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CFD Paramedic Course > AHA Algorithms Practice > Flashcards

AHA Algorithms Practice Flashcards

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1
Q

Pt has regular HR 42, complains weakness and dizziness. What Rx?

A

MOVAB.

Unstable bradycardia = atropine (0.5mg bolus every 3-5 min & repeat until max 3mg)

Pace if atropine doesnt work. Consider dopamine or epi infusion

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2
Q

Pt has HR 48, but feels fine & A&Ox4. What Rx?

A

MOVAB

Monitor them. Rx only when they have CHAAPS

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3
Q

Pt feels like heart is “beating out of her chest”. HR 162bpm. What initial Rx?

A

MOVAB (monitor, O2, airway/ IV or IO access, breathing support)

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4
Q

Pt has HR 170. How to determine if they are hemodynamically stable?

A

CHAAPS = chest pain, hypotension, AMS, Acute heart failure, Pulmonary edema, Shock SS

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5
Q

Pt has HR 180. Monitor shows wide QRS complex that appear polymorphic. What Rx?

A

MOVAB.

Polymorphic (irregular) wide complex SVT = possible torsades or V-fib.

Torsades = mag sulfate

Vfib = defibrillate

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6
Q

Pt has HR 168 w/ regular narrow complex SVT. She appears fine. What Rx

A

MOVAB.

Attempt to vagal. Then adenosine.

Consider B-blocker or Ca channel blocker (w/ MCP)

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7
Q

Pt has HR 177 w/ regular narrow complexes. She feels dizzy w/ palpitations. What Rx?

A

MOVAB

Consider adenosine. Cardiovert (50-100 J)

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8
Q

Pt has HR 150 w/ irregular narrow QRS complexes. He appears pale and is hypotensive. What Rx?

A

MOVAB

Synchronized cardioversion @ 120-200 J w/ biphasic pads or 200 J w/ monophasic pads

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9
Q

Pt w/ HR 156 w/ wide but regular complexes. BP is hypotensive. What Rx?

A

MOVAB

Consider adenosine if regular and monomorphic

Cardiovert @ 100 J.

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10
Q

Pt w/ HR 210 w/ wide regular complexes. What Rx?

A

MOVAB

Adenosine if its regular and monomorphic.

consider antiarrhythmic infusions (ex. Amiodarone)

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11
Q

You’ve initiated CPR on cardiac arrest pt & attach monitor w/ pads. What next?

A

Determine rhythm: shockable or not

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12
Q

Cardiac arrest pt presents w/ shockable rhythm. What Rx?

A

Defibrillate & continue 2 min CPR (alternate Epi w/ amiodarone)

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13
Q

You’ve started doing CPR on a pt and finally get the pads and monitor on them. Rhythm is asystole, what do you do next?

A

Do 2 min CPR, get IV/IO, start Epi, prep or get an adv airway/ETCO2.

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14
Q

Normally you alternate between epi and amiodarone during CPR. When wouldn’t you do the amiodarone?

A

During asystole. It’s just repeating epi, until you get a shockable rhythm, then you start the amiodarone alternations

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15
Q

How often do you check for a shockable rhythm during a cardiac arrest?

A

Between every 2 min cycle of CPR

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16
Q

What’s the first thing you do after you get ROSC?

A

Get a BP and a pulse. Then a 12 lead

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17
Q

You’ve gotten ROSC on a pt and their BP is 88/62. What do you do?

A

Listen to lung sounds. If they’re dry, fluids and then vasopressors. If they’re wet, only vasopressor infusion (epi, norepi, dopamine)

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18
Q

You’ve got a ROSC on a pt with good BP. What’s next?

A

Get a 12 lead to rule out a STEMI or AMI, if they have it, CATH lab for coronary reperfusion.

Set up IV infusion with whatever medication converted them to ROSC

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19
Q

You’ve got a pt complaining of chest pain what are the general steps you must take?

A
  1. MOVAB = monitor/12-lead, O2 if needed, Airway, breathing
  2. MONA= aspirin, O2 if needed, Nitro, and morphine if needed
  3. Use 12 lead to rule out STEMI
  4. If STEMI, notify ER in advance: tell them time of onset
  5. Check if they qualify for clot busting treatment
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20
Q

Your pt is in unstable condition DT SVT (narrow & regular). The rate is too fast to determine the rhythm. What can you do to better assess the rhythm?

A

Give adenosine while printing another ECG; the medication will slow the rhythm down long enough to determine indications for cardioversion.

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21
Q

Pt complains of dizziness & syncope. Monitor shows 3rd degree Heart block w/ rate 42. What Rx?

A

MOVAB.

Atropine ineffective. Choose one of the following: dopamine infusion, epi infusion, Transcutaneous pacing.

