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.
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.
What is the preferred method of access for epi administration during cardiac arrest in most pts? Peripheral IV
An AED does not promptly analyze a rythm. What is your next step? Begin chest compressions.
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
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
What is a common but sometimes fatal mistake in cardiac arrest management? Prolonged interruptions in chest compressions.
Which action is a componant of high-quality chest comressions? Allowing complete chest recoil
Which action increases the chance of successful conversion of ventricular fibrillation? Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes PEA? Sinus rhythm without a pulse
What is the best strategy for perfoming high-quality CPR on a pt.with an advanced airway in place? Provide continuous chest compressions without pauses and 10 ventilations per minute.
3 min after witnessing a cardiac arrest, one memeber of your team inserts an ET tube while another performs continuous chest comressions. During subsequent ventilation, 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.
The use of quantitative capnography in intubated pt's does what? Allows for monitoring CPR quality
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.
Which is a safe and effective practice within the defibrillation sequence? Be sure O2 is NOT blowing over the pt's chest during shock.
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.
What is an advantage of using hands-free d-fib pads instead of d-fib paddles? Hands-free allows for more rapid d-fib.
What action is recommended to help minimize interruptions in chest compressions during CPR? Continue CPR while charging the defibrillator.
Which action is included in the BLS survey? Early defibrillation
Which drug and dose are recommended for the management of a pt. in refractory V-FIB? Amioderone 300mg
What is the appropriate interval for an interruption in chest compressions? 10 seconds or less
Which of the following is a sign of effective CPR? PETCO2 = or > 10mm Hg
What is the primary purpose of a medical emergency team or rapid response team? Identifying and treating early clinical deterioration.
Which action improves the quality of chest compressions delivered during resuscitave attemepts? Shitch providers about every 2 min or every 5 compression cycles.
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
A pt. presents to the ER with a new onset of dizziness and fatigue. On examination, 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
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? 2-10mcg/kg/min
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.
A monitored pt. in the ICU developed a sudden 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 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.
Choose an appropriate inidication to stop or withhold resuscitive efforts. Evidence of rigor mortis.
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 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.
What is the appropriate procedure for ET suctioning after the catheter is selected?
Suction during withdrawl, but not for longer than 10 seconds.
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
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
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
What is the proper ventilation rate for a pt. in cardiac arrest who has an advanced airway in place? 8-10 breaths per minute
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.
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.
What is the initial priority for an unconscious pt. with any tachycardia on the monitor? Determine if a pulse is present.
Which rythm requires synchronized cardioversion? Unstable SVT
What is the recommended dose for adenosine for pt's in refractory, but stable narrow complex tachycardia? 12mg
What is the usual post-cardiac arrest target range for PETCO2 who achieves return of spontaneous circulation (ROSC)? 35-40mm Hg
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
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
What is the most reliable method of confirming and montioring correct placement of an ET tube? Continuous waveform capnography
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 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
What is the 1st treatment priority for a pt. who achieves ROSC? Optimizing ventilation and oxygenation.
Ventilations during Cardiac Arrest 2 every 30 compressions with a bag mask or 1 every 6 to 8 seconds w/advanced airway (8-10 breaths/minute)
ventilations during respiratory arrest 1 every 5 to 6 seconds 10 to 12 breaths/minute
tidal volume delivered w/bag mask 600mL
what does a PETCO2 of <10mmHg indicate in an intubated patient their CO is inadequate to to achieve ROSC
which drugs can be given with endotracheal route? only epi, vasopressin and lidocaine and you will need to double the dose
why do we give a saline bolus after infusion of a drug via peripheral IV? to hasten the time for peak response
steps for treating hypotension
1. IV bolus 1-2L normal saline 2. pressor: 0.1-0.5 mcg/kg/min for epi or norepi or 5-10mcg/kg/min of dopamine 3. treatable causes? (H's and T's) 4. obtain ECG
Do you shock PEA? do not shock asystole or PEA! treatment is vasopressor only!
reperfusion goal: time from door to balloon inflation (PCI) 90 minutes
reperfusion goal of 30 minutes is for... door-to-needle (fibrinolysis)
if pt is hemodynamically unstable do you give nitroglycerin? No, must have SBP >90mmHg
when is nitroglycerin contraindicated? inferior wall MI or RT ventricular infarction hypotension, brady or tachycardia recent phosphodiesterase use (Viagra)
4 D's of in-hospital therapy door to data to decision to drug (or PCI)
treatment of bradyarrhythmia 0.5 mg Atropine every 3-5 minutes, max of 3 mg if ineffective: transutaneous pacing or dopamine 2-10mcg/kg/min or epi 2-10mcg/min
when do you use synchronized shocks unstable SVT unstable afib unstable a flutter unstable, regular, monomorphic tachycardia w/a pulse
therapy for pt w/narrow QRS w/regular rhythm vagal maneuver or give adenosine
stroke general assessment w/in __ minutes of arrival CT w/in __ minutes interpret CT within __ minutes initiate fibrinolytic therapy within ? door-to-admission time of 3 hours
general assessment w/in 10 minutes of arrival CT w/in 25 minutes interpret CT within 45 minutes -initiate fibrinolytic therapy within 1 hour of arrival and 3 hours from symptom onset
