Exam 3 - VTach, VFib, Asystole, PEA

Question 1

2 most common causes of adult and pediatric arrest? Cause? What is blood oxygenation at arrest in each?

Answer 1

Adults= VT and Vfib. Due to Ischemic heart disease. Blood fully oxygenated at arrest.

Pediatric= PEA and asystole. Due to asphyxiation and acute respiratory failure. Hypoxic and/or hypovolemic at arrest.

Question 2

What is CPR priority?

Answer 2

CAB= Compression, Airway, Breathing.

Compressions are more important than anything else. Get to get the blood moving and there is usually enough oxygen in the blood without having to spend too much time.

Question 3

What are the three major types of VTach?

Answer 3

1. Stable
2. Unstable
3. PEA

Question 4

Stable tachycardias (such as Sinus Tachycardia) are usually managed how?

Answer 4

Rate control

Question 5

Unstable tachycardias (such as Wide-QRS Tachycardia) are usually managed how?

Answer 5

Cardioversion. Multiple agents including antiarrythmics.

Question 6

Treatment of Ventricular Tachycardia depends on knowing what about the QRS complex and hemodynamics?

Answer 6

QRS=narrow or wide. Narrow is less than 0.12s (120ms). Wide is more than 0.12s (120ms).

Hemodynamics=stable or unstable

Question 7

What is a normal QRS timing? Narrow and wide?

Answer 7

Normal aka Narrow=less than 0.12s (120ms).

Wide=more than 0.12s (120ms)

Question 8

What are the two types of morphology for VTach? Which requires more treatment?

Answer 8

1. Monomorphic

2. Polymorphic. Requires more treatment.

Question 9

Treatment for hemodynamically stable VTach with Wide-QRS and Monomorphic?

Answer 9

Adenosine

Question 10

Treatments for hemodynamically stable VTach with Wide-QRS and Polymorphic? (Hint: three)

Answer 10

1. Amiodarine or
2. Procainamide or
3. Sotalol

Question 11

What is the major treatment for all unstable V-tachs?

Answer 11

Synched Cardioversion. Except for Wide-QRS w/irregular rate.

Question 12

Treatment for Unstable, Narrow-QRS, Regular VTach? (Hint: Two)

Answer 12

1. Synched Cardioversion 50-100J

2. Adenosine

Question 13

Treatment for Unstable, Wide-QRS, Regular VTach?

Answer 13

Synch Cardioversion 100J

Question 14

Treatment for Unstable, Narrow-QRS, Irregular VTach?

Answer 14

Synched Cardioversion
Mono=200J
Biphasic=120-200J

Question 15

Treatment for Unstable, Wide-QRS, Irregular VTach?

Answer 15

NOT synched cardioversion. Instead, defibrillation dose.
Monophasic=360J
Biphasic=200J

Question 16

Which VTach do you NOT use synched cardioversion? What used instead?

Answer 16

Unstable, Wide-QRS, Irregular VTach.

Defibrillation dose:
Monophasic=360J
Biphasic=200J

Question 17

Define and describe PEA? Treatments?

Answer 17

Weak and disorganized electrical and cardiac activity. No palpable pulse, inadequate BP.

Tx: CPR and Epi q3-5 min. Vasopressin can take place of first or second Epi.

Question 18

Is PEA shockable? What medication to avoid?

Answer 18

Unshockable. Avoid Atropine.

Question 19

Define and describe Asystole? Treatments? What to avoid?

Answer 19

Flat line. Confirmation of death.

Tx: CPR and Epi q3-5 min. Vasopressin can take place of first or second Epi.
Avoid shock and Atropine.

Question 20

What type of poor outcome is associated with Vasopressin?

Answer 20

Poor neurological outcome.

Question 21

Defintion and treatment of symptomatic Bradycardia?

Answer 21

HR less than 50BPM with symptoms.
Symptoms: Hypotension, mental status change, CV collapse

Tx: First use Atropine q3-5min. If ineffective then Dopamine or Epi q1min OR Transvenous pacing.

Question 22

When use transvenous pacing in symptomatic Bradycardia?

Answer 22

After Atropine fails. Can also use Dopamine or Epi q1min.

Question 23

What does Epi increase during arrests?

Answer 23

Return of Spontaneous Circulation (ROSC)

Question 24

Epi increases survival to admission in which two conditions? Poor outcome is possible due to what?

Answer 24

Increased survival to admission in Pulseless VT and VF.

Poor outcome possibly due to catecholamine toxicity.

Question 25

Which med has improved ROSC to admission in asystole?

Answer 25

Vasopressin.

Question 26

Vasopressin MOA?

Answer 26

Non-adrenergic vasoconstrictor

Question 27

Pulseless VT and VF respond best to which med?

Answer 27

Epi

Question 28

Which med offers no benefit over Epi in Pulseless VT and VF?

Answer 28

Vasopressin

Question 29

Which med has poor neuro outcomes?

Answer 29

Vasopressin

Question 30

Amiodarine is a _____ ________ ____-__________. What are the benefits out-of-hospital and in-hospital compared to Lidocaine?

Answer 30

Broad spectrum anti-arrythmic.

Out of hospital=Improved survival to admission (not discharge) better than Lidocaine
In-hospital=Same odds as Lidocaine

Question 31

Beware of two problems with Amiodarine? How is it better tolated?

Answer 31

1. Hypotension
2. Bradycardia
   (does Amiodarine cause them or is Amiodarine CI’d with them? I think the former)
   Solvent-free Amiodarone better tolerated.

Question 32

What is main alternative to Amiodarone? High familiarity with which two?

Answer 32

Lidocaine

High-familiarity with VF and pulseless VT.

Question 33

VF arrest is sometimes linked to which electrolyte being low?

Answer 33

Hypomagnesemia.

Question 34

Give Magnesium in VF and pulseless VT in patients with what condition?

Answer 34

Torsades de Pointes

Question 35

Atropine MOA and acceptable primary agent in what?

Answer 35

MOA: Potent anticholinergic agent

Acceptable primary agent in Bradycardia/arrest.
slide 26 says “bradycardia/arrest”

Question 36

Dopamine MOA (cardiac and peripheral) and indications?

Answer 36

Norepinepherine precursor. Cardiac alpha and beta agonist. Peripheral dopamine receptor agonist.

Used in Bradycardia/arrest.