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22
Q

Your partner wants to push atropine on a 48 YOF but forgot the dose. What is it?

A

First dose = 0.5mg bolus & repeat every 3-5min until max dose 3mg

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23
Q

You have an unstable bradycardic pt and MCP orders a dopamine IV infusion. What is the dosage?

A

2-20mcg/kg per min. Titrate to effect.

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24
Q

You have an unstable bradycardic pt and MCP orders Epi IV infusion. What is the dosage/rate?

A

2-10 mcg/min. Titrate to effect.

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25
Q

Pt has HR 224 and appears cool pale diaphoretic w/ lethargy. What Rx?

A

Unstable SVT = cardiovert. Consider adenosine if narrow regular complex

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26
Q

Pt appears stable with HR 195 with wide QRS complexes. What Rx?

A

If complexes are regular and monomorphic, consider adenosine.

  • consider antiarrhythmic infusion
27
Q

Pt has HR 179 w/ narrow complex SVT. What Rx?

A

Vagal

  • adenosine if regular
  • MCP consider beta blocker or calcium channel blocker
28
Q

You print a 12 lead ECG on a pt w/ HR 160. How do you know if its wide or narrow complex SVT?

A

If the QRS complex is 3 or more little boxes = wide

29
Q

You have a stable pt w/ wide complex SVT and decide to give amiodarone. What dosage?

A

First dose 150mg over 10 min. Repeat PRN if VT recurs. Follow w/ maintenance infusion of 1mg/min for first 6 hours.

30
Q

MCP orders you to give Sotalol to your SVT pt. What is the dosage?

A

100mg (1.5mg/kg) over 5 min. Don’t give if prolonged QT

31
Q

You have a pt in stable condition w/ wide complex SVT. Your drug bag is missing amiodarone and Sotalol. What other drug could you use? What dosage?

A

Procainamide IV @ 20-50 mg/min until…

  • arhythmia is fixed
  • Hypotension
  • QRS duration increases >50%
  • max dose 17mg/kg given

Maintenance infusion @ 1-4mg/min.

Contraindication = prolonged QT or CHF

32
Q

Your pt has HR 188 and is altered & lethargic. Monitor displays narrow regular rhythms. You decide to synchronized cardiovert at what joules?

A

50-100 J (narrow regular)

33
Q

Your pt has HR 222 and is hypotensive. Monitor displays narrow irregular rhythms. You decide to synchronized cardiovert at what joules?

A

Biphasic pads = 120-200 J

Monophasic pads = 200J

34
Q

Your pt has HR 168 and is complaining of chest pain. Monitor displays wide regular rhythms. You decide to synchronized cardiovert at what joules?

A

100 J = wide regular

35
Q

Your pt has HR 196 and is altered. Monitor displays wide irregular rhythms. You decide to synchronized cardiovert at what joules?

A

No cardioversion. Use defib

36
Q

60 YOM found unconscious on ground apneic & pulses. What initial Rx?

A

Check pulse & breathing <10s, begin compressions 2w/ BVM immediately. Attach defib pads asap.

37
Q

You begin Compressions on a 35 YOF cardiac arrest. After attaching monitor you identify Vtach. What Rx?

A

Defibrillate immediately @ 120-200J (for biphasic pads) or 360J (monophasic pads)

38
Q

Your partner has been doing compressions > 2 min. What VS on monitor would indicate his quality of compressions?

A

ETCO2 (<10mm HG = bad quality)

39
Q

On a Cardiac arrest, you identify the initial rhythm being PEA. What Rx next?

A

Continue compressions 2min + Epi 1mg IVP. Consider Hs & Ts

40
Q

You’ve done 8 min of CPR on pt that has been in asystole. Suddenly you note a change in rhythm to vfib. What Rx next?

A

Defibrillate (120-200 J biphasic or 360 J monophasic) and resume immediate compressions w/ amiodarone (300mg initial dose).

41
Q

Your paramedic partner is directing the code. After 2 min CPR, he pushes Epi, checks for a pulse, and checks the monitor (vfib) before charging and defibrillating. Is this sequence effective or not.

A

Ineffective. compressions interrupted >10s.

  1. Charge the pads 15s & confirm pulse placement prior to stopping Compressions
  2. Then stop CPR & simultaneously check pulse & rhythm before defibrillating immediately
  3. Resume compressions & push epi or amiodarone after.
    * this way interrupts compressions <2s
42
Q

You & EMT are performing CPR on adult pt. You are bagging w/ basic OPA in place. EMT says its fine to compress & bag simultaneously. Is this correct?

A

No.

Simultaneous compression only when adv airway in place. 30:2 ratio for adults critical w/ basic adjuncts.

