ACLS practice Q's Flashcards
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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 action is recommended next?
Vagal manoevers, Seeking expert consultation, BB, CCB
For stable Wide QRS:
Infusion procainamide 20-50 mcg/min OR
Amiodarone 150mg over 10 min!
A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropine?
1 mg
A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
- Use of a phosphodiesterase inhibitor within the previous 24 hours
-hypotension, bradycardia, or tachy - SBP < 90 or < 50 BPM - inferior wall MI
In which situation does bradycardia require treatment
Hypotension
A patient is in cardiac arrest. High-quality chest compressions are being given. The patient has an advanced airway in place, and an IV has been started. The rhythm is asystole. What is the first drug/dose to administer?
Epinephrine 1 mg IV/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 88/56 mm Hg. Which therapy is now indicated? dose?
1) Epinephrine 2 to 10 mcg/min
2) dopamine 5-20 mcg/k/min
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred?
IV or IO
A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next?
Epinephrine 1 mg
A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy?
Hold aspirin for at least 24 hours if rtPA is administered
rtPA= recombinant tissue plasminoen activator. Breaks up blood clots and restores blood flow = altiplase
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first?
Epinephrine 1 mg IV/IO
A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, which was treated 5 years ago. What is your next action?
Give aspirin 160 to 325 mg to chew
What is the indication for the use of magnesium in cardiac arrest?
Pulseless ventricular tachycardia-associated torsades de pointes
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 manoeuvres have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered?
Adenosine 6 mg
followed by 12mg
You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving to this patient?
ASA
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?
Amiodarone 300 mg
then 150 mg
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. The patient has an advanced airway in place. Which best describes the recommended second dose of amiodarone for this patient?
150 mg IV push
A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient’s blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal manoeuvres. What is your next action?
Administer adenosine 6 mg IV push- with NS flush!
then 12 mg if needed
Which intervention is most appropriate for the treatment of a patient in asystole?
epi
Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale and diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm shown here. She is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. What do you administer next?
(S.Brady)
Atropine 1mg IV
After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?
EPI
A 35-year-old woman presents with a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her blood pressure is 120/78 mm Hg. Which intervention is indicated first?
(SVT with narrow QRS)
then?
Vagal manoeuvres
then: adenosine 6mg start
You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the patient was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IO access has been established. Which intervention would be your next action? (PEA)
EPI then advanced airway/capnography
A patient’s 12-lead ECG is transmitted by the paramedics and shows a STEMI. When the patient arrives in the emergency department, the rhythm shown here is seen on the cardiac monitor. The patient has resolution of moderate (5/10) chest pain after 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention is most important in reducing this patient’s in-hospital and 30-day mortality rate?
Reperfusion therapy- alteplase (clot buster)
with anticoag (heparin/daltiparin)
A patient becomes unresponsive. You are uncertain if a faint pulse is present. The rhythm shown here is seen on the cardiac monitor. An IV is in place. Which action do you take next?
Start high-quality CPR
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 here, without conversion of the rhythm. She is now extremely apprehensive. Her blood pressure is 128/70 mm Hg. What is the next appropriate intervention? (Same SVT narrow complex)
Administer adenosine 12 mg IV
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? (VT)
Give an immediate unsynchronized high-energy shock (defibrillation dose)
Which action should you take immediately after providing an AED shock?
Resume chest compressions
Which action is likely to cause air to enter the victim’s stomach (gastric inflation) during bag-mask ventilation?
Ventilating too quickly (correct 1 second)
What action minimizes the risk of air entering the victim’s stomach during bag-mask ventilation?
Ventilating until you see the chest rise
You are providing bag-mask ventilations to a patient in respiratory arrest. How often should you provide ventilations?
6 sec
A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm Hg. Which action do you take next?
Perform electrical cardioversion
when do you give adenosine? how much? and only if?
1) for SVT’s
2) 6mg rapid push followed by 12mg
3) can be wide or narrow QRS
- Narrow has to be regular
- Wide has to be regular and monomorphic
when would you cardiovert someone in SVT/A.fib?
what about QRS?
if they are stable or Unstable:
- hypotension, altered level of mental status, signs of shock, ischemic discomfort, or acute heart failure
- QRS can be narrow or wide
what is considered a wide QRS?
> or = to .12
what is the first line drug for bradycardia? dose? max?
then?
Atropine 1mg/dose Q3-5 min. Max 3 mg
then Transcutaneous pacing:
AND/OR:
- you want to start an epinephrine infusion at 2-10mcg/min
OR
- dopamine infusion 5-20 mcg/kg/min
what are some causes of bradycardia?
- MI
- drugs (BB,CCB, dig…)
- hypoxia
- electrolyte abnormality ex. hyperK+
how many shocks is EPI given in VF/pVT?
How many until antiarrhythmic drug given? Which drug?
- 2 shocks until Epi
- 3 shocks until Amiodarone or Lido iven
When is Amiodarone given? dose?
alternate drug?
for VF/pVT
after 3rd shocck
first dose is 300mg, next 150mg
Lidocaine is alternate
difference btwn VF and VT?
VF chaotic squiggle line
VT sharp peaks, could be up or down, there is a pattern
do not admin anticoags or antiplatelets when/
for 24 hrs after IV thrombolysis, typically after T scan to see i no hemorrhage
how much ASA should a person chew? when?
As long as not contraindicated and not hemorrhagic
160-325mg
cardioversion narrow QRS regular
sync 50-100J
cardioversion narrow QRS, irregular
sync 120-200J
cardioversion wide QRS, regular
sync 100J
cardioversion wide QRS, irreg
not sync, defib dose
