Need To Know Flashcards
Which action increases the chance of successful conversion of ventricular fibrillation?
Providing quality compressions immediately before a defibrillation attempt.
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.
Which action improves the quality of chest compressions delivered during resuscitave attemepts?
Switch 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
The use of quantitative capnography in intubated pt’s does what?
Allowsfor monitoring CPR quality
For the past 25 min, EMS crews have attemptedresuscitation 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.
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.
What is the primary purpose of a medical emergency team or rapid response team?
Identifying and treating early clinical deterioration.
Which action is included in the BLS survey?
Early defibrillation
Which of the following is a sign of effective CPR?
PETCO2 > 10mm Hg
Which drug and dose are recommended for the management of a pt. in refractory V-FIB?
Amioderone 300mg
A pt. presents to the ER with a new onset of dizziness and fatugue. Onexamination, 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
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 monitored pt. in the ICU developed a suddent 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
What is the recommended dose for adenosine for pt’s in refractory, but stable narrow complex tachycardia?
12mg
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.
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 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.
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
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
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 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.
Which rythm requires synchronized cardioversion?
Unstable SVT
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 of using ties that pass circumferentially around the patient’s neck when securing an advanced airway?
Obstruction of venous 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.
Which condition is an indication to stop or withhold resuscitative efforts?
Safety threat to providers
After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient’s lead II ECG appears below. What is your next action?
IV or IO access
IV or IO access
After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action?
.
Check for a pulse
What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest?
Not recommended for routine use
What survival advantages does CPR provide to a patient in ventricular fibrillation?
Produces a small amount of blood flow to the heart
What is the recommended compression rate for performing CPR?
At least 100 per minute
EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention?
defibrillation
defibrillation
A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to
.
administer a second shock.
If the heart muscle resets and initiates an organized rhythm this is called
ROSC return of spontaneous circulation
To place the pads on the victims bare chest, Place one pad on the upper-right chest (below the collarbone) and place the other pad
to the side of the left nipple, with the top edge of the pad a few inches below the armpit
Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest
Agonal gasps
Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route?
Lidocaine, epinephrine, vasopressin
if persistent tachycardia does not present with symptoms what do you need to consider wide QRS?
greater than 0.12 seconds
when do you consider cardioversion
if persistent tachycardia is causing
hypotension
altered mental status
signs of shock
chest pain
acute heart failure
what is considered a tachycardia requiring treatment
over 150 per minute
A patient with sinus bradycardia and a heart rate of 42 has diaphoresis and blood pressure of 80/60. What is the initial dose of atropine?
0.5 mg
What is the proper ventilation rate for a pt. in cardiac arrest who has an advanced airway in place?
8-10 breaths per minute
what constitutes symptomatic bradycardia
hypotension
altered mental status
signs of shock
chest pain
acute heart failure
how do you treat non-symptomatic bradycardia
monitor and observe
Bradycardia require treatment when?
chest pain or shortness of breath is present
what are the 5 h’s and 5 t’s
hypovolemia<br></br> hypoxia<br></br> hydrogen ion (acidosis)<br></br> hypo/hyperkalemia<br></br> hypothermia<br></br> <br></br> tension pneumothorax<br></br> tamponade, cardiac<br></br> toxins<br></br> thrombosis, pulmonary<br></br>
thrombosis, coronary
what do you do after return of spontaneous circulation
maintain O2 sat at 94 treat hypotension (fluids vasopressor) 12 lead EKG
if in coma consider hypothermia
if not in coma and ekg shows STEMI or AMI consider re-perfusion
You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action?
Give a single shock
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer?
amiodarone 300 mg
A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for a…
second dose of epinephrine 1 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 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone…
150 mg IV push
You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority?
Administer 1mg of epinephrine
What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC?
0.1 to 0.5 mcg/kg per minute IV infusion
What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC?
Potential oxygen toxicity
What is the recommended duration of therapeutic hypothermia after reaching the target temperature?
12 to 24 hours
What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest?
32°C to 34°C
What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC?
Decreased cerebral blood flow
Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation?
Transport the patient to a facility capable of performing PCI.
What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)?
Administration of IV or IO fluid bolus
Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?
Right ventricular infarction and dysfunction
Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)?
Measure from the corner of the mouth to the angle of the mandible.
What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation?
120to200J
Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique?
Performing a head tilt-chin lift maneuver
What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?
10 to 12 breaths per minute
how do you treat symptomatic bradycardia
0.5mg atropine every 3-5 mins to max of 3mg
if that doesn’t work try one of the following:
transcutaneous pacing
2-10mcg/kg / minute dopamine infusion
2-10mcg per minute epinephrine infusion
What is the initial priority for an unconscious pt. with any tachycardia on the monitor?
Determine if a pulse is present.
What is the appropriate procedure for ET suctioning after the catheter is selected?
Suction during withdrawl, but not for longer than 10 seconds.