43
Q

During CPR, you successfully visualize passage of ETT past vocal cords. What next?

A

Note teeth measurement & attach ETCO2 for confirmation. Never let go of tube until it is fully secured.

44
Q

Your team has been working a cardiac arrest for 10 min now. The team leader verbalizes the need to consider Hs and Ts. What are the Ts?

A

think: thrombo the lesbian raises Tension when she tox about her tampons

Thrombosis (cardiac or pulmonary), tension pneumo, toxicity, tamponade (pericardial)

45
Q

Your team has been working a cardiac arrest for 10 min now. The team leader verbalizes the need to consider Hs and Ts. What are the Hs?

A

think: HERMIs the homosexual DROve to KALI to play VOLIball

Hypothermia, hydrogen (acidosis), hyper/hypokalemia, hypovolemia

46
Q

What increase in ETCO2 indicates ROSC?

A

Sudden spike > or equal to 40mm Hg

47
Q

Your team has been working a cardiac arrest for 10 min now and notice a spike in pt’s ETCO2 to 55mm HG. What to do next?

A

Complete the 2 min of CPR!! (Heart needs help after ROSC)

Then check pulse & BP & initial ROSC protocol

48
Q

Your pt has achieved ROSC following administration of Epi. You know that you must maintain SPO2 & BP as part of ROSC protocol. What levels for each?

A

SPO2 94%, BP systolic >90mm HG

49
Q

Your ROSC pt has BP 72/45. What to do next?

A

Check for lung sounds & give IV/IO bolus (1-2L NS) if they are clear

50
Q

You want to give your hypotensive ROSC pt IV fluids to increase their BP, but note diffuse crackles in lungs. What do you do?

A

Vasopressor infusion (epi, norepi, or dopamine) & consider Hs & Ts.

51
Q

MCP orders Dopamine infusion for your ROSC pt. What rate & dose?

A

5-10mcg/kg/min

52
Q

MCP orders Epi infusion for your ROSC pt following ROSC. What dose/rate?

A

0.1-0.5mcg/kg/min

53
Q

After achieving ROSC, you successful maintain your pt’s BP & SPO2. What next?

A
  1. Get a 12-lead to rule out STEMI.

2. Assess if pt can follow commands. (Targeted temperature mgmt)

54
Q

You have found that your ROSC pt is unable to follow commands. What temperature range is required for target temperature MGMT?

A

32-36C

55
Q

You remember the acronym “MONA” during a Chest Pn call. What is it and what is the correct order.

A

MONA = morphine, o2, nitro, ASA.

Correct order = O2, ASA, Nitro & morphine (if nitro doesn’t help pain)

56
Q

What happens to a ROSC pt that shows a 12-lead w/ STEMI or high AMI suspicion?

A

They go immediately to the CATH lab

57
Q

Your pt in stable, wide complex SVT weighs 100kg. What’s the IV dosage of Sotalol for him?

A

Sotalol = 1.5mg/kg over 5 min

= (1.5 x 100kg)

= 150mg over 5min

58
Q

You’ve given an initial dose of 150 mg amiodarone over 10 min to a pt in stable, wide complex SVT. What is the maintenance infusion rate for her?

A

Continue with 1mg/min for first 6 hours

59
Q

Your symptomatic bradycardic pt was given the max dose of atropine. You’ve decided to try a dopamine infusion. What rate if pt weights 50kg?

A

Start at 6mcgs/kg/min at 1600/1 concentration

= (400mcgs/min x 60 drops/mL) 1600mcg/mL

= 15 drops/min

60
Q

You want to start a dopamine drop for a ROSC pt and know that your medic unit only carries 500ml bags. How do you mix it?

A

Take 800 mg and mix w/ 500mL NS to get concentration 1600mcg/1mL

61
Q

Your pt is in torsades on the monitor. What medication & what dosage?

A

Mag sulfate 1-2g (2-4mL of 50% solution) diluted in 10 mL D5W IVP.

62
Q

You’ve converted a pt into ROSC following an amiodarone administration. What infusion setup afterwards?

A

2 options:

360mg IV over 6 hr (1mg/min)

Or

540mg IV over 18 hours (0.5mg/min)

63
Q

You’ve converted a 100kg pt from VF to ROSC following epi administration. What’s the Epi drip rate for her during ROSC?

A

Rate = 0.1-0.5mcg/kg/min

10-50mcg/min

64
Q

You’ve achieved ROSC on a pt and want to set up a norepi drip. What’s the rate if she weighs 70kg?

A

0.1-0.5mcg/kg/min

= 7-35mcg/min

Rate = (7mcg/min x 60 drops/mL) / 0.1mg/mL

= 4200 drops / min?

CFD Paramedic Course (12 decks)

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