropine 0.5 mg IV

Bradycardia requires treatment when?

Chest pain or shortness of breath "hypotension"

A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into 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?

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

Which intervention is most appropriate for the treatment of a pt in asystole?

EPI

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 or vasopressin 40 units IV or IO

A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated?

Epinephrine 2 to 10 mcg/min

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 what?

Gain IV or IO access

He is unresponsive and does not appear to be breathing normally. You can clearly feel his carotid pulse. What is your next step?

Give 10 to 12 rescue breaths per minute

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. ASA was not taken by the patient because he had a history of gastritis treated 5 years ago. What is the next action?

Give ASA 160-325 chewed immediately

You arrive on the scene to find CPR in progress. Nursing staff report that the patient was recovering from a pulmonary embolism and suddenly collapsed. There is no pulse or spontaneous respirations. High-quality CPR and effective bag-mask ventilation are being provided. An IV has been initiated. What would you do now?

Give epinephrine 1 mg IV

What should you do after the AED delivers a shock

Immediately resume CPR

what is the recommended rate of high quality CPR

Once an advanced airway is in place, chest compressions can be continuous (at a rate of at least 100/min) and no longer cycled with ventilations. Rescue breaths can then be provided at about 1 breath every 6 to 8 seconds (about 8 to 10 breaths per minute). Excessive ventilation should be avoided.

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

Perform immediate electrical cardioversion

A patient with possible STEMI has ongoing chest discomfort. What is a containdication to the administration of nitrates?

Phosphodiesterase inhibitor within 24 hours

polymorphic ventricular tachycardia

QRS waves will not be symmetrical, because each ventricular impulse can be generated from a different location on the rhythm strip, the QRS might be somewhat taller or wider

A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown above (Reentry supraventricular tachycardia) without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70 mm Hg. What is the next appropriate intervention?

Repeat adenosine 12 mg IV

A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is: asystole

Resume high-quality chest compressions.

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

Second dose of epinephrine 1 mg

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. What should you do?

Seek expert consultation

When can you use magnesium in cardiac arrest?

VF/pulseless ventricular tachycardia associated with torsades de pointes

supraventricular tachycardia (SVT)

broad term for a number of tachyarrhythmias that originate above the ventricular electrical conduction system (purkinje fibers). Classic Paroxysmal SVT: narrow QRS complex very regular rhythm +/- inverted "retrograde" P waves after QRS complex

To reduce fatigue during CPR, how often should compressor switch roles?

every 5 cycles or 2 minutes

you are providing bag mask ventilations to a patient in respiratory arrest. how often should you provide ventilations?

every 5 to 6 seconds

a patient has been resuscitated from cardiac arrest. During post ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. which action is indicated next

give immediate high energy shock (defibrillation dose)

What is likely to cause air to enter the victim's stomach during bag-mask ventilation?

giving breaths too quickly with too much force

atrial flutter

not a stable rhythm and will frequently degenerate into atrial fibrillation atrial rates between 240-350 beats per minute, caused by electrical activity that moves in a self-perpetuating loop within the atria

pulseless electrical activity (PEA)

occurs when any heart rhythm that is observed on the electrocardiogram (ECG) does not produce a pulse can come in many different forms: sinus rhythm, tachycardia, and bradycardia can all be seen with PEA.

2nd degree AV block, Mobitz Type 1/Wenckebach

p-waves are regular (atrial rhythm will be regular) PR-interval progressively gets longer until a QRS is dropped and only the p-wave is present

A patient's 12-lead ECG was transmitted by the paramedics and showed an acute MI. The above findings are seen on rhythm strip when a monitor is placed in emergency department. The patient had resolution of moderate (5.10) chest pain with 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention below is most important, reducing in-hospital and 30-day mortality?

reperfusion therapy

ventricular fibrillation

uncoordinated contractions within the ventricles primary cause of VF is hypoxia → hyperirritability in the cardiac muscle tissue → multiple muscles cells within the ventricles simultaneously fire → fibrillation → ineffective cardiac output always pulseless no identifiable waveforms, completely erratic

a 35 year old women presents with a chief complaint of palpitations. she has no chest discomfort, shortness of breat, or light headedness. her blood pressure is 120/78 Hg. which intervention is indicated first.

vagal manuveours

what action minimizes the risk of air entering the victims stomach during bag mask ventilation

ventilating until you see the chest rise

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?

Adenosine 6 mg

How does complete chest recoil contribute to effective CPR?

Allows blood to flow into the ♥ and is necessary for cc to create blood flow.