Workbook Questions Section 2

Question 1

When monitoring a patient in Normal Sinus Rhythm (NSR) the correct order the electrical activity travels is:

a) Atrioventricular node, sinoatrial node, bundle of his then left and right bundle branch
b) Sinoatrial node, atrioventricular node, purkinje fibres then bundle of his
c) Sinoatrial node, atrioventricular node, bundle of his then purkinje fibres
d) Atrioventricular node, sinoatrial node, purkinje fibres then bundle of his

Answer 1

c) Sinoatrial node, atrioventricular node, bundle of his then purkinje fibres

Question 2

The correct duration of the PR interval in Normal Sinus Rhythm (NSR) is:

a) 0.04 – 0.06 sec
b) 0.06 – 0.12 sec
c) 0.12 – 0.2 sec
d) 0.2 – 0.5 sec

Answer 2

c) 0.12 – 0.2 sec

Question 3

A “P” wave in an ECG waveform indicates:

a) Atrial depolarisation
b) Atrial repolarisation
c) Ventricular depolarisation
d) Ventricle repolarisation

Answer 3

a) Atrial depolarisation

Question 4

The accumulation of fluid within the lungs commonly caused by hypertension, valve dysfunction or volume overload is known as:

a) STEMI
b) Congestive Cardiac Failure
c) NSTEMI
d) Acute Cardiogenic Pulmonary Oedema

Answer 4

d) Acute Cardiogenic Pulmonary Oedema

Question 5

When performing chest compressions on an adult patient, what is the correct depth to compress the chest?

a) 1/3 of the chest 5-6cm (55mm)
b) 1-2cm (15mm)
c) ⅔ the depth of the chest
d) 10cm (100mm)

Answer 5

c) ⅔ the depth of the chest

Question 6

1 small square on ECG paper represents:

a) 1mm or 0.04 seconds
b) 5mm or 0.2 seconds
c) 25mm or 1 seconds
d) 50mm or 2 seconds

Answer 6

a) 1mm or 0.04 seconds

Question 7

A “T” wave in an ECG waveform indicates:

a) Atrial depolarisation
b) Atrial repolarisation
c) Ventricular depolarisation
d) Ventricle repolarisation

Answer 7

d) Ventricle repolarisation

Question 8

When instructing your patient to perform the Modified Valsalva Manoeuvre, how long should try and maintain 40mmHg when blowing through the tubing?

a) 5-10 seconds
b) 10-15 seconds
c) 15-20 seconds
d) 20-25 seconds

Answer 8

c) 15-20 seconds

Question 9

Which of the following is NOT a metric of High Performance CPR (HP-CPR)?

a) Optimise chest compression rate: 100-120cpm
b) Promote full chest recoil i.e. no leaning
c) Ensure two full ventilations in 2 seconds
d) Minimise interruptions

Answer 9

c) Ensure two full ventilations in 2 seconds

Question 10

Prolonged CPR in Blunt Traumatic Cardiac Arrest after reversible causes have been addressed is almost never associated with a good outcome. If delivery cannot be achieved within _____________ minutes from arrival on scene, it is reasonable to terminate resuscitation if no ROSC is achieved after 10 minutes, and Determination of Death criteria are met:

a) 15 minutes
b) 20 minutes
c) 25 minutes
d) 30 minutes

Answer 10

c) 25 minutes

Question 11

What are the reversible causes in cardiac arrest? (4H’s & 4T’s):

Answer 11

· Hypoxia
· Hypovolaemia
· Hyper/ hypokalaemia / metabolic disorders
· Hypothermia / hyperthermia

· Tension pneumothorax
· Tamponade
· Toxins
· Thrombosis (pulmonary / coronary

Question 12

a) Bradycardia is a rate of < ________ beats per minute,
b) A normal heart rate is between ______ and _______ beats per minute.
c) Tachycardia is a rate of > ______ beats per minute.

Answer 12

a) Bradycardia is a rate of < 60 beats per minute
b) A normal heart rate is between 60 and 100beats per minute.
c) Tachycardia is a rate of > 100 beats per minute.

Question 13

List 2 signs/symptoms a person might be presenting with if they had symptomatic bradycardia:

Answer 13

Unstable bradycardia (with pulse and not associated with traumatic cause):

Poor signs of perfusion, including:

Hypotension
Altered conscious state
Diaphoresis
Shortness of breath and/or cyanosis
Syncope

Question 14

A patient can be treated with a modified Valsalva Manoeuvre suffering Supraventricular Tachycardia (SVT) will have a rate of:

Answer 14

> 180 beats per minute

Question 15

You are attending a patient who is suffering from Supraventricular Tachycardia. What are the contraindications you must rule out before you can administer the Modified Valsalva Manoeuvre?

Answer 15

Recent or current acute myocardial infarction

Severe coronary artery disease

Haemodynamic instability (i.e. systolic BP below 90mmHg)

Known glaucoma or retinal myopathy

Question 16

According to the CPG Recognition of Life Extinct (ROLE) / Determination of Death / Withholding and Termination of Resuscitation (TOR). When recognising life extinct, a Determination of Death must be made with the following criteria:

i) No ________ pulses at all AND
ii) __________ for > _______ seconds AND
iii) _________ and __________ pupils with NO ____________ reflexes at all AND
iv) No signs of _____________ at all AND
v) No auscultated ___________ sounds

Answer 16

i) No CENTRAL pulses at all AND
ii) ASYSTOLE for > 30 seconds AND
iii) FIXED and DILATED pupils with NO CORNEAL reflexes at all AND
iv) No signs of BREATHING at all AND
v) No auscultated HEART sounds

Question 17

What is the inclusion criteria for a patient to be entered into the STEMI Protocol?

Answer 17

1. Signs and symptoms <12 hours
2. Mobile and independant ADLs
3. GCS 15

Question 18

Which hospitals can this patient go for cardiac catheterisation intervention?

Answer 18

Royal Perth Hospital
Sir Charles Gardener Hospital
Fiona Stanley Hospital
SJOG Murdoch

Question 19

In reference to Clinical Skill Defibrillation, state if these are TRUE or FALSE:

a) Defibrillation must not occur over a medication patch or pacemaker site?

TRUE/FALSE

b) The device can be used safely in direct presence of possible ignition sources e.g. flammable vapours, and/or explosive materials

TRUE/FALSE

c) Pads cannot be placed over ECG dots

TRUE/FALSE

Answer 19

a) TRUE
b) FALSE
c) TRUE

Question 20

What are the 4 classes of haemorrhagic shock and the signs you’d expect to see at each?

Answer 20

Class 1
< 15%
Few signs

Class 2
15 - 30%
Increased pulse & respiration rate, decreased pulse pressure

Class 3
30 - 40%
Pulse > 120/min, respiratory rate 30 - 40/min, decompensation (systolic BP < 90mmHg)

Class 4
> 40%
Pulse > 140/min, marked decrease in systolic BP, profound lethargy.

Question 21

a) Which medications would you consider giving this patient to treat her chest pain?
b) Which additional medication would you consider giving if a 12 lead indicated so?

Answer 21

a)
Aspirin
GTN

b)
Heparin