Case 4 - VF/pVT

Question 1

A patient is said to be in “refractory” VF when the rhythm is ______ the first shock.

A. precipitated by
B. unresponsive to

Answer 1

B. unresponsive to

Question 2

A (monophasic/biphasic) defibrillator is used by delivering the maximal, unsynchronized energy dose from the outset.

Answer 2

monophasic

Question 3

T/F: After delivering a shock in pVT/VF, you should check a pulse.

Answer 3

False! IMMEDIATELY resume compressions

Question 4

Why do we continue CPR after every shock w/o checking for a pulse?

Answer 4

Successful defibrillation often produces a slow, non-perfusing rhythm. Continuing CPR allows for end organ perfusion while the heart “catches up.”

Question 5

In the case of witnessed VF sudden cardiac death, the likelihood of survival decreases by ____% with each passing minute without defibrillation.

A. 0-3
B. 7-10
C. 17-20

Answer 5

B. 7-10%

EARLY defibrillation is key in these cases.

Question 6

A pulse check is performed when what condition is met?

A. 2 minutes of CPR has been performed
B. An organized rhythm is present on the monitor
C. The patient begins spontaneous respirations

Answer 6

B. An organized rhythm is present on the monitor (p. 99)

Question 7

What arrest med was removed from the 2015 AHA update?

A. Vasopressin
B. Lidocaine
C. Epinephrine
D. Amiodarone

Answer 7

A. Vasopressin

Question 8

For refractory VF/pVT, what first line antiarrhythmic is given?

A. Lidocaine
B. Amiodarone

Answer 8

B. Amiodarone

Question 9

Doses of amiodarone for VF/pVT.

Answer 9

300 mg IV/IO

150 mg IV/IO

Question 10

First dose of lidocaine for VF/pVT

Answer 10

1-1.5 mg/kg IV/IO

Question 11

Second dose of lidocaine for VF/pVT

Answer 11

0.5-0.75 mg/kg IV/IO

Question 12

Maxdose of lidocaine for VF/pVT

Answer 12

3 mg/kg IV/IO

Question 13

What medication is used for the Tx of Torsades de Points?

Answer 13

1-2 gm IV/IO Magnesium diluted in 10 mL NS given over 5-20 minutes

Question 14

List the reversible Hs and Tx

Answer 14

Hypovolemia - fluid replacement with NS
Hypoxia - Advanced airway with supp. oxygen
Hypothermia - rewarming
H+ ions - 50-100 mEq sodium bicarbonate
Hypo/hyperkalemia - 1 gm CaCl2 IV

Question 15

List the reversible Ts and Tx

Answer 15

Toxins - specific to toxin
Tension pneumothorax - needle decompression
Tamponade - cardiac - rapid transport to trauma center
Thrombus - pulmonary - rapid transport
Thrombus - coronary - rapid transport

Question 16

Which of the following is necessary for out-of-hospital resuscitation monitoring?

A. Pulse oximetry
B. Waveform capnography/End Tidal CO2
C. 12-Lead ECG

Answer 16

B. Waveform capnography/End Tidal CO2

Question 17

An ETCO2 of less than ____ indicates a poor likelihood of survival.

A. 25 mmHg
B. 10 mmHg
C. 5 mmHg

Answer 17

B. 10 mmHg

Question 18

T/F: A patient with hypothermia (core temperature under 30C/86F) should not receive anti-arrhythmics, but only epinephrine.

Answer 18

True.

Anti-arrhythmics may accumulate to toxic levels in the hypothermic patient. (p. 104)

Question 19

For patients with a core temp between ______, you should start CPR, provide defibrillation, and give medications at longer intervals.

Answer 19

86-93.2F

Question 20

For suspected opioid induced cardiac arrest, what is the IN dose of Naloxone?

Answer 20

2 mg